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0018 LIETRIM CIRCLE - Health
18 Lietrim Circle Centerville P A = 169 052 � ' rf TOWN OF BARNSTABLE LOCATION L<r 1 M c 1 r r.(k SEWAGE# VILLAGE CO I tMN- ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. Sr PTIC TANK CAPACITY (//��M 4.EACHING FACILITY:(type) Ptl- - NOW 1-31N, (size) NO.OF BEDROOMS 3 OWNER Goo PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY --f-/I S,0Q_770n. r r3Atk Q i 0 O A 3 a , �. 3 a 15 (3 S y 3 a") ly Y s3 ac� 31 1"1 NOTES TO THE FILE October 13, 2011 Precision Pools and Patios 18 Lietrim Circle Centerville, MA Cynthia Martin Donald Desmarais Precision Pools and Patios was visited due the concern of the use, handling and storage of hazardous materials (i.e. pool chemicals). This residential home, garage and shed were empty and a real estate'for sale sign was in the yard. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Lietrim Circle Property Address Richard Bond Owner Owner's Name information is required for every Centerville Ma 02632 9/12/2011 page. 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 filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your I cursor-do not Sean M. Jones use the return Name of Inspector key. Capewide Enterprises —� Company Name 153 Commercial St. Company Address Mashpee Ma. 02649 Cityrrown State Zip Code 508477-8877 SI 4522 Telephone Number License Number 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 16.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9/12/2011 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 is a shared system or has a design flow of 10,000 gpd or greater,,theainspector and the system owner shall submit the report to the appropriate regionawifiice.of`the bEP''ihe 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 dQe$t}ot bad;�reos dhow the system will perform in the future under the same or different conditions of use. M Title Official 'on F I t5ins•11/10 5 Otfia InsPec4 Form:Subsurface Sewage i pose System•Page 1 of 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Lietrim Circle Property Address Richard Bond Owner Owner's Name information is required for every Centerville Ma 02632 9/12/2011 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) 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: The dwelling located at 18 Lietrim Cir. Centerville is served by a Title V septic system consisting of a 1000 gallon septic tank, d-box, leach pit and 2 flowdiffusers. 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-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ° 18 Lietrim Circle Property Address Richard Bond Owner Owner's Name information is required for every Centerville Ma 02632 9/12/2011 page. Cityrrown State Zip Code Date of Inspection 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): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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): C) 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. 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Lietrim Circle Property Address Richard Bond Owner Owner's Name information is required for every Centerville Ma 02632 9/12/2011 page. Cityrrown State Zip Code Date of Inspection 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: ❑ 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". Method used to determine 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. 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 ❑ ® 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 due to an overloaded or clogged SAS or cesspool ❑ ® 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 %day flow Wins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 't 18 Lietrim Circle Property Address Richard Bond Owner Owner's(dame information is required for every Centerville Ma 02632 9/12/2011 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ElRequired 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. ❑ ® 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 well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® 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. ❑ ® 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. 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. t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Lietrim Circle Property Address Richard Bond Owner Owner's Name information is required for every Centerville Ma 02632 9/12/2011 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: 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? ❑ ® 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 this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ 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. ® ❑ 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): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 gpd t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Lietrim Circle Property Address Richard Bond Owner Owners Name information is Centerville Ma 02632 9/12/2011 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date Commerciallindustrial 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 Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '^ 18 Lietrim Circle Property Address Richard Bond Owner Owner's Name information is required for every Centerville Ma 02632 9/12/2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 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/Altemative 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): t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Lietrim Circle Property Address Richard Bond Owner Owner's Name information is required for every Centerville Ma 02632 9/12/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Tank and pit original, d-box and flowdiffusers added at a later date. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3 feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments(on condition of joints, venting, evidence of leakage, etc.): Joints ok, no leakage, vented through roof Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: 5" t5ins-11f10 Tide 5 official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Lietrim Circle Property Address Richard Bond Owner Owner's Name information is required for every Centerville Ma 02632 9/12/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 3.5' Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" - Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers and took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years as maintenance. water level was at bottom of outlet invert, tank was not leaking and was structurally sound. Outlet baffle intact. 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 t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Lietrim Circle Property Address Richard Bond Owner Owner's Name information is required for every Centerville Ma 02632 9/12/2011 page. Cityfrown State Zip Code Date of Inspection 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.): 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Lietrim Circle Property Address Richard Bond Owner Owner's Name information is required for every Centerville Ma 02632 9/12/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): 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.): Water level was even with both outlets and had no high water stains indicating past hydraulic overloading. 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: i t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Lietrim Circle Property Address Richard Bond Owner Owner's Name information is required for every Centerville Ma 02632 9/12/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ® leaching chambers number: 2 flowdiffusers ❑ 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.): Vegetation was normal, no signs of past saturation. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts up Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Lietrim Circle Property Address Richard Bond Owner Owner's(dame information is required for every Centerville Ma 02632 9/12/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): t5ins•11110 Title 6 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Lietrim Circle Property Address Richard Bond Owner Owner's Name information is required for every Centerville Ma 02632 9/12/2011 page. Cityrrown State Zip Code Date of Inspection 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 A-I p�(L e 1 13 2 Q A-Z ZS T e-2 13 3 t' T Lt�> F A3 27 03 �y 31 13-y )'7 1 IOy irr,$�fx A- S° s3 t5ins-11/10 Title 5 Official Inspection Farr.Subsurface Sewage Disposal System•Page 15 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Lietrim Circle Property Address Richard Bond Owner Owner's Name information is required for every Centerville Ma 02632 9/12/2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20+ 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: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Lietrim Circle Property Address Richard Bond Owner Owner's Name information is required for every Centerville Ma 02632 9/12/2011 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Message Page 1 of 2 O'Connell, Timothy From: McKean, Thomas Sent: Tuesday, November 17, 2009 3:40 PM To: O'Connell, Timothy Subject: Fw: street hazards From: Geiler,Tom To: 'Janet Joakim' <janetjoakim@aol.com> Cc: McKean, Thomas Sent: Mon Nov 16 16:34:42 2009 Subject: RE: street hazards We could ask the Police Dept to look at the truck and the refrigerator to see if there is a violation. I will ask Health to see if it is a registered rental property and if not we will contact the owner. If it is registered, staff can check to see how many occupants there are. It is a 2 bedroom 2 bath home. There should be no more than 3 vehicles parked on the property. The street is probably void of any parking restrictions. The Town Manager can authorize No Parking signs on any"public"way. Lietrim is a private way. -----Original Message----.- From: Janet Joakim [mailto:janetjoakim@aol.com] Sent: Monday, November 16, 2009 2:00 PM To: Geiler, Tom Subject: Fwd: street hazards Hi Tom - I want to get back to the people who sent the message below-what are the rules/laws/ordinances re: heavy equipment? Can we do anything about the possibility that it is overcrowded? Thanks janet Janet S. Joakim Barnstable Town Council Precinct 6 Phone and Voice Mail: JOAKIM-2632 (562-546-2632) home - 508-420-2153 Committee to Elect Janet Joakim 206 Donegal Circle Centerville, MA 02632 -----Original Message----- From: ClassyClarinet@aol.com To: Janetjoakim@aol.com Sent: Sat, Nov 14, 2009 1:12 pm Subject: street hazards Hi Janet, First of all congratulations on your re-election. We have a situation on Lietrim Circle that we need to let you know about. Number 