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Home My WebLink About0108 THISTLE DRIVE - Health 108 Thistle Drive Centerville A= 148-117 SMEAD No.2-153LOR UPC 12534 .m..d.com - Yad.in USA ♦�-WOO� Wfu1pM1RN0011CTW I$DUBOWSH "��'°".�'° ' anfsnaaowr wwwtpy Town of Barnstable �. -Barnstable SHE Op taw �° �� Regulatory Services Department �;t;a�1 (i BARNSTABLE, 'i 1 "A55. a Public Health Division �$A 1i63 rED MA a, 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geder,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7006 0810 0000 3524 6734 September 13, 2012 Mr. & Mrs. Charles J. Tapsell 108 Thistle Drive Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 108 Thistle Drive, Centerville, MA was last inspected on 9/4/2012, by David J. Burnie, 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: • Distribution-box needs to be replaced • Septic tank outlet tee needs to be replaced. You are ordered to replace the above listed septic system components within two (2) years) from the date you receive this notification. i Failure to repair/replace the septic system within the deadline period will result in future enforcement action. i PER ORDER Ol~'`T E BOARD OF HEALTH ? 09 Q Thomas McKean, R.S., CHO Agent of the Board of Health \ I Document in Scrap(2) i - Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=9841 /VY ll Logged In As: Parcel- Detail Tuesday,September 11 2012 Parcel Lookup Parcel Info Parcel ID 148-117 ( Developeer LOT 37 Location 108 THISTLE DRIVE I Pri Frontage 172 Sec Road CEDRIC ROAD I Front Sec age 95 Village CENTERVILLE I Fire District C-O-MM Town sewer exists at this address NO I Road Index 1711 Asbuilt Septic Scan: Interactive Map' I 148117_1 1 - Owner Info owner TAPSELL, DOROTHY C&CHARLES J TRS I Co-Owner DCT REVOCABLE TRUST Streets 108 THISTLE DR I Street2 City CENTERVILLE I State MA I zip 02632 Country J - Land Info Acres 0.45 I use Single Fam MDL-01 I zoning RC Nghbd 0105 Topography Level I Road Paved Utilities Public Water,Gas,Septic I Location - Construction Info Building 1 of 1 Year Roof Ext 1975 Gable/Hip Wood Shingle Built Struct Wall TO 001 Living 1452 I Roof Asph/F GIs/Cmp I AC None I EP 12 Area Cover Type Style Ranch I wall Drywall I Rooms 2 Bedrooms I o 14 '=,z 14 14 Int Bath Model Residential I Floor Carpet ( Rooms 2 Full I eas ^R 5 BMT � OAS.T 9 Grade Average I Heat Hot Water I Total 5 Rooms I 14 Type Rooms I • _ Stories 1 Story I Heat Oil I Found- Typical 4a Fuel ation Gross 3 Area172 Permit History http://issq 12/intranet/propdata/Parcei Detaii.aspx?ID=9841 9/11/2012 �P T Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 108 Thistle dr. Property Address Charles Tapsell 206 Alder Rd. Westwood Ma. 02090 Owner Owner's Name information is Ma. 02632 required for every Centerville 9-4-12 page. Cityrrown 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 A. General Information filling out forms on the computer, use only the tab 1. Inspector: j key to move your - ~ cursor-do not j David J Burnie use the return Name of Inspector key. David J Burnie Mgmt, Inc - xy Company Name 3 307 A Commerce Park North Company Address So Chatham Ma. 02659 Cityrrown State Zip Code 1-866-980-1440 SI 386 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 16.000).The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9-4-12 specto Sign tU71' 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. LX t5ins-11/10 Title 5 Official Inspection Ft: t�surfac.e Sewage Disposal System-Page 1 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ,•''p 108 Thistle dr. Property Address Charles Tapsell 206 Alder Rd.Westwood Ma. 02090 Owner Owner's Name information is required for every Centerville Ma. 02632 9-4-12 page. State CitylTown 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: 1000 gallon Septic tank and one leaching pit. NOTE. There is a certified plot plan that shows a 1000 gallon septic tank a distribution box and a leaching pit dated 8-19-75. There is also a permit#95-79 showing a new leaching pit being installed. We were able to confirm this during the inspection. The old orangeburg pipe was not disconnected at the time of the repair. We used a sewer camera to inspect the orangburg pipe and it dead ended right where the previous leaching pit had been located. We pulled tapes from the asbuilt and the location matched the sewer camera location, we probed to try to locate the leaching pit. Probing to 5'deep and we could not find a leaching pit. I believe this pit was pumped filled and abandoned as would have been required during the prior repair. 