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HomeMy WebLinkAbout0062 YACHT CLUB ROAD - Health YACHT CLUE RD. CENTERVILLE A=210 - 037 SIlI ls�'00wo g4 Illl UPC 12543 No..., 5_LOR. kWO/ HASTINGS,MN Gil }� sc� � '. ,. ago - L Commonwealth of Massachusetts - Title Official Inspection Form ' - Subsurface Sewage Disposals System Form-Not for Voluntary Assessments 82 Yacht Club load, Centerville, MA t5rapertyAddrz5s Patricia Gisleson 82 Yacht Club Road O4vner's Name ' owner - _.... infor ' ti tervi9le MA 02632 9129/2020 required for e Cen very �. . . _ Page Citylaovan state dap Code Date,of Inspection Inspection results must be submitted on this form.Inspection farms may not be altered in any. way.Please see com,pletenes.s c ecklist at the end of the form. Important:Men filling out formA. Inspector Informationf� on the computer, use only the tab Armando Pantoia key to move your Name of inspector cursor-do not Joe Martins dba.Accu Sepcheck trr;o the return -- %'ai'ilpa(ly Nafrl� key- k7 Nodhside Drive ray Company Address South Dennis MA 02660 Csty�l Dion State Zip Core � F 508-385-5891 Si 142t Telephone dumber License Number B. Certification I certify that:'I airs a DEP approved system:inspector in full compliance with Section 16.340 of Title 5 (310 C'MR 15.000): 1 have personally inspected the.sewage disposal system at the property address listed move; the information reported below is tfue„accurate and complete as of the time of nay inspection, and the inspection was performed based an 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. [] Deeds Further Evaluation by the Local Approving Authority. 4. ❑ Fails y t t G 9130Y2020, 11/2312020- REVISED Inspector's Signature — Date The system inspector shalt 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 oxymer shall submit the report to the appropriate regional office of the DEP.The original form should be sent to the systems owner and copies sent to the buyer, if applicable,and the approAng authority. Please note: This report only describes conditions at the time of inspection and under the conttitiorrs of use at ti'rat circie.This inspection doves not address how slue systern vvils piarlorm in the future under the same or different conditions of use. !Sin&p.*Jv„•ru 7.2Gt2G9 G - Title 5 Wrickii 1i sooebofi FOM-S10*11r6m f-ww moo 040=1*-"Jam-Nge-:1 a 18 TOWN OF BARNSTABLE 1 LOCATION SEWAGE # VILLAGE e4 C a k�f R. V t ASSESSOR'S MAP &LOT -2/6 63 7, INSTALLER'S NAME&PHONE NO. Agilej� R&__ �5_m t- SEPTIC TANK CAPACITY 1 = LEACHING FACILITY: (type)a ��� 1s `� (size) NO.OF BEDROOMS BUILDER OR-OWNER PERMIT DATE: -?ff—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 within 300 feet of leaching facility)- Feet Furnished by it , All Gommortwealth of Massachuseft Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 82 Yacht Club Road, Centerville, MA Property Address Patricia Gisleson 82 Yacht Club Road information is Centerville MA 02532 9/2912020 r"ulred for every page. GttprTown state Zip Code Date of—lnspe-Giioil C. Inspection Summary Inspection Surnmary; COITIplete 1,2, 3, or 5 and all Of 4 and 6. 1) System Passes: 1 have not found any information which indicates that any of the failure 0teriadescribed in 310 CMR 15,303 or in 310 CIVIR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: . ................. ..................... 211 System Conditionatly Passas: C one.or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system„upon completion of the repia ce ment or repair, as approved by the Board of Health,will pass_ Checkthe box for"yes", "no'or'not,determined"(Y,N,ND) for the following statements. If'nQ1 determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or Trot}is structurally unsound, exhibits substantial infiltration or eAltration or tank failure is imminent.System will pass inspef,,ion it the existing tank is replaced with a complying septic tank a,$ approved by the Board of Health. I A i-notal 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 El N n, NO (Explain belorw)- t5inyy.doc-to.7Q&Xn;3 Commonwealth of Massachusetts T. _go Title 5 OfficialInspection For �.R r Subsurface Sewage Disposal System Form Not for V iuntaiy Assessments 82 Yacht Club Road, Centerville, MA -`` Property AddressPatricia Gi-sleson 82 Yacht Club Road Ovoner Ownor's Name requiredfrr 9s