18 has turned into a rental with absentee landlords. The issue is that they are regularly parking a large truck, trailer and bulldozer on the street. This is very dangerous since you have to pass it by being in the middle of the street with oncoming cars coming around the corner. There 11/17/2009 Message Page 2 of 2 have been several close calls and one day there will be an accident. What are the laws about parking and having construction equipment on the road. Also there is a refrigerator in the driveway that has been there since May with the doors on -there are younger children close by and that is a worry. Please drive by when you can and see what we mean. At times there can be 6 or 7 cars there. One more thing, there was a physical fight there with someone who was dropped off and then picked up by a speeding car. Let us know-thanks for checking into this-we have a great neighborhood but this brings it down. Peter and Brenda Crowell 11/17/2009 1 G� 10cep COMMONWEALTH OF MASSACHUSETTS', - EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS . DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION. FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: r-18'Lietrim Circle Centerville, AM 02632 Owner's Name: Richard Bond l•� Owner's Address: Date of Inspection: May 9, 2008 Name of Inspector:(Please Print) James M. Ford Company Name: James.M.Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400 . g CERTIFICATION STATEMENT 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 7 training and experience in the proper function and maintenance of on site sewage disposal systems. I.am a DEP c approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: �. ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ils 1 Inspector's.Signature: Date: May 9. 2008 The system inspector shall sub a copy o this inspection report to the Approving Authority(Board of Health or DEP)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: Notes.and Comments ****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. Title 5 Inspection Form 6/15/2000 page I 1 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART A CERTIFICATION (continued) Property Address: 18 Lietrim Circle. Centerville. MA Owner's Name: Richard Bond Date of Inspection: May 9, 2008 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.30.3 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. Answer yes,no or not determined(Y,N,ND)in the 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. ND explain: 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 obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: 2' Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 18 Lietrins Circle Centerville: MA Owner's Name: Richard Bond Date of Inspection: May 9. 2008 C. 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 toL 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 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: 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 aseptic 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 distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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. > 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 18 Lietrim Circle Centerville. AM Owner's Name: Richard Bond Date of Inspection: May 9. 2008 D. System Failure Criteria applicable.to all systems: You must indicate either"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 due to an overloaded or clogged SAS or cesspool ✓ 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 %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. ✓ 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 well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] No (Yes/No)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 detennine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve.a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes."or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 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. 4 r Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 18 Lietrim Circle Centerville, MA Owner's Name: Richard Bond Date of Inspection: Ma 9. 2008 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: 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? ✓ _ 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 this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ 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: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ 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(3)(b)]. 5 Page 6 of 11. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: M Lietrhn Circle Centerville MA Owner's Name: Richard Bond Date of Inspection: May 9. 2008 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): N/a Is laundry on a separate sewage system(yes or no): n1a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): spd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding.tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unknown Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for.pumping: 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) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Date of installation 8121198-new leach field added-per as-built Were sewage odors detected when arriving at the site(yes or no).: No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 18 Lietrim Circle Centerville; MA Owner's Name: Richard Bond Date of Inspection: Me 9. 