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0594 MAIN STREET (CENT.) - Health (2)
594 MAIN STREET Centerville (formerly 598, prior 602) A = 207 - 015 o Jll»I�je(ia® � Z UPC 12534 No.2� MAiTINO�.YN sr ug 16 13 04:43p p.1 ■ 1 ■ ■ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 594 Main St Property Address Robert Bagshaw Owner Owner's Name information required for every Certerville MA 02632 6-28-13 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information ,``��<<lu�nt►np� // on the computer, �����'(_NOFf�gV; use only the tab 1. Inspector: (� ;'���' key eyour \t �� =� JAMES cursor or-do not James D.Sears v = use the return Name of Inspector key. CapewideEnterprises,LLC _ Company Name �, lF' •� G�6� • 153 Commercial St. ///iprstwllsu E���``` Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 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 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 7-2-13 ors 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. **'*This report only describes.conditiions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. . t5ins.3r13 Ttlle 5 Official Inspection Form 800 Sewage Disposal System-Page 1 of 17 Aug 16 13 04:43p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 594 Main St. Property Address Robert Bagshaw Owner Owner's Name information required for every Certerville MA 02632 6-28-13 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: 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•3M 3 TNe 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Aug 16 13 04:44p p,3 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 594 Main St. Property Address Robert Bagshaw Owner Owner's Name information required for every Certerville MA 02632 6-28-13 page_ City/Town State Zip Code Date of Inspection B. Certification (corn.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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-3rt3 TiBe 5 Ori oal Inspection Fw=Subsurface Sewage Disposer System-Page 3 or 17 Aug 16 13 04:44p p.4 Commonwealth of Massachusetts R.-RUVENIMIRS-W Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 594 Main St. Property Address Robert Bagshaw Owner Owners Name information is Certerville MA 02632 6-28-13 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cost.) 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: #4 This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliiform 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 cwmcft*is less than 6" below invert or available volume is less than %day flow C JV i y 4' lsir,s.3113 Tdle 6 Olfidel kwpedion Form:SubaLafece Sewage Disposal System-Pape 4 or 17 Aug 1613 04:44p p,5 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 594 Main St. Properly Add Tess Robert Bagshaw Owner Owners Name information is required for every Certerville MA 02632 6-28-13 page. Citylrown State Tip Code ©ate of Inspection B. Certification (cont) Yes No ❑ ® 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. ❑ 0 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 II of a public water supply well If you have answered"yes'to any question in Section E the system is oonsidered 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 Mna-3113 title 5 orGael Mspecdw For[SubsWace sewage Dapoaaf syatem-Paga 5 of 17 Aug 16 13 04:45p p.6 Commonweailth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 594 Main St. Property Address Robert Bagshaw Owner Owner's Name information is required for every Cert+erville MA 02632 6-28-13 page. cityrrrown 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? ® El available as built plans of the system obtained and examined?(If they were not available note as NIA) ® ❑ 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)1 D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15,203 (for example: 110 gpd x#of bedrooms): 330 t5irs•3113 Title 5 Official Inspection Form:Subvidwe Sewega Disposal System•Page 6 of 17 Aug 16 13 04:45p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 594 Main St. Property Address Robert Bagshaw Owner Owner's Name information is required for every Certerville MA 02632 6-28-13 page. Gtyfrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal.Tank D.Box and four infiltrators. Number of current residents: O Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry.system Inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available(fast 2 years usage(gpd)): 2011-47,000Gals 2012-71,00OGaI s Detail: Sump pump? ❑ Yes ® No Last date of occupancy; NA Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatslpersons/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•31113 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 or 17 Aug 16 13 04:45p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 594 Main St Property Address Robert Bagshaw Owner owner's Name information f is Certerville MA 02632 6-28-13 required for every page_ Cityrrown State Zip Code Date of Inspection D. System information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: NA 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/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank_Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Tdte 5 OfSaed inspection Form:Subsurface