Centerville MA 026_32_ 9129)202€i _ required for every _ -. ._ page. Gityam-in St3teT lyaCade Oaleof'Inspection C. inspection 5umMary (cant.) 2) System Coinoitionally Passes (coat): ® Pump Chamber pumpstalarms not operational.System will pass with Board of Healtb approval if pumpslalarrns are repaired. D observation of sewage backup or breaX out or high static water level in the distribution box clue 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 E Y 0 N ❑ NO(Explain below)-, lE obstruction is removed El Y ❑ N ❑ ND(Explain Mow): distribution box is leveled or replaced Y 0 N 0 ND(Explain below): The system required pumping more than 4 times a year due to broken or obstructed p pe(s).The system will pass inspection if(with approval of the Board of Health): broken pipes) are replaced ❑ Y" © ►N D NO(Explain below) ] obstruction is removed Q Y 0 N D NO(Explain below); 3) Further Evaluation is Required by the Board of Health: El Conditions exist which require further evaluation by the Board of Health in order to detennine 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 31.0 CI II 15:30311')(b)that the s stere is not fuinction ny n a wanner rY�c"°ti;+!! protect public heailth, safety and the environment: h;inspAc rcm).7!'z6"Z la site 5 Offdol Iupmtim..=tarn:Subsmrfne Saaage Vs.�A0GW Sfitem•Page l oi18 < " Commr onweatth of Massachusetts Title 5 Official Inspection Farm! ' Slubsaurfa:ce Sewage Disposal System Form -Not for Voluntary Assessments �r 82 Yacht Club Road, Centerville,MA Property Addm.n Patncia Gisleson 82 Yacht Club Road Owner WOV'S NarnP _ information is Centerville Is A M32 9l t'2020i required fpa every _. page. Clty)`rown_ ate Zip Gode Date of Inspection C. inspection Summary (cont) D 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 rnarsh b: System will fail unless the Board of health (and Public Water Supplier,if any) determines that the systern'i:s 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 1'00 feet of a surface water supply or tributary to a surface grater supply:. 0 The system has a septic tank and SAS and the SAS is within a Zone t of,a public water supply. E) The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply welt 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 weir",. Method used to determine distance: * This system passes if the well water analysis, performed at a.CEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 pprn, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form, c. Othe,r. _ _._..._ ..... _ ..-._-- _..... ----. ..... 4) System Failure.Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following:for all fnspections5 Yes No Backup of sewage into facility dr systerrl cornponeint,due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface watery El ID due to an overloaded or clogged SAS or cesspool, ISin l.thk:•icy.7t%fl201.$ TMrL 5 Cffr.,.i*It3-gG'don Fwrr;..v;l°J.Hs�firct 9 Di-;{%:taI {'`hey 4 4r I& Commonwozith of Mas,sachusetts Title ,5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 82 Yacht Club Road, Centerville, MA Patricia G-isileso n 82 Yacht Club Road Owner Owner's, Name inforTnatioD is required for every Centerville IMA 02532 912912020 Page. Gitwfovin State Zip Code- �,Df ITV�Ct ion C. Inspection SUMM,ary (cont.) 4) .System Failure Criteria Applicable to All Systems: (cont,) Yes No 0 9 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 T below invert or,available volume is less than 11�day flow Required pumping more than 4 times in the last year MOT'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, Cl N Any portion of cesspool or privy is,within 1 GO feet of a surface water supply or tributary to a surface water supply, Cl E Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. C3 E Any portion of a cesspool or privy is within 50 feet,of aprivate water supply well, Any portion of a cesspool or prlvy 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 Soard 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 systerns,you must indicate either"yes"or"no"to each of the following, in addit1b. n to the questions in Section CA. Yes No 0 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 El 0 the system is located in a nitrogen sensitive area (Inteirim Wellhead Protection Area—IWPA) or a mapped Zone 11 of a public water supply well Isin5p dot:-rcw 