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): L15,ns1/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 108 Thistle dr. Property Address Charles Tapsell 206 Alder Rd. Westwood Ma. 02090 Owner Owner's Name information is required for every Centerville Ma. 02632 9-4-12 page. State City/Town 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): Distribution box is rotted and Ieaking.The outlet baffle in the septic tank is rotted and needs to be replaced with a PVC tee. ❑ 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, t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 108 Thistle dr. Property Address Charles Tapsell 206 Alder Rd. Westwood Ma. 02090 Owner Owner's Name information is Ma. 02632 required for every Centerville 9-4-12 page. State City/Town Zip Code Date of Inspection 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 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 t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 5 108 Thistle dr. Property Address Charles Tapsell 206 Alder Rd. Westwood Ma. 02090 Owner Owner's Name information is required for every Centerville Ma. 02632 9-4-12 page. Cityrrown State Zip Code Date of Inspection ❑ ® 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 Y2 day flow 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 108 Thistle dr. Property Address Charles Tapsell 206 Alder Rd.Westwood Ma. 02090 Owner Owner's Name information is required for every Centerville Ma. 02632 9-4-12 page. State City/Town Zip Code Date of Inspection ❑ ❑ 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. C. Checklist 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 ❑ ® 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)] t5ins-11/1 D Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 108 Thistle dr. Property Address Charles Tapsell 206 Alder Rd. Westwood Ma. 02090 Owner Owner's Name information is required for every Centerville Ma. 02632 9-4.12 page. State Citylrown Zip Code Date of Inspection 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 D. System Information Description: 1000 gallon septic tank, distribution box and 1 leaching pit. Number of current residents: varies 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)): yes Detail: 2011214gpd.......2010167gpd Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: t5ins•11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 108 Thistle dr. Property Address Charles Tapsell 206 Alder Rd. Westwood Ma. 02090 Owner Owner's Name information is Ma. 02632 required for every Centerville 9-4-12 page. cityrrown State Zip Code Date of Inspection 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: D. System Information (cont.) Last date of occupancy/use: DateZre Other(describe below): General Information Pumping Records: /� Source of information: �N'� � — Was system pumped as part of the inspection? IV07r' � �P,� Yes No If yes, volume pumped: gallons 41) How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool t5ins•11/10 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 108 Thistle dr. Property Address Charles Tapsell 206 Alder Rd. Westwood Ma. 02090 Owner Owner's Name information is required for every Centerville Ma. 02632 9-4-12 page. State Cityrfown Zip Code Date of Inspection ❑ 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): D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Original 1975............Repair 1995 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 36"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments(on condition of joints, venting, evidence of leakage, etc.): Normal as to what we can see. Septic Tank(locate on site plan): Depth below grade: inlet 15" outlet 28" g feet t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 is Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 108 Thistle dr. Property Address Charles Tapsell 206 Alder Rd. Westwood Ma. 02090 Owner Owner's Name information is required for every Centerville Ma. 02632 9-4_12 page. State City/Town Zip Code Date of Inspection Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) Normal working level, some minor decay.normal for age. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 1-2 Distance from top of scum to top of outlet tee or baffle 20" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Tape and Estimated. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Recommend tank be service every 2 years. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 108 Thistle dr. Property Address Charles Tapsell 206 Alder Rd. Westwood Ma. 02090 Owner Owner's Name information is required for every Centerville Ma. 02632 9-4_12 page. State City/Town Zip Code Date of Inspection 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 D. System Information (cont.) Comments ( pumping onrecommendations integrity, inlet and outlet tee or baffle condition, structural inte rit , liquid levels as related to outlet invert, evidence of leakage, etc.): outlet baffle needs to be replaced. 