The URL can be used to link to this page

Home My WebLink About0054 PINE TREE DRIVE - Health 54 Pine Tree Centerville A= 188 — 112 No. 42101/3 ORA ESSELTE 10%U& s � $8 -It a- Commonwealth of Massachusetts (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments J •" 54 Pine Tree Drive Property Address Monroy Owner information is Owner's Name required for every Centerville MA 02632 6/23/20 page. City(rown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Description: 1983 permit shows 2 bedroom, 2 chambers added in 1992 shows 2 bedroom umber of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Occupied Date t5insp.doc-rev.7l26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Bg r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a 54 Pine Tree Drive Property Address Monroy Owner Owners Name information is required for every Centerville MA 02632 6/23/20 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. A. Inspector Information S14 14(Aq Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 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: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 6/23/20 Inspec s ignature 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 original form 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection forth:Subsurface Sewage Disposal System•Page 1 of 18 1 Commonwealth of Massachusetts (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �e 54 Pine Tree Drive Property Address Monroy Owner Owner's Name information is required for every Centerville MA 02632 6/23/20 page. 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: ❑ 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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form !- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Pine Tree Drive Property Address Monroy Owner information is Owner's Name required for every Centerville MA 02632 6/23/20 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 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: -P e 1 t6insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal SystemPage 3 of 6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Pine Tree Drive Property Address Monroy Owner� information is Owner's Name required for every Centerville MA 02632 6/23/20 page. Cityrrown 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 ❑ ® 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 p Y rY •u 54 Pine Tree Drive Property Address Monroy Owner Owner's Name information is required for every Centerville MA 02632 6/23/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 Y day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® 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. M' 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 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,. 54 Pine Tree Drive Property Address Monroy Owner information is Owner's Name required for every Centerville MA 02632 6/23/20 page. City[Town State Zip Code Date of Inspection 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"to any question 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 all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility.or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �o 54 Pine Tree Drive Property Address Monroy Owner information is Owner's Name required for every Centerville MA 02632 6/23/20 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Description: 1983 permit shows 2 bedroom, 2 chambers added in 1992 shows 2 bedroom Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: OccupiedDate t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts �v - ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Pine Tree Drive Property Address Monroy Owner information is Owner's Name required for every Centerville MA 02632 6/23/20 page. Cityrrown 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 ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Pumped spring 2017 per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Pine Tree Drive Property Address Monroy Owner information is Owner's Name required for every Centerville MA 02632 6/23/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known)and source of information: 1983 with 2 additional chmbers added 1992 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 2'6" Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10' p feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/2 61201 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts o� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Pine Tree Drive Property Address Monroy Owner information is Owner's Name required for every Centerville MA 02632 6/23/20 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 2' Depth below grade. feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) H-10 tank appears to be structurally sound, inlet cover raised to 10" of grade If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000g Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle >12" Scum thickness 1/2 Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3yrs to prolong the life of the system t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Pine Tree Drive Property Address Monroy Owner information is Owner's Name required for every Centerville MA 02632 6/23/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts re Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 54 Pine Tree Drive Property Address Monroy inform Owneration is Owner's Name required for every Centerville MA 02632 6/23/20 page. Citylrown 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 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 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.): H-10 D-box is 3' below grade, no adverse conditions observed t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 I Commonwealth of Massachusetts ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Pine Tree Drive Property Address Monroy Owner Owner's Name information is required for every Centerville MA 02632 6/23/20 page. 