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Home My WebLink About0140 PATRIOT WAY - Health 140 PATRIOT WAY Centerville A= 193 -082 S M E A D WEEPING YOU ORGANI7Fn No. 12534 2-153LOR WHOM MW WUSA Q.ET 0WANlM AT SUEM-Cnu Town of Barnstable Inspectional Services BAaxhrABLL "`" i639'. Public Health Division �� a 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4988 0930 October 8, 2019 WILSON, MAUREEN M 140 PATRIOT WAY CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 140 Patriot Way, Centerville, MA was inspected on 09/09/2019 by Michael DeCosta, Jr., certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • The distribution box is rotted. You are ordered to replace the distribution box within one (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH ` Thom s c ean, R.S., Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\140 Patriot Way Centerville.doc i i Town of Barnstable 039, ,0� Inspectional Services Department Ar fD MA'f A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER d, be K Repair deadline: e a Y' Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts H/1 c7 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments :k:• 140 Patriot Way Property Address r , Owner Nancy Montgomery ► , information is required for every Owner's Name / page. Centerville V/ MA 02632 September 9,2019 City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in anyway. Please'0 completeness checklist at the end of the form. A. Inspector Information tab 1. Inspector: r <. Michael DeCosta,Jr. R` Name of Inspector Wind River Environmental Company Name 46 Lizotte Drive Suite 1000 Company Address : : s. Marlborough MA 01752 Citylrown State Zip Code (508)400-8083 SI 13230 } Telephone Number License Number B. Certifications'' U4! I certify that:I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5(310 CMR; ..Fy 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection;and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. .; ; After conducting this inspection I have determined that the system: 7 ❑ Passes `' 0 Conditionally Passes ❑ Needs Further Evaluation by the Local Approving Authority ❑ Fails s. September 9,2019 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the;';' inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The origin f, should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of`'''' use at that time.This inspection does not address how the system will perform in the future under the", same or different conditions of use. q , t5ins.doc.rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System 0 Page 1 of,19 Commonwealth of Massachusetts 10 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Patriot Way y` . Property Address Owner Nancy Montgomery information is required for every Owner's NameY{k,^' page. Centerville MA 02632 September 9,2019 ° City/Town State Zip Code Date of Inspection C. Inspection summary >� Inspection Summary:Complete 1,2,3,or 5 and all of 4 and 6. 1)System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 2)System Conditionally Passes: Y/ 4. Q 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', r 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) A�,x+ t;^ { 4, t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System a Page 2 of 19 r f . Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Patriot Way Property Address Owner Nancy Montgomery information is Owner's Name required for every page. Centerville MA 02632 September 9,2019 City/Town State Zip Code Date of Inspection Av+. C. Inspection summary (cont.) : `v 2)System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval if z pumps/alarms are repaired. Q 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): Q distribution box is leveled or replaced Q Y ❑ N ❑ ND(Explain below):; :`.s The distribution box is heavily deteriorated and must be replaced. ❑ 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): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the- system is not functioning in a manner which will protect public health,safety and the environment: ts.,. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of�19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments o 140 Patriot Way Property Address Owner Nancy Montgomery information is required for every Owner's Name page. Centerville MA 02632 September 9,2019 City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface- water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private. water supply well". ~' Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4)System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ z Backup of sewage into facility or system component due to overloaded or clogged SAS' or cesspool ❑ Q Discharge or ponding of effluent to the surface of the ground or surface waters due an overloaded or clogged SAS or cesspool t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of`t 9 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Patriot Way Property Address Owner Nancy Montgomery information is Owner's Name required for every R page. Centerville MA 02632 September 9,2019 City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) 4) System Failure Criteria Applicable to All Systems:(cont.) Yes No ❑ Q Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Q Liquid depth in cesspool is less than 6"below invert or available volume is less than''Y2 day flow ❑ Q Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped:_ ❑ Q Any portion of the SAS,cesspool or privy is below high ground water elevation. n ❑ Q Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary,.. to a surface water supply. ❑ Q Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Q Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Q 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.] ❑ Q The system is a cesspool serving a facility with a design flow of 2000gpd-10,000gpd. ❑ Q 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. 5)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 CA. 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 t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 19 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Patriot Way Property Address '��° Owner Nancy Montgomery information is required for every Owner's Name page. Centerville MA 02632 September 9,2019 City/Town State Zip Code Date of Inspection ,fr C. Inspection summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat,or answered"yes"in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for au inspections: Yes No Q ❑ Pumping information was provided by the owner,occupant,or Board of Health ❑ Q Were any of the system components pumped out in the previous two weeks? Q ❑ Has the system received normal flows in the previous two week period? ❑ Q Have large volumes of water been introduced to the system recently or as part of this_- inspection? Q ❑ Were as built plans of the system obtained and examined?(If they were not available,,`,;,, note as N/A) Q ❑ Was the facility or dwelling inspected for signs of sewage back up? Q ❑ Was the site inspected for signs of break out? Q ❑ Were all system components,excluding the SAS,located on site? Q ❑ 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? Q ❑ 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: Q ❑ Existing information. For example,a plan at the Board of Health. ❑ Z 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)] f0. t5ins.doc�rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System�Page 6 6 of 19 Commonwealth of Massachusetts 97) Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Patriot Way Property Address Owner Nancy Montgomery information is required for every Owner's Name page. Centerville MA 02632 September 9,2019 City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 GPD Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes Q No Does residence have a water treatment unit? ❑ Yes Q No If yes,discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes Q No information in this report.) Laundry system inspected? ❑ Yes Q No Seasonaluse? ❑ Y , Yes Q No' Water meter readings, if available(last 2 years usage(gpd)): Unavailable Detail: Unavailable Sump pump? ❑ Yes Q No�, Last date of occupancy: Current Date t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System a Page 7 of 94 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Patriot Way Property Address Owner Nancy Montgomery information is required for every Owner's Name page. Centerville MA 02632 September 9,2019 City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No;:;: .,, If yes, discharges to Industrial waste holding tank present? ❑ Yes ❑ NF Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date a Other(describe below): General Information 3. Pumping Records: Source of information: Wind River Environmental last pumped on 8/8/19,see attached. Was system pumped as part of the inspection? 