70(i0DI A T816 5 Wic-iGO lo-,Dtoo Form),Subwrb�_&,vaigo his{. j 5yeteill-Page 5 Of la Commonwealth of Massachusetts _ `title 5 Official Inspection For AZ Subsurface Sewage Disposal System Farm Not for Voluntary Assessments ryl ,I 82 Yacht Club load, Centerville„ 1vfA Property Address Patricia Gisleson 32 Yacht Club Road Owner Ownr 5 Name €niorrnation Lseveryreq0ted for Centerville MA 02632 9I29�202� Me, CRyTTo%vn State Zip Code Date of 1rx ct ors Co inspection Summary (cont.) If you have answered"yes"to any question in Section 0.5 the system is considered a significant tt II.WC3ly o. /�ilaswered'yes"to any question n IS rzr�{`•An-/' � Q h- T/�th � gg-� ya'ktfl/l{1'as failed.The V � t'V� r1t V\r44b41t V.'T 1VW4YL Il�u Itiey ix 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 316 CMR 15„3g4, 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 atl inspections: Yes No Pumping information was provided by the owner, occupant, or Board of Health I were any of the system components purripeo out inl 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 NIA) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? C] `titi�ere all system components, excluding the SAS, located on site? U 0 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 scuts? 0 Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface;sewage disposal syfsterns? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: 0 ❑ Existing information, For example, a plan at the Board of Health. Determined.in the t"teld (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CltllR 15.302(s)] I,nxpa.orr:•err.7✓?6*D?t' Ts~lc5L'1ikial Nape Pion F:n+rr;,�'.bsvffaw 79Q P"a 6 or Is Commonwealth of Massachusetts Title le Official Inspection Form subsurface Sewage Dispersal System Form -that for Voluntary Assessments 82 Yacht Club Read,CenteviiEe, MA Fropertlr Address Patricia Gisleson 82 Yacht Club Road tra�n2r �e,+r�sr's F'�tr�le information i for every Centerville MR 02632_ 9129t2029 page. Cdy/Town stale Zip Code. Date of InsNction Do System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3,-.. w Number of bedrooms (actual): 2__ DESIGN flog based on 310 CMR 15_203 (for example: 1100gpdxot'be€iraor�s), 330 GPD ,.�.w.,.. . Description-, 1500 G SEPTIC TANK, DBOX AND 3(500 G CHAMBERS WITH STONE) Number of current residents: - -- :Does residence have a garbage grinder? ❑ Yes ® No ✓vnci rC`:7d..",rt�C a..'y a water treatment,.unit? u Vacs, q, N1 If yes,discharges to; _ __________.... _ ........_....... Is'laundry on a separate sewage systern? (Include laundry system inspection ® Yes Z No information in this report:) Laundry system inspected? El Yes ❑ No Seasonal use? C Yes Z No Water meter readings, if available (last 2 years triage(gpd)) 28 GPD Detail:. 2019: 6,€00 G ; 2018: 15,000 G Sump purnp? Q Yes E No Last date of crecupanc JUL Y 2020y: Date Gnsp,db. -ro,.+416v'-U_;y Tfle 5 Cyt5631 rn pp fi m Fc m:S4;dnurfrarc S,,%igo Dispowl syblism-rage 7..of 18 Commonwealth of Massachusetts r=. Twtle 6 Official Inspection Form- Subsurface Sewage Disposal System Form a Not for Voluntary Assessments 82 Yacht Club Road, Center-ville, MA K. Praperj Addres's Patricia Gisleson 82 Yacht Club Road OWN( Jtwr€r's!Marne � — required fo is Centerville MA 02b32 9/29/2020 required for every __�.._. ._ . _ _ page, ChytTovn State Zip Code Date of Inspection D. System Information (cant.) 2. Commercial/I rid'ustrial Flow conditions: Type of Establishment: Design flow (based on 310 CMR 15,203). Gallons.per day{0pd) Basis of design flan(Seats/pemonslN.ft., etc.): _—_----__-- Grease trap present? 1] Yes ❑ No Water treatment unit present? E] YeS 0 No If yes; discharges to: Industrial waste holding lank present? D Yes E1 No Non-sanitary waste discharged to the Title 5 system? D Yes ❑ No Water meter readings, if available: Last date of occupancyluse: Date' Other(describe below).