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 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 108 Thistle dr. Property Address Charles Tapsell 206 Alder Rd. Westwood Ma. 02090 Owner Owner's Name information is required for every Centerville Ma. 02632 9-4-12 page. State City/Town Zip Code Date of Inspection 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 D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert leaking 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.): Distribution box is rotted and needs to be replaced. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No 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 108 Thistle dr. Property Address Charles Tapsell 206 Alder Rd. Westwood Ma. 02090 Owner Owner's Name information is required for every Centerville Sta. 02632 9-4-12 page State Citylrown Zip Code Date of Inspection 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: One leaching pit found and found 6 inches standing water. D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 108 Thistle dr. Property Address Charles Tapsell 206 Alder Rd. Westwood Ma. 02090 Owner Owner's Name information is required for every Centerville Ma. 02632 94-12 page. State City/Town Zip Code Date of Inspection 6 inches standing water. 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 D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): None Privy (locate on site plan): Materials of construction: Dimensions Depth of solids t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 108 Thistle dr. Property Address Charles Tapsell 206 Alder Rd. Westwood Ma. 02090 Owner Owner's Name information is required for every Centerville Ma. 02632 9-4-12 page. State City/Town Zip Code Date of Inspection Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): D. System Information (cost.) 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 108 Thistle dr. Property Address Charles Tapsell 206 Alder Rd. Westwood Ma. 02090 Owner Owners Name information is required for every Centerville Ma. 02632 9-4-12 page. State Citylrown 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: 16' feet Please indicate all methods used to determine the high ground water elevation: t5ins-11/10 Title 5 Official Inspedion Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonarea�th of I�afi Title 5 Official Inspection Form Wf1brVdmVwyAssesmmft IF ftw 10F A- ((�) (Vjj kIrO1R[ Qtl Sty � �!Ci' 9 AP/1 I babe Z0 Cafe Die 6f Irs6achan Pa". CI<ylrom D. System Informaiion (conL) etc e"Of She Disposal System:Pry a view of ft sewaW dbpoW syst m%kwkx&V tree to at[east two perum ertt referenm MrW mft or benchmarlm.Loci A weds wMM 100 fmt Low* where puM water am*entm the WMing.Check one of the bom below: p t wW4ve1xh in ttte arm bekmv ❑ drawing aftactwd sepwM* H005 - 1 ' \ 40 \ \ � ` �� , 2- Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM , 108 Thistle dr. Property Address Charles Tapsell 206 Alder Rd. Westwood Ma. 02090 Owner Owner's Name information is required for eve Ma. 02632 re 9-4-12 a every Centerville state page. City/Town Zip Code Date of Inspection ❑ 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: installers-(attach documentation) ❑ Checked with local excavators, sta ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS map Hyannis dated 1974 gives this general area a grade elevation of 50.00' it gives Lake wequaquet an elevation of 34'. Estimating ground water at this location of 16' below grade. the bottom of the leaching pit is 9' below grade allowing for an estimated seperation to ground water of 7' Before filing this Inspection Report, please see Report Completeness Checklist on next page. 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 No. 9_01A /�/S rCJ�/ / Fee�' D --I THE COMMONWEALTH OF MASSACHUSETTS it Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 21pplitation for Misposal *pstrm ConstrULtion Permit Application for a Permit to Construct( ) Kepir() Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Own is N e,Adder ss,and Tel. o. �a6 Assessor's Map/Parcel /�� '/I Q�j ,q, Q d Installer's Name,Adddss,and Tel.No. ��<_ Designer's Name, and Tel.No. 73vo �' �1�? � Type of Building: 30 '°Q Dwelling No.of Bedrooms�� Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alteration (Answer when applicable) 4� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the vironmental Code and not to place the system in operation until a Certificate of Compliance has been issued i oard o �;h. Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued --------------------------------------------------------------------- ------------------------------------ �O�AL PAS No y x V Ze ro. r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for ]Disposal *pstrm Construction permit 00 Application for a Permit to Construct( ) Kepair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /ag „/� (Own is Name,Add ss,and Tel.N`o.. Assessor's Map/Parcel �/��, (/ /�, `� ' �G,9 Installer's Name Add ss,and Tel.No. ` Designer's Name,Address,and Tel.No. Type of Building: U Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons' Showers( ) Cafet�ria Other Fixtures Design Flow(min.required) gpd Design flow provided gpd� Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ; x Date last inspected: Agreement: i The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the vironmental Code and not to place the system in operation until a Certificate of Compliance has been issued . hi oard o e th. �...•------^> n�D oe / Date Application Approved by Date r - V „ Application Disapproved by Date for the following reasons Permit No. Date Issued -----------------------------------------------------------------------`----------- ----------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIIFY,that the On-site Sew a Disposal system,}Constructed (( )_ Repaired(�) Upgraded( ) Abandoned( )by •��/��1J✓ \l ' �< i�✓ ! at �� / h/S%��2 has been cons cted in accofarie with the provisions of Title 5 andt for Disposal System Construction Permit No. tedInstaller �//V�/ &l f /"� Designer #bedrooms .3 Approved design flow gpd The Date issuance of this permit shall not construed asaguarantee that the system will function-as designed. t i Inspector ----------------------------------------------------------------------------------------=--------------------------=------------------- No. Fee ./ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Veposal bpstem (Construction permit Permission is hereby granted t onstruct( ) Repair pgrade( Ab don( ) System located at ( i and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. // i Provided:Co cation st be completed within three years of the date of this permit. Date Approved by i ) j TOWN OF BARNSTABLE LG'CATIOIV _1oa�� I -�"t.lS _.�t2_ SEWAGE # ll,!�-Vj VILLAGE �;;-}L, s'.?l/�C ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. �nZ,- -► �'[ SEPTIC TANK CAPACITY LEACHING FAC.ILITY:(type z (/jl/,�,,A , / f (size) NO. OF BEDROOMS PRIVATE WELL O UBLIC_�ATT BUILDER O OWNERS �4l�S' � DATE PERMIT ISSUED: f'-- 0 _116 .� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No j G q3 -3131 j 1'O 8m-&I0N SEWAGE PERMIT NO. - VILLAGE I N S T A LLER'S NAME i ADDRESS S U I L D E R OR OWNER DATE PERMIT ISSUED 2 DATE COMPLIANCE ISSUED o° av /D c,5 GA 4— '�c f 10 7 No.---•-•Z ----• Fus... ... ...... THE COMMONWEALTH OF MASSACHUSETTS . ., BOARD OF HEALTH jun't, OF.....4.a4. A^........................................................... Appliration -for Uhipoiia l larks Cnonstrurtion Vrrmft Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal "�^ �• System at: J� � �. -I��'---------=�' --------------------------- *------------- ------- 7.............................---------------------- -- -- ----- Loc o ion-Address _ �y ...... .................... .... ��--r`-�-- ... _ ��a f / r�Lgt No/ _ Owner °A$d/dress �- ------------ -•••-••---••--•.....---•--•-•-••-----••----•.------ Inst ller Address UType of Building Size Lot_/-/i___�3 ....Sq. feet Dwelling—No. of Bedrooms-------------7-------------------------- Attic ( ) Garbage Grinder ( ) per., Other—Type of Building --------------------------•- No. of persons.--------------------------- Showers ( ) — Cafeteria ( ) a'' Other fixtures W Design Flow.$.70........:.........................gallons per person per day. Total daily flow.._.........7-I _4__...................gallons. WSeptic Tank—Liquid capacitV_0//:2'_gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No_ ____________________ Width............. . . Total Length.---___-_-___--.-. Total leaching area..-.-.-.---_.---.---sq. ft. _____ Diameter-'f ) ... Total leaching area..................sq. ft. Seepage Pit No............... _ e below inlet__ ...___ ___. Z Other Distribution box ( ) Dosing tank ( ) A ' �C GF- �— aPercolation Test Results Performed by----_----------------- ................................................. Date----------------------------------- Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-..-_-----_---.-_.--.--- !X, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water--.-.._.___--_-.----.--- -------------------- --------------------- ---------------- - ---....