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Home My WebLink About0036 MOON PENNY LANE - Health oon Pennv Lane _ PF Center iIIe# P A = 192 008 f �IN Jf �QECYCIFp�D 7�18(j(t%p 2° art, UPC 12543 NO�. . 5. 53LOR �lb1T.00wJ�a HASTINGS, MN I l t r COMMONWEALTH OF MASSACHUSETTS "S 115 z� EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS . DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVE® nCT 1 9 2004 TOWN OF BAPNSTABLE TIME 5 HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARV,ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP Property Address: 36 Moonpenny Lane Q Centerville ARCEL - Owner's Name: Jim Burke ir0T ay, Owner's Address: Date of Inspection:A2—# 10&=o Name of Inspector:(please print) W' 1 1 jam F._ •Robinson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P 0 Box 1089 _Centerville, MA Telephone Number: (5081 775-8776 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15340 of Title 5(310 CMR 15.000). The system: asses Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: e G The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heatth•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 io the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ` ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 - _ tl Page 2 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 3 6 Moonpenny Lane Centerville Owner.. Jim Riirkp Date of Inspection: —S Inspection Summary: Check A,B,C,D or E I ALWAYS complete all of Section D A. Syst Passes: 1 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exftltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. •A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: t Observation of sewage backup or break out or high static water level in-the distribution box due to-broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due.to broken or obsutxled pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipes)are replaced obstruction is zcnoved ND explain: �- ---- existing existing A� J I a I I D . I I m new closet with sliding I I i 120^ barn doors(2),interior � t I shelving �I it --------- ------T--� t c a a 1 I I I i N ROOM L------1------- ------J_--J C . 281/2" I G CABINETRY&COUNTERTOPS I B m •5howplace'Pendleton 215'door style •full-overlay frameless,Blum hardware ------ •perimeter color:'soft Cream' •Island color:'Dovetail' •countertops:511estone'Ocean Jasper' s ———— KITCHEN REMODEL m —— °I c •demo entire kitchen including tile flooring Ff n •new cased opening into TV room(LVL) •new cased opening-TV room Into living room •new specialty closet in dining room w/sliding doors io ienb" 91 V8" •new wiring/plumbing as per layout 48" `..Gp,{1TIRI�oa a •new tile floor +� Isaivib" •install all new fixtures,cabinetry,tile,hardwareiieirE:BRITiON,.am3 C1 Oi9TR.N0. '' LIVING ROOM •5ubZero to remain In place RE �� yA.y oEa`O Q.uW Meter SCALE: DATE: oesgrco Esxtlonv For: ALL DIMENSIONS AND SIZE aPNtoveo Br: DATE: RTI SAN ITC H E N S INC. DESIGN PLANS ARE PROVIDED FORE NF DESIGNATIONS GIVEN ARE Begg-Whitman Residence FAIR USE EY THE OLIENOPESIT OF SUBJECT TO VERIFICATION ON A PLANS REMASN THE PROPERLY OF THIS A.1 36 Moon Penny Lane FIRM AND CAN NOT BE USED OR REUSED KMAJOB SITE AND ADJUSTMENT q 2/S/2019 937A Main Street Osterville,MA 02655 508-428-8828 —THOUTPERMISSION. WOK)NAL TO FIT SITE CONDITIONS. Centerville,MA 02632 KITCHEN-BATH A:iSOCIATtON NOT TO SCALE ELEVATION A ELEVATION B �q P❑ MMBE ®® ®® q 12 5/8' ® N ®p m ® Y I® m O O G C o double boo pullout c case tr89t1 C ELEVATION G ELEVATION E book PLUMBING FIXTURES case Whitehaven® Sensate TM door by doorby Self-trimming Apron Front Sink Pull-Down Kitchen Sink Faucet owner owner K-5827 K-72218 ELEVATION D o cooktop cabinet \ o q micro - '_ yJ,-fit book drawer case F [I E CEdIREd M ber ALL DIMENSIONS AND SIZE SCALE: Oeagne0 EspeaaOY For: FMOvfO BY: �7�. DESIGN PLANS ARE PROVIDED FOR THE DESIGNATIONS GNEN ARE RTISAN "✓IITCHENS INC. Begg-Whitman Residence FAIRUSE BYTHE CLIENTOR H[S AGENT. SUBJECT TO VERIFICATION ON PLANS REMAIN THE PROPERTY OP THIS 36 Moon Penny Lane FIRM AND CAN NOT BE USED OR REUSED LOB SITE AND AD]USTMENT 937A Main Street Osterville,MA 02655 508-428-8828 Centerville,MA 02632 WrTHWT PERMISSION. KAIICHEJ aATH TO FIT SITE CONDITIONS. ASSOCIATION Vox®Round MASTER BATH REMODEL MASTER BATH Above-counter Bathroom Sink •demo entire bath K-14800 •leave existing 1/2 wall,reconfigure shower •save existing tall white cabinetry units •new 1/2 wall,new seat ' •change hinged door to sliding barn door 90 DEGREE" 90 DEGREE" •new tile throughout(+underlayment) Single F-Olon Handsha—r Single-Handle Vessel Lavatory Faucet - WlehsrdeBar •install all new fixtures cabinetry,the hardware CABINETRY&COUNTERTOP5 -140 3/b" •5howplace'Chesapeake 215' EE 577Itb" 21 1/4° •full overlay,frameless w/legs and shelves •Red Oak,stain color:'Autumn' •countertop,bench etc:remnant e m 17 7/b" _ shelf n I E El I I i T(� 0 � 61 114" I N existing existing FT