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HomeMy WebLinkAbout0103 LONG POND CIRCLE - Health 103 LONG POND CIRCLE, CENTERVILLE A= r 1. I 1 t �y Nb. 42101/3 ORA ESSELTE 10% O © O O r ij LOCATION e�0 SEWAGE PERMIT NO. 1 VILLAGE INSTALLER'S NAME&ADDRESS BUILDER OR OWNER 1 DATE PERMIT ISSUED j. DATE CO PIA E ISSUED -rv- toy-77 -'09 3 pro"? rack 00466 No. ( � Z� THE COMMONWEALTH OF MASSACHUSETTS r FEE y 4 BOAR OF E LTH OF APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( V�Upgrade (Abandon ( ) ❑Complete System ❑Individual Components oLocat on Owner's Name Map/Parcel# Address na— /Glns aller's Name Designers Name cy Address address C, _ S"S o Telephone# Telephone# Type of Building: Lot Size Sq.feet Dwelling—No.of Bedrooms �l Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min. required) gpd Calculated design flow gpd Design flow provided LA gpd Plan: ,ate �l C4 Number of sheets Rev'sion Date Title M— .I r -� CLt.J-_ Description of Soils) �i MSU 1,— V' Soil Evaluator Form No. Name of Soil Evaluato Date of Evaluation - DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not lace the system in operation until a Certificate of Compliance has been issued by the.Board of Health. Signed / Date/d --2d-7a �C. r �. S' FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. FEE THE COMMONWE �OF MASSACHUSETTS FEE k 4 ?BOAR " OF HEALTH ' t. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( Upgrade( v4/Abandon ( ) - ❑Complete System ❑Individual Components Locar m Owner's Name Map/Parcel# - Address # '- lephone S �J dg wiC Ins Iler's Name - ,� Designer's amc Telephone# Telephone# Type of;Building: Lot Size Sq.feet 'Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons L22 Showers ( ), Cafeteria ( ) Other,fixtures Design Flow(min:required)��gpd Calculated design.4low �O gpd Design flow provided to( � gpd Plan ' ate . �Ct Number of sheets l� Revision Date Title 1 � 0 1 'a- ,. Description of S.pil(s) : - " C4t �Soil-.Evaluator Form No. N,anie o Soil Evaluator. Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONtS r� The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not t lace the system,in operation until a Certificate of Compliance has been issued by the Board of Health! Signed �./rr�e.�-C.-�"."...'- (� Date/d %2;)�r7 9r Insuectt_,;,.on_s� ` .'C. �l• — / t; FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. / / THE COMMONWEALTH OF MASSACHUSETTS FEE v,�Sf>;t► �O(.� BOARD OF HEALTH CERTIFICATE OF COMPLIANCE + Description of Work:, E] Individual Component(s) omplete System The undersign hereby certify that he Sewage Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned,( ) by: ru at /6 3 C7 k � has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No dated Approved Design Flow (g d) Installer v Designer: Inspectors ( at17 <..... The issuance of this certificate shall not be construed as a guarantee that thg syste,`vill function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No.7 THE COMMONWEALTH OF MASSACHUSETTS FEE �rNs �I>Q BOARD OF HEALTH R DISPOSAL SYSTEM CONSTRUCTION PERMIT` Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( Aba don ( ) an individual sewage disposal system at 1 e I l ot" r A! C t -c let-; gar. c' ,r^ as described in the application for Disposal System Construction Permit No. / t 2 dq::' dated r. Provided: Constr cti n shall b co leted within three years of the date of this r 't.All local condition must . t. p :r .^ U Date•.• Board of Health / v FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) (SW) HOBBS&WARREN TM PUBLISHERS- BOSTON S LOCATION SEWAGE PERMIT NO. VILLAGE INSTALLER'S NAME&ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED DATE CO P IA E ISSUED ioj- d ` 04 A946G I f COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTFFAIRS F ` w DEPARTMENT OF ENVIRONMENTAL PROTECTION � I d SOUTHEAST REGIONAL OFFICE ARGEO PAUL CELLUCCI r.,;:: .' .` BOB DURAND Governor _ Secretary JANE SWIFT . EDWARD P.KUNCE Lieutenant Governor Acting Commissioner May 13, 1999 Frederick Kiley RE: BARNSTABLE—Sewage Disposal System Environmental Reclamation, Inc. Inspection P.O. Box 3596 Waquoit,Massachusetts 02536 Dear Mr.Kiley: This letter is intended as a follow-up to the April 21, 1999 meeting between you and Department staff.At that meeting you agreed that with all future subsurface sewage disposal system inspections you will submit results of inspections to the approving authority within(30)days as required under section 15:301 (10)of.Title 5 Q 10 CMR 15.000). At that same meeting you agreed that with all subsequent inspections you will measure setbacks from existing components as required under section 15.302 of Title 5.It was also agreed that you will not.perform repairs or upgrades to any subsurface disposal system without obtaining a Disposal System Construction Permit from the approving authority. Also,should you desire to continue to perform septic inspections,you must register for the next System Inspector Course as a refresher, and submit a copy of your inspections to this Department for the next(2)years.If you do not wish to continue performing inspections,you must provide proof to this Department that you have contacted the.Department's Training Center in Millbury,MA,.requesting,that your name be deleted from the inspectors list. The telephone number for the Millbury Training Center is(508)756 7281. Should you have further question or require additional information,please contact John Viveiros at(508) 946 2859. Sincerely, 1. Elizabeth A.Kouloheras,Chief Cape Cod Watershed K/JV/cb CERTIFIED MAIL NO.Z 539 134 094 RETURN RECEIPT REQUESTED cc: Barnstable Board of Health P.O. Box 434 Hyannis, MA 02601 20 Riverside Drive•Lakeville,Massachusetts 02347• FAX(508)947-6557•Telephone(508)946-2700 This information is available in alternate format by calling our ADA Coordinator at(617)574-6872. DEP on the World Wide Web: http:Ihnww.magnet.state.me.usfdep ��«�Printed on Recycled Paper LIP- 1/ ?l y - - GC.. 7,f±-, 9 / �9} - r/L.i G--II- a-4- ---- — y�_ p �'pv2, S�� r'a�.._ Vln_o�G� �o���ri,- __-S f.►1a.L/ ���a. R'j,�.�,. � tiJ'E�—ire®-- - - re Ai -- -. --. •- 6) - -`=�r �st�„J_g"z-e�- - - -� .�-� r- . c�,�r�,Lam,�'�-,,. _d�? _ Cswe.�- J"1 ��d' � „6,Y��� �' cv - 25 - �� - J• f STEVEN FREEDMAN, M.D. 103 LONG POND CIRCLE POST OFFICE BOX 1115 CENTERVILLE MA 02632-1115 TELEPHONE: (508) 775-1095 e-mail: steven&eedmamm mediaone.net 16 Apr 99 Mr. Thomas McKean,Director Department of Public Health, Safety and Environmental Services Public Health Division 367 Main Street P.O. Box 504 Hyannis MA 02601 Dear Tom: I have tried to reach you without success this week simply to discuss the unsystematic sampling of how other townships handle the burden of Title 5 reports. My preference would be to chat with you and transmit my thoughts for your consideration,in,person or.by,telephone, rather than memorializing the informal data, most of which you probably know already. I have enjoyed speaking with people in Harwich, Brewster, Falmouth, Mashpee, and in-the County office in Barnstable. All of them have been generous of their time, for which I have thanked them. . I realize you are very busy. Perhaps you might want to give me a ring when the time is right for you to speak by phone or by appointment. If I don't hear from you in a month or two, I'll try again. Thanks very much for letting me try to help the Township and the Department. I hope that you will get a chance to hear the few observations and impressions I have gathered.for that a . Appreciativ :Steven Fre dman,,M J Steven , ,, c COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION SOUTHEAST REGIONAL OFFICE ARGEO PAUL CELLUCCI BOB DURAND Governor Secretary JANE SWIFTpy EDWARD P.KUNCE . Lieutenant Governor 0,' Acting Commissioner CORRECTED LETTER April 7, 1999 Frederick Kiely RE: BARNSTABLE—Request for . Environmental Reclamation Inc., . System Inspection Meeting P.O. Box 3596 Waquoit, Massachusetts 02536 Dear Mr. Kiely: _ .The- Department of Environmental' Protection. has received a complaint - concerning a Title 5 .Inspection conducted by you for property located at 103 . Long Pond Circle, Centerville. Massachusetts. A,preliminary. review by the Department resulted in a decision to investigate this complaint further:. You are requested to meet with Department staff on Wednesday, April 21, 1999 at 1:30 P.m.. at the Department's Southeast Regional .Office, 20; Riverside Drive, Lakeville, Massachusetts, to discuss. this matter. Please. bring all documents you ha'v'e that support your inspection of this property. Should yoii ---need. to reschedule this meeting, or if you have any questions, please contact John Viveiros at (508) 946-2859. Sincerely, Elizabeth A. Zoheras, Chief • Cape Cod Watershed K/JV/cb a CERTIFIED MAIL #Z 539 134 089 RETURN RECEIPT REQUESTED cc: DEP—SERO ATTN: Jeffrey Gould Barnstable Board of Health P.O. Box 534 ,.0 Hyannis, "~MA:`02601 . _ _, _ .._�. v., ; 'fir ,. .