Sewage Disposed System•Page 8 of 17 Aug 16 13 04:46p p.9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 594 Main St Property Address Robert Bagshaw Owner Owner's Name information is required for every Certlerville MA 02632 6-28-13 page. Citylrown state Zip Code Date of Inspection D. System Information (cons.) Approximate age of all components,date installed(if known)and source of information: 1997 Permit#97-615 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line- feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40 Septic Tank(locate on site plan): Depth below grade: 14 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: 1500 Gal. Precast Sludge depth: 21' 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewape Disposal Syslem•Pape 9 of 17 Aug 16 13 04:46p p.10 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System form-Not for Voluntary Assessments 594 Main St. Property Address Robert Bagshaw Owner Owner's Name information is required for every Certerville MA 02632 6-28-13 page. Citylrown state Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28e Scum thickness OFF 8. Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Asbuilt-Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tank at working level.Tank and covers at 14"below grade. In and outlet tee's. No sign of leakage or over loading. 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 15ins.W13 Tale 5 Official nspection Farm;Subsurface Sewage Disposal System-Page 10 of 17 !, Aug 16 13 04:46p p.11 Commonwealth of Massachusetts Title '5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 594 Main St. Property Address Robert 6agshaw Owner Ownees Name information is Certerville MA 02632 6-28-13 required for every page. Cityrrown 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•M3 Title 5 official Inspection Form:Substsface Sewage Disposal SyrAam-Page 11 of 17 Aug 16 13 04:47p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 594 Main St Property Address Robert Bagshaw Owner, Owner's Name required for every tan is Certerville MA 02632 6-28-13 require page_ Citylrown 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.): D Box is 16"x16"-22" below grade w/one line out Box is clean and solid. No sign of over loading or solid carry over. 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.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: tgns.W13 - Title 5 019da1 Inspedion Fam:Subsurfaoa Sewage Disposal System•Pape 12 of 17 Aug 16 13 04:47p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Fonn-Not for Voluntary Assessments 594 Main St. Property Address Robert Bagshaw Owner Owner's Name information is required for every Certerville MA 02632 6-28-13 page. cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4 ❑ 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.): Leaching is four infiltrators 10'x30'x2'. Ck D Box and camera out. Leaching is clean and dry. No sign of over loading. 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 i5ins 13113 Title 5 Otflcial Inspection Form:subsurface e Disposal Sewage isp System•Pape 13 0117 Aug 16 13 04:47p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 694 Main St. Property Address Robert Bagshaw Owner Owners Name information's Certenrille MA 02632 6-28-13 required for every C /Town page. � 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•3113 Tine 5 Offidal Inspealm Form:Suosurtace SeWage Disposal System•Page 14 or 17 Aug 16 13 04:48p p.15 Commonwealth of.Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 594 Main St Property Address Robert Bagshaw Owner owners Narne information is required for every Certerville MA 02632 6-26-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 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 13 /} 4 ' 3 8 13_j 3 � Mm•3M3 TRIG 5 official hapection Fom4,%ttmaraca Sewage Disposal Systam-Page 15 of 17 Aug 16 13 04:48p p.16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 594 Main St. Property Address Robert Bagshaw Owner Owner's Name information is Certerville MA 02632 6-28-13 required for every page. CitylTown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells ��eVo Estimated depth tolhigh ground water. 30+ 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 prop"lobservation 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 groundwater elevation: Rear Drops off and abutting property more then 30'+. Before filing this Inspection Report, please see Report Completeness Checklist on next page. ;sins-M3 - Titre 5 Orfidat Inspection Fans Subsurface sewage uisposal system-Page 10 of 17 Aug 1613 04:48p p.17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 594 Main St. Property Address Robert Bagshaw Owner Owner's Name information is required for every Certerville MA 02632 6-28-13 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 0 System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins'W13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 oFtME Town of Barnstable r • Board of Health 9q'ArFDA`�� P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. . FAX: 508-790-6304 Ralph A.Murphy,M:D. Sumner Kaufman,M.S.P.H. To: BAGSHAW,ROBERT E JR Date Monday,March 05,2001 609 TREMONT ST#2 BOSTON M 02118 RE:Underground