2008 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 20" Material'of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes orno): (attach a copy of certificate) Dimensions: 1000 Qal. Sludge depth: 2 Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: S" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert There did not appear to be anv sins of leakage GREASE TRAP: None .(locate on site plan). Depth below grade: 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: Comments(on pumping_recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 18 Lietrim Circle Centerville, MA Owner's Name: Richard Bond Date of Inspection: May 9, 2008 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.):. DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was clean. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 y Page 9 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 18 Lietrim Circle Centerville, MA Owner's Name: Richard Bond Date of Inspection: May 9. 2008 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1000 gala Pit-original ✓ leaching chambers,number:, 2 flow diffusors-newer system leaching galleries,number: leaching trenches,number,length: . Teaching 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.): I dug down beside the.flow diffusors and the stone was clean. There did not appear to be any sigans offailure The older nit was not dug up. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 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 or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None locate on site plan) ( P ) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of pondin&condition of vegetation,etc.): 9 ' Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 18 Lietrim Circle Centerville, MA' Owner's Name: Richard Bond Date of Inspection: May 9, 2008 SKETCH OF SEWAGE.DISPOSAL SYSTEM Provide a sketch 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. ao a 25 t3 y S 3 a"1 ly, - � 3 ► 1� 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 18 Lietrim Circle Centerville, MA Owner's Name: Richard Bond Date of Inspection: May 9, 2008 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 30+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed.site(abutting property/observation hole within 150 feet-of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps, the maps were showinggpproximately.30'+/-to groundwater at this site. This.report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,either expressed, written or implied, relating to the septic system, the inspection, this.report and/or any.components of the septic system which have not been located and inspected. 11 Town of Barnstable Regulatory Services Thomas F. Geiler, Director v 6 9� `�g' Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit". If you should have any questions regarding this report, lease contact the certified Septic P p System Inspector who conducted the inspection. Q:\SEPTIC\Disclaimer Private Septic Inspections.DOC � .z is RECEIVED PARCEL, OCT 2 5 2004 LOT 5 TOWN OF BARNSTABLE HEALTH DEPT. DATE 10113104 PROPERTY ADDRESS 18 C.ieta.im ci zC'ee wn Cent e'zv-iiie Nazz 02632 On the above date, the4eptic system at the address above was Inspected. This system consists of the following: 1. 1-1000 ga.R.Ron ze/at-ic tank. 2., 1- Dizta.igut.ion fox. 3., 2-500 gaiion ieach.iag chamgenz., Based on inspection, I certify the following conditions: 7h.iz .ins A 7.itie Five Septic System. SeRt.ic byztem .iz .in paope2 woak.ing mdea at the /7aesen.t time.. M SIGNATURE Name: Robert A. Paolini Company: Joseph P. Macomber & Son Inc Address: P. O. Box 66 Centerville, Mass 02632 Phone: 508-775-3338 or 508-775-6412 Nunn JOSEPH P. MACOMBER & SON,. INC.. Tanks-Cesspools-Leachf iekis Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 026.32-0066 775.333E 775.6412 • COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF EwiptoNWNTAL AFFAIRS d DEPARTMENT OF' NVIItON NTAL pROTtOTION Y TITLE 5 OFFICIAL INSPECTION FORM—.NO.TTOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART-A CERTIFICATION Property Address:1.8 L.ie.t/ti.m C.iacie en.teay.iiie Na Owner's Name: W a.e.t e2 /,Jo o el Owner's Address: game Date of Inspection: 10 4 Name of Inspector: (please printy2 o ezt. . Company Name: 1) .ma comk.eia .S-Qn Zrzc. Mailing Address: - Cen eav a..026 32 , Telephone Number: 5 0 8—77 5:3 3 3 8 CERTIFICATION STATEMENT 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'Fitle 5(310 CMR 15:000). The system: XXX passes -Conditionally Passes Needs Further Evaluation by the Local Approving Authority F ils 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 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. Notes and Comments ' ****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. T:Ax.4 7.0"Arstinn Rnrm 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address-1 8 L.ie;ta.im C.izc.2e Cen.teay.iiie Na Owner:lda / bl o o.P-,4 Date of.Inspection: 1 n l 9 3/n 6 InspectionS.untmary: Check A;B C,D(yr.E/ALWAYS complete-all of Section D A. System Passes: /LO I have not found any information which indiciates'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: Sept-ic 3urtem .iz .in i2 o12an z.)o2k/a oado/7 ri thv 4nnnv_rz# fimv B. System Conditionally Passes: NO One or more system components as described in the"Conditional-Pass"section need to be replaced:or repaired.The system,upon completion of replacement or repair,as approved by the Board of Healtl'i,will pass. fr Answer yes,no or not.determined(Y,N,ND)in the for the following statements.If"not determined"please explain. NO The septic tank is metal and.over 20 years old*or the septic tank(whether metal or:not)isstructurally unsound,exhibits substantial infiltration or exfiltration.or tank failure.isimminent:System.will pass inspection if the existing tank is replaced with'a complying septic t=k.