>'s: .. r.. <j 20 Riverside Drive-Lakeville,Massachusetts 02347­'FAX(508)947-6557•Telephone(508)946-2700 This information is available in alternate format by calling our ADA Coordinator at(617)574-6872. DEP on the World WideWeb: http://www.magnetstate.ma.us/dep ��Printed on Recycled Paper STEVEN FREEDMAN, M.D. 103 LONG POND CIRCLE POST OFFICE BOX 1115 CENTERVILLE MA 02632-1115 TELEPHONE: (508) 775-1095 e-mail: stevenfreedmanmdamediaone.net 23 March 99 Mr. John Viveiros, Environmental Engineer Department of Environmental Protection Southeast Region 20 Lakeside Drive Lakeville MA 02347 ' Re: Inspection: Dated 26 Dec 97 Inspector: Frederick Kiely/ Company: Environmental Reclamation Inc. [ERI] .z P.O. Box3596 Waquoit Ma 02536 [508]-457-5020 Property: Estate of Edwin S. Mycock 103 Long Pond Circle Centerville Ma 02632 Passed: 15 Jan 98 Signed: 15 Jan 98 BY CERTIFIED U.S. POST Dear Mr. Viveiros: Enclosed please find ten of the other eleven Title 5 inspections conducted by Mr. Kiely/ERI from the time of certification in December 95 to the present. My impression as a self-educated reader of Title 5 inspections is that this.group of reports gives the impression of cursory work when compared to that-of other inspectors. The reports seem less detailed in scope than that of the majority of inspectors. Many inspections seem to have been filed late. Lines have not been completed where instructions clearly state that they should be. Measurements from fixed points often are lacking, as well as critical dimensions of components of some systems. Groundwater observations appear very approximate. In one report of a commercial property on Falmouth Road near the Mashpee River, it would be difficult from the data to know whether effluent was being deposited into the river. I also have noticed that the report on my property is presumably the last report [dated 15 Jan 98 but never submitted] that Mr. Kiely/ERI performed within the boundaries of the Town of Barnstable. In addition, all but two properties were in Cotuit itself. I wonder, therefore,whether Mr. Kiely/ERI has conducted subsequent inspections and upon whose recommendation. I think the members of the hearing might be curious to see the entire record of Title 5 work, looking both at the source of referral and location of sites for patterns of statistical nesting, not to mention accuracy of inspection and fulfillment of reporting requirements per 310 CMR 15.000. Perhaps Mr. Kiely is doing work on larger ERI projects in a capacity more difficult to track than Title 5 home inspections. Undoubtedly the article in the Boston Globe boston.com on 21 Mar 99 by Davis Bushnell has caught your attention. I suspect that the Department will soon find itself having to deal more seriously with inspectors perceived as incompetent, perfunctory, negligent or fraudulent as the general public comes to realize the gravity of the economic burden when a certified inspector does not do a proper job. Mr. Kiely/ERI deserves notoriety for my case. Likewise the Department's reputation of fairness to the citizen is squarely on the line in this instance. I am enclosing copies of the ten reports and the newspaper clipping for your perusal. I want to wake up members of the hearing committee by providing data. I want them to realize just how off-the-mark Mr. Kiely/ERI really were when inspecting my property, even when measured against a self-generated standard of somewhat casual approach, in my opinion, to the obligations of Title V requirements. Had I your vote,I would recommend revocation and fine. Respectfully, Steven Freedman, M.D. cc: Office of the Attorney General Department of Health, Town of Barnstable ✓ STEVEN FREEDMAN, M.D. 103 LONG POND CIRCLE POST OFFICE BOX 1115 CENTERVILLE MA 02632-1115 TELEPHONE: (508) 775-1095 e-mail: stevenfreedmanmd i ,mediaone.net 19 March 99 Mr. John Viveiros, Environmental Engineer Department of Environmental Protection Southeast Region 20 Lakeside Drive Lakeville MA 02347 Re: Inspection: Dated 26 Dec 97 Inspector: Frederick Kiely/ Company: Environmental Reclamation Inc. [ERI] P.O. Box 3596 Waquoit Ma 02536 [508]-457-5020 Property: Estate of Edwin S. Mycock 103 Long Pond Circle Centerville Ma 02632 Passed: 15 Jan 98 Signed: 15 Jan 98 BY CERTIFIED U.S. POST Dear Mr. Viveiros: I appreciate your speaking with me 17 Mar 99 about the various activities of Mr. Kiely and Environmental Reclamation Inc. [including undocumented "speed levelers" deliberately and illegally installed to mask system failure]. However,I was very surprised and disappointed to be told that I would not be permitted to attend the hearing on the presentation of the actual facts of Mr. Kiely's and ERI's multiple violations of Title 5 during the inspection that directly defrauded me out of $400,000.00 and counting. My residence today on a Great Pond in Centerville cannot be sold as it stands. -Page 2- I cannot understand why you must exclude me when my input, documents and evidence of losses are fundamental to your decision about the state's response to Mr. Kiely as a Systems Inspector. In the interim I have contacted the office of the Attorney General, and at their specific request I am submitting to that office a continuing report of this matter. They have indicated a particular interest and sensitivity to my plight and to the larger issues involving Mr. Kiely and any such inspection company supervised by the Commonwealth. I have been amazed myself by the level of attention given this matter by neighbors, realtors, the local press and the Department of Public Health. In an area like Barnstable,where so much property of value is located at or near waterways, the integrity of the inspection system is absolutely paramount. I hope that I will be notified by you that my actual testimony can be provided at the hearing. Regardless, I will be seeking a detailed report of the proceedings. Respectfully, Steven Freedman, M.D. cc: Office of the Attorney General / Department of Public Health, Town of Barnstable IME Town of Barnstable BARNSr�er.,�. Department of Health, Safety, and Environmental Services MASS. 059. 1�a Public Health Division '°rEora P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health March 8; 1999 Mr. John Viveiros Department of Environmental Protection 20 Riverside Drive Lakeville, MA 02347 Dear Mr. Viveiros, The property located at 103 Long Pond Drive, Centerville was inspected by Glen Harrington, R.S., Health Inspector due to an inquiry on February 24, 1999. Mr. Frederick Kiely performed a subsurface sewage Disposal System inspection on December 26, 1997 which was utilized for property transfer. The following deficiencies were noted regarding the inspection report completed by Frederick Kiely: • 310 CMR 15.019: Disposal System Installers Permit. The inspector performed repairs without obtaining an Installers Permit from approving authority (Town of Barnstable). • 15.301(10): Inspection Report not received by the Town of Barnstable Board of Health within 30 days. Report not received at all but the inspection report was apparently utilized for transfer of property. • 15.302: No setbacks measured from wetlands or pond to soil absorption system. • No location of water line shown on site plan portion of report. • No dimensions to components from two permanent landmarks. • Wrong number of bedrooms indicated on the inspection report. Four bedrooms are