Storage Tank at__fi022 MAIN STREET(CENT.) Map Parcel: 207014 Tank NO: 01 Tag NO: 00732 Our records indicate that your underground fuel(or chemical)storage tank is over 30 years old,and has not been removed as required by section 03: subsection 2 of the Town of Barnstable Health Regulation regarding fuel and chemical storage systems. You are directed to remove this tank sixty(60)days from the date of this notice. After your tank is removed, please furnish this office evidence in the form of a permit from your local Fire Department within ninety(90)days of the receipt of this notice. You may request a hearing provided a written petition requesting same is received by the Board of Health within ten(10) days after this order is served. Per Order of the Board of Health Thomas A.McKean,RS,CHO Health Agent N I, F0RM F.P. 292 L'0111- tilmni14 of flag arfm ##s Department of Public Safety Division of Fire Prevention and Regulation AppUCATION FOR PERW, AND PS.RMT, FOR REMOVAL AND TRANSPORTATION TO APPROVED 'WANK YARD FDID'� 01920 permit f Date September 4, 19 96_ Centerville city, Tbwn of Lyatrc: t . 8 2 S . 4 0 M . G . L Cy . L = DIG SnFE 2NMBER Fee Paid• S 10.00 963504432 b � F-Is", Me--- star% date 9/3/96 In accordance with t-he provisions cf Chapter 148 , SeC. 32A, M.G. L. , Advanced Envrronmental Services 527 CHR 9 . oo apciicatien is he_eL,y fade by P.O. Box 472 S. A 02660 street e'.ddre_=s & Citj or _m cdTI 7 Dennis,> S 1 7 -natre o a_ uf pol"cnnl _ Applicants name printed; +�'- C�►N�e�/I-PIS/� For permissicn to re:ADVe and trans ort cne underCrvu"� s�orage tank f- �5141A Owner: Constance Bearse Street Addrsss : 598 Main Str le F irn transpertirg waste: Advanced Environmental State r,; c, ; MV5083856100 Hazardous waste manifest 4 E.P.A. T Approved tank yard: J.G. Grants 03501 Tank yard Address : Readville, MA Type of inert gas: UL tank Jr ! Wank capacity: 275 Substance last stored: #2 Fuel Date of issue• September 4, 19 96 Date of exr r,=icn : September 18, 1a 96 . Si anatur=/�'it�e Cf Qif i cn, Qrantirc perm -1�,� ���- ) FT, a CERTERVILLE-OSTEIZVILLE-MARSTONS MILLS FIRE DISTRICT 1875 ROUTE 28 CEN T,ERv;LLE, MA 02632 (508) 790-2380/FAX*(508) 790-2385 OILMAZARDOUS MATERIAL RELEASE FORM F.A. 0614 LOCATION: ADDRE.;S OF R..ELEASE: 598 Main Street Centerville MA 02632 + i f i'ATE��r RELE ASE: Unknown t PRODiIC:T RELEASED: #2 fuel Oil E^Tlr"1ATED,QUANTITY, : Unknown CORRECT T IVE tii_ '(iti "'II_Iti1IM1:LIYRLCF!i1'{._IDLE I" Notificar �OI1 S i i NOTIFICATIONS- FIRE DEPARTMENT: YES(X) r'!OrER 1 DATE: 9/4/96 NATIONAL RESPONSE i_Ep . E RlE: 10_ _ Tr T _12___ 1T_r.. Y�'.:i THE _ DE OF EN !!PONMEINTAL PROTECT 11ON `(ES(Xl_ r'JOr. ) DATE:1 rjpjE: 01 `:;P iLi is_iiih.[ii('i}yTiih.': 'YE=xX 1 140 J E 9 6 1020 a T,,. .., n CAT 96 Tih'1E: D OF �Ti, 1LZ... i r1Ot. i DATE: T1IME: 1020_ TO'n�N H ARI ORM A'S,TER: YES( ''i NO(X 1 C:uTE: OTHE . A,;EPJCIE.=: N/A TIME:__ COflMENTS: On location at above stated ust. U on remo on neath one end of the tank.. Soil had fuel oil odor. Soil in area under tank in. excavation also had fuel oil odor. Initial meter readings showed 32 m. Bottom of tank at fill end of tank found to be in very poor condition. At least one dime size hole was found during inspection. Barnstable Board of Health notified to complete an additional site ins ection/evaluation. Tank com an site awaiting Board of Health ins ector. on REPORTED O•,•:Mar in MacNeel Fire ev tion 0 /�� f��er Septem �4 1996 "!,,'HITS COP!'-FIRE DEPARTMENT ti ELL'i'',;' - F"-'-C E. . F'1111::;Y�F';'-BOARD OF HEALTH FmdMapll?arCel° 207015 Town f,Barnstabl®� k � ' K, iealtb ?epartmeit Fleatth S stem & i�lWIN, p w 1 yip 3 £`� a - �P imap'lParc k 207015 a� � 11, Tank6Nbr 01� Tag Nbr 00000 ry: Installed opcna 1444, B Test Notcation Date i, Status At Removal`Not�frcation�Date . T st [ �a E Abandon 7,gal l / IFov \ 09/04/1996 Ianc@ s .u��iii r.�ya% vi7C n ' y� Fuel Stored FO Fuel,Stprage�Reason H y x Capacity Construction Leak etectwn GathocitG-Detect�on z 1 # ,Sto age Taknfo 000275 SS r �' �Addit�onal���td)sl'� ADVANCED ENVIROMENTAL � 0 r„n CMatlge� ecord? f ys Find;MaplParcel 207014 Town q Barnstable511, u Health pepartment Health System M p Parcel/� 207014 TankjNbr . 01 TagNb 00732 j 1'ns#al[ed 01/01/1968 Loca#�n B 44444 oin W, -pae D to Removal Notification ate Nest � 3 Abandon �, Ftemovat �� � ' ' Kahanee a���6r W/A k�0 l/p/g, �FuelStored D � � Fuel Storage Reason H ` u ' a achy �Constructfon kea stet n Cag tection s St rage Tank Info 000000 SS ( V Additional Deta is A04 SSUMED 20YRS-9/88 CAP UNKNWN � n,� T AsChange�tecord?" � y i h41,0 nZ 0 7-0 )-S Town of Barnstable " BASTAe Department of Health, Safety, and Environmental Services Public Health Division ArFD��p P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health September 2, 1998 Mrs. Constance Bearse, 602 Main Street Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF THE TOWN OF BARNSTABLE REGULATION REGARDING FUEL AND CHEMICAL STORAGE SYSTEMS Our records indicate that you have an underground fuel oil tank located at 602 Main Street, Centerville,MA. This tank is listed on Parcel 207 on Assessor's Map 014 and registered as tank tag# 732. This tank is not located in a critical zone of contribution to