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. ' ND explain: No 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. obstruction is removed distribution box is leveled or replaced ND explain: tyre 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 obstruction is removed ND explain: 2. Page 3 of l l O)6";E'3CIAL 1�1"SrI:ECTIO FORM-NOT VOR VADL-UNTA.Ry. iI'DISPOSALS•Y.S E••IrTSP'11;CTION�RM TS SUBStWA CE SEWACL PART:A . . CERTIFICATION(6ontinued) : Property Address: Cente2vie2 Na. - Owner:.vnefoai n n U Date of Inspection: 9 n/12/')A C. Further Evaluation-is.Required by the Board of Health: no Conditions.exist which require further..evaluationby.the Board:oPHeaith;in-ortier.:to;deterniineifthesystem is failing to protect publie,health,safety or thb environment. ( )(b) 1. System will;pass unless Bob rd-oi'.Health determines+in aeeordastce with 31Q.CMlrt 15:3031 that the ch. il•protect ublic health,safe andale..enviroument: .a•marinerwhi wj P safety of function to P system is n �$ no Cesspool or privy is within,50 feet of asurface water n_o Cesspool or privy is within 50.feet of•a bordering vegetated wetland or a salt marsh. 2. System will fail unless the Board-of Health(and Public Water Supplier'-if any),datermines.-that the system is functioning in a matlner that proteets thepablic Health,safety and environment: The system has a septic tank and soil absorption system•(SA•S).:and the SAS is within 100 feet.ofa surface water supply or-tributary to a..surface water supply. no The system-has•a.septic tank and SAS and the:SAS is!within a Zone 1 of a--public wateresupply. n o The system has a septic tank and.$AS:andthe SAS is within, fcet of a private water.supply well. n`o The system has a septic tank and SAS and the7SAS is less than 100 feet.but 50 feet or.3hore froth a private water supply well* .Method used to determine distance- **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from-pollution from that facility 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 bo attached to-this form. 3. Other: r of Page 4 fII OFFICIAL-INSPECTION FORM NOT'FORVOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 18 L.ce t 2.im Ci/t c.2e Cen.te2v.�.�-2e. I'1a. • Owner: ld d it e 2 bl o o i;& Date of Inspection: 1 0/1 3/i)4 D. System Failure Criteria applicable to all systems:. You must indicate"yes"or"no"to.each.of the 1ollowing:for all�inspectio= Yes No x Backup of sewage:inter-fat ity.or system component due to overloaded,or clogged SAS.,or cesspool x Discharge.or-ponding of effluent to the.surface of the:;ground or..surfacematers due to an overloaded or clogged SAS or cesspool x Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool x Liquid depth in-cesspool is less than.6"below invert or available volume is less than'/z..day flow x Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped x Any portion of the SAS,cesspool or privy is below high ground water elevation. _ x Any.portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. x Any portion.of a cesspool or privy is within a:Zone-l of a public.well.. _ x Any portion of a cesspool or privy is within.50 feet of a private water supply well. _ x 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 coliform bacteria and volatile organic.compounds indicates:that the well is.free from pollution:from:that,facility 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 attaehed.to this form.] no (Yes/No)The system fails.I have determined that one or.more,ofthe:above,failure..criteria exist as described in 310 C1vIR 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 1.01000 gpd to 15,000. gpd• .. You must indicate either"yes"or"no"to.each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no ' — n o the-system is within 400 feet of a surface drinking water supply — n o the system.is within 200 feet of a tribu g supply tributary.to a surface drinking water su 1 n o the:system is located In a nitrogen sensitive area Qnterim Wellhead Protection Area—IWPA)or a mapped Zone II 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. 4 Page 5 of 11 OFF ICI'AL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS gtBSURFACE SEWAGE DISPOSALSYSTEM INSPECTION FORM PART B CRECIMIST Property Address: 18 Ll atlz lm UILQ ee• ranfon»il�l�v,1L-- Owner: Date of Inspection: ^I_Z) A 1�14 9 4 Check if the following have been done You must indicate"yes°'or"no"as to each.of the following: 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? x Has the system received normal flows in the previous two week period? — — , x Have large volumes of water been introduced to the system recently or as part of th�-inspection? x _ Were as built plans of-he system'obtained and examined?