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Home My WebLink About0331 STRAWBERRY HILL ROAD - Health 331 STRAWBERRYHILL, CENTERVILLE A=248-300 UPC 12534 ' No.2�153,OR � HASTINGS,MN I c Commonwealth of Massachusetts Title 5 Official Inspection Form �= Subsurface Sewage Disposal System Form - Not for Voluntary Assessments < � 331 Strawberry Hill Road Property Address Brandon Robert Decoste Owner Owner's Name information is required for every Centerville ✓ MA 02632 04/01/2021 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. Imngoutforms A. Inspector Information 5�,� �5310 filling out forms on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road Company Address Teaticket Ma. 02536 Citylrown State Zip Code 508-280-3356 S13938 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 04/02/2021 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The 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 Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts m - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �n 331 Strawberry Hill Road Property Address Brandon Robert Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 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: This 3 bedroom home has an H-10 1000 gallon septic tank with an H-10 D-Box feeding (4) Hi Cap Infiltrators. At the time of the inspection no visible failure criteria was found. 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 c Commonwealth of Massachusetts p Title 5 Official Inspection Fora, p Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 0 331 Strawberry Hill Road Property Address Brandon Robert Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 331 Strawberry Hill Road Property Address Brandon Robert Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® 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 c Commonwealth of Massachusetts M1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 331 Strawberry Hill Road Property Address Brandon Robert Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 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 '/2 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. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 c Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments, 331 Strawberry Hill Road u- Property Address Brandon Robert Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 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 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments In 331 Strawberry Hill Road V� Property Address Brandon Robert Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 plus GPD Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Doe residence s have a water treatment unit. El 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 ears usage d town water 9 ( Y 9 (gP ))� Detail: In 2020-72,000 gallons were used and in 2019-66,000 gallons were used. Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 C Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ............c� / 331 Strawberry Hill Road Property Address Brandon Robert Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. Citylrown 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: 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 c Commonwealth of Massachusetts Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 331 Strawberry Hill Road Property Address Brandon Robert Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. City/Town 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: New Leaching 9/11/1998 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 15"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flushed and came freely. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 331 Strawberry Hill Road Property Address Brandon Robert Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 6„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: H-10 1000 gallon 1„ Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 35" Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the baffle was in place. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Fora' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments /n 331 Strawberry Hill Road Property Address Brandon Robert Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. Citylrown 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 331 Strawberry Hill Road Property Address Brandon Robert Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. Cityfrown 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" 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 the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 I c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 331 Strawberry Hill Road Property Address Brandon Robert Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. Cityrrown 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: ❑ leaching galleries number: ® leaching trenches number, length: (1) 30'x11'x2'w/4 infiltrators ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V � 331 Strawberry Hill Road Property Address Brandon Robert Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. CityfTown 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.): At the time of the inspection no visible failure criteria was found. 