HomeMy WebLinkAbout0168 HOLLY POINT ROAD - Health 168 Holly Point Drive
Centerville
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o Ms. Ruth Rosenblatt
168 Holly Point Drive
Centerville,'MA 02632
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PS Form 3800,August 2oo8(Reverse)PSN 7530-02-000-9047
•
j`iF
Town of Barnstable Barnstable
rp,-
1°� BOARD OF HEALTH I i
IIA MASS.LE,1, 200 Main Street Hyannis MA 02601 m
9Q MASS. � 7 Y
oDJfD MAS"`� 2007
Office: 508-862-4644 Wayne Miller,M.D.
FAX: 508-790-6304 Paul Canniff,D.M.D.
Junichi Sawayanagi
CERTIFIED MAIL# 7011 0470 0001 4525 76.185
June 11, 2012
Ms. Ruth Rosenblatt
168 Holly Point Drive
Centerville, MA 02632
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
• The septic system located 168 Holly Point Drive, Centerville, MA was last inspected on
5/14/2012, by Mark L. White, a certified septic inspector for the state of Massachusetts.
The inspection of the septic system showed that the system "Needed Further
Evaluation" under the guidelines of the 1995 TITLE 5(310 CMR 15.00); However,
further evaluation showed that the system does "Pass"
PER ORDER OF THE BOARD OF HEALTH
cKean, R.S. CHO
Agent of the Board of Health
•
Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\l68 Holly Pt.,Cent..doc `'
F .
Qx
Commonwealth of Massachusetts l,J ��-
t w v Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
cr
M 168 HOLLY POINT DR
Property Address
Owner RUTH ROSENBLATT
information is Owner's Name
required for every page. CENTERVILLE MA 02632 MAY 14 ,2012
Cityrrown State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.Please see completeness checklist at the end of the form.
Important:When A. General Information
filling out forms
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not MARK L WHITE
use the return Name of Inspector
key.
�►/�� A.B. CANCO
�U Company Name
350 RT 28 f
Company Address
t 'v
WEST YARMOUTH MA
CitylTown State 02673 y,
T Zip Code
608-775-2820 S-13381
Telephone Number } License Number a °
f
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection-
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system:
❑ ❑ ❑ ```� OF44
Urbz
�N
Passes Conditionally Passes ,
n o�:..
: MARK ••;��=
Needs Further Evaluation by the Local Approving Authority o. WHITE :P S
*; No.S13381 y
�. MAY 14, 2012 ''.,�� eRTIF�
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DER)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the-inspector and the system owner shall submit the
• report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions'at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
' the same or different conditions of use.
t5ins•11/10 Title 5 Official Inspection Fonn,Subsurfa a Disposal sol?20
Coipinonw6alth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
168 HOLLY POINT DR
Property Address
1
Owner RUTH ROSENBLATT
information is Owner's Name I
required for every page. CENTERVILLE MA 02632 MAY 14 ,2012
Cityrrown State 1 Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/a/ways'complete all of Section D
A) System Passes: I
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be -
replaced or repaired. The system, upon completion of the replacement or repair, as approved
by the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank-failure is imminent. System
will pass inspection if the existing tank is replaced with a complying septic tank as approved by the
Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 20
1 1
Cor>nr ionyvealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
ti SVByet 168 HOLLY POINT DR
Property Address
Owner RUTH ROSENBLATT
information is Owner's Name
required for every page. CENTERVILLE MA 02632 MAY 14 ,2012
Cityrrown State Zip Code Date of Inspection
r
B. Certification (cont.)
B) System Conditionally Passes(cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box
due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System
will pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
i
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
i
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).
The system will pass inspection if(with approval of the Board of Health): .
