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HomeMy WebLinkAbout0039 LAKEWOOD DRIVE - Health 39 LAKEWOOD DRIVE CENTERVILLE A= 212 -008 ri * , �Iwo Town of Barnstable Inspectional Services �ARN3TABL£. `""SS' Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4988 1500 March 9, 2020 (original mailed February 5, 2020) GOODWILL, DOUGLAS J & PATRICIA K 259 OHIO AVE WEST-SPRINGFIELD, MA 01089 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 39 Lakewood Drive, Centerville was inspected on 01/22/2020 by Michael T Bisienere,certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • The septic tank is leaking. You will need to either seal the septic tank or replace the septic tank. You are ordered to repair or replace the septic tank within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\39 Lakewood Drive Centerville Second Order Letter with Correction.doc IKE Town of Barnstable Inspectional Services Department Tfb MA'S A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTRER Iea, 16 nI Sep �� +� Sew e Sip c ���k or �e-�/4C.e 44L Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc r Stanton, David From: Cape Septic Inspections <septicinspectormike@aol.com> Sent: Tuesday, February 04, 2020 9:51 AM To: Stanton, David Subject: Re: Septic Inspection at 39 lakewood Dr, Centerville The D box I would say if from evaporations. The tank I would guess is leaking at the seam.There was also some root intrusion.There is no water on at the home. A pump truck could refill the tank due to the topography some bushes and or trees would have to be cut to get a truck up the driveway.The property has been neglected for 20 year due to a freeze up. I will be happy to due what ever it takes so we can make the proper decision on this matter. Mike 508-280-3356 Thank you Mike Bisienere Cape Septic Inspections 508-280-3356 On Feb 4, 2020, at 9:25 AM, Stanton, David <David.Stanton@town.barnstable.ma.us>wrote: Hi Mike, The Health Director wanted me to follow up with you regarding the recent conditional pass for 39 Lakewood Drive, Centerville. Did the tank or d-box appear cracked causing them to be%full and empty? We are wondering if the house being unoccupied for almost 20 years would put these components in that condition of being%2 full\empty from evaporation? If that is the case, can they be filled and rechecked a few days later to see if the water levels stay at operating level? Thanks, David W. Stanton, RS Chief Health Inspector Town of Barnstable 200 Main Street Hyannis, MA 02601 Direct phone: (508) 862-4647 Health Dept. phone: (508) 862-4644 Health Dept. fax (508) 790-6304 CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! 1 Commonwealth of Massachusetts 21°?- 009 i� Title 5 Official Inspection Form tI Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ............. !% 39 Lakewood Drive V� Property Address Douglas& Patricia Goodwill Owner Owner's Name information is Centerville MA 02632 01/22/2020 required for every page. City/Town 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:out forms A. Inspector Information filling out forms on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road Co � Company Address Teaticket Ma. 02536 Cityrrown State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ® Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 01-26-2020 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of t 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 ti Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Lakewood Drive Property Address Douglas & Patricia Goodwill Owner Owner's Name information is required for every Centerville MA 02632 01/22/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ 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: 2) System Conditionally Passes: ® One or more system components as described in the"Conditional Pass" section need to be t 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. t 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): The H-10 1000 gallon septic tank was less than half full at the time of the inspection also the H-10 D- Box was dry. The home has a precast leaching pit with stone that is in great shape. The highest visible stain line is appx. one foot up from the bottonm of the leaching pit. This home was been vacant for almost 20 years. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Lakewood Drive Property Address Douglas & Patricia Goodwill Owner Owner's Name information is required for every Centerville MA 02632 01/22/2020 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): t ❑ 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): i 3) Further Evaluation is Required by the Board of Health: ❑ 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. a. 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts �- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �,• 39 Lakewood Drive Property Address Douglas & Patricia Goodwill Owner Owner's Name information is required for every Centerville MA 02632 01/22/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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. 