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 Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 9 P Y rY c 331 Strawberry Hill Road Property Address Brandon Robert Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. CityrTown 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 331 Strawberry Hill Road Property Address Brandon Robert Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately r f � DL t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 331 Strawberry Hill Road Property Address Brandon Robert Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 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: 11 plus feetfeet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting 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: I augered a hole at a lower elevation and shot it with a transit to show 4 plus feet of seperation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/2 612 0 1 8 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 331 Strawberry Hill Road u Property Address Brandon Robert Decoste Owner Owner's Name information is required for every Centerville MA 02632 _04/01/2021 page. City/Town 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 Z 203 4,99 061 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not qW f r International Mail See reverse re t i Z Postage Certified Fee Special Delivery Fee Restricted Delivery Fee LO Return Receipt Showing to Whom&Date Delivered Return Receipt Showing to Whom, Date,&Addressee's Address 0 TOTAL Postage&Fees M Postmark or Date ti a i Stick postage stamps to article to cover First-Class postage,certified mall fee,and charges for any selected optional services(See front). I 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). ai 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Q) cc return address of the article,date,detach,and retain the receipt,and mail the article. U) 3. If you want a return receipt,write the certified mail number and your name and address rn j on a return receipt card,Form 3811,and attach it to the front of the article by means of the i gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article 'a I RETURN RECEIPT REQUESTED adjacent to the number. Q I 4. If you want delivery restricted to the addressee, or to an authorized agent of the O O addressee,endorse RESTRICTED DELIVERY on the front of the article. M 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. ti 6. Save this receipt and present it if you make an inquiry. 102595-97-6-0145 a FINE„p Town of Barnstable BA STABLE : Department of Health, Safety, and Environmental Services '"ASM& Public Health Division A'f01A0�� P.O. Box 534, Hyannis MA 02601 Office: 508-8624644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health August 25, 1998 Alfred &Newell Bleau 28 Peach Tree Road Marstons Mills, MA 02648 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE, AND 105 CMR 410.00 STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property owned by you located at 331 Strawberry Hill Road, listed as Parcel 300 on Assessor's Map 248 was inspected on August 24, 1998, by Jerome Dunning, Health Inspector for the Town of Barnstable, because of a complaint. The following violation of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code II -Minimum Standards of Fitness for Human Habitation was observed: REGULATION 310 CMR 15.02 (207) AND 105 CMR 410 300• Overflowing sewage onto the ground. This violation is a serious public health hazard. 1) You are directed to hire a licensed septage hauler to pump the overflowing cesspool within twenty-four(24) hours of receipt of this letter. 2) You are also directed to keep the on-site sewage disposal system pumped as many times as necessary to keep from overflowing onto the ground. 3) You are further directed to contact and hire a licensed Disposal Works Installer within seven (7) days of receipt of this letter in order to repair this system or connect to town sewer. You may request a hearing before the Board of Health if written petition requesting same is received within seven (7) days after the date the order is served. Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH T c ean Director of Public Health NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THS STATE ENVIRONMENTAL CODE TITLE V• MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE AND 105 CMR 410.00 STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property owned by you located at S`t ,rP,e,.