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0047 SEA MEADOW CIRCLE - Health
47 SEA MEADOW CIRCLE Centerville A = 246 — 228 No. 42101/3 ORA ESSELTE 10% 0 0 0 0 Gf SHE Tkriftid Town of Barnstable Barnstable Regulatory Services Department ;e'caC j + BARN STABLE, 9� ``69. ,�� Public Health Division m ATED MAC A' 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO April 21, 2015 Joanne F. Goldstein 30 Mill Street Newton, MA 02459 RE: 47 Sea Meadow Circle, Centerville Dear Mrs. Goldstein: Attached is the front page of your septic inspection report from our files. It was done on 3/22/13 and shows it passed. If you decide you would like a copy of the full report, just send a check to us for $4.00 to cover the cost and we will be happy to sent it back to you. Sincere , Sharon Crocker Administrative Assistant J:\LETTERS\let 47 Sea Meadow Cir Cent Apr 2015.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Seameadow Circle Property Address i- Joan Maslow (t io J0Anne- Owner Owner's Name / information is required for every W• Hyannisport Ma 02672 Mar-22-13. page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way:Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information (� I on the computer,use only the tab 1. Inspector: J J key to move your cursor-do not Matthew Gilfoy use the return Name of Inspector key. B & B Excavation,lnc. � Company Name 14 Teaberry Lane Company Address Forestdale MA 02644 City/Town State Zip Code 508-477-0653 S 113640 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site .^ sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: Passes, ❑ Conditionally Passes ❑ Fails i :Needs Further Evaluation by the Local Approving Authority a : c �GL Mar-23-13 N Insp toes Signatur6 Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes 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. l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Town of Barnstable Barnstable Regulatory Services Department A "'"SS. i639. Public Health Division �1� m �Fp" 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7014 1200 0001 0358 0482 f February 24, 2015 Joanne F. Goldstein 30 Mill Street Newton, MA 02459 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 47 Sea Meadow Circle, Centerville, MA was last inspected on 3122/2013, by Matthew Gilfoy, a certified 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 5 (310 CMR 15.00) due to the following: • Septic tank needs repair or replacement. You are ordered to repair or replace the septic system components within two (2) years 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 OARD OF HEALTH cs. vy cs� o cKean, R.S., Agent of the Board of Health Q:\SEPTIC\Conditionally Passes Ltr\47 Sea Meadow Cir Cent Mar 2013.doc Parcel Detail , ; ,_17300 > C� issgl2/intr anet/prupdatgrp�,i celDet-1I spy,Is Apps http--www,town,barn Application center suggested Sites • Imported From IE r®Parcel Looku U;New Tab LVj'Bing,1 Video;5 Incredible Tin.".. S c 1ST p B;lhSi§&0 Parcel Info m . , Parcel ID 246-228 Developer Lot LOTS 12&12A Location 47 SEA MEADOW CIRC11 Pri Frontage Sec Road J sec Frontage Village CENTERVILLE Fire District C-O-MM I Town sewer exists atthis address No Road Index;2097 Asbuilt Septic Scan; X73 Interactive Map =I�r 4 y�" 2462281 ii ..Owneririfo •� _ - Y - P � _; �.-y Owner �GOLDSTEIN JOANNE F Co_' Owner Streetl F30 MILL STREET Street2 city NEWTON state MA J Zip 02469 Country i v land Info Acres 0.29 use Single Fam MDL-01 zoning RB N9hbd 0101 Topography Level Road Paved utilities Public Water,Gas,Sepilc Location _ f' ristruction Info I I N Year.nnn I Roof I Ext,h, start Q:ISEPTIC1Conditionaly Q��SEPTIC1Conditionally... Panel Detail G66 Ch 47 Sea Meadow Cir Cent �. �� Computer name : HEALTH899JF User name : flvnni Operatinq Svstem : Windows NT(5.1) Town of Barnstable Barnstable y . Regulatory Services Department AHnWcaCftv 1 I IAxNSPAESM 9MAR& ,m� Public Health Division a FDN `A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7012. 1010 0000 2850 7633 April 3., 2013 �°� Joan Maslow PO Box 607 West Hyannisport, MA 02672 ' Re: 47 Sea Meadow Circle ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 47 Sea Meadow Circle, Centerville, MA was last inspected on 3/22/2013, by Matthew Gilfoy, a certified 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 5 (310 CMR 15.00) due to the following: • Septic tank needs repair or replacement. You are ordered to repair or replace the septic system components within two (2) years 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 Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\conditionally passed\47 Sea Meadow Cir Cent Mar 2013.doc J https://tools.usps.com/go/TrackConfinnAction.action?tRef=fullpage&tLc=1&text28777=&tLabels=70121010000028507633 English Customer USPS Mobile Register/Sign In Service cuspscom Search USPS.com or Track Packac d Quick Tools Track Ship a Package Send Mail Manage Your Mail Shop Business Solutions Enter up to 10 Tracking A Find Find USPS Locations Buy Stamps �e�u Customer Service) Cal d t T ra c k i n g TM Have questions?We're here to help. Loo p I¢Co Hold Mail --- Change of Address 1 Tracking Number:70121010000028507633 { i Requested label is archived. Restore