actually present. • Report indicated that there was not a garbage grinder when one does exist. • No description of septic tank provided. Solids and liquid level were taken. However, no detailed description of physical conditions of septic tank or tees provided. K.S.q/freedm • No description of distribution box provided. Inspector explained that he installed speed levelers due to uneven distribution box, but did not provide description in report. • No water use records provided for last two years. The complaint was based upon the discovery of high groundwater during a utility line installation. The new owner, Dr. Steven Freedman, then requested a full inspection to be performed. Douglas William of American Home&Environmental, Inc. recently performed the second inspection. The second report is enclosed for your review. Mr. Williams determined that the existing septic system is in groundwater. However, Mr. Kiely claimed that distance to groundwater was 6.6 feet when he inspected the system. The discrepancy in distance to groundwater warranted additional investigation. On February 24 and March 3, 1999, Glen Harrington, R.S., Health Inspector, observed the site conditions and results of Mr. Williams inspection. Elevations taken by Doug Williams and the Health Inspector determined that the SAS was within the groundwater table. Dr. Freedman took pictures during the inspections. Enclosed for your review are the two inspection reports discussed in this letter. I request that you hold a hearing in regards to deficiencies reported in Frederick Keily's inspection report and take appropriate action. Sincerely yours, C; Thomas McKean Director of Public Health cc: Frederick Kiely Environmental Reclamation, Inc. Dr. Steven Freedman Doug Williams K.S.q/freedm Queryl 3/8/99 '�e.S 66a e,a�, w�dt7L.Ik.ac I'C Inspector number Address Village Pass/Fail Frederick Kiely 59 — Lewis Pond Road Cotuit P V,6u Frederick Kiely-,' 42 Nelson Lane Marstons Mi F/R WgIA- Frederick Kiel/ 58 Tracey Road Cotuit P t_klV 19'1L /PLtmf p kr /Ais7tcrlalJ 1hvv.*rGG� Frederick Kielyof e T728 Falmouth Road/Route 28 Cotuit 0, P O-J k - Po,I- v►o ytqs, Frederick Kiely 778 Putnam Avenue Aff 45li Cotuit P � �144--C l('�A• Frederick Kiely 35 Piney Road Cotuit P a1wit-0 A A&yil ederick Kiely 4464 Falmouth Road/Route 28 Cotuit P 0• �`ff'' S 'r;4 �;r w Frederick Kiely Sandalwood Drive Cotuit P ?6 IlRla�b-�I[J.1 ^Frederick Kiely Highland Avenue ' Cotuit "CPO P CPO aw cam-w-.z� (' �D 'l��--� D•Oor gIgW rederick Ki ) 11y� ely . 179 Mooring Drive Cotuit P 7 -g +�^p �""4-L,;,eA AD tier �. � Gt d.1- 4 ?mod /111 ;�/ CL Vim- N S A- C7� c ���-ass • s zw• 6va, T),, Page 1 07 March 99 103 Long Pond Circle P.O. Box 1115 Centerville MA 02632-1115 Tel 508-775-1095 Mr. John Viveiros, Environmental Engineer Department of Environmental Protection Southeast Region 20 Lakeside Drive Lakeville MA 02347 Re: Inspection: Dated 26 Dec 97 Inspector: Frederick Kiely/ Company: Environmental Reclamation Inc. [ERI] P.O. Box 3596 Waquoit Ma 02536 [508]-457-5020 Property: Estate of Edwin S. Mycock 103 Long Pond Circle Centerville Ma 02632 Passed: 15 Jan 98 Signed: 15 Jan 98 Dear Mr. Viveiros: I am writing as buyer of the above-cited property on 29 May 98. 1 believe that I have been severely damaged by the report in question secondary to multiple violations of Title V (310 CMR 15.000),some of which violations seeming "unlawful" since they constitute "unfair or deceptive acts or practices in the conduct of any trade or commerce" (MGL 93A, Section 2[a]). I also believe that Environmental Reclamation Inc. and Mr. Frederick Kiely used methods, acts or practices that they knew, or should have known, to be unlawful, and that the attorney general may therefore consider bringing proceedings in the public interest against both Mr. Kiely and Environmental Reclamation Inc. (93A[4]). I recognize that Section 3 of Chapter 93A states that "nothing...shall apply to transactions or actions otherwise permitted under laws as administered by any regulatory board or officer acting under statutory authority of the commonwealth or of the United States." Please be kind enough to notify me of any hearings that the Department of Environmental Protection holds pursuant to this matter that I am permitted to attend. My training is that of a medical doctor now retired. I have no expertise in the law or in matters within the domain of your department. I would like to narrate what has happened as best I understand, however. Sellers gave me a packet of inspection material that included a house inspection done for a different prospective buyer dated 08 Oct 97 and a lead inspection dated 09 Oct 97. The same packet contained the purported "passed" Title V performed as indicated above by Kiely/ERI. No one ever indicated that this report was simply an owner-authorized Title V inspection, since that would have obligated the seller to perform a second Title V inspection and filing with the Board of Health. This February 1999 I engaged Douglas Williams, Sr. to do general contracting at my home at 103 Long Pond Circle. Since 200-amp electrical service had to be brought into the house through a trench dug five feet below ground, Mr. Williams asked to see a copy of the Title V. When I produced my copy of the Kiely/ERI Title V, Mr. Williams advised me that he felt that the Kiely/ERI Title V could not possibly be accurate or passing. We discussed the matter logically, requesting advice of your office. I then authorized Mr. Williams, a DEP-approved inspector himself, to perform another Title V, knowing that submission to the authorities was not mandatory. The results were so shocking to me that I decided to register the FAILED report in the public interest as well as in my own. I felt that the system could be placing at risk the ground water and the pond in which children and families swim, boat and play. The Barnstable Health Officials have twice come on site with my blessing,verifying the findings, and I have provided a full set of pictures to them along with the registration of the failed report. The Kiely/ERI report has never been filed. The Board of Health in Barnstable has decided to let your jurisdictional issues precede theirs, after which they will deal as they see fit with Kiely/ERI. Let me list the deficiencies, not necessarily in order of importance, and definitely not exclusive of what professionals will duly note to you. I simply want to go on record as a layman about my understanding. I have witnessed the excavation, taken documentary photographs, and have asked questions of Mr. Williams and members of the Barnstable team in order to grasp the engineering, sanitary and technical matters as best I could. 1. This house was bought with a garbage disposal that I have not used after learning that its operation is contraindicated in my township. The original report does not note such a garbage grinder in the first-floor kitchen. 2. The house has four bedrooms, not three as noted in the original inspection. 3. The Soil Absorption System is below the high groundwater elevation. 4. Pumping information was easily obtained by phone per Mr. Williams and is duly noted,whereas no such information is provided by Kiely/ERI. 5. Kiely/ERI reports that the septic tank has a depth below grade of 20" [vs. 2' in the Williams report]; that the size is 1000 gallons [vs. 6' x10' x5']; Sludge depth 6" [vs. "none"]; distance from top of sludge to bottom of outlet tee or baffle 24" [vs. N/A]; both reports claim measurements were taken. The Williams report states: "No layers indicate pumping yet no records?" 6. Distribution box depth of liquid level above outlet level "0" vs. "V' Kiely/ERI report says "no evidence of solids carryover" vs. "Not level... Flow levelers installed by prior inspector 12-26-97." {Mr. Kiely has informed several people that he installed flow levelers during his inspection. The rules require no repair to be done during inspection and that a permit be obtained later to repair the system. Mr. Kiely is not authorized to do such repair in the first place in Barnstable, per local officials, even with the necessary permit.