- 1 Pumping Records: Source of information: NO PUMP HISTORY ON'FILE PER TOWN RECORD Was system pumped as part of the inspe0ion? Yes No If yes,volume pumped': gatOns - How was quantity pumped determined? Reason for pumping` ........... t5lnsp.dor•re.7Fe" ltJtli TIEte 5 4Yklalt h.Mcdon Form:Subudzoc lw. qte l isP=jI ys*�rrj•Page 8 of 18 Commonwealth of Massachusetts Title 6 Official Ins senor Form ti P Subsurface Sewage Disposal System Form m Not for Voluntary Assessments ,82 Yacht Club Road, C-ritervilleMAc Propetty Addrezz Patricia Gis.leson 82 Yacht Club Road owner 4--pAiner's.Naa-ve information is required for e%,M penterville MA m 02632 9/2912OZO page. City[Town State Zip Code Date of Inspection D. System Information (cont.) 4- Type of Systems: 0 Septic tank,distribution box,soil absorption system D Single cesspool El Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records, if any) D I nnovative/Alte mative 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 CEP approval. F-1 Other(describe): Approximate age of all components,, date installed. (if known) and source of inforrnation: AGE: 22 YEARS OLD ; INSTALLED: 4/111998 SOURCE: PER BARNSTABLE BOO. Were sewage odors detected when arriving at the site? ❑ Yes No 5, Building Sewer(locate on site plan): Depth below grade: foot Material of construction: EJ cast iron 9 40 PVC ❑ other(explain), >10 Distance from private,water supply well or suction line: feet 111-1-1- Comments(on condition of joints, venting, evidence of leakage, etc.): NO EVIDENCE OF LEAKAGE. Talo 5(N.5.i,,J Ircportion Form Suk*kafact Sw�oaqo Dis I avAOM posa taa q of to Commonwealth of Massachusetts Title 5 Official' Inspection Form Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments 82 Yacht Club Road., Centerville, MA Property Address Patricia Gisteson 82 Yacht Club Road Owner information is required for eveTy Centerville MA 02632 912912020 page- City/Tovin State Zip Code Date of Inspection D. System Information (cont) 6. Septic Tank(locate on site plan): Depth below grade- 0.5fee,t Material of construction: concrete F metal [I fiberglass polyethylene other(explain) If tank is metal, list age- yeas Is.age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes No Dimensions: 10'X6'X5',, 1500 G Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 011 Distance from top of scurn to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? CORETAKER Comments (on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,. liquid levels as related to outlet invert, eVidence of leakage, etc-), HAS PVC INLET TEE AN D PVC OUTLET TEE WITH 1.4"LEG AND GAS BAFFLE. Ll 0 U ID LEVEL 13 48"AT OUTLET INVERT. NO EVIDENCE OF LEAKAGE, .A,o-rkw,7U2M& Commonwealth of Massachusetts Titte 5 Official Inspection Forrr Subsurface Sewage Disposal System 1=vrrn -Nut for Volurrtary. se:ssrnents 82 Yacht Club Road Centerville [ Property Address Patricia Gisleson 82,Yacht Club Road 4v�ner Owner'sName __k � -.._ w._ information is �entervilie MA G26 2 9129l2020 required for every __ ._._ ._ .. . ._____.�__ __�__-.�_ page Erty+Tovvn_ St to ;dip Code Date of Inspection D. System Information (cant, 7_ Grease Trap(locate on site plan): Depth below grade: 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; 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.sde plan); Depth Wow grad: NOTAPPLIC,�gl_�. . .m_..... .._ f atedal of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions; Capacity: gallons .�_� Design Flow gallons per clay #5incp.dac cn+r,it�'l'J2Jt t# ?'i;le S G 'rra!lr.;::pe:.tian f`ceitF:Dub.6Aa S rrapc Drr,,D a1%,St0M-Page 14❑316 Commonwealth of Massachusetts Fite 6 Official InP s, ec F t*on tern j Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments ti 82 Yacht Club Road, Centerville, MA Patricia Gisleson 8Z Yacht Club'Road OVII)LIF OwNer's Name information is requiTed,for,Gvery Centerville MA G2632 9/29/2020 Pig Cityffown D. System Information (cont) 8. Tight or Holding Tank (cont,) Alarm present: Ej Yes E] No Alarm level: Mann in wotking order CJ Yes El No Date of last pumping: Date Comments (condition of alan'n and float switches,.etc.): Attach Py of cu rre nt purti ping =trad"(required), Is copy,attached? Yes N,o 9. Distribution Box (if present must be opened) (Io,cate on site plan): Depth of liquid level above outlet invert AT INVERT Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence vi nce of leakage into or out of box, etc.): DBOX IS IN GOOD CONDITION V\ATH 1 PIPE IN AND 1 PIPE OUT.NO EMDENCE OF SOLIDS CARRYOVER. OM100 I'd TMG 5 0MOA In"pion Formquowrix,,Sawan r 0 Mp 45�os*J ,�Wn fl 12 of� Commonwealth of Massachusetts Ti 'E cia Inspection ter l� Subsurface Sewage'Disposa System Form Not for Voluntary Assessments r Iy 82 Yacht.Club Road, Centerville, MA Property Address Patricia Gisleson 82 Yacht Club Road' ptitn�r t7avne� M1lrne ._._ information is Centerville Mai 02632 9129/2020 required for every Page. CitylTown state Zia Code Date of Inspection D. System Information (cont:) 19: Pump Charnbeir(locate on site plan): Pumps in working orrier:. ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ Ne Comments (note condition of pump chamber, condition of frumps and appurtenances, etc.)- -r___..____._... 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: 3 (500 G)`iaUU`ITH STONE ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number,dirrlensions: ❑ overflow cesspool ntimber: — innovativelatternative system Type/name oftechnology: _ ............. _.....__ , .__._..... 3,nsu:Joc•nr: ft ra tR 7�44,5 Qfii¢i;dilm-I*don Forty Stt)sixrrzc_a$airmen Dispr=I s�fAErn•P401 18 0118 Commonwealth of'Massachusetfis Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 82 Yacht Club Road, Centerville, PEA. €olae yt Address � _ Patricia G sleson 82 Yacht Club Road Owner � _ � _ ___._ .__ __ __..._.3. __u. .. �__ _ _........_.. o>n�ner's Name fequiredfotion is Centerville MA 02632 9/29/2020 re�`uire�rvr`every r - MCI. cityf rows State Zip Code Cate of Inspection D. System Information (cant.) 11. Soil Absorption System (SAS) (cont.) Commerft (note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.); SAS TYPE-1 3 (500 G)CHAMBERS NTH STONE. LIQUID LEVEL` gw STAINLINE: U" CONDITION OF STONE: CLEAN/VYSIBLE GRADE TO SAS BOTTOM T ADDITiONAL COMMENTS:OBSERVED LEACHING COMPONENT VA T H CAMERA AND USED PROBE TO DETERMINE THE TOP OF SAS WHICH IS 3.8`AND ADDED 3.2" FORAPPROXIlVATE DIMENSIONS TO FIGURE SAS BOTTOM TO GRADE'WHICH IS 7`. 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 n Yes 0 No Comments(note condition of soil,signs of hydraulic failure, level of,ponding,condition of vegetation, etc;): 15ivp.dw_-ae:.706M18 TaJm 5 C#fr.40 Irmpct on Four=:.F,.b*trF w Svomq y Disru j]Syziom-( `e 1.4 0118 ,4,-\ Commonwealth of Massachusetts r - Title le Official Inspection Form a Subsurface Se rape Disposal System Forma Not for Voluntary Assessments $2 Yacht Club Road, Centerville, MA P operty.Address Patricia Gisleson 82 Yacht Club Road Owner i�v,r�er'`€<e3ame .,.. inforrnatarn is Centerville MA 02632 9/29/2020 reytfired for every - page- City(Town State Zip Cade Date of Inspn4ion D. System 'Info rmatio In (cant) 13. Privy(locate on site plan): Materla€s of construction: NOT APPLICABLE Dimensions NOT APPLICABLE Depth of solids NOT APPLICABLE _ Comments. (note corifton of sail, signs of hydraulfG failure, level of ponding, conditlon of vegetation, etc.): NOT APPLICABLE drr.p.dm rcv,TW 018 Thte S Oftial IrrspKtM Foam; UVMMI SYSVIm-Ra r_i 5 Of is Y Commonwealth of Ma sachuseds Title 5 OfficialInspection Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 82 Yacht Clue Road,Centerville,MA Cnv er Oviners Mart,.' r — cu,r for evL Centerville MA _ 02632_. ., 912 ?202t3 page. Stale Zep Date of (Miwedjan D. System Information (writ.) 14. Sketch Of Sewage Driaposat System. Provide a+thew of take sew c` a this Ysat-systern`,,Ind,ra°d'ing ties to at least%Uvo:permao,ent reference landmarks or ben.chYnar s. Locate all wells within 100 feet. I_ cr e where public"ruler supply enters the building. Check one of the boxes below: hand-sketch in the area i)elow D, drawing atlachad separately I s L-FT .5F De I i r f Commonwealth of Massachusetts R Title 5 Official Inspection Form TAI Subsurface Sewage Disposal System Form Not for Voluntary Assessments 82 Yacht Club Road, Centerville, MA Property Address Patricia Gisleson 82 Yacht Club Road Owner Cm-ner'sNime information is required for every Centerville MA 02632 9/2912020 Page. C�tylTo:rr, state Zip Code Date of Inspection D. System Information (cont.) 15. Sfte Exam: Check Slope Surface water Check cellar Shallow wells Estimated depth to high ground water: 10 Please indicate all methods used to determine the, !high ground water elevation: E] Obtained from system design plans on record It checked, date of design plan reviewed: ❑ Observed site (abutting pro pe rtylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators. installefs- (attach documentation) Accessed USGS database-explain: GOOGLE MAPS, CCC,GROUNDWATER CONTOUR MAPS OR JOHNSON&DAVIS MAP, FRIMPTER. You must describe how you established the high