(If they were not available: is N/A) x Was the facility or dwelling inspected for signs of sewage back up? x Was the site inspected for signs of break out? x • _ Were all system components,excluding the SAS;located on site'? x — 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? x _ 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 deter rived based on: Yes no .. x Existing information.For example,a plan at the Board of.Health. _ x Determined in the field(if any of the failure criteria related to Part C is at issue approximationvf distance is unacceptable)[310 CMR 15.302(3)(b)j 5 Page 6 of 11 OFF10- AFL ANSPRICTIa0N:.-FORM%-NOT FOR V43.I,LFNURY ASSESSMENTS SUBSI-RYAClEJ-SEi?V.AGE DISFOSAL�SYST x'M,INSPECTJQN.'FORM PART.0 SYSTEM-INFORMATION Property Address: 18 L e t iz i m C i It e e e Centeay.itee. (la., Owner: ida P-na binn.�4 Date of Inspection: 1 1.«3 n 4 FLOW CONDITIONS RESIDENTIAL Number of bedro sed.ms(design):�,;�.. Number ofbedrooms.<actual): 2 DESIGN`�low•ba on 3I0 C1VTT�15.�03('for eicariiple:'I IO'gpd z 1#•oi'bedrooms)': '3 z/ /0=3 3 0 yid Number of current residents:, 2 Doesresidence have a garbage grinder(yes br no): n o Is laundry on a sepgrate sewage.sysiem-(yes or.no):.•a {if yes separate inspection required] Laundry system inspected(yes or no):r/e_h Seasonal use:(yes or no):n� AW, 3�f by tI Water meter readings,if available(last 2 years usage(gpd)): Sump pum (yes or no):r,,.Q_ Last date of occupancy:ppp o n f COMMERCIAL-fIP bUSTRIAL Type of estab" . 't: .n a . ; Des fgn flgw. �on 310 CiVIlt 15.2U3):. n¢ V Basis.of di:5,Wflow(seats./persons/sq%etc.): n a Grease trappresent(yes or no):'na Industrial waste holding tank present.(yes or no)ka— Non-sanitary waste discharged to the Title 5 system-(yes or no): na Water-meter readings,if available: n,7 Last date of occupancy/use: n a OTIjER(descri4e)•, n OT'{NERAL INFQRATION ". . Pumping Records Source of information: .a•'!.-NacomPe2 ansd zon Was system pumped as part of the inspection(yes or no):n o If yes,volume pumped:_gallons--How was quantity pumped determined? Reasonfor.p..umping: Bumped tank '12111,/02 TYPE OF SYSTEM x Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool _Privy _Shared system(ayes 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) _Tight tank _Attach a.copy-of the DEP.approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: _66,A'fn� nda 812119R Were sewage odors detected when arriving at:the site(yes or no):n 6 _ Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM a PART C SYSTEM INFORMATION(continued) Property Address: 18 f jo f„ ;,,, ('J n r Oe (�onfonu�l/Oo� /7ri Owner: /�)ri O f o n Date of Inspection: BUELDING SEWER(locate on site plan) Depth below grade: 22" Materials of construction:_cast iron x_40 PVC_other(explain): Distance from private water supply wej.or suction line: I 0 f ' Comments(on condition of joints,venting,evidence of leakage,etc.): 'ah.t_ No Re- SEPTICSci�st e_ve�t ed .thaough house vents. TANKv e,6(locate on site plan) Depth below grade: 2 4" Material,of construction: x concrete metal,_fiberglass_polyethylene _other(explain) — ' If tank is-metal list age:n_0 Is age confirmed by a Certificate of Compliance certificate) mP (yes or no):_(attach a copy of Dimensions: 5' 8"h.igh/4 ' 10'wade/8' 6".tong Sludge depth:-2 Distance from top of sludge to bottom of outlet tee or baffle: 2' 7" Scum thickness: Distance from top of scum to top of outlet tee or baffle:j n ri v Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle eonditio structural irate as related to outlet invert,evidence of leakage,etc.): n' sty,liquid levels .st2uctu2ai e GREASE TRAP:n° (locate on site plan) Depth below grade: n a Material of construction:_concrete_metal____fiberglass_polyethylene other (explain): n Dimensions: n u Scum thickness:_ n 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 Date of last pumping: n a — Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural inte as related to outlet invert,evidence of leakage,etc.): 8rity,liquid levels tea.3et z a.12 not 2e�sent. Title S TnenPMinn Fnrm F/1 ShMl1 7 Page 8 of I I OFFICIAL IN-S.PECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUS&URFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address, 18 L.ie.ta.im C.iacke Ce nIaIz2) OOa,4a Owner: f^_ 4 410 9g4 Date of Inspection: 3,�1 a* TIGHT or HOIrDING TANKr'z0 (tank must be pumped at time of inspe'ction)(locate on site plan) Depth below grade: na Material of construction: concrete metal fiberglass____polyethylene other(explain): Dimensions: rza Capacity: na .gallons Design Flow: = gallons/day Alarm present(yes or no): rza Alarm level: /za Alarm 1n working order(yes or no): rna Date of last pumping: rza Comments(condition of ai.arm and float-switches,etc.): Tight o2 ho ed.irzg .tankz noZ 12ar.,inat DISTRIBUTION BOX: ens (if present must be opetted)(locate on site plan) Depth of liquid level above outlet invert: no 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.) /'env ��iA •f� n �n•f'nnn �w Nn ez)]rJOnl`O Q4 /,n..P. dA ca22U ove2 ' PUMP CHAMBER:no. (locate on site.plan) Pumps in working order(yes or.no): rza Alarms in working order(yes or no): na Comments(note condition of pump chamber,condition of pumps and appurtenances,etb.): Pump chamgea not 2e.sent.' 8 I Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS --. SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 18 Ll e.Lz im Lillc-2e C'onte2v.�.�.�e, 17a, Owner:. bl n O f o a GI a o 24 Date of Inspection: 1 n/> 3/0 4 A lY SOIL ABSORPTION SYSTEM(SAS)yens .