} 7. Kiely/ERI report indicates leaching fields, dimensions "1 approx. 20 x 40" and "no signs of hydraulic failure" vs. "leaching trenches 3, in stone, in water, unknown length" and "one " overflow cesspool. 8. Kiely/ERI.makes no.further comment about the Soil Absorption System vs. Williams "leach fields in water—at pond water level." 9, Kiely/ERI notes one cesspool one kitchen gray water," indication of groundwater"none," and "empty at time of inspection" vs. Williams "one cylinder; depth-top of liquid to inlet invert 35"; depth of solids layer"none"; depth of scum layer"N/A"; dimensions of cesspool"6 x 8"; material of construction "cement"; indication of groundwater"no"; "Not pumped — takes grey water from kitchen only and not connected to other system-"; further comment "Elevation indicates in may sit it water-" 10. Kiely/ERI states depth to ground water 6.6 feet, observation of site checked as method used, and that"a small diameter observation well was installed at the edge of the drain field." The drawing puts the drain field where it cannot possibly be [see pictures] and fails to show the five outlet pipes from the D- box that Kiely stated were repaired illegally with levelers at the time of inspection [see pictures of same]. (Efforts were made to take pictures of the field from angles that would show the shallow slope, the old tree growth, the sharp embankment to the road, and the level of ground water observed by Williams.) Williams's report sketches with measurements the cesspool, the septic tank, the D-box with one pipe entering and with five pipes exiting, together with sites of test holes A and B, both of which had water and were photographed. Domestic water was noted 4' from the cesspool. Williams indicates the site exam was by slope, surface water, check cellar. Williams says that the estimated depth to groundwater is minus 0.5 feet and that the methods used were observed site (observation hole), determined from local conditions, checked with local Board of health, checked Fema Maps, and Checked pumping records." Williams further adds that "excavated test hole at leach field and outside of area water at pond is same level by transit. 11. Kiely/ERI report was never submitted to the Board of Health and would be presumed therefore not to have ever been a valid "pass" by virtue of non- filing itself. I am dismayed at the above recitation of discrepancies with facts on the ground and in the house, omissions of materially important nature, confessed out-of-code tampering acknowledged only long afterward to several individuals, reporting code violation, certification violation, permit code violation, lack of requisite filing, and poorly drawn fanciful sketches of the system on the part of Kiely/ERI. I hope that administrative punishment in the aggregate will be the maximum that can be applied by the Department of Environmental Protection and by the Barnstable Board of Health. I will be seeking superior court review of the damages that I have incurred and the anguish Kiely/ERI have caused to me. I do not know whether, when brought to code, the environment will still please me at all because of the irreparable damage to the site regardless of the significant sums for engineering, construction, and landscaping necessary to try to make the system good. I feel that I endured tremendous and malicious misfortune and wonder where else this type of business practice has been perpetrated but not found out yet. Thank you for your help in these matters. Enclosed are copies of photos, all of the originals of which I have given to the Barnstable Board of Health to supplement their case. Mr. Williams may also have his own photographs, and a letter from Barnstable will be forthcoming to you as well as one from Mr. Williams. As stated previously, I felt so outraged that I had to detail a record for elf. Sincer yours, Steve Fr man, M.D. Cc: t,4arnstable Board of Health Douglas Williams, Sr., American Home and Environmental Inc., P.O. Box 1069, Centerville MA 02632, Tel: 5087775-1500 Encl: nineteen computer-printed pictures from photo glossy prints in my possession,with annotation in my handwriting L Town of Barnstable Department of Health, Safety,and Environmental Services Health Division 367 Main Street, Hyannis MA 02601 Office: S08.790-6263 Thames A McKean FAX: 308-775-3344.. Director of Public Heft tM! MRNB 1'AB�,P� sun NIA . [ENGINEER LETTER] TO: Qx Q 14 M t4 Cow (Date) )"11-3rdA 99 co ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system located at 103 ' iF "was inspected on al.089 by D_Q!! la5 a Massachuse is Icensed septic inspector. .S The inspection of Vow septic system showed that fails under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: jacwm moo,l a o�iol 5�► M ups s ,r) u are directed to hire a licensed professional engineer (PE) to design a system that will bring the septic system in compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within twenty-one (21) days of your receipt of this letter. You are also directed to hire a licensed septic system installer to install the system components within forty- five (45) days of your receipt of this order. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to ryany court of competent jurisdiction as provided for by the laws of the Commonwe ER ORDER OF THE BOARD OF HEAL Q A\ Thomas A. McKean, R.S., C.H. �� e�d��n tiP Agent ofth ealth '1~tad"^ S r3opt ° ► -101 of Barnstable _ > .s e� P ��.,,,� A 5-W., • ur� s nor � � ..� �� �.,,� - i—� COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET,BOSTON MA 02108 (617)292-5500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: Name of Owner 5*vG--Aj Address of Owner:/D3 konj Onr� GrGrG _ ( � �Djt cC M,¢SS Date of Inspection: 2-19-99 // Name of Inspector:(Please Print) J� 1 am a DEP approved syS�j���� inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: &LgrLiC�J Ploue+ ft7w2evr11E+✓r11� =TlC. Marling Address:`V;;n c I oG q tlu-k 'A of L-`z- /n 4 . 6z.c.32- Teleptxxm Number: 508- '1,1 S-1 Soy 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 inspection. The inspection was performed based on my training and experience in the proper function and. maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority 49. Fails Inspector's Signature: 1 Date: Z-2:5- IMl The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty(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 Department of'Environmentai Protection. The original should be sent toots system owner•and copies sent to:the buyer, if applicable, and the approving authority. . NOTES AND COMMENTS l� Is f� ` 40(cr— copA or- �,r f=o�t lh r9'f1�1rJ`�vr`e_ a1�`i e �e ,be� `Jro p"r-t Zv i �,.w Z.-�0-19 CA AA-) ol� �y-2S-9 7J Fo2n� ,kJ Eirvr- ?_111 501-15 tkre- SA-me -} IZC F J L LSD Lid 1 z-;Z? parr arm e -Fi�(' (y�p�n-'t TrA,s fF,— w q-s r7A%e_ od 4 rrdr- revised 9/2/98 Pagel of11 `�Printed on Recycled Paper I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A • CERTIFICATION(continued) Property Address: (O-±> MA. Owner: 'S. F(&= b^4w ` Date of Inspection: INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 1-5.303 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. Indicate yes, no, or not determined (Y,N, or ND), Describe basis of determination in all instances. If "not determined", explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached)indicating that the tank was installed within twenty (20)years prior to the date of the inspection;or the septic tank, whether or not metal,is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced, obstruction is removed distribution box is levelled or replaced The system required pumping-more than four times a year due to broken or obstructed pipe(s). The system will-Vass- inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: I o 3 L� � C, J, Ye— Owner: S.'Am&-any A-AJ Date of Inspection: z.-i -9`I 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 the public health, safety and 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 W A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT_ Cesspool or privy is within 50 feet of 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 THt PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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. Method used to determine distance (approximation not valid).