0 Yes ❑ No If yes,volume pumped: 1000 gallons How was quantity pumped determined? Quantity measured by pump truck Reason for pumping: Check structural integrity of the tank t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 1gM Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Patriot Way Property Address Owner Nancy Montgomery information is required for every Owner's Name page. Centerville MA 02632 September 9,2019 ` CityfTown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: 0 Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes,attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,date installed(if known)and source of information: 1978 Were sewage odors detected when arriving at the site? ❑ Yes 0 No 5. Building Sewer(locate on site plan): Depth below grade: 1.6 feet Material of construction: <µ Q cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints,venting,evidence of leakage,etc.): All the joints are sealed and there are no leaks. t5ins.doc •rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Patriot Way Property Address Owner Nancy Montgomery information is required for every Owner's Name page. Centerville MA 02632 September 9,2019 City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: Q concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) aw: If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No ; Dimensions: 8'x 5'x 4' Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 36" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels' as related to outlet invert, evidence of leakage,etc.): The covers are 1'below grade.The tees are good and the liquid level is normal with minimal solids and sludge:" The tank appears to be structurally sound and not leaking. Recommend pumping the tank annually. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of-49 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments =••— 140 Patriot Way Property Address Owner Nancy Montgomery information is required for every Owner's Name page. Centerville MA 02632 September 9,2019 CitylTown State Zip Code Date of Inspection " D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet ;.3 Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle ` Date of last pumping: Date Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page,�,t,;of.,ts.,,. Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Patriot Way xa Property Address Owner Nancy Montgomery information is required for every Owner's Name page. Centerville MA 02632 September 9,2019 City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level:_ Alarm in working order: ❑ Yes ❑ No Date of last pumping: ` Date Comments(condition of alarm and float switches,etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No r 9. 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.): The distribution box is 10"below grade and 16"x 20".The box has one outlet to the leach pit.The liquid level is} normal with minimal carryover into the box.The box is heavily deteriorated and must be replaced. 01 t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System 0 Page 12 of-19 Commonwealth of Massachusetts COTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 140 Patriot Way Property Address Owner Nancy Montgomery information is required for every Owner's Name page. Centerville MA 02632 September 9,2019 City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): *If pumps or alarms are not in working order,system is a conditional pass. 11. Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located,explain why: Type: 0 leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5ins.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ;`i... 140 Patriot Way Property Address Owner Nancy Montgomery 7, - information is required for every Owner's Name page. Centerville MA 02632 September 9,2019 City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System(SAS)(Cont.) f ; Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,,.. etc.): The pit has 4'of available space.There is no evidence of high stains or hydraulic failure.The vegetation is normal. 12. 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 `'=7 Materials of construction Indication of groundwater inflow ❑ Yes ❑ No _. Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): •4�u t5ins.doc rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System Page 14 of 19- M Commonwealth of Massachusetts u f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Patriot Way Property Address Owner Nancy Montgomery information is required for every Owner's Name page. Centerville MA 02632 September 9,2019 City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of'19 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Patriot Way Property Address Owner Nancy Montgomery information is Owners Name required for every page. Centerville MA 02632 September 9,2019 City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or . benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.Check one•of the boxes below: Q hand-sketch in the area below ❑ drawing attached separately a r WJ t t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of,1.9 a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments e 140 Patriot Way Property Address Owner Nancy Montgomery information is required for every Owner's Name page. Centerville MA 02632 September 9,2019 Citylfown State Zip Code Date of Inspection D. System Information (cont.) -j 15. Site Exam: Q Check Slope Q Surface water Q Check cellar Q Shallow wells Estimated depth to high ground water: 10'+ feet Please indicate all methods used to determine the high ground water elevation: [J( Obtained from system design plans on record If checked,date of design plan reviewed: 1978 Date 4' s ❑ Observed site(abutting property/observation hole within 150 feet of SAS) :.:.. ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater information obtained from the soil logs on the design plans. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 19 ' Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Patriot Way Property Address Owner Nancy Montgomery information is required for every Owner's Name page. Centerville MA 02632 September 9,2019 .' Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: Q A. Inspection information:Complete all fields in this section. Q B.Certification:Signed&Dated and 1,2,3,or 4 checked Q C. Inspection Summary: A 1,2,3,or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed Q D.System Information: For 8:Tight/Holding Tank-Pumping contract attached e2.w For 15: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 16: Explanation of estimated depth to high groundwater included % l5ins.doc rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System Page 18 of 19- Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Patriot Way Property Address Owner Nancy Montgomery information is required for every Owner's Name page. Centerville MA 02632 September 9,2019 City/Town State Zip Code Date of Inspection Pumping Record t workorderg 0217073100 Custp 1472336 Customer Since.2011 Tax_6.2500 lk Job Comments Tech Comments 08/8/2o14 D%Pumping, nnkawm gals i tank lccatian naknoan coverts) aaccrar., Property caaar by Aug 7 after 7am ticOmt i ,... (if pasadbla plaaao got plans, thank yon) TA ]019-310-F 290> 200000 50d NO RawnwaaIIatina.:. .... System Owner System Location Nancy eLmtgrnmry Urinary BOM 140 vatriot Way i4o-Patriot way Cantarvilla, Ra 02632 CwLtervills, WA 02632 (617) 653-4060 Mntgonary Nancy t 46171 6'53-4060 ServiceDat¢c zso da/oe/sofa faro*mm Caft to Confirm: Service TVw. Btandard. Previous Semite:07/31/2013 tprox. Gals: a CCLS: h Below Grade:0 custom tkean: Lac2tirat))e�ils Cust Ae: NO F'i#ter. Township: tnspectian/T5: County: F=Zr3tant •-.� Sue T3 . x-s,•y vwwi.ng 3000 '• 1 G6 '.30D 4582 M , Bovirnaoaotal ccapxianca RnolAaat of 1$L56 $, 3 to00 ' 3 Oo Fuel./ Ycargy R.acoTary s '� 1 Oo §'r 30 0440 36 05 s� $ 01000.00 4su3kZteQeepypurg}nhap4ty rmoa =9 0.0,0 . s strac staaa trc •tw a fiRw vo$atsiW Yarcouth D15posst Wtlmre< Payment:D il: Waste Code.ow9sapric 11100.aoao CfunelL $dlE R9P: RR_Ragaira ranta116 CSltl latrine Alford uaa ca Receipt. Thick: Tedtalclanx Isaac Jo25ft 0a1 Site.07r33 AN P®trtl6sdjer Tech Notes. aydtao operating Fine. Sa2m gs al water iaval. L1ght top aalida. 63amratm bottom aludga. Rath baffles are Intact, main line clear, no filter is present on the tank, current tank can be cmtfittad mdtlt a filter., ocverfa.l matured. P=p ovary- Customer not oft site :2 years. Racoamntd Boost —A tive,cel8 eMltiva,lnatalli:og a fiitar,lnatalLing a riser. X v Customer S*atvre - t5ins.