our public drinking supply wells but is 30 years old or older. You must have your underground tank removed within 30 days from the receipt of this order letter. For the removal of the tank you must first obtain a removal permit from the Fire Department. I have enclosed tank removal information for you. Upon removal of your tank, please return valve tag#732 to the Health Department. You may request a hearing before the Board of Health if written petition requesting same is received within seven (7) days of receipt of this notice. Sincerely yours, cKean Director of Public Health Enclosure: Tank Removal Information No. LS/ _ .. Fee ° THE COMMONWEALTH OF MASSACHUSETTS Entered in comput es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS f�eNam661110 0[pplication for Mi!9poo5al *pgtem Construction Permit Ir Application for a Permit to Construct( )Repair(Xpgrade( )Abandon Vcomplete System ❑Individual Components 1 ) 7 Location Address or Lot N04:--::ff ���✓ Owner's Name,Address and Tel.No. Assessor's Map/Parcel eew ewllle 6dL Installe 's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ®r#& j 7 Type of Building: Dwelling No.of Bedrooms�� Lot Size sq. ft. Garbage Grinder( � Other Type of Building /` iJeT eff flee No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 6—eD Type of S.A.S. Description of Soil i Nature of Repairs or Alterations(Answer when applicable) Date last inspected: 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 issued this d /� Signed � '�"`��O Date IePh,S�/�, Application Approved by Date I Z Application Disapproved for the following reasons Permit No. /s Date Issued � S Fee �tcY1 THE COMMONWEALTH OF MASSACHUSETTS Entered in_..pute r —Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 1�eNum66141 2pplication for -Migpogar *pttem Construction Permit Application for a Permit to Construct( )Repair(,V)Upgrade( )Abandon( ) C�Complete System O Individual Components Location Address or Lot No. `yf����T Owner's Name,Address and Tel.No. Assessor's Map/Parcel Cel 7Zo!'1//11e �dL- 5 Ile Installer's Name,Address,and Tel No. Designer's Name,Address and Tel.No. 7/ Type of Building: Dwelling No.of Bedrooms�3 Lot Size sq.ft. Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow Ile gallons per day. Calculated daily flow 33"'o; gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. V /yldr�i�/�Cs`S Description of Soil /4 X W Z r Nature of Repairs or Alterations(Answer when applicable) 1 � ' Date last inspected: 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 issued bv this. ardyop, ----- Signed Date AO12,S`/l/';--, Application Approved by _ Date /O 2 7 7 Application Disapproved for the following reasons Permit No. t _ Date*Issued --------------.---------------'-- t THE COMMONWEALTH OF MASSACHUSETTS7"49�y BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CE TIFY,that the On-site Sewage Disposal System Constructed ( )Repaired(P<Upgraded( ) Abandoned )by �"� at .S 76 *0 1 67 G 8 n 1-?!rn ,1 1e A !/ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. A dated Installer Designer The issuance of this permit shall not I c strued as a guarantee that the syste will function as designed. Date 0 Inspector ----- -- /----------------------- ---�j—/ ------ No. I 7 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 0i.9po0ar *pgteT1'11_'CT_ on.5truction Permit Permission is hereby granted to Construe( )Repair( grade( )Ab ndon � System located at 5 9 8 ���rl ✓`�` C���`r/^I/Ile 6�9 sw and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructiop m'�ust be completed within three years of the date of this permit. Date: �� Z 7 '/ Approved by __ Assessing As-Built Cards Page 1 of 1 .5q- TOWN OFBARNSTABLE LOCATION I!/1 v�7` Ale SEWAGE# VILLAGE Ce4 ZtQZZZ& ASSESSOR'S MAP&LOT_?111 INSTALLER'S NAME&PHONE NO. �O/fDL�3r��C04�57` 7T/Q39p �� SEPTIC TANK CAPACITY Ord d 6'41 LEACHING FACHM:(type)_r h,e4kS �l/�(size) / 1?A �X.2 ! NO.OF BEDROOMS BUII.DER 0R� �"a-w PERMITDATE: /AAA 7 1% COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility rjF Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) /�/AP Feet Edge of Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 3V I 3 r.3 00 �I. http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=207015&seq=1 5/1/2014 I ' f mot ,, Town of Barnstable Department of Health,Safety, and Environmental Services e,►twereat.E, Mom. Public Health Division '°rEDMI�� P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO / FAX: 508-790-6304 Director of Public Health November 7, 1997 Connie Bearse 602 Main Street Centerville,MA 02632 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE,TITLE 5. The septic system owned by you located at 602 Main Street, Centerville was inspected on October 18, 1997 by Joseph Macomber,Jr. a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 1.5.00)due to the following: • The cesspool required pumping numerous times. Also, root intrusion was observed into the cesspool. In addition,the cesspool was not structurally sound. You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within(45)forty-five days of receipt of this notice. You are also directed to bring the septic system into compliance within ninety(90)days of receipt of this order letter. 