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: ❑ leaching pits number: ® leaching chambers number: 4 f t®S ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Pine Tree Drive Property Address Monroy Owner information is Owner's Name required for every Centerville MA 02632 6/23/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System(SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Flo diffusor chambers per BOH record, were video inspected, the old set from 1983 are in hydraulic failure, the new set of 2 have approximately 1"of effluent at this time with no indication of hydraulic failure, bottom of chambers approximately 4-5' below grade 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 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments v 54 Pine Tree Drive Property Address Monroy Owner Owner's Name information is required for every Centerville MA 02632 6/23/20 page. Citylrown 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.): I I , t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Pine Tree Drive Property Address Monroy Owner information is Owner's Name required for every Centerville MA 02632 6/23/20 page. Cityrrown 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: ® hand-sketch in the area below ❑ drawing attached separately iq�a �V duo ch�bFns rnrn G-C)(0 Y� t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 I • r Commonwealth of Massachusetts �. p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Pine Tree Drive Property Address Monroy Owner information is Owner's Name required for every Centerville MA 02632 6/23/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 9 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: n/a Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: 4'seperation per compliance on file at BOH ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping shows the site at 24'msl and nearby surface water at 15'msl You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Pine Tree Drive Property Address Monroy Owner information is Owners Name required for every Centerville MA 02632 6/23/20 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed& Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 it McKean, Thomas From: McKean, Thomas on behalf of Health Sent: Tuesday, August 25, 2020 9:45 AM To: melanie@mycapecodrealty.com'; Health Subject: RE: Question for Mr. Mckean on 54 Pine Tree Dr, Centerville Good Morning, NOTICE The disposal works construction permits were issued in 1983 and in 1992 for two(2) bedrooms maximum at this property (reference: DWCP#83-1100 and #92-239) . The septic system was originally designed for two bedrooms without any additional design capacity for a garbage grinder. All potential buyers should be notified that this is a two (2) bedroom dwelling without a garbage grinder. A third bedroom in the basement (without permits) is not authorized at this property; it will have to be removed. A building permit is required to remove the basement room properly. Also if a garbage grinder was added, it will have to be removed by a licensed plumber. A copy of this notice will be added to the file for this property. Sincerely, Thomas McKean From: melanie(&mycapecodrealty.com [ma i Ito:melanie@mycapecodrealty.com] Sent: Monday, August 24, 2020 10:18 PM To: Health Cc: Melanie Subject: Question for Mr. Mckean on 54 Pine Tree Dr, Centerville Mr. Mckeen, I received a septic inspection report for 54 Pine Tree Dr. in Centerville. (attached). I have questions about things that seem unusual in the report. 1- Are inspectors required to go in the house? Some information is wrong in the report. And it seems the inspector should have easily seen it. 2- Page 7 seems to have 2 mistakes: -# BR Design : 2 -#BR Actual: 3 There are only 2 BR in the house (on the main floor). Would you be counting the bedroom in the finished basement ? Even though it does not have an egress window? 1 If so, does it mean the septic does not have the right capacity for the # of actual bedrooms? How can it pass then? - GARBAGE GRINDER/DISPOSAL The report says there is no garbage grinder. But there is a garbage disposal in the kitchen. 3- Report says 2 out of 4 'flo diffusor chambers' are in Hydraulic failure: half of the system is failing. Ref. p.14 Section 11 SAS (cont.) notes. It looks to me like: -there is a system that is already under capacity for the actual number of bedrooms -half of that system is failing, but -the Title V inspection passed... How can this pass? Can the buyer be forced to upgrade it after closing because it does not have enough capacity? How is the finished basement factored in the bedroom count in this? What does the buyer need to expect? I want to make sure the buyer knows what is needed. I really appreciate your help. Please call me as early as you need Tuesday morning. The buyer needs decide what to do by Tuesday afternoon and we just got the copy of that report. Thank you, Melanie Cauchon i Melanie Cauchon, Broker/Owner My Cape Cod Realty - Melanie Cauchon Real Estate MA Broker License #9539385 Brewster, MA 02631 508-776-5378 Melanie(cbMyCapeCodRealty.com www.MyCapeCodRealty.com CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! 2 Town of Barnstable Barnstable r `MA ` Board of Health y MASS.S5. 039• 1.