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 20
Comt nonyvealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
,M 0, 168 HOLLY POINT DR
Property Address
Owner RUTH ROSENBLATT
information is Owner's Name
required for every page. CENTERVILLE MA 02632 MAY 14 ,2012
Cityrrown State Zip Code Date of Inspection
I
I
C) Further Evaluation is Required by the Board of Health:
0 Conditions exist which require further evaluation by the Board of Health in order to determine
if the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public
health, safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑x The system has a septic tank and soil absorption system (SAS) and the SAS is
within 100 feet of a surface water supply or tributary to a surface water supply.-
El The system has a septic tank and SAS and the SAS is within a Zone 1 of a public
water _ supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private
water supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine MEASURED FROM LEACH PIT TO WATERS EDGE
distance::,,
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
-to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 20
ComiY'monWealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
168 HOLLY POINT DR
Property Address
Owner RUTH ROSENBLATT
information is Owner's Name
required for every page. CENTERVILLE MA { 02632 MAY 14 ,2012
— --
Cityrrown State Zip Code Date of Inspection
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"or"No"to each of the following for all inspections:
Yes No
❑ 0 Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ FX] Static liquid level in the distribution box above outlet invert due to an
overloaded or clogged SAS or cesspool
❑ 0 Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
B. Certification (cont.)
Yes No
❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ 0 Any portion of the SAS, cesspool or privy is below high ground water elevation.
n ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ 0 Any portion of a cesspool or privy is within a Zone 1 of a public well.
ElAny portion of a cesspool or privy is within 50 feet of a private water supply
well.
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 20
CoryimonWealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
168 HOLLY POINT DR
Property Address
Owner RUTH ROSENBLATT
information is Owner's Name
required for every page. CENTERVILLE MA 02632 MAY 14 ,2012
City/Town State Zip Code Date of Inspection
❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis.
[This system passes if the well water analysis, performed at a DEP
certified laboratory,for fecal coliform bacteria indicates absent and the
presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm, provided that no other failure criteria are triggered.A copy of
the analysis and chain of custody must be attached to this form.]
❑ The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ FX1 The system fails. 1 have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area— IWPA) or a mapped Zone 11 of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
❑x ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ x❑ Were any of the system components pumped out in the previous two weeks?
❑x ❑ Has the system received normal flows in the previous two week period?
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 20
Comihonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
"r 168 HOLLY POINT DR
Property Address
Owner RUTH ROSENBLATT
information is Owner's Name
required for every page. CENTERVILLE MA 02632 MAY 14 ,2012
Cityrrown State Zip Code Date of Inspection
❑ 0 Have large volumes of water been introduced to the system recently or as part of
this inspection?
❑ 0 Were as built plans of the system obtained and examined? (If they were not
available note as N/A)N/A
0 ❑ Was the facility or dwelling inspected for signs of sewage back up?
❑x ❑ Was the site inspected for signs of break out?
0 ❑ Were all system components, excluding the SAS, located on site?
0 ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
0 ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has
been determined based on:
❑ 0 Existing information. For example, a plan at the Board of Health.
0 ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): unk Number of bedrooms(actual): 5
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): unk
D. System Information
Description:
SYSTEM CONSISTS OF A 1000 GALLON SEPTIC TANK AND A LEACHING PIT NO
DISTRIBUTION BOX
t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 7 of 20
Corvimionwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
168 HOLLY POINT DR
Property Address
Owner RUTH ROSENBLATT
information is Owner's Name
required for every page. CENTERVILLE MA 02632 MAY 14 ,2012
i
Citylrown State Zip Code Date of Inspection
Number of current residents: UNK
Does residence have a garbage grinder? 0 Yes ElNo
Is laundry on a separate sewage system?[if yes separate inspection required] M Yes El
Laundry system inspected? ❑ Yes ❑
No
I Seasonal use? n Yes ElNo
Water meter readings, if available(last 2 years usage (gpd)):
2010-335000 2011-163000
Sump pump? I 0 Yes ❑
No
Last date of occupancy: D eRRENT
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑
No
Industrial waste holding tank present? ❑ Yes ❑
No
t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 20
ConimonWealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
168 HOLLY POINT DR
Property Address
Owner RUTH ROSENBLATT
information is Owner's Name
required for every page. CENTERVILLE MA ' 02632 MAY 14 ,2012
City/Town State Zip Code Date of Inspection
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑
No
Water meter readings, if available:
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
I
f
General Information
Pumping Records:
Source of information: TOWN 4/26/12
Was system pumped as part of the inspection? ❑ Yes ❑x No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
❑x Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 20
ConcimonWealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
i
168 HOLLY POINT DR
Property Address
Owner RUTH ROSENBLATT '
information is Owner's Name
required for every page. CENTERVILLE MA 02632 MAY 14 ,2012
-
City,rrown State Zip Code Date of Inspection
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
UNK
Were sewage odors detected when arriving at the site? ❑ Yes M No
Building Sewer(locate on site plan):
Depth below grade: 1 FOOT 5 INCHES
feet
Material of construction:
Elcast iron El40 PVC other(explain): ORANGEBERG
Distance from private water supply well or suction;line: feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
}
LINE WAS CLEAR, BUT RECOMMEND REPLACING AS IT IS ORANGEBERG PIPE.