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 any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE B ARD OF HEALTH s A. McKean,R.S.,C.H.O. Agent of the Board of Health yw�mwnmawust.aoe 9 t►,t:r� Town of Barnstable • Department of Health, Safety, and Environmental Services BARNSTABM MAC Public Health Division ><639• � Argo A 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 - Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health TO: ( ,on/)e. � 62 Z M03,N � mot— DATE:(%koke-xd) -79 7 Cal ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at Al� was inspected on Q J. / 997 by a Massachusetts licensed septic inspector. ter. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 1n5.00) due to the following: �^� Gez4 q 1 red! 0J i po,57)t rpo� i dvvsiJr, r 1�dra ve°� ;n zrxi �J You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within 1-4ttam fi "ays of receipt of this notice. You are also directed to bring the septic system into compliance within t ays of receipt of this order letter. 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 any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health q\hnhh\dbfi1e,\t1tle5i.dm TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS. BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted 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 `' :� \ � �� �°�s �� - 2,0 7 O A( DATE : . 10/18/97 602, PROPERTY ADDRESS : " Main Street Centerville,Mass . 02632 On the above date, I Inspected the "ptic. system at the -above address. This system conalsts of the following: 1 . 1 -6 ' x6 ' block cesspool . Based on my InPc�ectlon, I cerllfy the following condltlons: 2 . This is not a title five septic s'ystiam. ( 78 Code ) 3 . The sewage system is in failure. 4 . The cesspool has been pumped numerous amount of times . 5 . Must be upgraded to a title five septic system. ( 95 -Code ) • SIGNA7UR!7' Name :-J . P .- - Macomber Jr•, i --- --,----- --------- Company:_J • P . Macogber &- Son-`Inc . Add ress :_-3aac-66------a-- -- _-CentervilLe LMass__02632 Phone : 5�'_75-.3338------- I THIS CERTIFICATION DOES NOT CONSTffUTE A GUARANTY OR WARRANTY JOSEPN P. MACOMBER. & SON, INC. T+nki-C•upoolrL4 rchfleldi . Pump+d L Intt.illyd Town Sowor Connoctlont P.O. Box 66 ' Centerville, MA 02632.0066 775-3338 77!,b412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS 31 DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON, NIA 02108 617 292500 GoNcmor ARGEO PAU'L CELLUCCI ` D> D S S'' Lt Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F D RM PART A ®Q O RfC��Vr� CERTIFICATION Cr 2 G Z ra 4 1997 Property Address:-5Sf Main Street Centerville, Address of Owner: WNofe Date of Inspection: 10/17/97 (If different) N�(lyplAB(E Name of Inspector: Joseph P•Macomber JR. I am a DEP approved syster� inspector ursuant to Section 15.340 of Title 5 (310 CMR Company Name: J.P.Macomt�er & �on Inc. Mailing Address: Box 66 Centervi=_emass . 02632 6 g Telephone Number: 508-775-3338 CERTIFICATION STATEMENT I certify that I have personally nspecied the sewage disposal system at this address and that the information reponee �Io- -s u,.e a,, and complete as of the time of inspenion. The inspection was performed based on my training and experience in the DroDer runn,on jr maintenance of on-site sewage disposal systems. The system: _ Passes _ Conditionally Passes _ Needs funher Evaluation By the Local Approving Authority �fa�ls Inspector's Signature: s/ Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of comDieting inspection If the system is a shared system or has a design flow of 10,000 gpd or greater. the inspector and the system o,-�ef sra!t s o' the repon to the appropriate regional office of the Department of Environmental Protection. The original should be sen; to rre suer o, and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AI SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 Cn,,W. , ; 3 Any failure criteria not evaluated are indicated below. COMMENTS: BJ SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repairec. T ne 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 deierm,ned', The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Cen, cafe Compliance (artached) indicating that the tank was installed within twenty (20) years prior to the date of ire the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltral,on or failure is imminent. The. system will pass inspection if the existing septic tank is replaced with a conform,ng sro:-c _j-- as approved by the Board of Health. tr.vI..d 04/25/97) ➢ago 1 of 10 OEP on the Wono Woe Wet). http.rNeWW magnet state ma usioep Pnnteo on Recyciec Paper 71, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Propeny Address598 Main Street Centerville,Mass. 02632 o..ner: Connie Bearse Date of Inspection: 1 0/1 7/97 Bj SYSTEM CONDITIONALLY PASSES tcont,nuedl ,f�f? Sewage backup or breakout or high static water level observed in the distribution box is due to oroen c' oos: _, pipes) or due to a broken, senled or uneven distribution box. The system will pass inspection Board of Health). Describe observations: broken pipe(s) are replaced \ obstruction is removed distribution box is levelled or replaced A2P The system required pumping more than four times a year due to broken or obstructed p,pe(s) The systems ass 'nspect'on if (with approval of the Board of Health) broken pipets) are replaced obs(ruction is removed Cj FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Il _ Conditions exist which require funher evaluation by the Board of Health in order to determine if the system is fads ng t.:) o:o:ec •e public health, safety and the environment it SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A •Y'ANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Ali` 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 APPROPRIATED DETER,,u,ES Trt,,T 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 (he SAS is within 100 feet to a sonace wa s_DD•. 