Archived Details> Product & Tracking Information Available Actions Postal Product: Features: Certified Mail" April 25,2013,10:59 LDelivered BOYNTON 33437 am - —` r Track Another Package What's your tracking(or receipt)number? i . .._.. ......._. Track It I LEGAL ON USPS.COM ON ABOUT.USPS.COM OTHER USPS SITES Privacy Policy> Government Services> About USPS Home) Business Customer Gateway) Terms of Use) Buy Stamps&Shop) Newsroom> Postal Inspectors> FOIA> Print a Label with Postage> USPS Service Alerts) Inspector General> No FEAR Act EEO Data, Customer Service, Forms&Publications, Postal Explorer> Delivering Solutions to the Last Mile> Careers> Site Index, OuSPSCOW j Copyright©2014 USPS.All Rights Reserved. ( https://tools.usps.com/go/TrackConfirmAction.action?tRef=fullpage&tLc=1&text28777=&tLabe1s=7012101000... 4/1/2014 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every Y p W. H annis ort Ma 02672 Mar-22-13, _ page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, I use only the tab 1. Inspector: key to move your cursor-do not Matthew Gllfoy use the return Name of Inspector key. B & B Excavation,lnc. - tC=11 Company Name 14 Teaberry Lane Company Address Forestdale - MA 02644 - City/Town State Zip Code 508-477-0653 S 113640 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience.in the proper function and maintenance of on site LU sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: 8�a -- .L; Passes ❑ Conditionally Passes ❑ Fails o �wNeeds Further Evaluation by the Local Approving Authority _ y r 4J; O N Mar-23-13 Insp tor's Signat a Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes 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. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts = W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every Y P W. H annis ort Ma 02672 Mar-22-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Leak test preformed on septic tank 2-28-14 with BOH agent. Tank passed test. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts = W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every W. H annis ort Ma 02672 Mar-22-13 - Y P page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N FIND (Explain below): ❑ obstruction is removed ❑ Y ❑ N FIND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety&the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts = W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °wM 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every W• Hyannisport Ma 02672 Mar-22-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/ day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every y p W. H annis ort Ma 02672 Mar-22-13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 0,000g pd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �^M 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every y W. H annisp ort Ma 02672 Mar-22-13 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ M Pumping information was provided by the owner, occupant, or Board of Health ❑ Z 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203.(for example: 110 gpd x#of bedrooms): 330 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every y p W. H annis ort Ma 02672 Mar-22-13 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: 2011-202 gpd 2012-208 gpd Sump pump? ❑ Yes ® No Last date of occupancy: 1-20-2013Date 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 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every y p W. H annis ort Ma 02672 Mar-22-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every y p W H annis ort Ma 02672 Mar-22-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1988 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20feet Comments(on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in working order no sign of leakage or blockage. Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ® No Dimensions: 1000 gal Sludge depth: 4" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every y p W. H annis ort Ma 02672 Mar-22-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" 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 15" How were dimensions determined? scour stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank tested with BOH agent 2-28-14. Tank not in need of pump at this time. Tees in place with no signs of back up. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal 0 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every y p W. H annis ort Ma 02672 Mar-22-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every y p W. H annis ort Ma 02672 Mar-22-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At time of inspection d-box appears to be in good condition. 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.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c�M 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every y p W. H annis ort Ma 02672 Mar-22-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3-flow dill. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching appears to be in working condition. No sign of hydraulic failure 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every W. Hyannisport Ma 02672 Mar-22-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 C6'mnrn.onwea th of Massachusetts Tiftte 5 official l'nspection Form Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments M - Seamead,owCircle Prope,rt Address Joan Maslow Owner Owner's Name information is required for.every W Hyannisport Ma 02672 Mar 22 13 page. City/Town State Zip-Code Date of Inspection D. System, 'Informati:on (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at lleast two permanent reference landmarks or benchmarks. Locate,all wells within 1004eet. Locate ..Where public water supply enters the building. Check one of the boxes below: hand=sketch-in the=area below drawing attached separately X. 0 O A 3 A 3�' f3 . 23' 132 25 3 t5ins,1 vio Title 5 Official Inspection Form:Subsurface Sewage Disposal`System-:Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every y p W. H annis ort Ma 02672 Mar-22-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 7 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: sept-11-87 Date ❑ 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: Taken from plan dated sept-11-87 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts • W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M e' 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every y P W. H annis ort Ma 02672 Mar-22-13 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Postal fT1 (Domlestic Mail Oilly;No In-surance Coverage Provided) For m information visit our website at � F F . O Ln CO Postage $ ti O Certified Fee o) O Return Receipt Fee i Post O (Endorsement Required) Here N O Restricted Delivery Fee tT j O (Endorsement Required) t r-q O Total Postage&Fees L Q H ru to r Joan Maslow PO Box 607 West Hyannis Port, MA 02672 Certified Mail Provides: .y ' ■ A mailing receipt r , ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Maile or Priority Maile. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized a gent.Advise the clerk or mark the mailpiece with the endorsement"Restricted�eiivery'. r If a postmark on the Certified Mail receipt is desired,please present the arti- ' cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 II i SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS . . ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery Is desired. • � ❑Agent ■ Print your name and address on the reverse Yb ❑Addressee so that we can return the card to you. B. 9eceived by(Printed Name) C4D %Deli ry■ Attach this card to the back of the mailpiece, ��or on the front If space permits. D. Is delivery address differentfrom item 1 Yen 1. Article Addressed to: If YES,enter delivery address below: ❑No I M j``Joan Maslow I �-1?0 BOX-607 ' 3. Service T e I West Hyannis Port, MA 02672 1 ❑certified Mail ❑Express Mail ❑Registered ❑Retum Receipt for Merchandise - -- j ❑Insured Mail O co.D. I 4. Restricted Delivery?(Extra Fee) ❑Y 2.Article Number F 7012 101D 0000 2850 7633 (mnsf�rirom service label I PS Form 3811',Fepruary 2004 Domestic Return Receipt 102595.02-M4540 UNITED STATES POSTAL SERVICE First-Class Mail Pbstage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • I I' I Town of Barnstable w I� Public Health Division;, I 200 Main Street : i 71" Hyannis,,.MA 02601-'�- I I I II 11� � I �rlll Iliill I11 lli �t I � 1� t a i , I r Town of Barnstable Barnstable l Regulatory Services Department ABASMSTABM y 9 ,m� Public Health Division • f01A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7012 1010 0000 2850 7633 April 3, 2013 Joan Maslow PO Box 607 West Hyannisport, MA 02672 Re: 47 Sea Meadow Circle ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 47 Sea Meadow Circle, Centerville, MA was last • inspected on 3/22/2013, by Matthew Gilfoy, a certified 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 5 (310 CMR 15.00) due to the following: • Septic tank needs repair or replacement. You are ordered to repair or replace the septic system components within two (2) years 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 Thomas McKean, R.S., CHO . Agent of the Board of Health • Q:\SEPTIC\conditionally passed\47 Sea Meadow Cir Cent Mar 2013.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=17309 0� YME 1� p Alit Logged In As: Parcel Detail Monday,April 1 2013 Parcel Lookuo Parcel Info Parcel ID j246-228 —) Developer Loot LOTS 12& 12A Location 47 SEA MEADOW CIRCLE ) Pri Frontage Sec Road I Sec Frontage Village CENTERVILLE _ �I Fire District C-O-MM I Town sewer exists at this address No ( Road Index 12097 Interactive Map 'Ar7 Owner Info_ Owner MASLOW,JOAN ( �Co-Owner Streetl[P O BOX 607 ) Street2} I City WEST HYANNISPORT �) State MA zip 102672 Country Land Info Acres 0.29 I use Single Fam MDL-01 ) zoning[RB7 Nghbd 10107 Topography!Level I Road P va e Utilities IPublic Water,Gas,Septic Location Construction Info Building 1 of 1 Year 1992 _I Roof G(Gable/Hip wall Wood Shingle I Ext Built Struct Living 2106 Roof Asph/F GIs/Cmp Central Area_ Cover TypeAC style Modontempt ern/C VVali Plastered I Rooms 3 Bedrooms I s :_ Model Residential I Carpet I Rooms Full Floor Type Rooms - a Grade Average Plus I Hot Alr�� t �5 Rooms t Heat 8 Stories I12 Stories Fuel lGas F ation Poured Conc. h Gross 4460 Area Permit History http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=17309 4/1/2013 ���� �' � �-e�l.