ground water elevation: SITE IS 50'ASL.GROUNDWATER CONTOUR IS 32'ASL WITH A MAX RISE OF 8'. GRADE TO SAS BOTTOM 13 7'. SEPARATION MATH 50-(,32+8+7)= 3. .......... Belore filing this Inspection Report,please see Report Completeness Checklist on next page. e,V202C,18 TWOOOM-101 MsPeCubt,Faiv&jbsurmcc 61romqc!Uispe*al bN,,stam-Page 170le e Commonwealth of Massachusetts f T"Itl e 5 Official inspection Form, Subsurface Sewage Disposal System Form ®Not for Voluntary Assessments 82 Yacht Club Road,Centerville, MA Property Address Patricia Gisleson 82 Yacht Club Read Ovmer 6Pvinf is Name i.rorrnation in requir+ed for everyCenterville MA 02632 9IM2020 Pa ge. Criytlo vn m. State Zip Code Date of InspecEim E. Report Completeness Checklist - Complete all applicable s+eetions of this form,inclusive of; A.. Inspector information:Complete all fields in this section. B. Certification: Signed&'Dated and 1,2,3 or 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 Setoage Disposal System drawn on pg. 16 or attached For 15:Explanation of estimated depth to high groundwater ir►clurled'. 15insp.dnr.rev.V2&201 8- TWO 5 Offif al lrlspect"Farm'ubuur`ace zwH p Large 180 1.8 COVID-19 Title 5 Inspection Addendum Due to thy; CO'v!D-19 pandemic,ACCU SEPCHECK will to'llow the fotlowing pracu. w,for your own and our omp I ovee safity: 1. We Will not go into your house, 2.We wfl] practice social distancing. I We*11 have a.form for you to fill out and,sign. These are required fields on the inspection form. 4.This form is available via email. You can email for back to joernartins@corncast,net. OWNER NAME:aiir,,�, i d arte .,?,:�p '..w4p ASPECTiON LOCAT[ON: 1.01VNE R, veri��that the inforr ratio a btlow, is cc OWNER StGNATURErw Please indicate the following for your resideme-, .1, 'Row many bedrowns are pre-sent" (Rod morn definition:no less than70 squarc W,nota �alk-through room (pri,.aq),height no 11ts'S thau 7",,.Clectrical scrvicc and ventilaholl,at Least ere window) I L�the-ne a gar*- e grinder". (YWES) et) 3. Is tberesiden.te seaso,=L mcaning that it is inhabited less d 6 months per VPV.?(YES/N OLAL- 4. Current number of occupants: 5. Last&ac of ocvapancv, 6. Is,the laund.ry cortnected To thpp"Idi ipe?(YESINO) 114� m Wbat is�Ox sewer pipe ade,j"U 111S sil�-wer P � of? (cast jr0o, PVC, othcr) FV6 _-,Any eyidp.nce of ie"e?(YESN0)---AV 7. Is there a swnp pump) (YES)NN 0) Ali, 8. Is thcrc.av,-atar treatrnaqt unit'?(-YTS!-NO) 0. please:Include a eketched floor phM of Vou r woot rzy,indicating 13awracms,all flours pre smOUving rooras, batb.Tooms,khchens, dinkg rooms.ete. For unf Hshed basernews, '-UNF- J �n j a Y'RAW, _j f T F- 7 _j .......... TOWN OF BARNSTABLE BAR-W 50669 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager I E Address of Offender <5 '0\v-Vk-T L 0 _MV/MB Reg.# Village/State/Zip V t ) f al L i- L 'MA Q 'Z'_(P S Z _ Business Name on ;114' 20 /0 Business Address Signature of Enforcing Officer Village/State/Zip C�r, 1 6- y te.r1 t� Location of Offense Enforcing Dept/Division Offense C. k ;_ -A-S, Facts Zo U 1_ S f 4L L 4­4 S 1.04 -,-A I_Iejl�a This will serve only as a� warning. At this time no legal action has 6e'4fi _tat'ken It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. �• TOWN OF BARNSTABLE BAR-W 35 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager r a"ti.' t „R .a .: ILI. E -S Address of Offender MV/MB Reg.# Village/State/Zip Business Name /.• am/pm,,) on 20 ' = _ f, Business Address Signature of .Enforcing Officer Village/State/Zip ;•..t L y Location of Offense ``" 'ramr „.,:5 t Enforcing Dept/Division Offense - `.3 r.,- cis .k , ' .. Eli .? �!� .�a.•'V, 1 0 Facts '+.. wJ .4 1 $.} ,+ •.l L. '. ,.. ,.,- {,t S i.,.. .7,.E � k"''q This will serve only as atwarning. At this time no legal action has been taken, ' It is the goal of Town agencies to achieve voluntary compliance of Town -;Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. Parcel Detail OA--�'A CN s c=4 U Page 1 of 1 1 ti J ~vH VA'A� go. Parcel Lookup ti� h/LJ `��- r� 02637— Z Z Parcel info Parcel ID 210-037 Developer;'LOT 47& Lot Location 82 YACHT CLUB ROAD Pri Frontage;95 Sec Sec Road JOHNNY CAKE ROAD - •164 Frontage -_ Village CENTERVILLE Fire District?C-O-MM Sewer Acct Road Index 1888 Asbuilt Septic Sc n: Interactive c } 4 =' 210037_1 Map —� 8 s Owner Info owner