Septic Tank(locate on site plan):
1 FOOT
Depth below grade feet
Material of construction:
Fx]concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain)
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 20
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
168 HOLLY POINT DR
Property Address
Owner RUTH ROSENBLATT
information is Owner's Name
required for every page. CENTERVILLE MA 02632 MAY 14 ,2012
Citylrown State Zip Code Date of Inspection
1
I
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑
No
Dimensions:
Sludge depth: ,
D. System Information (cont.)
I
Septic Tank(cont.)
NO SLUDGE-TANK PUMPED 20
Distance from top of sludge to bottom of outlet tee or baffle DAYS PRIOR
NO SCUM-TANK PUMPED 20
Scum thickness DAYS PRIOR
Distance from top of scum to top of outlet tee or baffle N/A
Distance from bottom of scum to bottom of outlet tee or baffle N/A
How were dimensions determined?
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.)
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 20
CorrimonWealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
`M 168 HOLLY POINT DR
Property Address
Owner RUTH ROSENBLATT
information is Owner's Name
required for every page. CENTERVILLE MA 02632 MAY 14 ,2012
City/Town State Zip Code Date of Inspection
i
I
Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 20
Com'rnonw'ei alth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
168 HOLLY POINT DR
Property Address
Owner RUTH ROSENBLATT
information is Owner's Name
required for every page. CENTERVILLE MA 02632 MAY 14 ,2012
City/Town State. Zip Code Date of Inspection
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain):
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
D. System Information (cont.)
Distribution Box(if present must be opened)(locate on site plan):
Depth of liquid level above outlet invert NO DISTRIBUTION BOX
I
t5ins•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 20
Commonwealth of Massachusetts
Official Inspection Form
Title p
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
168 HOLLY POINT DR
Property Address
Owner RUTH ROSENBLATT
information is Owner's Name '
required for every page. CENTERVILLE MA 02632 MAY 14 ,2012
-
City/Town State Zip Code Date of Inspection
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
E
1
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System(SAS)(locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 20
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
168 HOLLY POINT DR
Property Address
Owner RUTH ROSENBLATT
information is Owner's Name
required for every
page.
CENTERVILLE MA 02632 MAY 14 ,2012
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
(] leaching pits number:11 6X6 PIT
❑ leaching chambers number:
❑ leaching galleries number.
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.)
PIT IS HOLDING 6 INCHES OF LIQUID
I
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
t5ins•11/10 Title 5 Official Inspection Form:Subswface Sewage Disposal System•Page 15 of 20
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
^M s 168 HOLLY POINT DR
Property Address
Owner RUTH ROSENBLATT
information is Owner's Name
required for every page. CENTERVILLE MA 02632 MAY 14 ,2012
City/Town State Zip Code Date of Inspection
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
D. System Information (cont.)
Comments( signs note condition of soil si of hydraulic failure, level of ponding, condition of vegetation,
etc.):
4
Privy (locate on site plan): i
Materials of construction: .