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 sua�i, -ell The system has a septic tank and soil absorption system and the SAS is within 50 feel of a private wager s �c The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or -note :,c- a private water supply well, unless a well water analysis for coliform bacteria and volatile organic cornpo�-ncs �c;_a es a the well is free from pollution from that facility and the p(esen a of ammonia nitrogen and nitrate nitroge'- 6 less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER ➢.q. 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A • CERTIFICATION (continued) Property Address:598 Main Street Centerville Mai 0_ner. Connie Bearse Date of Inspection: 10/17/97 D) SYSTEM FAILS: You must indicate e,. et "Yes" or "No" as to each of the following S I have determined that the system violates one or more of the following failure criteria as defined n 310 C for this determination is identified below. The Board of Health should be contacted to determine what will De r.eces;;r� ._ the failure YeS n1� o Backup of sewage into faciLry or system component due to an overloaded or clogged SAS or cess000i Discharge or pondrng of effluent to the surface of the ground or surface waters due to an ovedoadee or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cess-_oo Liquid depth in cesspool is less than 6" below inven or available volume is less than 1!2 day iior Reau.red pumping more than 4 times in the last year NOT due to clogged or obstructed a pe.s Number of times pumped _,Eibaoe /S Any ponion of the Soil Absorption System, cesspool or privy is below the high grouncwa'.er eie a, o Any pon,on of a cesspool or privy is within 100 feet of a surface water supply or tributar,. to a s.rla_e "a:er s_ c Any portion of a cesspool or pnvy,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 ponron of a cesspool or privy Is less than 100 feet but greater than 50 feet from a pr,�ate »a,er e : . acceptable water quality analysis. If the well has been analyzed to be acceptable, artach cops of -ell -,:e, a.-.a.:s" col,form bacieria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen E) LARGE SYSTEM FAILS: you must indicate ether "Yes" or "No" as to each of the following: The following crnena apply to large systems in addition to the criteria above. ,L2 L The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system :s a r, ,-.,'• : .n Public health and w(ery 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 100 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 TdYc '_ere I c public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the ground,aler Irea:r�e requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for funher niorr:zt cr ,s Ir.v�••d 0i/75/17) ➢.q. ) of 10 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Properly Address:598 Main Street Centerville Ma Owner: Connie Bearse Date of Inspection: 1 0/1 7/9 7 Check i( the following have been done You must indicate either "Yes" or "No" as to each of the following. Yes N 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 receiv,ng normal now rates during that period. Large volumes of water have not been introduced into the system rece^u, c as pan 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. The site was inspected for signs of breakout. All system components, 4�1)luding the Soil Absorption System, have been located on the site. 1j/Qn/tL_ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for cond,(.on oT 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 faciliry owner land occupants, if djfferent from owner) were provided with information on (he proper m,ain(en,ance c, Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. _ Determined in the field lit any of the failure criteria related to Pan C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) 1 . The present sewage system is in failure. 1A. System has been pumped numerous times . B. Cesspool has root intrusion. c. Cesspool is not structurally sound. lr•v1..d 01/J S/97) P.y. 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Properly Address:598 Main Street Centerville Ma owner: Connie Bearse Date of Inspection: 1 0/1 7/97 FLOW CONDITIONS RESIDENTIAL: Design now. P.d./bedroom for S.A.S. Number of bedrooms:, Number of current residents:AJ 0au'rs ;1,9a--W7' Garbage grinder (yes or no): Aid Laundry connected to system (yes or no):-Ao Seasonal use (yes or no) Water meter readings, if available (last two (2) year usage (gpd): �� d/99(1('�/ !