�c.���� VIxf Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is �/� II� - Ma 02672 Mar -13 required 9ered for every. - State Zip Code Date of inspection -CI /Town. ..... . I (U G2�....... Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end.of the form. Important:When A. General Information filling out forms on the computer, - - use only the tab 1. Inspector: key to move your cursor-do not... Matthew Gilfoy use the return:key. Name of Inspector B & B Excavation,lnc. . .... r� Company Name 14 Teaberry Lane . Company Address .j Forestdale MA :. 02644.::: . City/Town State Zip Code 508-477-0653 S113640 Telephone Number License.Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the:inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on eRe sewage disposal systems. I am .a.DEP approved system inspector pursuant(Rdection t,, 340 Title 5(310 CMR 15.000). The system: 6 ❑ Passes__ I Conditional) � Y Passes ❑ F cn y. Needs Further Evaluation by the Local Approving Authority Mar-23-13 Inspect VS Signature. Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the.system owner shall submit the.. report to the appropriate regional office of the DEP. The original should be sent to the system owner ..and copies sent to.the buyer,-if-applicable, and the approving authority..... ""This report only describes 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. �71zv l5ins•11/10 Title 5 Official Inspectio or Subsurface Sewage Disposal System•.Page 1 of 17 'Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is W. Hyannis ort Ma 02672 Mar-22-13 required for every y p page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ® One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ® Y ❑ N ❑ ND (Explain below): Upon inspection water level was below invert of outlet pipe indicating the tanks is leaking. The tank will need to be replace to for a passing report to be issued per Barnstable BOH. The system is also not designed to handle a grabage grinder and that must be removed also. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every Y P W. H annis ort Ma 02672 Mar-22-13 _ page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public,health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 i Commonwealth of Massachusetts u W Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every Y P W. Fl annis ort Ma 02672 Mar-22-13 _ page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than'/ day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every W. H annis ort Ma 02672 Mar-22-13 - Y P page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I COMMohwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form: Not for Voluntary Assessments 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every.. W. Hyannisport Ma 02672 Mar-22-13 page. City/Town::. State Zip Code Date of Inspection I C. Checklist a. Check if:the following have been done..You must indicate"yes" or"no" as to each of the following: Yes No _. ® Pumping information was provided by the owner, occupant, or Board of Health ❑ N 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 thesystem: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)] D. System.Information Residential Flow Conditions: Number of bedrooms(design):: 3. . -- Number of bedrooms(actual); 3 DESIGN flow based on 310 CMR 15.203.(for example: 110 gpd x#of bedrooms). - 330 t5ins•11/10:_ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•.Page 6 of 17 i Commonwealth of Massachusetts rz Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every y p W. H annis ort Ma 02672 Mar-22-13 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: 2011-202 gpd 2012-208 gpd Sump pump? ❑ Yes ® No Last date of occupancy: 1-20-2013Date 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 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every W. Hyannisport Ma 02672 Mar-22-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every y p W. H annis ort Ma 02672 Mar-22-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1988 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1'6" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in working order no sign of leakage or blockage. Septic Tank(locate on site plan): ' Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ® No Dimensions: 100 gal 411 Sludge depth: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every W. Hyannisport Ma 02672 Mar-22-13 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle n/a Scum thickness V. Distance from top of scum to top of outlet tee or baffle n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a How were dimensions determined? scour stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank was leaking with a low water level, as a result it was not possible to take proper measurements to tees. 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every y p W. H annis ort Ma 02672 Mar-22-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every y p W. H annis ort Ma 02672 Mar-22-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At time of inspection d-box appears to be in good condition. 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.