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System a Page 19 of 19 4� if ANS G _ i i i I LT c:z �- e �6�S p c,,,J'� �"5T!�cY /.a C� — j 9 v Z t. +� o i TO OF BARNSTABLE LOCATION 1�'Ukn G SEWAGE# C VILLAGE C,e.. L��_ ASSESSOR'S MAP&PARCEL /993/0 :&, INSTALLER'S NAME&PHONE NO. C)d f SEPTIC TANK CAPACITY LEACHING FACILITY.(type M-K NO.OF BEDROOMS OWNER PERMIT DATE: . / 2 l �, COMPLIANCE DATE: '•�`Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feT of leaching facility) Feet Edge,of.Wetland and Leaching Facility(If any wetlands exist within 360 feet of leaching facility) Feet FURNISHED BY <+ 4 �� :. 4,Gs . 60 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippliLatlon for MispoBal �&pstpm (Const urtlon VPrmit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System 9rdividual Components Location Address or Lot No. 1.10 firs fi c``` Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ,C, n,k InSsG11eI'sName,�A�dr; nd��I JN � e J� Q—J Designer's Name,Address,and Tel.No. Type of uilding: Dwelling No.of Bedrooms A Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow providedAl gpd Plan Date Number of sheets Revision Date Title 0 9 Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �Q.(J�G�(� P k(5 �L, )_0 Q i S�(\b L) U✓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 Certificate of Compliance has been issued by this Board of H th Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. �Lo ( Date Issued { t 1 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplitatlon for 0spoBal *pstrm Construction Permit Application for a Permit to Construct( ) Repair�Upgrade( ) Abandon( ) ❑Complete System 04ndividual Components Location Address or Lot No. 1L,� � fi S-,y Owner's Name,Address,and Tel.No. Assessor's Map/Parcel c� _ C� � -C t \ '� C,'J I" _ems r n Installer's Name,Address,and Tel. v. Designer's Name,Address,and Tel.No. Type of uilding: O r r Dwelling No.of Bedrooms A� Lot Size sq.ft. Garbage Grinder'(' ) Other Type of Building No.of Persons Showers( ) Ceteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Zf \ b N1 o vl 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 provisiions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of H It r ., .Signed _ Date Y:tl Il I F � Application Approved by Date Application Disapproved by Date for the following reasons Permit No. g_o r� " Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS ( Certificate of Compliance THIS IS TO C TIFY,that the On-site Sewage Disposal system Constructed( ) Repaired� l Upgraded( ) Abandoned( )by C� AA T= at k.1 r 7c, ` _ has been constructed in accordance with the provisions of Title 5 and the for Lisposal System Construction Permit No. �61�'L��dated Installer V Designer #bedrooms Approved design flow gpd The issuance of this permit shall no be construed as a guarantee that the syste n wiYl"f Rictiwas esign d. Date 1 ,/� /_C? Inspectors (V\ ---------------------- L----------------------------------------------------------------------------------------------------------------------------------------------- No. --- ------ No. 6� 1 — 7- Fee--- �� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction Permit Permission is he by granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. I f _ Provided:Construction must be completed within three years of the date of this permit. Date t Approved by 1 % . AsBuilt Page 1 of 1 LOCATION SEWA, E PERMIT NO, VILLAGE ' G—(b 7 // /1�17-121 V i-' tL�All �if'J,Z-'L j INSTALLER'S NAME & ADDRESS [7'�1q a('1 6U 6YZIi B UILDE OR OWNER t cJ iiJ 4-YZ c _rc DATE PERMIT ISSUED Z Z2 j 20 DATE COMPLIANCE ISSUED i r c bttp:Hissgl2/intranet/propdata/prebuilt.aspx?mappar=193082&seq=1 9/5/2019 �e �/o l0 C A T ION S E W A E PERMIT N0. 121d l� �% 'VILLffAGE r�-7 Pq 7 -12i m j - aJA y INSTA lER'S NAME A ADDRESS SZ 144� �Qav c°r&,� B U I L D E OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED f'2--2-7- 74- Di3 �� 'l � � � �. �-/��,�% THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application is hereby made for a Permit to Construct L�e or Repair an Individual Sewage Disposal 1_1 Location-Add� or Lot No. Own Address Instal r Address Type of Building Size Lot--- .......Sq. feet Dwelling—No. of Bedrooms... Garbage Grinder ( ) Percolation Test Result M.).ruEb.c ... Date........... Test Pit No. I................minutesperinch Depth of Test Pit----- Depth to ground water.........4-Q/Pf. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I'i 1E 5 of the State Sanitary Code—T signed fur�yr agrees not to place the system in operation until a Certificate of Compliance has been i e y the b d of liezltl-,. Date Date � __._'_____ Date PermitNo......................................................... ' Date � . '--- ------------- -------------- No.._..../� ...... Fimim 4`. ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......OF........ .1 /1 _QL9 ..................... ApplirFa#ion for Disposal Murks Tontruriion thrmit Application is hereby made for a Permit to Construct S>� or Repair ( ) an Individual Sewage Disposal System at: --• .!�._!.S?4.. _l..t.,l Y...... � .�:r l�.1.��..�....... La------� ,.6.......................... • - Location-Add r s� _ or Lot No. - �2.!'..�.!2/` !J--•---.... �1 Y.A^?n�.l.S.._._ Owner _ Address Instal r Address V ?Type of Building Size Lot.. ..!.k9........Sq. feet ,.� Dwelling—No. of Bedrooms_....................................Expansion Attic (�'Cf Garbage Grinder ( ) '_l Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures .............................. .. ----•-•--•--••--•-•----------- W Design Flow............................................gallons per person per day. Total daily flow...... . ..................gallons. 1:14 Septic Tank—Liquid capacitAO.0 allons Length................ Width---------------. Diameter---------------- Depth................ W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching,area....................sq. ft. x Seepage Pit No.___•-.-_k.......... Diameter-__-- Depth below inlet-_6..-O.... Total leaching area.7. /,:=,..(=%_..sq. ft. Z Other Distribution box (?< Dosing tk ( ) aPercolation Test Result Performed by-------- _ _J� .....�� C�►+1�.._.. Date..........�.U........` ,.a Test Pit No. I................minutes per inch Depth of Test Pit----- Depth to ground water.._...�Vy/ t. (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ........................ ••• ...----•---------•-------•----....................------.....................................------•--------......---...... D Description of Soil --- ---------- ! ►_..-... .L. ' -------------------------------------- r? ``�A^° =/%kk..FE..L ............................................................................ W -------------------------------------------5 "G....------. Q.A r�- 'S r --------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable................................................................................................ -----------------------------•-•-.------•••-•-••-•-----------.......--•----•---......................---........-•--------------••................-----•--•--------•-•-•--•---•-•-----•-••--•--.....•-•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.;. 5 of the State Sanitary Code—T e undersigned fur er agrees not to place the system in operation until a Certificate of Compliance has been iss e y the bo d of h th. 1 ned10 I ,/,,..... _. . . Application Approved BY = ! %ddd% " Date Application Disapproved for the following reasons:__.._ ...........................•---•-----........._......-------•------------------•--------•••---••---•-•-•----------------•--•----•--------------------------------------.-------- ....................... Date PermitNo......................................................... Issued-........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....T. J cad......0F:......B S.kA1:5_:K:A.-( J. ....................... Trrtifiratr of ToutpliFanrr THIS IS 1--0 CERTIFY, That the Individual .wage Disposal System constructed (�or Repai ed ( ) by--•--------..I....•C - .►. ` .... i r�'�5.._. ._.... . _�C 1?.! :.k....�!.. 1s'.- 4-l.I.! Installer has been installed in accordance with the provisions of�`"L"P 5 of The State Sanitary Coe as described in the application for Disposal Works Construction Permit N _ ?U..................... da.ted___..#7._ '.7h;..__.._._...._... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Insp ,pctor ------------ -------------------------•--•--------•----•--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ` .Aj......OF........1 � r'�/�.`-�..5�4 .�-- -............... ~ No......................... FEE......:.:+............. Disposal Works 05ontrnrlion Vrrmit Permission is hereby granted....