GISLESON, PATRICIA M Co-owner Streets P O BOX 172 Street2 - - - � City CENTERVILLE State MA zip,02632 ___ Country USA Land Info Acres 0.35 use Single Fam MDL-01 zoning RD-1 Nghbd 0105 — Topography Level Road Paved Utilities Public Water,Gas,Septic Location Construction Info Building 1 of 1 Year 1959 I Roof Gable/Hi p -- - Ext Wood Shin gle- Built - - - _ Struct ------____ Wall W Qk,- Effect 849 1 Roof Asph/F GIs/Crop AC None I x, 10, Area 1 Cover Type Style Cottage Int Drywall Bed 2 Bedrooms Wall Y Rooms j4 QAa 24 4_FEP 24 Int Bath Model Residential I Floor ---_I R oms+1 Full ,10, Grade Average Minus I Heat Hot Air I Total 14 Rooms I Type Rooms Stories 1 Story I Heat Gas I Found Fuel ation' Typical _ I Permit History Issue Date Purpose Permit# Amount Insp Date Comments 03/01/1995 �1337532 �$o 01/15/1996 00:00:00 �CE SHED Visit History Date Who Purpose http:Hissgl2/Intranet/Propdata/PareelDetail.aspx?ID=15017 1/26/2010 TOWN OF BARNSTABLE LOCATION SEWAGE # ASSESSOR'S MAP &LOT 1/6 63 7 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY / = LEACHING FACILITY: (type)a _ (size) .:N;O,-..:OF BEDROOMS .� 'BUILDER OR OWNER P c� '--.r���_C • ;;PERMIT DATE: 3 '3 D Q'�i COMPLIANCE DATE: `.Separation Distance Between the: `,Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility F& 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 f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE CErifiratr of Camplinurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repairedj(XXX) J.P.Macflmber jr by - ................._._........ _......... ....... ....... - - ...... at . _....82 Yacht Club Road Centerville ...................---------------...............-----------....-------------.......-----------...- --_ ------------------------------------........-------------.......---------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit N . . ^ . �G.i a . _ : - . ..... THE ...... ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.Lt DATE...................-_- ..'....- — %.. ..... - Inspector -- ---------------`--,,. - -................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.... FEE$..30.00 r - Disposal nrkii Tlanitrudion "wrntit Permission is hereby granted.......`T R?2_,_MICA(n J)c---------------------------------------------- ----------------------------------- to Construct ( ) or Repair y(XX) an Individual Sewage Disposal System 82 Yacht Club Road Centerville. atNo.............................................................................................................................. Street pp as shown on the application for Disposal Works Construction Permit No..IS-_ ._ Dated.._._. . __ .: rA-------------------------------•-------------•-- C)Board of Health DATE................ ...... `✓ �� FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS No....��Y 6-y9l /F. .. ..3 0 .0 0.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABL.E Allp irFatiun for Divi-pnuFai Wurkii Towitrnr#inn Prrmit Application is hereby made for a Permit to Construct ( ) or Repair=XX an Individual Sewage Disposal System at: ,82 Yacht Club Road Centerville ... . ---•---------------•---•---•--•----.............•---•- --------------••-••---•-------•---------•--------•--•---•---•----..........-----•-----------...... Location-Address or Lot No. ......................Patr_iaia_._Gis.Le.sQn.........------------------ ---------------------------------------------------•-•-----•----•----•-------•--......-------•--- Owner Address W .S._P...Macambe r...Jx-................................ Installer Address d Type of Building Size Lot............................Sq. feet U Dwellin X--No. of Bedrooms-____-_-__3_________________ _-__Ex Expansion Attic.-� $� -------- p� ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d Other .fixtures ---------------------------------•----------•--- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width---------------- Diameter................ Depth_______-__---_-- x Disposal Trench—No. .................... Width.................... Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per Inch Depth of Test Pit______.__-----_.-___ Depth to ground water...__-_______-__-____.-. 44 Test Pit No. 2................minutes per inch Depth of Test Pit__.._..-.-______-__. Depth to ground water........................ 