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every Y P W. H annis ort Ma 02672 Mar-22-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3-flow dill. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching appears to be in working condition. No sign of hydraulic failure 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 c < Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every y p W. H annis ort Ma 02672 Mar-22-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Coxnmohwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every y p W. H annis ort Ma 02672 Mar-22-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 AI Al - 23' C 3 y A 3. 30' A H " 371 61- 23 62 25' 3° t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commohwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every y p W. H annis ort Ma 02672 Mar-22-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 7 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: sept-11-87 Date ❑ 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: Taken from plan dated sept-11-87 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r — I . Commohwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 47 Seameadow Circle Property Address Joan Maslow Owner Owner's Name information is required for every y p W. H annis ort Ma 02672 Mar-22-13 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 �_ . �/ � Spa, mc�4�,� I c� Cs�' I _ ��_ _- I 0 ,' _ �. V� c�i��� �� `�' yG`-' � - Page 1 of 1 I r i • T%. https:Hne 1-attach.ymail.com/us.fl 207.mail.yahoo.com/ya/securedownload?mid=2_0_0_1_... 2/24/2014 Lv �� TOWN OF BARNSTABLE LOCATION �' Se4a+e�G�vi �rrl� SEWAGE # VILLAGE Ca,r �,. `�• ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. JC4n SEPTIC TANK CAPACITY LEACHING FACILITY:(type) rlo (size) A9 X 30 NO. OF BEDROOMS ;3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER y.,�. � 1vv�'7~ �Pe�/T� �� s/- DATE PERMIT ISSUED: 3 `f DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �/ �- M Q\��M1\.� a v t�1 30� �'� �` o��� f/ � I , - / ! w T1.00 N �� c��- Z, ".�"�- Fims.......................... i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH da......... .... ......................0 F.. .Pt C�(a.--......... Appliratinn for Dispniitti Workii Tonstrn.rtiun ranfit Application is hereby made for a Permit to Construct ()Q or Repair ( ) an Individual Sewage Disposal System at K!9& �COS 1� L cation-A es rt No. • - -............................... , o -----...... •------ Owner Addressa."a. T....................................................... ?...._..... ........-•-•-•--•--••-------•---•--•....•. --•••-----•.•••_. .....Installer Address Type of Building `' Size Lot_ �,}_4�_........Sq. f t Dwelling—No. of Bedrooms..........................................Expansion Attic (NCD Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ............................ . W Design Flow.............5......................gallons per person er day. Total daily flow........... ......................gallons. WSeptic Tank—Liquid capacity gallons Length__ " ?_.. Width_ _9.Q. Diameter"" .._._. De ths5- x Disposal Trench—No.......'�........... Width..... 3=....... Total Length....a ....... Total leaching area.2.61(P.....sq. ft. Seepage Pit No..............£../..... Diameter.................... Deptl-i below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box lid Dosing tank ( � f '-' Percolation Test Results Performed by.... KL_ ...-Y 5. 1 _� Ce.............. Date_.T°.! 5� Test Pit No. 1....4 -_-minutes per inch Depth of Test Pit-__--Lt........... Depth to ground water.....1_A............... (i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water............_ll.•---_-. a --------------------------------------------------•--- •. •• ••-•--. 0 1 .L®aW. -_�U6S01 L..--• t-1 .lit E� TD....� Description of Soil-------�-'�'.......................�------•------ -- -•--•-•-----------------•---•-•------ U -----=-------------------- •------------------------------------------- •----------- ._..•------------------------------------------------------------------------------------ •--------------- ---------------- ----•----------------------------------------------------•------------------------------------------------------------------------------------------------------------------••......•••••.....-----..... U Nature of Repairs or Alterations—Answer when applicable..........DESIGNING..ENG M�J$T-•$)PERVISE_. _. -- _. � ____________INSTALLATION•AND-CERTIFY IN Agreement: THE SYSTEM WAS INSTALLED IN STRICT The undersigned agrees to install the aforedescribed IndivikQP9"VmTQR"em in accordance with the provisions of TITiZi 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be I su by the board of health. Signed ._. C. 1: .. s �? .... ---- --------------•... ---..... Application Approved By _.... ....................................... .._ ..... - /� ........-• Date Application Disapproved for the following reasons:................................................................................................................ ....................•------.....---•--------•---•-------------------------------------............-•-•--.--••-•-••-•........