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•11110 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 20
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
168 HOLLY POINT DR
Property Address
Owner RUTH ROSENBLATT
information is Owner's Name E
required for every Page. CENTERVILLE MA 02632 MAY 14 ,2012
City/Town State Zip Code Date of Inspection
I
i
I
1
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
hand-sketch in the area below
® drawing attached separately
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 20
i
ConjmonWbalth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
`,M 5 168 HOLLY POINT DR
Property Address
Owner RUTH ROSENBLATT
information is Owner's Name
required for every page. CENTERVILLE MA 02632 MAY 14 ,2012
City/Town State Zip Code Date of Inspection
i
II
I
I
D. System Information (cont.)
Site Exam:
Check Slope
t5ins-11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 20
Con)monwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM 168 HOLLY POINT DR
Property Address
Owner RUTH ROSENBLATT
information is Owner's Name
required for every page. CENTERVILLE MA 02632 MAY 14 ,2012
Cityrrown State Zip Code Date of Inspection
IX-1 Surface water
Check cellar
❑x Shallow wells
Estimated depth to high ground water: 15
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
shot grades from leach pit to waters edge
t5ins--11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 19 of 20
Corrlmonvvealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
wM 168 HOLLY POINT DR
Property Address
Owner RUTH ROSENBLATT
information is Owner's Name
required for every page. CENTERVILLE MA 02632 MAY 14 ,2012
Cityrrown State Zip Code Date of Inspection
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
E. Report Completeness Checklist
R Inspection Summary: A, B, C, D, or E checked
n Inspection Summary D (System Failure Criteria Applicable to All Systems)completed
� System Information—Estimated depth to high groundwater
❑x Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins-11/10 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 20 of 20
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Town of Barnstable
BarnstnbFe
THE—Tom,'
BOARD OF HEALTH m"a��
na MASS.SS. 1 f: 200 Main Street� Hyannis MA 026011639..
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9 MA �Q
MAI ale 2007
Office: 508-862-4644 Wayne Miller,M.D.
FAX: 508-790-6304 Paul Canniff,D.M.D.
Junichi Sawayanagi
CERTIFIED MAIL# 7011 0470 0001 4525 7307
July 2,2012
Att. Malcolm L. & Ruth B. Rosenblatt,TRS
241 Perkins Street C-405
Boston, MA 02130
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located 168 Holly Point Drive, Centerville, MA was last inspected on
5/14/2012, by Mark L. White, a certified septic inspector for the state of Massachusetts.
The inspection of the septic system showed that the system "Needed Further
Evaluation" under the guidelines of the 1995 TITLE 5(3 10 CMR 15.00); However,
further evaluation showed that the system does "Pass"
PER ORDER OF T E BOARD OF HEALTH
Thomas McKean, R.S. CHO
Agent of the Board of Health
r
I
Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\168 Holly Pt.,Cent..doc
i
' 4
7
PUBLIC HEALTH DIVISION
The mission of the Public Health Division is to Number of Complaints Received and Investigated:
12
provide community and environmental health 20 95 20 49
protection services so that citizens and visitors may Refuse(Rubbish, garbage)
enjoy a safer and healthier environment while Article II(Substandard Housing) 118 73
maintaining personal physical health. Overcrowded Housing 38 20
Title V (Sewage) 23 13
Fiscal Year 2012 Major Accomplishments Food Establishments 58 42
Hazardous Waste(spills, leaks) 34 20
• Conducted a total of 6,178 inspections at rental Public Swimming Pools 4 4
houses, restaurants, motels,public swimming Motels 7 8
pools, retail stores, septic systems, recreational Horse Stables(manure, odors) 6 1
,camps, hazardous material sites, horse stables, and Water Bodies 3 4
other facilities by the Public Health Division staff. West Nile Virus Surveillance - -
Misc. (body art,fuel tanks, camps) 48 34
• Issued 4,423 permits and collected fees totaling Total 434 268
$361,891.