I ry re-using re-using I Z-o I O O Ln f .000•0 opO.o 000.0 I r o ,� a:�D°D°°o a000°, •a l a a0 o o ° a0 o o CID?o I o 0 I p G¢ oop Op °C, Ge 1,o o°Ot0 0 °O90 iv o00•0 a o00.0 0, 0°0 °Oo0 ° O � •O��OOO°QO m o o a o Oo 0 o OD 0 0 0 0 to Og o O o Od ,o t o O°avo.0 o° o o°oto 000.0 ,a00•o 4 112" 43" ELEVATION A 15' 52 3/4" 5 3l4"26 5116 34 1/16" Cer41i�Mentlw oesgretl esceaeuy For: ALL DIMENSIONS AND SIZE nmevEo ay' SCALE: DATE: DESIGN PLANS ARE DROVIDED FORTHE DESIGNATIONS GIVEN ARE F Begg-Whitman Residence FAIR USE BY THE CLIENT OR HIS ACBNT. SUBJECT TO VERIFICATION ON RTI SAN ITC H E N S INC. PLANS REMAIN THE DROPERIY OF THIS JOB SITE AND ADJUSTMENT 36 Moon Penny Lane FIRM AND CAN NOT BE USED OR REUSED 2/s/2019 937A Main Street Osterville,MA 02655 508-428-8828 Centerville,MA 02632 WITHOUT PERMISSION. KITCHEN+BATH TO FIT SITE CONDITIONS. A950CIATION Page 3 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 36 Moonpenny Lane Centerville Owner: Jim Burke Date of Inspection:,/b T�_ � 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 fa ling 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 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the s tem 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. k The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a r rivate water supply well- Method used to determine distance ' This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform b teria and volatile organic compounds indicates that the well is free from pollution from that facility and ' th presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other fai ure criteria are triggered.A copy of the analysis must be attached to this form. J 3. O her: 3 Page 4 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 36 Moonpenny Lane Centerville Owner: Jim Burke _ Date of Inspection: -• a' D. ystem Failure Criteria applicable to all systems: , You ust mdi(ate').res".or"no"to each of the following for all inspections: ' Yes o Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above.outlet invert due to an overloaded or clogged SAS or ' cesspool _ Liquid depth in cesspool is less than 6"below invert or available volume is less than'/:day flow _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number , of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within I00.feet of a surface water supply or tributary to a surface water supply. Any portion of.a cesspool or.privy is within a Zone 1 of a.public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.IThis system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free.from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] / (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E: Lar a Systems: To be co idercd a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd- You must' dicate either"yes"or"no"to each of the following: (The follow g criteria apply to large systems in addition to die criteria above) yes no _ _ the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the ystem is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped' . Zon 11 of a public water supply well If you have ans red"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section above the large system has failed.The owner or operator of any large system considered a significant threat nder Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The syste owner should contact the appropriate regional office of the Department. 4 f Pape 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 36 Moonpenny Lane Centerville Owner: Jim Burke Date of Inspection: Check if the following have been done.You must indicate"yes"or"no"as to each of the following: •y 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 week_s? Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection?, _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) — Was the facility or dwelling inspected for signs of sewage backup? 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? ,b — _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no ti.A Existing information.For example,a plan at the Board of Health. t Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance. is unacceptable)[310 CMR 15.302(3)(b)] », 4b 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 36 Moonpenny Lane Centerville Owner: Jim Burke Date of Inspection: - d FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):. Number of bedrooms(actual): L .. DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of ooms)•ti, — Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no [if yes separate inspection required] ' Laundry system inspected(yes or no): Ae0 Seasonal use:(yes or no):A Water meter readings,if available(last 2 years usage(gpd)): 2003 - 162, 000 Sump pump(yes or no): A. d 2002 - 277,000 ' Last date of occupancy: a.. COMMERCIAL/IND TRIAL Type of establishment: Design flow(based on 10 CMR 15.203): pd Basis of design flow( eats/persons/sgft,etc.): r Grease trap