-- r...... to Construct-- or Repair ( ) an Individual Sewage Disposal S stem at No............=............... .E.i.LaT------ . .....------ . ...... Street as shown on the application for Disposal Works Construction Per it Noo.; /"___,_. ___ Dated.....�1'`! '_�..................... Board of DATE.. /= ....~ ...---- a ... Ada FORM 1255 HOBBS & WARREN, INC., PUBLISHERS w-�;. .. .. --- - - - -c ♦., ,:vyi le E F' 0 r,y nor•#.¢�,'�r disk J2 —7 /a� v �•s � ..�t{ ,. - _ F ,r.�i a � > A R, a t�!w�d,y� �r.�? `�kg6rt ( n�`4Qill { v„! 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':. 3. \ P' +. • C - Fa' ( t x K - .54:.; Sf Nl� ra#. qa ` 4 r r.t• a P i Y a' t '�/� ...� �, \ r " 4 ' vs lirt. �I��:R;.wit �. It ' 1_`Ar ..r• ^. _�, � r , "Sir' '. 9 61 s�. qr �} :F R� i.` a r' b.�• O /••�' � � n,P,. q s 8• y 5 w * ,, ;� fi. y �. � � r ►J �9 / � 3-� �.' - � � • t. AA�:�t�Q`�` �� y .. �/(� NTH OF�� 1, r y ' ��Pf�� •F C� 9 yy4A r .A :�� .. ip ' `o� ROBE T P. t �nr�� /It A_' h C'4 ,�$ `iy�4; 'w ,Y BUNIKIS i 5 v 3gp` C• 4 No.22162 � i � +r h �� k r'. ti a :., '.y" ''s.. .. +i 'r �..'"4 ''}« 3 ,d �4s o/R` G/S,TF+a �.�• :k r t NAI 4( +< i7Ca'at a S r ;LEGEND * r ,< r 3 'f' PLOT ` PLAN i <4 EX`ISTit�.G , SPOT ELEVATION 0.0 CERTIFIED ' EXISTING CONTOUR — =— O -' ` ' FINISHED SPOT ELEVATION. 16.0 !o -r / (, p�+ Tf� 107� y/,�a ,�/x ,3 „ FINiSHED CON70UR -- - O - .-- C�/YT IL-L-C aY { :APPROVED SCARD OF HEALTH j v Irma a s "eat DATE �' AG'ENTp' � CA.��;9:� Say ..:', DATES `I`)� '-- 7 L ClI�E®GE ENc INEERIA/G CU. INC ri '. ;y,... CLIENT __ 2 _ CERTIFY"`THAT ;THE, PROPOSED EGISTERE REGISTERE01 7 f JOB N0. . pk ILDING SHOWN O'N THOS PLAN � t LAND CC4NFORMS TO THE 'TONING LAWNS , ` ENGINEER! SURVEYOfi DR. BY �--A- ENGINEER! _ OE' BARNSTABLE , MASS h 33 �fVQ MAIN ST ;• 712 MAIN ST. CH. BY p.-_ � k, YARMO•.UTH, MAC S. HYANNIS, MASS. VAiE SHEET-L OF :z- - D� R G. LAND SURdEX 't , • t�7r,tat F''�( x {,�',, 3'ii �c�.'i t.'L, -r � '4"', - ' `:r .. .. `... '�. .a � •d.. jctil( oF."E. Town of Barnstable la € adrE U.S.POSTAGE Public Health Division _ ��PITNEYBOWES 9.""ST"B'`.$ 200 Main Street ''. /PST .� MASS. �'"leDMn+"• Hyannis,MA02601ZIP 02 4VV $ 006.800 ` 7015 17311 0001W 4988 119300 I 00003364550CT. 08, 2019. I � WILSON, MAUREEN M ` 140.,PATRIOT WAY �M 4. L si�C'a i,3�'i�54 a 0 -SENDER; NOT DELIVERAE#LE AS AGURESSEDUNABLE TO FORWARD �pp !9TF p SC: 0260140OZOID p 1Ag*'15ZZ—aS}.,8d859—€ 8-4{41 _ _�„�t ,Z, 1 �� }; vo{tit{i,I�4�ii!{F�li�li�ii41114914161��II®itf il'Iii�1 9i111flit�i/i •• .. .••. I a Complete items 1,2,and 3. E ature ■ Print your name and address•on the reverse 0 Agent I I so that we can return the card to you. ❑Addressee j ■ Attach this card to the back of the mailpieCe, B. ived by(Printed Name) C. Date of Delivery I or on the front if space permits. - I rr. _:..__.-_ddi ess different from item 11 ❑Yes I delivery address below: ❑No WILSON, MAUREEN M � j 140 PATRIOT WAY t CENTERVILLE, MA 02632 I II I IIIIII IIII wi3a -_tl ❑Priority Mail 11IN I III I III III II I II II IN I I I III s® I ❑Adult Signature ❑Registered MailailTm \ ❑o. R Adult Signature Restricted Delivery ❑Registered Mail Restricted� \\ 9590 9402 3630 7305 3401 70 ertified Mail® Delivery I Certified Mail Restricted Delivery et urn Receipt for I ❑Collect on Delivery Merchandise I+ 2,_Article_Number_Mransfer_from service label) ❑Collect on Delivery`Restricted Delivery El Signature ConfinnationTm`pit ❑Signature Confirmation 7 015 1730 0001 4988 093.0 .., ;il Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt Il 'r-rr-r17rri rrTr rrrTrT 7 TrTrI,r,ft ,.- r, 1 r rya Town of Barnstable Inspectional Services sn tvt�ra�Ui b 9 �� Public Health Division s 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4988 0930 October 8, 2019 —"-— WILSON,MAUREEN M 140 PATRIOT WAY CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 140 Patriot Way, Centerville, MA was inspected on 09/09/2019 by Michael DeCosta,Jr., certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • The distribution box is rotted. You are ordered to replace the distribution box within one (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. . PER ORDER OF THE BOARD OF HEALTH Thom s c ean, R.S., Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mail ing\Conditionally Passes Letters\140 Patriot Way Centerville.doc