- 3) OTHER revised 9/2/98 P2ge3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) C Property Address: to 3 L" 17� C%M le C&�.7VQ_V,- owner: SZVD ANOOPV Date of Inspection- Z lcj S9 D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure,conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into fecilityor system component-due-to an 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 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for -coliform bacteria,volatile organic.compounds, ammonia nitrogen and nitrate nitrogen. - E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 surfaceArinking 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: (03 Owner: Date of Inspect m: Check if the following have been done:You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant,or Board of Health. None of the system components have,been pumpediforatJeast two weeks an&the'rystem hasAmmwmceivingmtwal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. X _ All system components, excluding the Soil Absorption System,have been located on the site. _ The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction,dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on-the site has been determined based on: 1 Existing information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [15.302(3)(b)) _ The facility owner(and=cupants.if different from..owner).,were.provided.with information-Dn.tha.prnpa main*enaaca„f SubSurface Disposal Systems. revised 9/2/98 Page 5of11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM RWORMATION Property Address:Io 3 C,�t(e. (2P—ft7W .0 8L-L-z-/& o"s j;96 le 414 , Owner: S• ��M rq+.). Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: 11 p g.p.d./bedroom. Number of bedrooms(design): Number of bedrooms(actual): Total DESIGN flow yyp Number of current residents: I Garbage grinder(yes or no):�cS Laundry(separate system) (yes or no): If yes,sepacaLeanspection,required _ Laundry system inspected "�or no) Seasonal use(yes or no): Water meter readings,if available(last two year's usage(gpd): Sump Pump(yes or no): AJO Last date of occupancy: RESe-rl— COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: qpd ( Based on 15.203) Basis of design flow 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: OTHER:(Describe) Last date of occupancy: EaENERAL INFORMATION PUMPING RECORDS and source of information: 1g96 6cr-o6D47- &- 'a.4 jcvrnaf2;le Sa�jAGs System pumped as part of inspection: (yes or & _ If yes, volume pumped: a1_Agallons Reason for pumping: U IU ILIVOW Al 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed{if known)-and source oftiwformation: .�© � � S .•-.�._' Sewage odors detected when arriving at the site: (yes or no) AID revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: i o-5 L p,nl P&"8 Grcl e- Owner: IS.FiZGVD41 6-) Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grade:_ Material of construction:_cast iron_40 PVC_other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage,-etc.) SEPTIC TANK:_ (locate on site plan) Depth below grade:_ Material of construction:11concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ Js.age_confirmed by Certificate of Compliance_(Yes/No) Dimensions: (v ao, )(S Sludge depth: NMe Distance from top of sludge to bottom of outlet tee or baffle: N }- - Scum thickness:J— ' Distance from top of scum to top of outlet tee or baffle: Al ,rj- Distance from bottom of scum to bottom of outlet ee or baffle: A11A How dimensions were determined: Comments: (recommendation for pumping, condition of inlet and outlet tees or-baffles, depth of liquid level in relation to outlet invert,structur"tegrity, evidence of leakage,etc.) LPuErs zr-.l.e 47an, ,7uMpa-16 ST- NO RSeo2,IDs GREASE TRAP: (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: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property address: I d3 La�.�t `�e�.� C��t c� u Owner: 5. r�ee c(,, I Date of Inspection: TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or 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 Alarm level: Alarm in working order:Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note-if level and distribution is e u evidence of solids carryover,evidence of leakage into or out of box, etc.) Ndr (tx.l LS-oce� 7�.srA�Ie 'fit u 2C(ar snvnL2&C:02 17- z& -4� PUMP CHAMBER:_ (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.) revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 u L Nn Qdr.�L Ctr-C�� Owner: S,ReQeer m&n Date of Inspection: Z_ t ct 4 ct SOIL ABSORPTION SYSTEM(SAS):_ (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:_ leaching chambers,number:_ .leaching galleries,number: leaching trenches,number, length: 01VIL,0dr-1 I e—f T 4 leaching fields, number, dimensions: overflow cesspool,number: I Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) 1=r G-`:b c r N k1 A lL F4't Qp� f v�iW_ LEr;E� CESSPOOLS:_ (locate on site plan) ' Number and configuration: Depth-top of liquid to inlet invert: 3 S " Depth of solids layer: rUax+Q Depth of scum layer: u Dimensions of cesspool: y tj Materials of construction: CS s, T Indication of groundwater: AID inflow (cesspool must be pum ad as part of inspection) RlUTwt�EJ— (jno1 .. Ic, ttT!i G, h PSg F ,00 7- 4enAPe7aw -,U Q �r SySA�r+ Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of-vegetation, etc.) �(ev �`td►� �NDre T MAY Sr r ,ry PRIVY:_ (locate on site plan) Materjals of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(cmnued) Property Address: 10 G,v�.� �irQ C,��� Owner: 5.'rr&,eSvM A-v Date of kupec&m: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 6 '7a - .27-�� � E _ C 32 — 4 revised 9/2/98 Page 10of11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ` PART C SYSTEM INFORMATION(cwWmued) Property Address: Owner: S• r"- e-tsfl�a'J Date of Inspection: NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water /*"Check Cellar Shallow wells Estimated Depth to Groundwater 7�Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed.Site (Abutting property,observation hole, bpsemeot sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed)W A-71r-n- N � IS SA-wl E L C—J GZRNSA revised 9/2/98 P2ge11of11 Freedman septic letter AMERICAN HOME & ENVIRONMENTAL INC. P.O.Box 1069,Centerville,Mass 02632 Hyannis 508-775-1500 Osterville 508-428-0318 Mass 800-564-0345 Building-Remodeling-home&environmental Inspections fax: 508-428-0347 8 8 ,rF Z r® 6 � ka w Town of Barnstable Board of Health �� r999 Main Street Hyannis Massachusetts 02601 Enclosed is a septic inspection done on 103 Long Pond Drive , Centerville on 2-19-99 Z � Also is a report that was done to transfer the title to the current owner,Dr. Stephen F reedman of this address. They are totally different in findings. The first report locates the system in a different area. Evidence that the system was p umped was obvious due to no scum or sludge in the tank. The first report had the system 6.6 f eet to ground water when the D-box and leach field ar resting in water. The cesspool had never been excavated which was evident due to undisturbed soil in the area. From your informat ion, there was never a filing of this report to you ,yet the property was transfered. I am filing this report, although not required to do so, at the request of the owner. s hould you have any questions please call my office. Reessp—ectfully, / D Douglas L. Williams Sr: cc: DEP Lakeville Page 1 1' COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON, MA 02108 617-292-5500 B 7� z,off. 613 6 4 -11 WILLIAM F.WELD �co T , Y CORE Governor T - Secretary ARGEO PAUL CELLUCCI W ODAVID 8 STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ;S to missioner PART A cD CERTIFICATION LIP Property Address: 103 L.On j qtA► CtccIe..,Ce.Tt4tur Address of Owner: Date of Inspection: z-tq-qq (If different) Name of Inspector: D o u e 1 a s L . W i 11 i a m s Sr I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15,000) Company Name:. AmAr; ran Hame K. Fn yi rnmmPnta1 Inc , Mailing Address: P,T)0 . Roy 1069 . Centerville , Mass 02632 Telephone Number: 5 0 8-7 7 5-1 5 0 0/S O R-4 8-0 31 R 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 inspection. The inspection was performed based on my training and experience in the properjunction and maintenance of on-site sewage disposal systems. The system: _ Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature. Date:Date• Z I4-•lj9 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty:(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving.authority. -ts - dN w A7- 09lneis INSPECTION SUMMARY: IJO FORL "7RA^+SFtlt Check A, B, C, or D�•. �Ofpc3t; �AKD 13 407- A) SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. 