►,,, �,�� listed as ParcelAgg on Assessor's Map 3&o, was .inspect on R, _a�j cpfr , 199 , by DL, -vivf,v/ & , Health Inspector for the Town of Barnsta le because of a complaint. The following violations of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code II - Minimum Standards of Fitness for Human Habitation were observed: REGULATION 310 CMR 15.02 (207) AND 105 CMR 410.300: Overflowing sewage onto the ground. This violation is a serious public health hazard. 1) You are directed to hire a licensed septage hauler to pump the overflowing cesspool within twenty-four (24) hours of receipt of this letter. 2) You . are also directed to keep the on-site sewage disposal system pumped as many times as necessary to keep from overflowing onto the ground. 3) You are further directed to contact and hire a licensed Disposal Works Installer within seven (7) days of receipt of this letter in order to repair the system. You may request a hearing before the Board of Health if written petition requesting same is received within seven (7) days after the date the order is served. Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health PAR ] Real Estate System - General Property Inquiry] Help [ ] I Parcel Id: 248 300- - Account No: 156761 Parent : Location: 331 STRAWBERRY HILL RD �� Neighborhood: 55DC Fire Dist : CO Devel Lot : 4 -71) Lot Size : . 27 Acres Current Own: BLEAU, ALFRED A & NEWELL, B State Class : 101 & MORSE, RICHARD P JR No. Bldgs : 1 Area: 1152i 28 PEACH TREE DR Year Added: MARSTONS MILLS MA 2648 Deed Date : 030193 Reference : 8492/100 January 1st : BLEAU, ALFRED A & NEWELL, B Deed MMDD: 0393 Deed Ref : 8492/100 Comments : Values : Land: 25600 Buildings : 53400 Extra Features : Road System: 331 Index: 1546 (STRAWBERRY HILL ROAD ) Frntg: 125 Index: 1819 (WEST VIEW LANE ) Frntg: 75 Control Info: Last Auto Upd: 050695 Status : C Last TACS Update : 081693 Land Reviewed By: Date: 0000 Bldgs Reviewed By: Date : 0000 Tax Title : Account : Taken: Account Status : Hold Status : ' Cancel [ ] Press XMT for more data Next screen [QAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name [ ] Parcel Number [248] [301] [ ] [ ] [ ] TOWN OF BARNNSTABLE LOCATION 3 3 15 _QL,ta y� ��\�, SEWAGE # 60 VILLAGE CE O ASSESSOR'S MAP & LOT 9 Y2,3,Oo INSTALLER'S NAME&PHONE NO. ILA SEPTIC TANK CAPACITY AIL LEACHING FACILITY: (type) �� T (size) Sz))d«r'3 NO. OF BEDROOMS YBUILDER OR OWNER &C-S PERMITDATE: 1B CQMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ro i; SENDER: v ■Complete items 1 and/or 2 for additional services. I also wish to receive the a� ■Complete items 3,4a,and 4b. following services(for an' ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. a'► ■A acc this form to the front of the mailpiece,or on the back if space does not �. ❑ Addressee's Address permit. � $ ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N ■The Return Receipt will show to whom the article was delivered and the date .. + e delivered. Consult postmaster for fee. ° I 0 3.A 'cl ddres d to: 4a.Article Number o 4b.Service Type o r° �O'D ❑ Registered Certified cc ❑ Express Mail ❑ Insured cl ❑ Return Receipt for Merchandise ❑ COD ` a J 7.Date of Delivery Z - LONVL142.. ,8 0 n 5.Received 0 y: (P me) 8.Addressee's Address(Only if requested and fee is paid)cc t g 6.Signature:(Addressee or Agent) ~ H X PS Form 3811, Decbmber:iss4 ` 102595-97-s-0179 Domestic Return Receipt UNITED STATES POSTAL SERVICE First-Class Mail I Postage&Fees Paid I LISPS Permit No.G-10 • Print your name, address,and ZIP Code in this box• I ,b. Public Health Divislon down of Bamstable I e I.O.BOX534 fiyannisr Massachusetts 02601 I P No. / Fee " THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Y Zipprtcation for �Oi5pooal *p5tem Construction 3permit Application for a Permit to Construct( )Repair( )Upgrade( Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. —31 1 AA— cn Owner's Name,Address and Tel.No. Assessor's Map/Parcel Z LlZi 00 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. a-6 .sue � Type of Building: Dwelling No.of Bedrooms --3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3-30 gallons per day. Calculated daily flow �� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank uy�__t( Type of S.A.S. �yn CTX�t A L— Description of Soil " S Nature of Repairs or Alterations(Answer when applicable) `mow �l--'r v�`r y 2� w c�\_ c�` SCCl�g ��►-� St,`�J �-��►q c�i�--o�ae Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions >thi e vironmental Cod nd not to place the system in operation until a Certifi- cate of Compliance ha en issued Health. G� Signed Date 8 Application Approved by Date 9_ Z Application Disapproved for the following reasons Permit No. Date Issued Z 1 E �7 i 'I TOWN OF BARNSTABLE j LOCATION 33 1 S T,ram. ,C ✓d• k�`6? SEWAGE # IS> --5-60 VILLAG ASSESSOR'S MAP & LOT - e INSTALLER'S NAME&PHONE NO. <TA( 0 —( &� 9`p SEPTIC TANK CAPACITY LEACHING FACII.ITY: (type) t��t_`. 1 � (size) ��'��'� NO. OF BEDROOMS BUILDER OR OWNER \e. PERMTTDATE: 5 -19 X15 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any.wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist _ - No. / 0 Z 0 .. ..,». Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(pprtcation for Migpogar *p.5tem Construction 3permit Application fora Permit to Construct( )Repair( )Upgrade(�Abandon( ) O Complete System O Individual Components Location Address or Lot No.c373-1 5-1 `��`' '�'�HUM Owner's Name,Address and Tel.No. Assessor's Map/Parcel ZL1 � Oc7 ` Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. V1A iIQ,-CYO Type of Building: Dwelling No.of Bedrooms '3 Lot Size sq. ft. _G_arbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �3 a0 gallons per day. Calculated daily flow -31_� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. ,�/� ,tl Description of Soil �L\ 1 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure'the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions tle 5 of the vironmental Cod nd not to place the system in operation until a Certifi- cate of Compliance has�bee issued by thi of Health. Signed Date 8 IC/ Application Approved by Date Z Application Disapproved for the following reasons Permit No. 'h` Date Issued t� 2 --------------------- - ----------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance ` THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by 11'4o-- S�� ; y at 5Z 91\(AJ IE C0 GLN-fG V0119as been cons tru d in ccordance with the provisions of Title 5 and the for Disposal System Construction Permit No. S79 0 dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date ! - Inspector ---(j—'----------------------------------- No. 90 T / Fee JV# --•► THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS Miopogar *p!tem Construction J)ermtt Permission is hereby granted to Construct( )Repair( )Upgrade( A_4 Aban [on,( ) System located at `31 `l c(�*�-' v f , 1 a a / � and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Con =ction must be completed within three years of the date of this t. Date: 1? /0� Approved by , 1 10/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) , hereby certify that the application for disposal works construction permit signed by me dated Q�8 `�� , concerning the property located at -33 N 5T itctj try `\ meets all of the following criteria: ere are no wetlands located within 100 feet of the proposed leaching facility There are no private wells within 150 feet of the proposed septic system ere is no increase in flow and/or change in use proposed • ere are no variances requested or needed. If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will=be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) 0` B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED: DATE: k6* LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cert I �c - 1 0 v t V, * �►► E . SN o ,. a • " Y-Ye. .a,.yn... w�s 4 1 1 I-OCnATtoN . H YAN N Mi • ' 1 j CECjT1 FY TYI E HoW N AS L O-r arV r�l5 PG4�1 Corr�r'�-y5 aV'�r� T/�� ow A P+.Atl .�� 5 .�..��t � ZGAJIA4 6,4W.5 0/= . T74t+ A�J� u1 t-[►1 t 13a'f"Z;D �/ta f7A i r. u1� sv erne �'t a k V- " PAVL L FQ to Ar,, ell 7 Z, J No.. — Fxs.....,/..� .. THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH Apphration -for Dis,poiittl Workii Tutu trurtion PProiit Application is herebymade for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........... -----<� ------------------- � 1 " ` ^r - ocation-A ess or Lot N e her Address a .. Install Address U Type of Building U Size Lot... 11, 7 4...Sq. feet Dwelling—No. of Bedrooms._ _ --___________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building No. of persons____________________________ Showers ( ) — Cafeteria ( ) dOther fi_ gs ..... ---•----- ------•--• -------------------------------------------------------------•---••-------------.---•--••--------------•-----•--••------- W Design Flow-------.---- ......................gallons per person per day. Total daily flow---fir?_-_________________.._._.-gallons. WSeptic Tank—Liquid capacity-_1 allons Length................ Width................ Diameter................ Depth.--.-____._.... x Disposal Trench—Ng.__.... VVidtll___-__ Total Length.................... Total leaching area____.____-_-.------.sq. ft. Seepage Pit No....__!....... Diameter .._._ 13epth belo inlet.......... ....... Total leaching area-._.-_-___-------sq. ft. z Other Distribution box ( ) Dosing tank ( ) d;`- — F-2 /` 7,1— aPercolation Test Results Performed by---------------------------------------------------------................ Date----•-•-----------••----------------.... Test Pit No. 1________________minutes per inch Depth of "Pest Pit-:------------------ Depth to ground water.-.___.-____.__._.__---- f� Test Pit No. 2----------------minutes per inch, Depth of Test Pit.................................... D�th t9 grou A water..._..._________-.__--.. -- ~ O i �, x Des ption of Soil !� ��u. "'_e't` -- ---_�'�- L� - w 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 Article XI of the State Sanitary ode— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beisd the board of health. /0Sign -------------•--•----------....