present( es or no):_ Industrial waste hot ng tank present(yes or no):_ Non-sanitary wast discharged to the Title 5 system(yes or no): Water meter read' gs,if available: Last date of occ ancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: 19 4 C 0 61 Was system pumped as part of the inspection(yes or no): ti U I.Eyes,volume pumped:)"kJ gallons--How was quantity pumped determined? ez Reason for pumping: .4 0-1- TYP�16F SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: 2r s - Were sewage odors detected when arriving at the site(yes or no):� 6 Page 7 of OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 3 6 Moonpennv Lane _Centerville Owner_Jim 13 i rk Date of Inspection: _ ;0 �. BUILDING SEWER locate on site plan) Depth below grade• Materials of con ction:_cast iron 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: L-1/10cate on site plan) Depth below grade:_ r • Material of construction: ✓concrete metal fiberglass_polyethylene _othcr(explain) _ —' If tank is metal list age:— Is age confi med•by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: l .0 G It Sludge depth:- Q Distance from top ofsludge to bottom of outlet tee or baffle:.Jy_ v Scum thickness: ,. Distance from top of scum to top of outlet tee or baffle: 40* Distance from bottom of scum to bottom of outlet tee or baffle: ,/A-j I How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as relateleako outlet invert,evidence of lea e,etc. - ! At G - A 4r r. 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 cum to top of outlet tee or baffle: Distance from bolt of scum to bottom of outlet tee or baffle: Date of last pumpi g: Comments(on p )ping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outI t invert,evidence of leakage,etc.): 7 Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 36 Moonpenny Lane Cen ryi11P Owner: ,.• s.- �- �: Date of Inspection: /G+-• G TIGHT or HOLDING ANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of constructio : concrete metal fiberglass polyethylene other(explain). Dimensions: Capacity: gallons Design Flow. allons/day Alarm present(ye or no): Alarm level: Alarm in working order(yes or no): r Date of last pu ing: ' Comments(co ition of alarm and float switches,etc.): L+ DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.).- PUMP CHAMBER: ocate on site plan) ` �� • 'i �' • " `' �' -" `'` 4� 1 Pumps in working order es or no): Alarms in working ord (yes or no): Comments(note cond' ion of pump chamber,condition of pumps and appurtenances,etc.): •, 8 Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 36 Moonpenny Lane Centervile Owner: Jim Burke Date of Inspection: 4Lj= SOIL ABSORPTION SYSTEM(SAS): «(locate on site plan,excavation not required) If SAS not located explain why: Type _ - leachingpits,number:2n- , leaching chambers,number: leaching galleries,number: leaching trenches,number,length: , °. leaching fields,number,.dimensions:-, overflow cesspool,number: i innovative/alternative system Type/name°of technology: Comments(note condition of soil,signs of hydraulic failure,level of podding,damp soil,condition of vegetation, etc.): r � t CESSPOOLS: cesspool must be pumped as part of inspection)(locate on site plan) Number and config ation: Depth-top of liqu d to inlet invert: Depth of solids la er. Depth of scum 1 er: Dimensions of esspoc Materials of c nstruction: Indication of oundwater inflow(yes or no): Comments ote condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): T. PRIVY: (local on site plan) Materials of cons ction: "' • " ! ,_ ��,� _, Dimensions: « ,_ Depth of soli t ► " Comments ote condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): a t"r - 9 Page 10 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 36 Moonpenny Lane Centerville Owner: Jim BLrki- Date of Inspection: /—Ap -: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. 3 1. %.qeAA V . V r /1 ' 3 � � �j-3r • 7-f A-- 1 - .6 -30 10 f Pape U of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'Property Address: 3 6 Moonpennv Lane Centerville Owner. Jim Burke Date of Inspection: SITE EXAM Slope Surface water Check cellar. Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) ✓Accessed USGS database-explain: You must describe how you established the high ground water elevation: 11 OF aA CERTIFICATE OF ANALYSI Page. SEP 2 2 2003 Barnstable County Health Laboratory TOWN OF BARNSTABLE 3SACHUSt,,i Report Dated: 9/15/2003 HEALTH DEPT. Report Prepared For: Order Number: G0322794 Patricia&James M.Burke 36 Moon Penny Lane Centerville, MA 02632 Laboratory ID#: 0322794-01 Description: Water-Drinking Water Sample#: 22794 Sampling Location: 1645 Main St.,West Barnstable Collected: 9/11/2003 Collected by: J.Burke Received: 9/11/2003 Test Parameters ITEM RESULT UNITS MDL MCL Method# Tested LAB: Microbiology Total Coliform Absent CFU/100mL 0 Absent 309 9/11/2003 Approved By: (Lab Director) 6�116 Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605