---------•--••---•-•--•--••--••-----•-•-•-••--•-••••-•-•---••---..._•-----•. --..... _ Dam 3 —�""�' � r s -------- THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH ........`...`. ..t...................OF. % t� ..� 4- �... it'?Cr ._.............._........ Apphration for Disposal Works Tonstrurtion ramit Application is hereby made for a Permit to Construct ('>Q or Repair ( ) an Individual Sewage Disposal System at: t .....�.~'.^d.��.:._.... .... �, u.4. ....... ..............•--• t..� ...—.—.. •__.........................-•--•-....... Location-Address or Lot No. ......-•..........................................•--•------•--................................... ..........-•..................................................................................... Owner Address W Installer Address Type of Building Size Lot.. _ . '.�....... Sq. Beet d :...:...:... Dwelling—No. of Bed ... Attic ( Garbage Grinder ( () Other—T e of Building No. of persons............................ Showers — Cafeteria P4Other fi?Sjures ••--•---------- ----•••---•-••------•--•-•--.........._.........---•-.•-- Design Flow........... .........................gallons per person per day. Total daily flow....... �......................gallons. 0� Septic Tank—Liquid capacity�'-19.gallons Length.6.-AE ... Width A.-«O.. Diameter: ........ Depth,.S�-2 s.. Disposal Trench—No....... .........•.. Width...... ....... Total Length...... ` ........ Total leaching area.IV��6_p_._...sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box Vrz� ' Dosing tank (? _ 0" Percolation Test Results_ Performed by...._-:.�:�. ..__ +, :a:1. +'._.................... Date........... .'..._.........-_.......... a Test Pit No. I... ...minutes per inch Depth of Test Pit----- �............ Depth to ground water....A_l________________ G Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ , a -------------=------------------------•-••--------••-------•---......yy........................._.�.y--•----..../..�...--------........ ---i•---------- • . _- .k':>h."r'\ r �sJ t',) C�r . i 1 1 .... ..'v� ..t i .....s✓r1 R:,"�:�.... . F�-i�...� �. f Description of So>.1------`--_--•-----------------------------=•-••-•------.....-•--•----•---._...--------•--------------•-------•-------------- ---•-•--•---- ...._._ .......... x MW ---------- ----------------------- -------- --------------------------------------------.._..... ------------......_....--------------------------------------------------------------- -----•----•--•--------------•----•••------•--------•-----•---•-•--•---------•--------------•------•----•-----------••....-----••--•--------------•----••••-•...••------------------------------•-------- 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n su d by the board of health. Signed..... . .............. -------- ................................3•_ �5.1 Date Application Approved By..........---- ...........---..-::~-:..... _ _ ------•------------- 2 -�-------------- Date Application Disapproved for the following reasons------------------------•--------------------•----------•---•------------------------------.........._.._........ .................................................................................•--.................----....................--------------------------------------------------------------•-•-....------ �_.-. Date Permit No..............Q;b...C t`- .. Issued....•.. .I �- Dat6 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tn#ifiratr of Toutplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by-••------••---•--------------------------------------------•-------•-•-----•-------•••------------------------•---••--•---------------•-----------------------------••----------------------------- Installer at...................---------------------------••--•------------._------•-------------------•--------- has been installed in accordance with the provisions of TITIE 5 of The State Sanitaryo a as described in the application for Disposal Works Construction Permit No._.. __ dated.__.___ ._�lS��................... PP P J-� ---5K THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................... a .....................W.to............................................ Z 1T(o /2 -26 THE COMMONWEALTH OF MASSACHUSETTS y` BOARD OF HEALTH � ...........................................OF..................................................................................... - FEE ............. Disposal Works T.5nns#r'trtim anti# Permissionis hereby granted....................................•------•--.---------------•...._..•-------.......--------------------------------........._............_.. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Street as shown on the application for Disposal Works Construction Permit NO :_=`�_��_ Dated_.__ / _�_mod.................... __._`"-Board of Health DATE------------------------------------------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS r 1 4F-ET t'�Iw GA28A.CoE. . .62ZI l.!^:Eta �-~ x It 3?o Gt = S L Sit E E ZlZ. t5�'t'lC � •r�.dtC .4 330 lx tSo� • �4�. GPa �2- .. .;..'. . . : . vs ' . (000 .C=Iki - .U�iE :�- �LW/ t]1FF1K50�S \ 1�/ 1� V 1��L( A.2t_A. 'la Sle G.P.D. SF. 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