� " 200 Main Street, Hyannis MA 02601 20p7 Office: 508-8624644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi Public and Environmental Health Program Policies, Procedures, and Guidelines i Bedroom Definition and Bedroom Count No. 2010-01; During the disposal works construction permit and/or building permit application approval process, whenever the maximum number of allowable bedrooms is in question, some research is required to determine whether the site is located within a nitrogen sensitive area, to determine the number of bedrooms previously approved on the disposal works construction permit on file, and to determine the capacity of the system. It may also involve some additional research at the Building Division Office to determine whether any room additions were approved in the past. For a proposed addition or renovation, full house plans are required showing both the existing and proposed layout. When there is a discrepancy in the records, there may be a need to request an affidavit from the owner of the home clearly indicating the number of bedrooms in existence at the property before 1986 if located within a zone of contribution to public water supply wells (or before July 2008 if the property is located inside a Saltwater Estuary District only). Full house plans together with a properly written affidavit from an existing and/or previous property owner may be used to resolve an issue of the existing versus allowable number of bedrooms at a particular property. Bedroom Definition According to the State Environmental Code, Title V, a "bedroom" is a room providing privacy, intended primarily for sleeping and consisting of all of the following: (a) floor space of no less than 70 square feet (b) for new construction, a ceiling height of no less than TY (c) for existing houses, a ceiling height of no less than 7'0" (d) an electrical service and ventilation; and (e) at least one window. Q:Policies\Bedroom DefinitionandBedroomCount 3/9/2010 Living rooms, dining rooms, kitchens, halls, bathrooms, unfinished cellars, and unheated storage areas over garages are not considered bedrooms. A proposed finished room located on a separate floor and within a separate structure (e.g. over a detached garage, a finished attic, sleeping loft, a finished room within a bunkhouse) is presumed to be a "bedroom." Elimination of Privacy/Recording of Deed Restriction A minimum five (5) feet cased opening is required for new construction (or a minimum four feet opening is required for pre-existing construction where five feet is not possible for example due to existing width of hallway where subject doorway is located) without any doors to eliminate or reduce "privacy" to a room which would otherwise be considered as a "bedroom." No glass sliding doors, french doors, nor any other doors shall be installed within the five feet or four feet opening. The applicant may seek approval for a smaller number of bedrooms than are presumed in this definition by granting to the Approving Authority a deed restriction limiting the number of bedrooms to the smaller number. Wayne Miller,M.D. Junichi Sawayanagi Paul Canniff, DMD Q:Policies\Bedroom DefinifionandBedroomCount 3/9/2010 TOWN OF BARNSTABLE LOCATION 7.2e,vt� SEWAGE N��3� VILLAGE <�- Q,l/P-1 �~7l z- ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. \J--T7,4,-472 e S-:~ SEPTIC TANK CAPACITY LEACHING FACILITYAtype) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER L/ BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: G " VARIANCE GRANTED: Yes No .✓ .�� , � �n �ry �1 ;.�, �, �— . �� a� - /=/o w �eF�� .q T.. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH . TOWN OF BARNSTABLE OCYI�DlsCor ►tmoz1t � ; I Appliration for Disposal Works Ton � � - 7040 Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systan 4 .. ...... - .. :. - u1 .................................... ................ Location-Address (r or Lot No. ..... � �� ,^ Owner Address l W J-- ..... 1'1�.-•-------•-•...................................... `.?s!!i 4!_. ..... .'>g a Installer _ - � Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.... . .....................•......__.._..Expansion Attic ( ) Garbage Grinder aOther—Type of Building ............................ No. of persons----_....................... Showers ( ) — Cafeteria ( ) Other fixtures ------------------------ W Design Flow..../��..............................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity/'_gallons Length................ Width................ Diameter................ Depth................ x �4ispo�Aench—No..................... Width,.................. Total Length.................... Total leaching area....................sq. ft. OiA............... Diameter.4/X_f...... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0-4 W Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water......................... fTq Test Pit No. 2................minutes per inch Depth of Test Pit---:................ Depth to ground water........................ 9 ------------------------------------------------------------------------------------•••••-•••---•---......................................................... 0 Description of Soil........................................................................................................................................................................ Wx ------------------•----........•------•-••-----•.....--------•---........•-•------•--------...........•--------••••----......-••---•----••----......................................................... W ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••--_.... U Nature 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 TITLE 5 of the State Environmental Code—The undersi ne rther agrees not to place the system in operation until a Certificate of Compliance has b9qng d by of health. Signed ...... ................... Application Approved By --- .... y ------ . J Dare Application Disapproved for the following reasons- ----------- -------------------- ------ ---------------------------------------- -- ----------------------................... ------------------- -"----.......... ----...