(locate on site plan,excavation not required) If SAS not located explain why: Located bee a e 10 . Type ye,3 leaching pits,number: 1 leaching chambers,number: Z 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.): No zigns o� h daauiic jai&. ze,� Vegetation j.3 no2mae., CESSPOOLS: no (cesspool must be pumped as part of mspection)(locate on site plan) Number and configuration: as Depth—top of liquid to inlet invert: na Depth of solids layer: na Depth of scum layer: na Dimensions of cesspool: na Materials of construction: na Indication of groundwater.inflow(yes or no)na Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Ce,6.s 12 oo.9h not p 2ezen.t PRIVY: no (locate on site plan) Materials of construction: nA r_. Dimensions: na - � m Depth of solids: na Comments(note condition of soil,signs of hydraulic failure,level ofponding,condition of vegetation,etc.): Pltiv not �2e�ent. I 9 Page 10 of 11 pFFICiA INSPEc,,`TON F'QRNI_ NOT'YFOR•NOLUNTA t?Y:ASSESSMENTS SII$SLIREACE SEWAGEMISPOSAL SySTEM. NSPECTION:FORM PART SYSTEM FNFORMAT<I.ON(continued)` Property Address:- 8 L L��mO C�/y/L e Owner. lJrj Of o n Va 0L 'n c ion TCH OF SEWAGlE•DI$POSAL SS =! ovide ding ties to at least two perinanerft reference an . ar or a sketch of the sewage disposal system inclu .` where public water supply enters.the building. nchmarks.Locate all wells ; a^ c: f' 10 e Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.0 SYSTEM INFORMATION(continued) Property Address:l8 L.ietaim Ci/tcie Cente2vi ee, Ma., Owner:Ida.Pty/7 Unn P4 _ Date of Inspection: 10/13/0 4 SITE EXAM Slope Surface water Check cellar. Shallow wells Estimated depth to ground water qQ feet Please indicate(check)all methods used to determine the high ground water elevation: n o Obtained from system design plans on record-If checked,date of design plan rgviewed: a o Observed site(abutting property/observation hole within 150 feet of.SAS) no Checked with local Board of Health-explain: _u_e_Xhecked:with local excavators,installers-(attach documentation) _UL,Accessed USGS database-explain:h t. 12, //.t o wm 9 ri 2 n.6 t a& e.,u.a.. ma., You must describe how you established'the high ground water elevation: ubP�.al� vntW R N.i..P,Pn_ - morin_.P. 12116194 gaound' wate2 e.eevation.6 agove '.yea .let' u,SPrlrr_;_JIC�C.�aOApauatinn we LP data inno . 1992 u,ynr/ •7orh'nirnl� PnPOofin 97_000_1 P-Prilo 412 nnnuaP rznag-6 o4 gliound `o Leaching Pit : "eet Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft pw-F.LinrptejMethod e Therefore,the vertical.separation distance between the bottom of the leaching pit and the adjusted groundwater table is foot: Do,(z , tt K { r 1 b,,roa, ) t {y l�.y+i 't `{ N 4 '' d r, 1" V r9 k .. > - r K h .e *`. 1t a L S, .. n: L`3,5 g` 2 _ ..:,. 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I _ .: ,", T Tn.—n','rTr•Tr rnr nrt'nTRf fs"�R a•.R.1•Cr.1f,•.T'T••T9'itTR,'T',Rn ngTL PIR'frR'f T'7 T TOWN OF Barnstable WARD OF IIEALTII SUIISURFACE SE}fAGE DISPOSAL SYSTEM INSPECTION FORM - PART D•- CERTIFICATION , nrrnn•+er►rTrr.s�+mnrrTen•.�rrT-•r.•.. — \...t..t.T••,••.' �T,11"•T.'rT,RS,',i'K.TTI T+I.r,1TT11l1T'rr•T—'.',nlTl'Y inRArT ���� -TYPE OR PN1NT CLCARLI'- PROPERTY INSPECTED STREET ADDRESS 18 Liet2im C.iacie ASSESSORS MAP , DF QCK AND PARCEL # 169-052 OWNER' s NAME &/aite2 lv�OW PA1?7' D - CERTXFICATION NAME OF INSPECTOR /2oe2 t ao ��ni COMPANY NAME Joseph P. Macomber &t6n Inc COMPANY ADDRESS Box 66 Centerville Mass 02632 Strevt Tovn yr C1ty State EIP COMPANY TELEPHONE ( 508 ) 775-3338 FAX ( 508 ) 790-1-578 n CERTIFICATION. STATEMENT I certify that I have personally inspected the sewage disposal system n this address and that the information ripported is true., accurate , and complete as of the time of �inspection. The inspection was performed and any 'recolnrnendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance or or- site sewage disposal systems . Check one ; xxx System PASSED The inspection which I have conducted has not found any information which indicates that th.e system fails to adequately protect public health or the environment as defined in 31.0 CM.R 16 . 303 , Any . failure criteria not evalunt.ed are as stated in the FAILURE CRITERIA section of this form , System FAILED* The inspection which I have condtloted has found that the system fails t protect the j)ub.lic health and the environment in accordance with Title 5 , 310 CMR 15 , 3Q3 , and as specifically noted on PART C - FAILURE CRITERIA of this ins ectior for ' Inspector Signature . Date ; ne copy of this cpvrification must be provided to the OWNER, the BUYER "( where applleable') and the I30ARD Q8 HEALT11, * If the inspection FAILED , 1,h'e' owner or ope'rotor, ehal'1 upgrcado ' the 4ystem' wiehin one year of the dote of the inspection , unless allowed or required otherwise as provided in 3.10 CHR 15_, 3.05 , partd , do No. Fee $ 5 O:O O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppfication for Migogal *pgtem Conmratton Permit Application for a Permit to Construct( )Repair�X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.1 8 L i e t r i m Circle Owner's Name,Address and Tel.No. 4 2 8—4 01 1 Centerville,Mass. 02632 Walter F. Woolf Assessor'sMap/Parcel // O ,(' Z 18 Lietrim Circle Installer's Name,Address,and Tel.No. S O 8—7 7 5—3 3 3 8 es�gner s ame, rest an a.110. 