� Sump Pump (yes or no):_0, Ift, Last date of occupant) COMMERCIAUINDUSTRIAL: Type of establishment.&//¢ Design flow: A4 Rallons/day Grease trap present. (yes or no)&4 industrial Waste Holding Tank present: (yes or no)4At Nor-sanitary waste discharged to the Title 5 system (yes or no)" Water meter readings, if available 2[- Last date of occupancy: 14� OTHER: (Describe) All? Last date of occupancy _ GENERAL INFORMATION PUMPING RE ORDS and source of inf rMallon, �v ` _ W' System pu d as pan of inspection: (yes or no)A?IJ If yes, volume pumped: gallons Reason for pumping TYPE OF SYSTEM ,CO Septic tank/distribution box/soil absorption system Single cesspool /lO Overflow cesspool Privy Shared system (yes or no) (if yes, aaach previous inspection records, if any) I/A Tech fogy etc. Copy of up to date contract? Other APPROXIMATE ACE of all components, date installed (if known) and source of information: 0' Sewage odors detected when arriving at the site: (yes or no) _ lr.vs..d 04/I5/97) F.y. 5 of 10 Num: Tim Ellstrom Cusbmw CO&: Ad*en: 598 Main Street cbea2 Town: Centerville sum: z1o: Ns®ng ad&OW: 582 Main St Centerville MA 02632 6/2177 thru 94 Constance Bearse 7124189 pump c 105.00 8/15/89 7/27/91 pump 1 pool 105.00 9/20/91 12/10/94 pump 1 pool 145.00 rec 3/14/95 . 4/14/97 pump 1 pool 145.00 4/23197 r I , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Pro erty Address: p 598 Main Street Centerville Ma 0-ner: Connie Bearse oats of Inspect;on: 1 0/1 7/97 BUILDING SEWER: locale on site plan) Depth below grade Material of construction Cast iron _ 40 PVC _ other (explain) D stance iromXivale wa( r supply well or suction line —4A — Diameter C 9),-ents (condition of joints venting. evidence of leakage. etc.) T SEPTIC TANK: locate on site Olin) Depth below grade:/6� "atenal of construct10741A concrete�metaLo(�iberglassif/APolyethylenV4(�other(explain) 1: tank is metal. list age Is age con(i(med by Cenificate of Compliance (Yes./No) Dimensions Ifle Sludge depth."_ Distance from top or sludge to bonom of outlet tee or baffle:-22641— Scum thickness _ Distance from top of scum to top of outlet tee or baffle Distance Iron oonom of scum to bonom of oudei tee or baffle -+ow dimensions were determined Comments irecommendanon for pumping. condition of inlet and outlet tees or baffles. depth of liquid level in relation to outlet inven, sir-c_:a ntegriry. evidence of leakage. etc.) GREASE TRAP:, notate on site plan) Dea(h below grade /111�1 Matenal of construct,of- /AconcreteO�/ etaWZFiberglass,4WPolyethyleneVol:�other(explain) /? Dimensions: 4404 Scum thickness. D,stance from top of scum to top of outlet tee or baffle:/t� D,stance from bonom of�scum to bonom of outlet tee or baffle: 10J 1 Date of last pumping Comments vecommendallon for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet rover.. ntegr,ry, evidence of leakage, etc 1 T 7lz' tr.vs..d Y.g. 6 of 10 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 598 Main Street Centerville Owner: Connie Bearse Date of Inspection: 10/17/97 TIGHT OR HOLDING TANK C(Tank must be pumped prior to, or at time, of inspeclion) (locate on site plan) Depth below grade:.,V--k Material of con slruaion]i%ncreteA+neta14AFiberglass PolyethylenepAother(explain) Dimensions Capaciry:_d gallons Design flow. gallons/day Alarm level, Alarm in working order& Yes;,j�)4No Date of previous pumping _ Comments (condition of inlet tee, condition of alarm and float switches, etc ) l �— DISTRIBUTION BOX:,Oj Uocate on site plan) Depth o: hcu-d level above outlet inven: It1w Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) 714 I ��tidz- t, �L_L� r. PUMP CHAMBER:/�'61. (locate on site plan) Pumps n „orkrng Order: (Yes or No) Alarms �n working order (Yes or N0) 9 Comments: (note condition of pump chamber, condition of pumps and appunenances, etc.) (r•v1.•G Os/75/97) P.g• 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properly Address: 598 Main Street Centerville Ma` Owner: Connie Bearse Date of Inspection: 1 0/1 7/9 7 SOIL ABSORPTION SYSTEM (SAS):7 ;locate 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. O leaching fields, number, dim lion overflow cesspool, numbe Alternative system: Name of Technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) CESSPOOL$: (locate on site plan) Number and Configuration: Depth-(op of liquid to inlet (nven: Depth of solids layer: Depth of scum layer: Dimensions of Cesspool. Materials of construaron: Indication of groundwater: inflow (cesspool must be pumped as pan of inspection) i,�i//DT Ati Dv Comments. (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 1 / &S41 PRIVY:yQGE (locate on site plan) Materials of construction: Dimensions: Depth of solids: .4 Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) /o (r.v1s.d 04/25/97) D.9. 