-••-----•--..........---------.. ......................... .� Date Application Approved B Date Application Disapproved for the following reasons:................................................................................................................ ---••-------•-•-•••-----•-••------•----•-•--------••••-----------------••--•----••-------•-•------------•...---••-•-•-------------•--------••---••--•-----------------------•-•----------•-•---------•••. Date PermitNo......................................................... Issued......f--�•----- Zd V -----_•---- ----_-•-•-- Date 4' + CP THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALTH Applirtttiutt -fur Ui�puott1 urko Tutiotrurtiom Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: - jwt'' ` -.�.�`.�.� Location•Address or Lot No.(� Lli r, a lL P 'Y1�A iL 1 cs t Owner .........................•--•---•---•-------Address U V Installer Address UType of Building Size Lot---. f--.7.9-l�__Sq. feet �-, Dwelling—No. of Bedrooms,-,,-----2"'---------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—a Type of Building -__y , of persons---------------------------- Showers Cafeteria ( ) Otherfixtures -----------------------------------------•--------- W Design Flow------_------- .......................... per person per day. Total daily flow-----_�—?3-------------------------gallons. WSeptic Tank—Liquid capacity---Z�gallons Length---------------- Width----- .......... Diameter................ Depth................ x Disposal Trench—No. .................... Width............_--Z�. Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No-------Z! _ Diameter. t-lril-.-Depth below inlet.................... Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 4/` f ®ter - t `.? /` ;7,1' aPercolation Test Results Performed by...... -----------------••--•-------------------------------••----..-•---- Date----.-....-..------------------•------- Test Pit No. I----------------minutes per inch Depth of "Pest Pit-..--.-_--__-.-_---- Depth to ground water_..--_.-.------.------.. G Test Pit No. 2................minutes per r inch� Depth of t Pit._, ..-�s--`--/D��epth �g�rou�nd water--------t------------ ------Descr-lption of Soil -.a_...-.. ��__;('�x=�-------— �i>tc�,� ------� � �7�� --��te�Ze ------------- W ---•--•------------------------------------------------.. ---•- ----------••-------- x -------•---------------------------•---•---•-- -----------------.-...--------------------------------------...-•------------------...-•-------------...-....--•-------------•----------•---------------- 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued bpy the board of health. Signed, o y ..................... / Date Application Approved BY---------- -------------------..___--------..----- � ' Date Application Disapproved for the following reasons---------- ----------------------------------------------------------------------------------------------------•- ------------------------------------------------------- -----------------------------•------------------------------------------------------------------------------------------------------------------ Date Permit No......................................................... Issued_- f _ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......;!.:''.`....-'fit... ..............OF......... ./l .................................. �rrtifirate of Tomfpt5tem turr �-- THIS IS TO CERi617Y, That the Ind idual Sewag is constructed ( ) or Repaired ( ) b CT'�--r-�v — Installer !V i r� /,t�jjti'...�i�j l r7J at - = f --�d'� � L.F < <.• . ------ �-�- - .- �.-::.-.- _ ---•• - ------•-••-•--••--•--•---•--••- has been installed in accordance with the provisions of Artich XI of The State Sanitary Code as described in the .? d _> application for Disposal Works Construction Permit No.=._�.�...-..-�.�-�-_-_.-_-_._. dated....�l�-^.... THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE . .` .....7°j---------------•--_.... Inspector•-------- ,=- --�.'L CL` ••--•--- THE COMMONWEALTH OF MASSACHUSETTS ( BOARD OF HEALTH .JT�--' .............. ........of............1`:...--f�'Lz.�-............-..-....-...-................. No......................... FEE....A�-........... Di-ripmW Norkii Tomitrurfignf rmi Permission is hereby granted_. _ -- . to Construct ( � r Repair" ( ) ;t i/Individual Sewage Dispoka/l System I at No. = �'• �f �f. (.� .1•� '' .. Ar��t , --------- /.�?�l r�tf 1 r. ` =A ..' Street v. as shown on the application for Disposal Works Construction Permit No' ...... ....... Dated--------- .....................7 ) �.... DATE...../0^^�' = ---------------------------------------------------- Board of Health �. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - 05) LOC&TION - - 5E%WACxE..�PERMIT UO. lW5TNLLER'S IJWE ADDRESS — - BUILDERS Q &V AE ADDRESS -- DLaTE PERMIT — D ATE COMPLI &KICF- R/p Z .p a „