02632 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass. 02632 Box 66 Centerville,Mass. 02632 Type of Building: Dwelling X No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building RES No. of Persons 3 Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 3 x 1 1 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1 000 gallons Type of S.A.S. 2-500 gallon chambers. Description of Soil Loamy sand to boney medium sand. Nature of Repairs or Alterations(Answer when applicable) Adding two 500 gallon chambers to the existing tank & pit. Adding Distribution box also. ' Date last inspected:_8/19/9 8 f , t` Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss d by this oar f e th. Signe4 Date 8/1 9/9 8 Application Approved b Date Application Disapprove for the following reasons Permit No. Date Issued �r No. Fee $ 5 0 5 Q 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Application for �BigoaY *p5tem Construction Permit Application for a.Pemiit to Construct( )RepairNX)Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or,Lot No.1 8 Lietrim Circle Owner's Name,Address and Tel.No. 4 2 8—4 01 1 Centervil'le,Mass. 0,.2632 Walter F. Woolf Assessor's Map/Pazce1 © /�� 18 Lietrim Circle Installer's Name,Address,and Tel.No. 5 0 8—7 7&-3 3 3 8 eslpe—,s ame, rests an e.Igo. J.P.Macomber & Son Inc. J.P.Macomber & Sorr Inc. Box 66 Centerville,Mass. 02632 Box 66 Centerville,Mass. 02632 Type of Building: Dwelling X No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building RES No. of Persons Showers( ) Cafeteria( )\ Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 3x1 1 0 gallons. Plan Date Number of sheets Revision Date w Title Size of Septic Tank 1000 gallons Type of S.A.S. 2-500 gallon chambers. Description of Soil Loamy sand to bonev medium sand. Nature of Repairs or Alterations(Answer when applicable) Adding two 500 gallon chambers to fhe'existinq tank & ,pit Adding Distribution box alsg34 Date last inspected: 8 119/9 8 f } Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system ` in accordance with the,,provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issuold by this goar f Health. Signed Date 8'/19/98 Application Approved by Date Application=Disapprove or the following reasons Permit No. j Date Issued ---------- ---- —:------ - --------- THE COMMONWEALTH ORMASSACHUSETTS- ` BARNSTABLE MASSACHUSETTS � e Certificate of�k j�ompliance THISOn-site IS TO CERTIFY,that the On site Sewage Disposal System Constructed( )Repaired (XX)Upgraded Abandoned( )by at ville Mass. a constructed in accorda ce with the provisions of Title 5 and the for Disposal System Construction Permit No co r`r Installer J.P.Macomber & Son Inc. .r:_'-Designer J.P_Macom er & Son The issuance of this permit shall not be construed as ajguaazantee that the system will function as designed. Date_ Q ") 1 G/ V � � Inspector t,. -j-a , <. Si n Fee ', THE COMMONWEALTH.OF MASSACHUSETTS PUBLIC.HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS MO gaY *pgtem Construction Permit Permission is hereby granted to Construct( )Repair(X)o Upgrade( )Abandon( Systemlocatedat 18 Lietrim Circle Centerville,Massl. and.as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her d ty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction st be om leted within three years of the date of thi rmit / Date: Approved by +ti 10/9/97 NOTICE: This Form ,Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) 1, Joseph P.Macomber Jam, hereby certify that the application for disposal works construction permit signed by me dated 8/1 9/98 , concerning the property located at 18 Lietrim circle centervi 1 1 P meets all of the following criteria: • There are no wetlands located within 100 feet of the proposed leaching facility There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • If the proposed leaching facility will be located within 250 feet of any wetlands, the bottom of the proposed leaching facility will=be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) B)Observed Groundwater Table Elevation(according to Health Division well map) 25 ' 7 SIGNED : ' DATE: 8/19/98 LICE D SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a cer-tified plot plan, this plan should be submitted). q:health folder:cent ' e s Two new 500 gallon chambers packed in 4 ' of 12'-" stone. Existing 1000 0 gallon leaching pit. New Distribution box ('3 Existing 1000 gallon septic tank. TOWN OF BARNSTABLE c� LOCATION Z F f eTg lffll C �• SEWAGE # VILLAGE C eA17'e e ✓I&!! ASSESSOR'S MAP & LOT l4::��? INSTALLER'S NAINIM&PHONE NO.H� �j4 C d.,*2 SEPTIC TANK CAPACITY • d y(3-- /�/ / � =_P LEACHING FACILITY: (type) 9-7,X'40 W C#/I �2W . NO.OF BEDROOMS BUMDE!a C►R OWNER PEP.N+ITDAM.�� .�_.. ' :tiI:'L'A"?CE Dr=a :;. ����' 21� Separation Distance Between the: Maximum Adjuster Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Z e o � o ze TOWN OF BARNSTABLE LOCATION /e� �C /r�� SEWAGE # / 6 VILLAGE C e.417 eX ✓///aP ASSESSOR'S MAP & LOT , a INSTALLER'S NAMME&P BONE NO.__.���i�1 C!1/rl IS e/r-sQ/� SEPTIC TANK CAPACITY ,� d©®-------------LZ___� LEACHING FACELI TY: (type) W C 64 NE).OF BEDROOMS BLI.DE�R.OR OWNER v_ _ PEP.MUDATr.:. _L _ f,�r 'LT-NCFi Separation Distance Between the: Maximum Adjusted Grour0water Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching'Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by - rT�., . � t i � / if b��i Y � , _ � � \ ���' ' cry ..� �1 �.s., '� ©� r � N e4l