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. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not.. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate:of;. Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration;•or;tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank'` as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:/Avww.magnet.state.ma.us/dep SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: ,f Owner: Date of Inspection: �(SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 FURTHER EVALUATION 15 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND.THE- ENVIRONMENT: The system has a,septic tank and soil absorption system (SAS) and the SAS is within 100 feet to'a surface,water;supply or tributary to a surface water supply. _ _ The system has a septic tank and soil absorption system and the SAS is within a Zone I.of a public.water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet.or,,morejrom;a private water supply well, unless a well water analysis 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 isµequal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Io 3 kbfJ6 pdn)D n�ejp,�C,�w(lt/e Owner: Date of Inspection: Z-19-9 c DJ SYSTEM FAILS: You must indicate ei;•.er "Yes" or"No" as to each of the following: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. ,The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an 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 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis'for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: ' The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6:00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: (D 3 de '`� Owner: ZV&uV—j �Z MwtN Date of Inspection: 2_t9.-cf9 Check if the following have been done: You must indicate either "Yes" or"No".as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced.into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they.are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or,industrial waste flow. ' i _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of.sludge, depth.of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. - � ONE W Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)j •� : . (revised 04/25/97) Page 4 of 20 Owner: 97�r1 ' % t�27Tt7rr�,Bs.J Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: I L O g p•d•/bedroom for S.A.S. Number of bedrooms: Number of current residents: Garbage grinder (yes or no):—�—F-5 ; Laundry connected to system (yes or no): Seasonal use (yes or no): NO Water meter readings, if available (last two (2)year usage (gpd): tl f A Sump Pump (yes or no): No •.. C�ssG?ao�.; '•,�0'7-' , CfiuNL�cTS�.:.7� �r�i,E. Last date of occupancy:_ (t° J�s OF TrlL-- Sy57�wn. . COMMERCIAUI NDUSTRIAL• Type of establishment: Design flow: gallons/day 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: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATIONj. PUMPING RECORDS and source of information: =A S f5 ct o� gcorr� + System pumped as part of inspection: (yes or no)� D If yes, volume pumped: gallons 'Reason for pumping: o TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool `. Privy is a Shared system (yes or no) (if yes, attach previous inspection records,'if any) _ I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no)_ :•,<! (revised 04/25/97) Page 5 of 10 SUBSURFACE SEVyAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 103 LOrJ4 p�+7 CtrC(Q. C9 7atP.t ICLC Owner: Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grade:, Material of construction: _cast iron _40 PVC ither (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:_ (locate on site plan) Depth below grade: Zrr� Material of construction: Xconcrete _metal _Fiberglass _Polyethylene —other(explain) . If tank is metal, list age _ Is,age confirmed by Certificate of Compliance _(Yes/No) Dimensions: 6 lO ?C S f Sludge depth: 14Me— Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: i Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to.outlet invert, structural, integrity, evidence,of leakage, etc.) M AQ Aftg -TAsJlL• w45 4tJAXK-. 1 GREASE TRAP: (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: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 a c: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C � 11 SYSTEM INFORMATION (continued). Property Address. I 03 1-01,11 Owner: r> c=—Vn W Date.of Inspection: 2_(q_qg xZ, TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection).: .'z 4 � 1 (locate on site plan) 4 (;; •_ Depth below grade: t° kFas },s Material of construction: concrete,,' metal _Fiberg lass'_PolyetNylene —Other(explain) Dimensions: ' , r# r Capacity: gallons k T Design flow: gallons/day Alarm level: Alarm in working order Yes; _ No Date of previous pumping: ds s rt "" , ' tQ0 !t Comments: (condition of inlet tee, condition of alarm and float switches, etc.) e Epp a 4"i\ F S j Y Fl•'F T���'I.W 'ff°y�G��i} DISTRIBUTION BOX:_ n f#sil li`{a` '9 ,< �r (locate on site plan), - N Depth of liquid level above outlet invert: 02 Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage.into or out of,box, etc.) t'r-„'� ,••«) '�? a V t 6urn •:`:. ` /S NO%' "`LlrtlCt ``''' "`'t' SITS` i!J ' /56LQlTwOa��t�t67ay;2y�trt n PUMP CHAMBER:_ n giX,rl!v� °i�r pvasr (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: t• (note condition of pump chamber, condition of pumps and appurtenances, etc.) _ t -,t •1 aE.at!+'�C�19���ki?�`s^�1�`1�'"sy`a',x�,'�.�'aE �a� Y ..: •:i rh 4 k {r a•lay 0 PyyJ'. a '" M`"" 'u c ey r �y (revised 04/25/97) } t# Page 7.of 10 h tiie r3 qy ,to ^ : X? SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION'FORM 4 i PART C: SYSTEM INFORMATION.(continued), Property Address: (o 3 57�v f-72L�E�/Y� r 7 1 � Owner: -� f3� �: ;,• �i `� F. t Date of Inspection: 2—(q SOIL.ABSORPTION SYSTEM (SAS):_ k<3 (locate on site plan, if possible; excavation not required, but may be approximated by pon-intrusive.methods) If not determined to be present, explain: 7 QV-A)C4& JOT Type; _f:F ,... a7'.—r ." f i (�la ±.� at tic'✓J�}VHyTz" leaching pits, number: ,\,.� + •" ��r,�e t),.; leaching chambers, number:_ leaching galleries, number: r£vs leaching trenches, number,length: UNKNohW J-1 670.• leaching fields„number; dimensions: overflow cesspool, number: ' Alternative system: }x HIM—i Name of Technology: U'{Comments: (note condition of soil, signs of hydraulic failure, level of•ponding, condition of vegetation,'.etc.) �7'5 IN T Wk •1Qt�nrCE{ i� �OlTO/r� E)- i. G.�. ,,.. s-.ems•.�: 'x�'.r.,�;a CESSPOOLS: tom (locate on site plan) V � > Number and configuration: I tlA jD X�, Depth-top of liquid to inlet in 5 t r flag Depth of solids layer: AJ404 ra �A�`;� �� 4 Depth of scum layer: film 0- Dimensions of cesspool: (04 Yrr/ £ clsr ' Materials of construction: mTrR' '$(ee(Cs.- r, wy rrf T v �,i, Indication of groundwater: yeS— inflow (cesspool must be pumped as part of inspection) RzcOYL &Oalar shed : boo Comments: iM )v£a37rr t }a(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc fA7r pA# N 779r►/L t$t%1f� °•"s /C)( Yj(+V i�v r x Bass a- C6* at_ �7ra do yv +\x Y t x,r '&, t ' —��y� a a (locate on site plan) w �.�•� 3 x.pr , Materials of construction: Dimensions +a Depth of solids: y �, � rage? � �. � •. Comments: s � (note condition of soil, signs of hydraulic failure, level of poncling, condition of vegetation,:etc.) K hf�0ki-t.7.'�.. (revised 01/25/97) s .n 3b� �t � Page B of 10 A fi iA� .+ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: (v3 L..OnX:- fPd V.