-------- ------- . . ..-------------- r Dare Permit No. ..-..✓. '� Issued ------i ce..... Dare Fimic THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ,.Z7' �J 11 Application for Disposallark, Toustrnr#tla�t Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System-at: - ..... / .......... ....................... ff//� Location-Address / or Lot No. ✓............ ----7 f Owner•--^--•--- •---------- '-----• ------ — ----------Address ----. --....•.... W 1 Installer Cl Address Type of Building Size Lot............................Sq. feet 1-1 Dwelling—No. of Bedrooms.....lecA................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building -_____-•--------•---_-_.---- No, of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures . W Design Flow.... ------------------------------gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity/� __gallons Length---------------- Width................ Diameter................ Depth................ x �Dispo%Trench—No..................... Width.................... Total Length-------------------- Total leaching area....................sq. ft. eepageiit Noc�•-__-•.____--- Diameter.y�? _•---- Depth below inlet_-••-•------------_ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water..._.................... (� Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water.......................- 0 a .--------••---------•••---••--•-------•-•-••-•••-----•-••---------------------------•----------•-------......----..._....._..----......-------•-•--••-------- Description of Soil---------------------------------------------------------------------------------•-------------••-----•-------•---- V W ------------------------ ----------------------------------------------------- •------------------------------------------------------------------------------------------------ .-------------------- V Nature 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b-en issued by the boa-rd of health. u Signed ------ ---------- ------ ' Date Application Approved BY -r ��-�-- •---ate �� ....... l � ...'' Date Application Disapproved for the following reasons- --------------------------------------------------------------------------------------- ---------------------------------------- -------------------- ------------------------------------------------------------------------------------------------------------------------- - ------------------------------------------ ---•-•--------•--------------------- Date Permit No. - - Issued -------- r -� "° te THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r TOWN-OF BARNSTABLE CZe>r#ifirak of (gomlattizinre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( U) by-------------!�1-- ---------- ------- at .---)1!--1"fi. -:L- - 1-taller.... "id�n -f".......-..--_................._-..--......._--.. has been installed in accordance with the provisions of TITLE 5 �f The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..� ............;?--P dated -_ /..-_dam-- . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------ ----- - -� Inspector -- { ---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE - N Disposal Works Tonstrudion Prrmft Permission is hereby granted -'' -•--------------------•---•----......-------•---•------.. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No.....t;,, .� z - .a I%.-) _ .1 !..-�..��-------------- s - �- �- �_..- o—r'—�p f- street as shown on the application for Disposal Works Construction Permit Nio, _2_ ated______ TBo�ardllof�xealth DATE ' :- .�_.....`'�' ------ FORM 3630E HOBBS&WARREN.INC..PUBLISHERS 6/16/2020 ShowAsbuilt(1700X2800) TOWN OF BARNSTABLE O LOCATION jF7i r2e n� SEWAGE p VILLAGE C'o•y f+..l ri , r ASSESSOR'S MAP 6r LOT 2- INSTALLER'S NAME 6 PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER C� BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED;_ G -$•�I'} VARIANCE GRANTED: Yes No_� a � 0 O https://itsqldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=188112&sq=1 1l1 "LOCATI,ON SEWAGE PERMIT NO. V I L L A C E ' INSTA.,II R'S AME i ADDRESS 8 U I L D E R OR OWNER DATE PERMIT ISSUED ,a DATE COMPLIANCE ISSUED - �a �--�, �� , V i � �. ��r � `'sue ,. � �' r �- �� , �� - -:�� -.� No �....11 .. Fss................"............... THE COMMONWEALTH OF MASSACHUSETTS R BOARD OF HEALTH .................. ........................OF..........................................................------................._...--- Ajip�iratiun for Diipuiittl Works Tunitrur#inn rrntit Application is hereby made for a P rmi to Construct ( ) or Repair ( ) an Individual Sewa a Disposal Systemat ..�.... ................ .....................1....#.r_�1`Z----•-----------•-------- --••.. L cation ddres or Lot No. ^c ', 1...G. 4.. .46Ca..........O._..-----=-•.......................... .. .......... .......................,..........== ...........:?: ..._..... ,q Owner d res ......,�ld-.�L.._.k,6.�................ ........ / .... ..-_.---..2..�., A---__-.._ ._... .. —ate Installer Address UType of Building / S'ize Lot....................tetF Dwelling—No. of Bedrooms. ......------•--._._.._._.Expansion Attic ( ) Garbage GPL4 Other—Type of Building No. of persons........................... Showers ( ) — Ca Q' Other fixtures ------------------------•------- . WDesign Flow............................................gallons per person per day. Total daily flow..__._._..-_.___----.._____...._.+:.......gallons. R; Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Dept? ----_----. W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area................_-. ft. x Seepage Pit No---------- ------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by........ ........................=........................................ Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R; ...................•--•--••---------•••-------•-------..............-------•.....--•---•-•--•----.....•_•_........------•--•---•---•---•-•....-----......... 0 Description of Soil........................................................................................................................................................................ V ................•--.....----.._..------...............---•-------.............__....--•.....................................------------------------------------------------------------- ----------- UW •-------------------....................................................................................... � ---•-----• ---•--. -----•-•-- Nature of Repairs or Alterat ns—Answer wh ` /S Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'i U 5 of the State Sanitary Code—: he undersigned further agrees not to place the system in operation until a Certificate of Compliance ha4 sued by the /board of health. ApplicationApproved Y. .... .. .............................................................. r--•---- --- .. ate Application Disapprov f o the following reasons:----••....................................•-•-------•--•------•----•----••--------------._...--••-----••-...---- ••---••••-----•---••----•--•....................•-----••-----........_--•--------•-•---••-......_..••---•.. Date PermitNo......................................................... Issued........................................................ Date No.p �.'!� FEs....�•"-_-0.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF......................................................... Appliratinn for Di,ipuual Works Tomitrnrtion Frratit Application is hereby made forj a� Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at :..�..... :'_"__. ............... )` L ation ddres �CT...Ins--f.-_ •-- _-- or Lot No. ...........d.� _...........•............... ........... ........... ................... Owner d re s -- ••• _..... U.._1.:. _ .�... 1i ....:........................................... �..... Installer Address U Type of Building Size Lot............................Sq. feet r a Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------•-•-•-------•-----------•--•--•--••-•-••...---•-•••-•--•-----•-•••------._...........---._..__....---•-•••..._-•_-•-•- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width........_----------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------------- ______ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 93L, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ••••-•-••-•---------•---•----•••--•••••--•-•------...•--------------••---•••........._...:----------........................................................ 0 Description of Soil........................................................................................................................................................................ x V ...-••---••---•••-•-•-••---••-•••----•-.._..•••--•--•-•----•-•••---•--•••-•----••--•--•--•.....----•---....-•-•---•--•--.....--•-•--••••-•------•--•---•-•--•----•.......................•- --__---- W •--••--------------------------------------••-••--••-----•--------------•--••--••••-•--•---•--•--•-•---•---•. �'" `" U Nature of Repairs or Alterations—Answer when applicable...A .__�" ............1. ._._.f.. .__.. .._�I........ ------------------------------------------•--•••--•-••-•--••--_---_.._.......---•••-......_. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLB 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has, ued by the board of health. ae Application Approved _. .....�f '_- '� ate Application Disapprov f o the following reasons-------------------------------•-----•-------•---------•-•----...--------------...•••-•-----•••---•-•-•----•--•- .......••--•---------•-•-•----•-•-•-•---•-•-•--•••••••-•-•-•••--•-•--•-----••-••-••-•-......----••------- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF................................................................................. Tnrtifirate of Tontpliaurr Tom. PTO ERT.� � , That the Individual Sewage Disposal System constructed ( or Repaired ( ) by ---•-_••• • �•- ' =_... .. -----------------------------------------------------------------------------------------------••------ `Z^- I. Installer E at.---•--�-/--'--•----/ail _ ,_. _-.�.,�._..-��((("'-""[[[-//%,�li�` -----------------•-----•----- has been installed in accordance with the provisions of TIF 5 of The State Sanitary Code d�e cxi�ed in the PP 1 �c ( ,e� a lication for Disposal Works Construction Permit No ______________ dated_./;r�_.ti_ _ ___..:..________..___.____ THE ISSUANCJE OF THIS CERTIFICATE SHALL NOT BE CONST AS A GUARANTEE THAT THE SYSTEM VIAL F -� TION SATISFACTORY. DATE...�--.�__-..Q....... Inspector • i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............O F.................................... �- No.. -••-_•:_.. f FEE........................ Diijro�ii tarm Toni#rndion "anti# Permission Is h y granted •- - to Construct. or Rej a ( ) £n'ndividual , .� e Disposal System atNo..---•------------- a::'.- .____�:(d, V'�------------------------------------------ ----------- Street .•�'` as shown on the application for Disposal Works Construction_Permit . o.................... Dated.......................................... •------...--•--••••--•--••---•-=__...•----•--•------••-•-•-••---•-•-•----•-••-•-•--•----•-•--•-•••-••- �li - __ -__ Board of Health , DATE--- y.> ..... , �r FORM 1255 A. M. SULK N. INC., BOSTON 6/16/2020 ShowAsbuilt(1653x2338) ?'L0CATION SE`WACE PERMIT NO. VILLAGE I N°S T,A L Ll R'S. M':E. i A.D'D:R?E S$ • R U.hLD`E.R OR OWNER DATE PERMIT ISS'UE:D i DATE COMPLIANCE ISSUED )�s �8 r Jl c https://itsqldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=188112&sq=2 1/1