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properly Address:598 Main Street Centerville Ma O»ner: Connie Bearse Date of inspection: 1 0/1 7/97 SKETCH OF SEWAGE DISPOSAL SYSTEM: ,nUude ties to at least two permanent references landmarks or benchmarks locate all wells within 100 (locate where public water supply comes into house) Cj Ic ..4,r S9� Main St. e- (1-1—a 04/75/17) P.y• 9 of 10 SUBSURFACE SEWAGE DISP SYSTEM INSPECTION FORM r C SYSTEM INFOI. :ION (continued) Properly rddress598 Main Street Centerville Ma owner: Connie Bearse Date of Inspection: 1 0/1 7/9 7 Depth to Croundwaler Feet Please indicate all the methods used to determine High Groundwater Elt'.a:ion: /Obtained from Design Plans on record Observahon of Site (Abuning property, observation hole, baser+uN"simp etc.) ZDei,,m-ne' it from lor_al conditions Check with local Board of health /Check FEMA Maps V C eck pumping records ---fff---- eck local excavators. installers cl Use USGS Data Descr-be in your own words how You established the High GroursdwxcrlIevat.on. Must be completed) Used Cape Cod Commission Map September of 1995 Water Table Contours And Public WaTER SUPPLY Wellhead Protection Areas . Ir•v 1.•C 04/73/117) i•� of 10 I `.• r.nr+--n.rr�— rnrnr.n rr+rs�*++a�+•r.rr.r•.�••••-rv.r:err-e.•.m rs•�yrr�-.r+R rrr+ �'�+s+�'� r*+-r�-r---.— - .- 'TOWN OF Barnstable WARD OF HEALTH SUIISURFACF SFWA(;E DISR)SAL SYSTEM INSI'FCTION FORM - PART D - CERTIFICATION `� �'•••T. r .--.. ..---+1mrm•n:T rla lr•rT1 rr-n11-..—•n.9mr11 TrnfT��lr rtr9rtTST1'Tsrt mnn•r.rrr..r+rr rrr+.r,r.:—..-.- r•�. �. -TYPO OR PRINT CI,CARLY- PROPERTY INSPECTED STREET ADDRESS 598 Main Street Centerville,Mass . ASSESSORS MAP , DLOCK AND PARCEL # OWNER' s NAME Connie BeBrse PART D - CERTIFICATION NAME OF INSPECTOR Joseph P. Macomber Jr . COMPANY NAME Joseph P. Macomber & ''ion , Inc . COMPANY ADDRESS Box 66 Centerville , Ma. 02632-0066 Strevt Town or City 5t tI tip COMPANY TELEPHONE (508 775 -3338 FAX ( 508 ) 790 -1 578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposa-1 system nt this address and that the information reported is true , accurate , and complete as of the time of .-inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : Systeci PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public IIea1Lll or, Lhe. environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . KXXXXXXXXXXX)t,s te m FAILED* The inspection which I have conducted has found that the system fails to Protect the 'Public health and the environment in accordance with Title 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date 10/20/97 One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the 130ARD OF 11IIAL'I'lt. • If the inspection FAILED, the owner or " porator shall upgrade the ayetem within one year oC the date of the inspection , unless allowed or required otherwise as provided in 310 CmR 16 , 305 , partd . doc J W U) 7 f ti b v SS ^0C _ byV 3,of THE COMMONWEALTH OF MA.SSACtrUSETTS DEPARTN1E T OF ENVIRON M-i NTAL PROTECTION BE IT KNOWN THAT =4 Joseph P. Macomber, Jr. Has satisfied the Department's qualif icati'q s as required and is hereby authorized to use the title CER { D TITLE S SYSTEM INSPECTOR as provided -M 310 CMR 15 .340 and Section 13 of Chapter 21A of the General Laws _ Issued by The Department of Environmental Protection. Acting [)ircct()( of the [) watcr 1'011ut on Conr(ol r,. 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) I ,hereby certify that the application for disposal works construction permit signed by me dated 1O12,5h 7 ,concerning the property located at S `� ��/�? G'Gy7`�j"�//1�� meets all of the following criteria: V 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 /h ere 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 n-QJ 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)�? SIGNED: DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cert f ^/ oFtME,� Town of Barnstable • Department of Health, Safety, and Environmental Services * anMSMBLE. "'" 1639. Public Health Division ♦0 ` A�FDNIP'�A P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 (/ Thomas A.McKean,RS,CHO FAX: 508-790-6304 T Director of Public Health- November 7, 1997 Conn7BeSar__6 et Centerville,MA 02632 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 602 Main Street, Centerville was inspected on October 18, 1997 by Joseph Macomber,Jr. a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: • The cesspool required pumping numerous times. Also, root intrusion was observed into the cesspool. In addition,the cesspool was not structurally sound. You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code,Title 5 within(45)forty-five days of receipt of this notice. You are also directed to bring the septic system into compliance within ninety(90) days of receipt of this order letter. 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 any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE B ARD OF HEALTH s A.McKean,R.S., C.H.O. Agent of the Board of Health g1Le:dth\dbfile Wfle5i.doc 4' � M v Q 28' (p 7'3 6'4 14'5 rr, co � I Lc) iA © m 3' '4 rQ� n4 o : CD0 co OPEN BELOW cor STORAGE -------------- Lo �N Lo 13'7 14'5 SECOND FLOOR DATE: DEC 30, 2003 SCALE 1/4" = 1 '-0" 28' 2'-*---5'2 �'{ 6'5 11'5 3' 2`6 2020 28 13' 2020 - 71 20201 5 O m et �/d' � co 5'2 -- -- ---- ------ -- ------- -- -- --- - -- -- ------ --- ------ ---------- ---- ---- --- o7 co iA e0 iA �. pp d co i hl o O i U i co i aD G Ell CV b0 OCii i[) N N M 713 6'4 1 4'5 I�`z --- ---- - ---- - - --- ---------- -- __----_ ------- -- o 3088 2020 2020 2020 —IL 4' $'S 3'2 3' � —T5 4' BOAT HOUSE, CENTERVILLE MASSACHUSETTS PLAN DATE: DEC 30, 2003 SCALE: 1/4" = 1'- 0"