-> � 7 Owner: 57tF:g),�i.v 7=4z_�/h/fiJ Date of Inspection: Z-tS-q � rM. SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks ;. locate all wells.within 100' (Locate where public water supply comes into house) p Q� h, r �• % a t�s � S.11 a. M • 'P�- 47- 3 " , r H� i yti .c t "DOM sr awdrs�2 �.�„e c� F L %Y f t r { 7AA IV 4 + � awi 1a5 +s (revised 04/25/97) ixr yrt �i Page 9 of 10 0 t "`�1}a ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Iva Lomb PQNo Cc2 �, C`apreRv,L,.Fr .: ,7 f • Owner: BTtyJG,i �M/f'n7 , Date of Inspection: Z_ t 9_q °l Depth,to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) . Determine it from local conditions CN4-T1ON , InJ jA> ' 1:71imdc7 Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) �&7-s LONb 96,vt) _ vrsvA-c. oN 1N _;r• £.l. (revised 04/25/97) Page 20 of 10 STEVEN FREEDMAN, M.D. 2+ " BOX 382763 COMMONWEALTH OF ASSACHUSETTS CAMBRIDGE MA 02238 2763 M EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON, MA 02108 617-292-5500 V� WILLIAM F.WELD sr Governor bill ��J TRUDY CORE�� Secretan• ARGEO PAUL CELLUCCI Lt.Goveior DAY1D� TRUHS ?�u. + fa SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM �, Complii3 loner PART A r` " CERTIFICATION Property Address: 103 Long Pond C i r. C e n t e r v i 1 31Adress of Owner: Same Date of Inspection: 12 (2 6/9 7 (If different) Name of Inspector: F r P ri a r i r•k K i a l y yo� 0 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR�15.000) �`9�9 Company Name: Environmental Reclamation Inc . �9 Mailing Address: _P_0 Box 3596 Waauoi_t MA 02536 Telephone Number: ( 5 0 8) 4 5 7—5 0 2 0 CERTIFICATION STATEMENT Z t 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: XXX Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: Date: 01 /1 5 /9 8 The System Inspector shall submit a.cop y of thisV' ctionreport to the Approving Authority within thirty (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.Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION.SUMMARY: Check A, B, C, or D: _ i A] SYSTEM PASSES: .z XXX I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303...Any failure criteria not evaluated are indicated below. COMMENTS: l 3 B] SYSTEM CONDITIONALLY PASSES: {j 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. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. _. The septic tank is metal, Uldess the owner or operator has provided the system inspector•.with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty(20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally t,r.s.%md, shows substantial infiltration or exhltration, or tank failure,is-imminent. The system will pass ii1speCion if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. i, (rwiaed 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:Uwww.magnet.state.ma.uudep ej Printed on Recycled Paper STEVEN FREEDMAN,M.D. BOX 382763 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM CAMBRIDGE MA 02238.2763 PART-A CERTIFICATION (continued) 103 Long Pond Cir. Address:Estate of Edwin S . Mycock f ner: te'of Inspection: 12/2 6/9 7 q. B)SYSTEM CONDITIONALLY PASSES (continued) r Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the'' Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 In CJ 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN'A MANNER ' WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water JJt Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. �)s 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES�THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: f s The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of'a public w p c water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. . The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds'indicates that #'K the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or I less than 5 ppm. Method used to determine distance (approximation not valid), j i 3) OTHER i i r I (revised 04/25/97) Page 2 of 10 , ;r • STEVEN FREEDMAN,M.D. BOX 382763 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM CAMBRIDGE MA 02238.2763 PART A CERTIFICATION (continued) r Address: 103 Long Pond Cir. ?r: Estate of Edwin S . M cock J e of Jnspection: 12/2 6/9 7 L Dj SYSTEM FAILS: You must indicate ei:!•er "Yes" or "No" as to each of the following: N/A I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct r the failure. N Yes No + Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool " s' Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. -. � �„ r 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 1/2 day flow. _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped i Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. fl Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.PP Y rY PP Y• Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. y Y 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for N coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. li y, LARGE SYSTEM FAILS: u must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: A :The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to i public health and safety and the environment because one or more of the following conditions exist: s No the system is within 400 feet of a surface drinking water supply ;I 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) e owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program I I" uirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further.information. j� fir; i6l 1j Its .. wised 04/25/97) Ii Pages 1 of 10 ,I. STEVEN FREEDMAN,M.D. BOX 382763 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM CAMBRI,DGE MA 02238 2763 III j�'Qi��il�l PART B ! J 11y CHECKLIST s r t erty Address: 103 Long Pond C i r . j der: Estate of Edwin S . Mycock-ate of Inspection: 12/26/97 ,,.Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following: Yes No l , iILa Pumping information was provided by the owner, occupant, or Board of Health. r _ None of the system components have been um for at least two weeks and the system has been receiving normal flow rates y duringthat period. Large vo volumes of water have not been introduced into the system recently or r Pe B as part of this inspection. I 17 JL As built plans have been obtained and examined. Note if they are not available with N/A, _ The facility or dwelling was inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. _ .The site was inspected for signs of breakout: _ All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. l The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. I X Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)) I I, I�rl� WE �•ICII{ I i 11I I I I;I i I ITV; i (revised 04/25/97) Page 4 of 10 r I% STEVEN FREEDMAN,M.D. BOX`382763 CAMBRIDGE MA 02238-2763 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION i r}.yAddress: 1Q3 Long Pond Cir. er. Estate of Edwin S . Mycock j te:of Inspection: 12/2 6/9 7 FLOW CONDITIONS RESIDENTIAL: F-besign flow: t;.p.d./bedroom for S.A.S. Number of bedrooms:_ Number of current residents: 1 Garbage grinder (yes or no):no Laundry connected to system (yes or no):__e s Seasonal use (yes or no):Ye s Water meter readings, if available (last two (2) year usage (gpd): ' Sump Pump (yes or no): no Last date of occupancy: 1 1 /9 7 i ui i COMMERCIAL/INDUSTRIAL: : N!A Type of establishment: Design flow:_gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding.Tank present: (yes or no)_ ,AEI Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: f OTHER: (Describe) ' Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: N/A w System pumped as part of inspection: (yes or no)_ " if yes, volume pumped: gallons _ (: Reason for pumping: TYPE OF SYSTEM ti is XX Septic tank/distribution box/soil absorption system X_ Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contracts' Other APPROXIMATE AGE of all components, date installed (if known) and source of information: 30 years Sewage odors detected when arriving at the site: (yes or no)one (rwiaad 04/25/97) Page 5 of 10 STEVEN FREEDMAN,M.D. BOX 382763 CAMBRIDGE MA 02238-2763 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 1 SYSTEM INFORMATION (continued) i ►fy'Address: 103 Long Pond Cir. ) Estate of Edwin S . Mycmck e`of Inspection: 12/2 6/9 7 BUILDING SEWER: !(Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC_other(explain) , Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:_ (locate on site plan) Depth below grade: 20" " Material of construction: X concrete _metal _Fiberglass _Polyethylene —other(explain) ; r If tank is metal, list age_ Is age confirmed by Certificate of Compltance _(Yes/No) u. Dimensions: 1 . 000 gal , !i de the� Sludge " P Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: n/a !I Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: measured Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural �1 integrity, evidence of leakage, etc.) GREASE TRAP: N/A (locate on site plan) Depth below grade: I t' i Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) { Dimensions Scum thickness: I,' - Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: t' Date of last pumping Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural i t integrity, evidence of leakage, etc.) . 1 I, (revised 04/25/97) Page 4 of 10 I!'r 0 !: �o STEVEN FREEDMAN, M.D. a BOX 382763 F CAMBRIDGE MA 02238-2763.' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARL C SYSTEM INFORMATION (continued) 'Address: 103 Long Pond Cir . erc Estate of Edwin S . Mycock ,,) of Inspection: ,F• b; TIGHT OR HOLDING TANK:N/A (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explein) t' l ' Dimensions: Capacity: gallons Design flow: gallons/day . Alarm level: Alarm in working order_Yes; _ No 7 Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) p' 1 �I I DISTRIBUTION BOX:_ W (locate on site plan) r Depth of liquid level above outlet invert: 0 �& Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) l No evidence of solids carryover. ;i PUMP CHAMBER:N/A (locate on site plan) Pumps in working order: (Yes or Nol P g Alarms in working order(Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) w y ,J �I 's; I 7 (rovimed 04/25/97) Paqo 7 of 10 �SF. �w STEVEN FREEDMAN,M-D: �` ' • _ . C BOX 382763 � " 0::"• m CAMBRIDGE MA 02238.2763 ON r4 M .e• !�. � 1 C1 x oo J N 63. U lz i6o S S?� OL •p t 6 i ` f s• Iv. QO � LI D a �° a� �zQ� . o• � � �"� '� •�`c' ti Pvu/ L. ,,onet Fo!Scm SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ST f EVEN FR EEDMAN,M.D. . PART C BOX 382763 SYSTEM INFORMATION (continued) CAMBRIDGE MA 02238-2763 Address: 103 Long Pond Cir. Estate of Edwin S . Mycock ,;Inspection: 12/2 6/9 7 4� 0 ETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks ?' locate all wells within 100' (Locate where public water supply comes into house) Oft .32 � � 1 snub wVE l I IN G- r 1 l 0 �J • � 4 { U !a 4 F zO © 1 7 a � o '10 00 le STEVEN FREEDMAN, M.D. BOX 382763 . CAMBRIDGE MA 02238-2763 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) dress: 103 Long Pond Cir. rty Ad `f ers Estate of Edwin S . Mycock e:of Inspection: 12/2 6/9 7 OIL ABSORPTION SYSTEM (SAS):_ jlocate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) ;If not determined to be present, explain: Type: leaching pits, number:_ ` leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length:__ leaching fields, number, dimensions: a1 prox 20 x 40 overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) POOLS: 1 CESS is (locate on site plan) Number and configuration; 1 kitchen gray water Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: none inflow (cesspool must be pumped as part of inspection) empty at time of inspection Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: A (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.) (revised 04/25/97) Page ! of 10 �L STEVEN FREEDMAN, M.D. BOX 382763 F SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM CAMBRIDGE MA 02238-27,63 PART C SYSTEM INFORMATION (continued) rrty Address: 103 Long Pond C i r. nor: Estate of Edwin S . Mycock `' to of Inspection: 12/2 6/9 7 Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on.record �_Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) A small diameter observation well was installed at the edge of the drain- field. I I I i l ........... x / h : s I, (revised 04/35/97) Pogo 10 of 10 c' Dr Freedman septic elevations of 2-22-99 , A Nome & Environmental Inc. dkMruction-Home & Environmental Inspections P.O. Box 1069, Centerville, Massachusetts, 02632 Hyannis 508-775-1500 Osterville 508-428-0318 Mass.800-564-0345 Fax 508-428-0347 Dr Freedman, 2-22-99 After speaking with Mr McKeon at the Board of Health I wanted to check my elivations on the septic. The following was found using a transit. Assuming the pond level at zero the following are measures to the height in relation to the pond. 9 Bottom of the leach field ' -6" (this is 6" in water) / bottom of invert pipe to leach field +17.5 " Top of the Distribution box +25" Top of septic tank +46" Bottom of the tank -21 - J S J Doug Williams v 0 Assuming the lake is at zero level............ 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BOX SEPTIC TANK ter , o •e•o; o::p•.. , 12 MAX. ,•rr�RY�' o:d A4 ,a o:4• p, •�. .Od.•Ap.A�,?0'..Q.o�Dp. ,o•v,n d D�; .. •..'e'. b.•t w� e e.•r' TOTAL LENGTH OF TRENCH d OUTLET PIPE LEVEL o•.'o•P• e 3 ID: ^ '� P v c .. . .. d FOR 2 FT. MIN. Q•.pi0•p - :e� a O 01' •'•w: •:. '. .:A,�. ,o ..4• ,.b' ..o ws• „a,r6r fJ� s" �;O:;;D� ,40 'b4', ' y oo, va ,ap •p. :'•�• �(p�00 •e.o. . C I. OR PVC TEES n G3o $$ :•' p p C7 0 C] o Q a p P,Dp 1500 GALLON L O�V ,; DIS TRISU TION BOA .q n ...:.• BSMT FL . /L �4 .•` ;, INSTALL ON LEVEL BASE FLOW DIFFUSORS PRECAST CONCPE TE ,a_., w , �, , H-20 L OA DING H-_d0 PETNFOPCED �r •e�c,'aa.d 'Q.b' G:'� 4::0 'Q'A �'Q►:® Dp O'�'PC'b.e•vQ-P.. •e. •�.•o•or�ep,vd" ,p.p •bD..• s. .�•Procb, :4'�'.p.4. i3t HG�7 . '/4 r a✓ ; I �� H TRENCH SECTION SEPTIC TANK INS TA L L ON L E VEL BA SE a NO TE, EXCA VA TE TO EL EV V. N�•a OR '� L OWER TO REMO VE A L L IMPER VIOUS ` 12" MIN. 1 Y _-- XCA VA TED MA LEACHING ARTA 4" orAM. -eyREPLACE E MA TERIAL BENEA TH THE O ,kHew H �" ' TERIAL WITH o, ,� 3" OF 1/8"-1/2" CI r o. � •b ' 'd.'.p',� A�D' b'•b ;b'•A;�• .�r q�ti CL EAN, CL A Y FREE SAND A A SHE S TONE 04 ' v r. b '. •Q o 17-1 -� �a�-' `~ r'��1 $ ( ,1-/ /0 Pry - „t p ,< A:o•. o• W D PEA ON 3,/4" - 1-1/2" WASHED ( .• - -''.._. _.` �.._ ` 1 '�/ �` /T ,,�r /c., CRUSHED STONE GENERA L NOTES TRENCH wI0 rH yy � . „ L, • }? --" 1. ALL L . ELEVA TIONS SH!9WN ARE BASED ON ASSUMED NUMBER GF TFENCHES 1 2. `� ALL PIPES IN THE SYSTEM MUST BE CAST IRON NUMBER OF 'DIFFUSORS 5 ,ry Orr SCNEDUL E 0 —: C. '. E � VA TION r I T - � q, �. yD THE BOARD OF HEALTH MUST BE NO TIFIED WHEN CONSTRUCTION' is COMPLETE PRIOR PERCOL A TION RA TE-7 TO BA CKFIL L ING = <2 MIN./IN. 4. ANY CHANGES IN THIS PLAN MUST BE APPROVED WITNESSED B Y.• P •^�' BY THE BOARD OF HEALTH AND CAPE 6 ISLANDS CrPS�� / ft f,nC u v SURVEYING CO., INC. ce-5P t DONNA MIORANDI ` MATERIALS AND INSTALLATION SHALL BE IN BARNS. BRD. OF HEALTH DESIGN DA TA ,� "t a COMPLIANCE WITH THE STATE SANITARY N G `� 1~� j �' \, CODE - TITLE V - AND LOCAL APPLICABLE DATE.- _MAY 7 1999 A co \ �J RULES AND REGULATIONS o � �` M R OF BEDROOMS 9 NORTH ARROW IS FROM RECORD PLANS AND 2" — � " ' IF? GARBAGE DISPOSAL NO -,� IS NOT TO BE USED FOR SOLAR PURPOSES '�� �� -• �' �. Q � � DAILY FLOW 440 GAL . r - �- m , �° \ 7. .FLOOD HAZARD ZONE C ( UNtHAZARD) fz / \ B. WA TER SUPPL Y TOWN WA TER �� SEPTIC TANK PEG 'D. 1�00 GAL . r ` ' ° "` SEPTIC TANK PROVIDED ?500 GAL - SEPTIC -- / /� s `-- CG N` `yA,� !! / , v,. ,,:• e o / a U c- S ,p w r.r 7 �. ,%.. ,� LEACHING RECJUIRED ✓ - - %` t,; t GPD. / 1 ✓ /^V 7 "4/ n le ..� /.-.�sa y J l c+r r J G r J q r Cl 1 c 1 F � � � �� '�/� AA REGI 'D = 440 GP0/0. 75 SF/GPO = 587 SF. / 20 ' +c► r o ,,1 r AA PROVIDED a 13 X 47 = 611 SF. k , _. � LEGEND D of cl PROPOSED ELEVATION �. , �; - >� ~ lid —— �G —— EXISTING CONTOUR SEP TIC UPGRA DE/PEPA IR OBSERVA TION PIT r+ 0 DISTRIBUTION BOX r PROPOSED SEWAGE DISPOSAL SYSTEM � d P RED FOR TRENCH PPE PA -77 ! 0 SEPTIC TANK a, S TE VEN FREEDMA N / ^ , HSE. NO. 103 LONG POND CIR. RESERVE APEA CEN TEP VIL L E—BARNS TABL E—MA SS. PIPE INVERT ELEVA TIONr Y CAPE 6 ISLANDS ENGINEERING F�'. PLOT PLAN �c�siE , SCALE AS,- NOTED 800 FALMOUTH ROAD SUITE 301 SCALE. MAP SEC P cL Lor HSE -: � t., ^ �, PLaN NJ;54 9 MASHPEE, MASS. ��