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: ❑ 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. ❑ 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". i Method used to determine distance: 9 *"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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters I due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Lakewood Drive Property Address Douglas& Patricia Goodwill Owner Owner's Name information is required for every Centerville MA 02632 01/22/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. F ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. r . 4 ❑ ® An portion of a cesspool or privy is less than 100 feet but greater than 50 feet Any P p Y r 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 r laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, s 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 2000 gpd- 10,000 gpd. ❑ ® The system fails. I 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. i 5) Large Systems: To be considered a large system the system must serve a facility with a t design flow of 10,000 gpd to 15,000 gpd. i For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. t . 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 II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 I f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .. 39 Lakewood Drive Property Address Douglas & Patricia Goodwill Owner Owner's Name information is required for every Centerville MA 02632 01/22/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no" for each of the following for all inspections: Yes No ' ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? i ❑ ® Has the system received normal flows in the previous two week period? ' Have large volumes of water been introduced to the system recently or as part of El ® this inspection? Were as built plans of the system obtained and examined? (If they were not ® ❑ available note as N/A) r ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ 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? ® ❑ 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: ® ❑ Existing information. For example, a plan at the Board of Health. I Determined in the field (if any of the failure criteria related to Part C is at issue ® El approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 t _ . Commonwealth of Massachusetts .Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Lakewood Drive Property Address Douglas& Patricia Goodwill Owner Owner's Name information is required for every Centerville MA 02632 01/22/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 plus GPD Description: I Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: I Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: No water use in recent years. I Sump pump? ❑ Yes ® No Last date of occupancy: 20 years Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments + 39 Lakewood Drive Property Address Douglas & Patricia Goodwill Owner Owner's Name information is required for every Centerville MA 02632 01/22/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No t Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: I Last date of occupancy/use: Date I Other(describe below): I t 3. Pumping Records: I i Source of information: it Was system pumped as part of the inspection? ❑ Yes ® No i If yes, volume pumped: gallons How was quantity pumped determined? Lt5insp.doc Reason for pumping: -rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts �- Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ........... !% 39 Lakewood Drive Property Address Douglas& Patricia Goodwill Owner Owner's Name information is required for every Centerville MA 02632 01/22/2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ 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): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 22"feet I Material of construction: i ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 c Commonwealth of Massachusetts - p Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Lakewood Drive Property Address Douglas& Patricia Goodwill Owner Owner's Name information is required for every Centerville MA 02632 01/22/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) , 6. Septic Tank(locate on site plan): Depth below grade: 14"feet Material of construction: / ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) r If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No H-10 1000 gallon Dimensions: Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle 33 t 1„ Scum thickness Distance from top of scum to top of outlet tee or baffle 44" Distance from bottom of scum to bottom of outlet tee or baffle water level below the tee. t How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was below working level and the baffle was in place. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Lakewood Drive Property Address Douglas & Patricia Goodwill Owner Owner's Name information is required for every Centerville MA 02632 01/22/2020- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): / 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): F Depth below grade: Material of construction: i ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): I _ Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts I Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !% 39 Lakewood Drive Property Address Douglas& Patricia Goodwill Owner Owner's Name I information is required for every Centerville MA 02632 01/22/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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.): i *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): i Depth of liquid level above outlet invert 0" 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.): At the time of the inspection the H-10 D-Box was dry. i t r t F e i I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Lakewood Drive Property Address Douglas & Patricia Goodwill Owner Owner's Name information is required for every Centerville MA 02632 01/22/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. 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.): i * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type. ® leaching pits number: One ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: L. 15,n.p.cloc innovative/alternative system Type/name of technology: •rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Lakewood Drive Property Address Douglas& Patricia Goodwill Owner Owner's Name information is required for every Centerville MA 02632 01/22/2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection the leaching was dry and no visible failure criteria was found. i t i 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): t , Number and configuration A Depth —top of liquid to inlet invert M Depth of solids layer I Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, ( etc.): 3 t r t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Lakewood Drive Property Address Douglas & Patricia Goodwill Owner Owner's Name information is required for every Centerville MA 02632 01/22/2020 t page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): r I I > I i 9 k t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Il � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 39 Lakewood Drive Property Address Douglas & Patricia Goodwill Owner Owner's Name information is required for every Centerville MA 02632 01/22/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 D,v 1 I I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 LOCATION SEW GE PER T NO. y9� -iy1�s loth �av� � 36� VILLAGE I N S T A L L E R'S NAME i' ADDRESS J. LIG A,1c'DEIROS T"cking & W alldRing 142 n et tidnnii. Mass. 771 2-8 I. B U I-L Of R OR OWNER ff DATE PERMIT ISSUED DATE COMPLIANCE ISSUED i I Q I � \ I � I /.eoogya/ S•/ /000 .aim ./-•v I Commonwealth of Massachusetts Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Lakewood Drive Property Address Douglas & Patricia Goodwill Owner Owner's Name information is required for every Centerville MA 02632 01/22/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: t ® Check Slope t . ® Surface water r r ® Check cellar ® Shallow wells Estimated depth to high ground water: 14 plus feet feet Please indicate all methods used to determine the high ground water elevation: r ❑ Obtained from system design plans on record I 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: I augered at a lower elevation and I shot it with a transit 2 t i . i i r Before filing this Inspection Report, please see Report Completeness Checklist on next page. i i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 k Commonwealth of Massachusetts Title 5 Official Inspection Form _ ti Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Lakewood Drive Property Address Douglas & Patricia Goodwill Owner Owner's Name information is required for every Centerville MA 02632 01/22/2020 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. t ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate I j 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included I �rc`� 2 �01-73,-7 C)F S�f y No F�2© i i t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 LO-CATION- SEW,pGE PER T NO. VILLAGE L. I N S T A L L E R'S NAME S A D D R E S S J- CRAIG MEDEIROS ricking & BulldRing 142 Carparollon 5treet fty0nnh, Mass. 775-0828 BUILDER OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED l rJ 6 �73 a.� t-7- `1 f THE COMMONWEALTH OF MASSACHUSETTS BOAR® O HEALTH OF........... .. �,� ................. ..................... Allpliration for Uh4pos al lVarkii Tonstru.rtiun thrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ---------------------------------•-- ................................. -Address or Lot No. ..... ......... ...... ner / ......Address ...... �. Installer Address dType of Building Size Lot.... _... Sq. feet Dwelling—No. of Bedrooms.....................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ................................ . ......................---------------•••--•-----------------•-•-------------------------- w Design Flow...._,�,1 ...........................gallons per-per-so day. Total daily flow__._.......��-'_. ..............gallons. WSeptic Tank—Liquid'capacit}r`oo&gallons Length..8........ Width._l�_._........ Diameter................ Depth__X ----•-. x Disposal Trench—No..................... Width............ ....... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......./.......... Diameter... Depth below inlet- tal leaching area.--- ft. Z Other Distribution box 4--y Dosing tank ( ) O '-' Percolation Test Results Performed by..__�ow ......<65— ...�.O.e. Date.....� ...�' ........ Test Pit No. 1................mmutes per inch Depth of Test Pit.................... Depth to ground ater.._...._................ G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 94 •-•--•-••-••-••--••••-•••-------•••-•••-•-••••••-••--•••---•---...•••-••......--•-----•...................................................................... O Description of Soil..... ----�--/-. ..... Zg?^-/_... . c, w U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -------------------------------------------------------------------••••-•••••••--•--.......-•---•-••-.......---•--•--------••••--••----••••-••-•-----••-•-••-•-•--•---•-----•-••--.......--•---•.-••••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI''1:% 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. igned• ....... . ... ...........•---•----...•-•••--•-•-•......••---•.....-•-•...... ................................ Dated Application Approved By.......... • ---•-••--•-.. .... _& Y....... (�. ...........7d'....•.... te Application Disapproved for the following reasons_........................... . •. .............................•-----..Da.........---•--. -----••-----•----••---------- •-----------•---•-....-----•-••------...--- Issued--• :.. Permit No. Date 70S 02s:_644 No......................... )Ems.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -------------------- OF.......... ,z. . AV11 iration for Bispniial Works Tomitrnrtion ramit Application is hereby made for a Permit to Construct ( '00 or Repair ( ) an Individual Sewage Disposal System at: ^Location-Address �r or Lot No. /yam.a�a:xc:a,� G. 3 Cam// fir 4 GC/ /�'/rS�`r , / �•. •• �, I •S , . Owner Address W Installer Address dType of Building Size Lot______.._....... feet Dwelling—No. of Bedrooms....... ..............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) A4 Other fixtures _______________________________ ______________ {' Ions. Design Flow___...4' __________________________gallons per,person per day. Total daily flow_.__._._..__.__________-__:___._____..__._gal WSeptic Tank—Liquid'capacity.�2�Q _gallons Length__R_,____. Width__;_'.___.__. Diameter________________ Depth_.y'..._...._. x Disposal Trench—No. .................... Width____.__._.________ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......./.......... Diameter._. Depth below inlet_:__'__`___. Total leaching area._:�r..� q. ft. Z Other Distribution box (�;, Dosing tank ( ) ; � *2 ,/ ,/ Percolation Test Results Performed by..__.! © ......'5: ? ...__ ! ' .!1­4 '4'_ Date__._ _�-_�l/��_____.. � Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' O Description of Soil......___. " �i r --......_:.....................:��, t - - a ' ,� �............ W •----•-•••-..-------------••••---•-•••---•---•-•-•--•-••-•••---------•------------•----•------•---------------------------------•--•----•----•••••••-•---•-•----••--------•--•-----•-----------------•-- UNature of Repairs or,Alterations—Answer when applicable_----------------------_------------------------------------------------------------------------ ..---•-••••-•-----•-•-•-•••••--•-•-••--•-•--•---•-•--•-•--•-••••--•-•-••--•••--•••••---••-•-........-•--•--•-•-••-••----•••-•----.....--•----•-------•-•-•---•----•---•-•-••--••...............•••---•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITILL 5 of-,the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. �+ igned. . . --- -------- APPlication Approved By---•-- ...!' ... -••- ............................................... (.j �' `----•--- Date Application Disapproved for the following reasons:...............................................--•------•------------------•----•--------._...--•----..._....---- ---------------------------------•--------•--._.._..--------•------------------------------•---------•------•----.._._...----------•------------------------------------------------•--._...----•---•-•- Date PermitNo......................................................... Issued------•---•----------------•---.._..__.........._...... -----.----•--••- Date Y THE COMMONWEALTH OF MASSACHUSETTS r ABOARD O HEALTH {:�.... ..Q....�F'.�.L.........OF........... ............................................. Tfrtifiratr of Toutplianrr THIS I T E IFY�7, at the Ind vidual Sewage Disposal System constructed ( or Repaired ( ) Iler atv! f✓ = r„`' �........................ -•---•----- -.'------------------------- has been installed in accordance with the provisions of ��F o Tie State Sanitary Co as describe in the application for Disposal Works Construction Permit N .......__............... dated_..._ ....`� .'...................... THE THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A ARANTEE THAT THE SYSTEM WILL FUNCTION, SATISFACTORY. DATE................................................................................ Inspector................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH . .........OF:. ...... .. ................................. ........... .-o NO......................... FEE. Per ss>on is 'ereby granted , o `w �� ---•-••- y tr ct epair a ndi� Se �isp`o teto Cons � l ..e2.._...--•-=- ...- � � .at No... / treet 17 as shown on the application for Disposal Works Construction g,zrrit,7No.._-__/,_t_.