Number of Routine Inspections Conducted:
• Public Health Division staff conducted 1,288 food 2011 2012
establishment inspections at restaurants,retail food Food Service 963 905
stores, bed and breakfast establishments and Retail Food 281 283
mobile food units. Each food establishment Supermarkets 21 14
inspection included the completion of a multiple- Mobile Food Units 3 10
item inspection report form followed by an Bed&Breakfast 21 7
informal discussion with the person in charge Residential Kitchens 12 9
(P.I.C.) of the food establishment to review each. Motels 38 30
of the violations observed and to provide, Swimming Pools 119 136
recommendations to prevent future recurrence of-,�o Whirlpools-Saunas 22 20
the violations. Camps 14 8
• Investigated and responded to 268 public health Stables 91 71
related complaints during fiscal year 2012. Staff Sewage 341
703 495 467
282
responded to overcrowded housing complaints, Test Holes
hazardous waste, garbage, sewage, food, and Percolation Tests 95 82
various other types of public health related Massage/Body Art 5 5
complaints received by telephone (many Hazardous Material 125 157
anonymously) within 24 hours with an onsite�Tanning Facilities 5 5
Rentals(Housing) 2,175 2,158
investigation. Miscellaneous 493 452
• Provided influenza vaccinations during five(5) Re-inspections 1,015 818
clinics held at several locations. Credited to pre- Total Inspections 7,151 6,178
planning and the efficiency of nurses, volunteers, Building Permit Applications Reviewed and
and Public Health Division staff, Town of Approved: 2011 2012
Barnstable citizens were quickly assisted at the 1,585 1,528
clinics, with less than ten minute waiting times.
Handicapped citizens received vaccinations at our Disposal Work Construction Permits Reviewed and
drive-through service area at the St. George Greek Approved: 2011 2012
Orthodox Church Community Center while 412 447
remaining inside their vehicles. These vaccines
provide lifesaving protection to the chronically ill Communicable Diseases: 2011 2012
and other vulnerable persons in the community. Total 170 162
• Reviewed and approved 1,528 building permit Fees Collected During 2011 2012
applications involving the construction of new $370,039 $361,891
homes,commercial buildings, sheds, additions,
alterations, remodeling work, and demolitions. Respectfully submitted,
• Issued 447 disposal works construction permits Thomas A. McKean, RS, CHO
during fiscal year 2012.
l ne t own of t5arnstame Barnstable
oFWE rgy�o Office of Town Manager bw
367 Main Street, Hyannis MA 02601
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Office: 508-862-4610 2007
Fax: 508-790-6226
Email: tom.lynch2ttown.bamstable.mams Thomas K. Lynch, Town Manager
September 3, 2013
Dear Department Head:
As you know, we have transitioned to an Annual Report which coincides with our fiscal year. This means
that work on the 2013 (fiscal year)Annual Report will commence shortly.
This format will cover activity from July 1, 2012-June 30, 2013.
Please read instructions carefully;-Reminder we have limited afi departments to a two (2)page
maximum departmental report.M Also each board, commission, and committee has a maximum of a
one (1)page report.
What follows is a format guideline for all Departments/Divisions to assist you in preparing your reports.
We would request that your reports incorporate the following categories:
• Mission (Please be brief)
• Major Accomplishments (Prior year in bullet form)
• If applicable, major projects or initiatives
• Graphs if appropriate set up in a separate file
• Photos - Send photos in a separate file, not within the report
• Where to go for more information (if applicable)
• Stats on performance (again, only if applicable)
Lastly, please include a head-and-shoulders photograph of yourself and all recently appointed chairs of the
boards, commissions, committees during FY13 for publication in the annual report. This is mandatory.
The deadline for submission®of above is no later than Friday,November 22,2013
We are hoping to increase the number of new photographs in this year's report. Please include with your
report submission any photos you may have from Fiscal 2013 that reflect your department's activities.
Please note: Editors reserve the right to use photos- all submissions may not be included in this year's
report. Contact editor Sarah Colvin at sarah.colvin(cDtown,barnstable.ma.us with any questions.
Email reports to Shirlee.Oakleyotown.barnstable.ma.us in regular page format using Microsoft word
and be sure to identify file by name of department, division. Again, please keep photos in separate file.
Thank you for your cooperation. Should you have any questions please do not hesitate to contact me thru
email provided or 508-862-4604.
Shirlee Oakley
Confidential Assistant
Town Managers Office