-......-•--•- -• •-----......-•-•-----------•-•-•--•----- -- 0 Description -.. of Soil---- � - - •r - :,hJ ---- Ze ir 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 by the b and of health. Si F � = c •.- ------- -----•-------------•--•-•------- Date Application Approved By....... Ord ------------------------ .2® —7S—---- Date Application Disapproved for the following reasons:--•------------•---------------------------------------•-----------------------....-------- •-•---•-•-•- •-•-••-•-••-•---••••••------•---•---•-•--•-------•-•••----------•----•---••-•••----••--•-•--••---•-----•----------------------------------------------------------------------------------------------- Date Permit No. Issued f---? 7 J............................... .-- Date No.......... 16...... Fl±:a... d...."........_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... r11"w --------OF..... .. . ..(,l�/Y1......... Appliratiuu -for Di-s uml Works Tuwitrurtion Vrrnift Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: f'........"----••--•---......... ---C------_-------------------- ................. ------=_--'--- --------•-••----------------.................................. Location-Address or No/ � 112 ------1-�!cdl- '�'� - !r ---------------- ---- `J U L LJ 4/,)( �� % �j �� , --------- --------- Owner 10 Address ----------- Installer ----------------------------------Add-----ress-------- � Type of Building Size Lot_ ...9.....�...��.3..__.Sq. feet U Dwelling—No. of Bedrooms.............7_-_--______-_--..._._..Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---_-.-_-__-_•__-_-_______ Showers ( ) — Cafeteria ( ) 04 Other fixtures W Design F1ow.S.0..................................gallons per person per day. Total daily flow-__--_____-Q_,6.....................gallons. P4 Septic Tank—Liquid capacity/U�Pgallons Length---------------- Width................ Diameter---------------- Depth-.-.-_-___---. xDisposal Trench—No. .................... Width..._._._._____ � Total Length---._.____________-- Total leaching area--------------------sq. ft. Seepage Pit No..................... Diameter"..r�� _��Det below inlet.. _.____._....... Total leaching area------------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) �� — cf " G— 7-I — 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____________________ Depth to ground water.----______-__--____---. w' ---------------- i Description of Soil ; _�.. .r: L TcrG�/J --------- '� ---------- , .. �, . , 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 by the board ofoffhhealth. Si Application Approved By...___�i . _____�..._. `G... (.... - --°Z � Date Date Application Disapproved for the following reasons:------_..--•----•--•---•-•---•--••--•----------------------------------•-------.....--••----.._........._.....-- .............•-------......--•-••--•--••••---•----------------•---------••-•-- --•---------------------------------...........-----•---•••..---• ........... --------------• ---•---------.---•- -. n � Dat� Permit No. Issued..--•.. ................•----•--•--•••••J>-•-•--... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH ... .......,:Lt...:�..............OF......... al�...:..................................................... Qrrtffirate of 01am rlitturr T �IS TO ER Y, That the Individual Sewage Disposal System constructed (�or Repaired ) nstatter has been installed in accordance with the provisions of - tic e XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._s ....2.7G................ dated_._....:. .._'._75�:-"_......-••-•• THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS,7WED AS AIGVARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. i orl- /-,� DATE................................................................................ Inspector........ --------------------------------------------•-------------------- THE COMMONWEALTH OF MASSACHUSETTS 7� BOARD F HEALTH / l.. . ...............OF.... X ...a'G ..................................................... No.------.....�` ----- FEE.-) .............. Uffipoiia/l Work n,�I 5trurtiuu Vat of Permission is hereby granted.....V.. ... i `mil_.................... to Cons ruct .v or Repair _i an I vldual e a e Disp 'gys em _ 7 at No. t lJ' r - t' Street as shown on the application for Disposal Works Construction P it No._- _._: __.__ e . Dated..... _a G_ 7 v ................. :.- J. q. DATE................................................................................ Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS C� A�&ahg-OU2 O � �f/ ply "�' L l�" C�� `.�''.�..... ��n;•cla_"✓. 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