-�____ ated.d._`_~�`---r. .............. -------------------- DATE_......... •-•----------------------------------------------•---------•--•-••--- 7' Board of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS C3 �. O Ln Fdr delivery information,;,visit 03 Certified Mail Fee Ir $ $ y Extra Services&Fees(check box,add fee as Al d ❑Return Receipt(hardoopy) ❑Return Receipt(electronic) $ N t0'Iflfk ore Certified Mall Restricted Delivery $ O ❑Adult Signature Required $ r' ❑AdultSignatureResMctedDelivery$ Postage � GOODWILL, DOAV A SA4 & PATRC A K VE� - U1 259 OHIO o . WEST SPRINGFIELD, MA 01089 -:r, r ,r r,r•r Certified IAail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique Identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipient's retail associate. L signature)that is retained by the Postal Service- Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders. Adult signature service,which requires the }, ■You may purchase Certified Mail service with signee to be at least 21 years of age(not �kst-Class Mail®,First-Class P ckage Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is gVailable for requires the signee to be at least 21 years of age international mail. and provides delivery to the addressee specified ■Insurance coverage isypotavailable for purchase by name,or to the addressee's authorized agent vi`ith Certified Mail Serve.However,the purchase (not available at retail). of Certified Mail serAOSPoes not change the ■To ensure that your Certified Mail receipt is Insurance coverage automatically Included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark.If you would like a postmark on r. ■For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarking.If you don't need a postmark on this Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion, of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. y electronic version.For a hardcopy return receipt, 1 complete PS Form 3811,Domestic Retum Receipt attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records. Ps Form 3800,Apdi 2ois(Reverse)PSN 753o-oa-000 047 ,i $ENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete i Feroll,2,and 3. A. Sign t e ■ Print your name and address on the reverse X ❑Agent so that we can return the card to you. I ❑Addressee ■ Attach this card to the back of the mailpiece, ceived by(P-^ria ted Name) C. Date of Delivery or on the front if space permits. l ®/3(ZjZrr�fQ �GL 1. Article Addressed to: D. Is delive address different from Item 11_ El Yes — ry ddre"ss't elow:'C(®No GOODWILL, DOUGLAS J & PATRICIA K �,��' 9 259 OHIO AVE O WEST SPRINGFIELD, MA 01089cot IYA o. II I IIIIII I'll IIII IIIIIII IIIIIII II I IIIIIII III '_ ❑AdultvSgn SignatureEJ_ ❑Registeority MaiMa;for l cte utt Signature Restri �d Deny ❑Reeggjgt u'ified Mail® \ a very 9590 9402 5357 9189 1907 91 ❑Certified Mall Restricted Delivery etum R- ❑Collect on Delivery ;7h diee _i.,ti„n- .n_rnuoc+_nn Delivery Restricted Delivery ❑'SI'nature ConfirmationT"" Aail ❑Signature Confirmation 7 015 1730 0 0 01 4 9 8 8 1500 Aail Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt USPS TRACKING# First-Class Mail Postage&Fees Paid USPS Permit No.G-10 9590 9402 5357 9189 1907 91 I United States •Sender:Please print your name,address,and ZIP+4®in this box• Postal Service -� _ Ztown of Barnstable Health Division `°.a •a 200 Main Street II Hyannis,MA 02601 I � I I � 311921 '::-St U.S.POSTAGE>>PITNEY BOWES � 0 Public Health Division _ //�Z��G7m BARNnABLE. 200 Main Street - oo `, FORu+'� Hyannis,MA 02601 ZIP 02601 V4. �.1 02 $ 006.90 0000336455 FEB. 06. 2020, 7015 1520 0000 1967 7528 GOODWILL_DOUGLAS J & PATRICIA K UNCisAZME;W. 1 aar r S-44 02601 >4 0 .� .iozi .� COMPLETE .N COMPLETE THIS SECTION ON DELIVERYi I' ■ Complete items 1,2,and 3. A. Signature ■ Print your name and address on the reverse. X ❑Agent so that we can return the card to you. ❑Addressee , ' ■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery or on the front if space permits. n_is dWiv--address different from item 1? ❑Yes I ar delivery address below: ❑No f GO 'WILL, DOUGLAS J & PATRICIA K 259 OHIO AVENUE t I *ZST SPRINGFIELD, MA 01089 I II I IIIIII I'll III I IIIIIII IIIIIII II I I I I it 11 I i III . ❑Adult Signature,} ❑Rregis erediMaFm Express@ I ❑ dult Signature Restricted Delivery ❑Registered Mail Restricted I ery 9590 9402 5357 9189 1906 16 PCertified Mail Restricted Delivery '4eu Receipt for I ❑Collect on Delivery Merchandise / 2_—Article_Number Mansfer_from_serv_ice label) ❑Collect on Delivery Restricted Delivery ❑Signature ConfirmationTM I 7 015 15200 0 0 0 19 6 7 7 5 2 E Nljail ❑Signature Confirmation (v ail Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt I1 I TI T—T tTt'iz -v, r+.rr itt.. ` �trti Town of Barnstable Inspectional Services r aaxtvWABLE, "`" 039. Public Health Division �'b 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1520 0000 1967 7528 February 5, 2020 GOODWILL,'DOUGLAS-J &PATRICIA K - 259 OHIO AVE WEST SPRINGFIELD, MA 01089 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 39 Lakewood Drive, Centerville was inspected on 01/22/2020 by Michael T Bisienere, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • The septic tank is leaking. You will need to either seal the septic tank or replace the septic tank. You are ordered to replace the distribution box within two (2)years from the date you receive this notification. Failure to repair/replace the septic system,within the deadline period will result in future enforcement action. 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