9 --••-----•••-----------------•--•-•-•••••-•-•••-•--•-••---•-----•••-•-----...---------------............-•----------•----------•------------ .------- .------ 0 Description of Soil.................................................................................................................. ----------------- ----- ............................ U .....................Sand---&---Graval.............................................................................................................................................. W ------ ---- ------ --- ------ --------- - ---- --------- - - -- --- - ------- -- U Nature of Repairs or Alterations—Answer when applicable._-_-Omit-_-Cesspool . Install 1 —1 000 .................. .......................... gallon... ank,_1.-distribution box and 1 -1 000.... allon leach pit. Agreement. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Complia 'ce has bee is � he boar of ealth. Signed f- ---p- ---------- - +.......... ................ ------------------ ....3.f 2.1./...9.5---------- Dace Application.Approved By ................. --,�, i. ........................ .. ........ 'L)a e . .:...- Application Disapproved for the following reasons: ..-_-------------------------------------------------------------------------------------------------------_------1------- .................................................. . ........................-....-......--..........._.........._.......... ...........__..... ... .......... --------------------------------------- Dare p u PermitNo. ..... .5- ---------------- Issued .............................. ..........._.......... Dare I -------_-- --_--------_--- -------------- — ---__--_-- -- THE COMMONWEALTH OF MASSACHUSETTS� J - BOARD OF HEALTH - TOWN OF BARNSTABLE Appliration for Bi-npit ial Works Towitrnrtion lirrmit �4 Y Application is hereby made for a Permit to Construct ( ) or Repair X(XX)X an Individual Sewage Disposal System at: 82 Yacht Club Road Centerville F .............. ----.......----•-----..._.......------..........--•.................. ................................................................................................. Locaiion-Address or Lot No. = P-1 t r �- c e s art.-•------•---•---•-•--•---- Owner Address 7 1? MaAanlaer .Jr e - ..................... R... __-------.... Installer Address ° + Type of Building Size Lot............................Sq. feet t, DwellinglX'No. of Bedrooms.--:,-_-__-_______________________----._-Expansion Attic ( ) Garbage Grinder ( ) Pk ' ' Other—Type of Building ____________________________ No. of persons---_........................ Showers ( ) — Cafeteria ( ) P4 Other fixtures ----- -------------------------- t� W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length________________ Width---------------- Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.__-............... Depth below inlet.................... Total leaching area..................sq. ft. z\ Other Distribution box ( ) Dosing tank ( ) b a \• Percolation Test Results Performed by......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit-----------:........'Depth to ground water......................... 1 44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ a ---••-•--•----------------------•----••---•-••••--......-----•-•--••......----•----....--•--------------..._.....--••----••----------..............--•----- ODescription of Soil......................................................................................................................... .-------------------------------.--..--..... x . v •-•---•••--� �-•-.....Cr�vel Ws -------- -- ------------- -- -- U Nature of Repairs or Alterations—Answer when applicable._-.--Omit Cesspool. Install 1— (01g (7 gallon tank, 1 -distribution box and 1 -1000 gallon leach pig 4........................................................................•.--•-----------------------------•---------------------------•--_-------•----------_---------.--------------•--•--------.-•---. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliante has been issued y he board.of ealth. 01 Signed - `G � ,------------------_ ....-3.�.2.�.�.9 5...:...... Dace Application.Approved B ----_u .....�- Wit.-�a, ......��.5. PP PP y .................. .....:........... �............. Date Application Disapproved for the following reasons: ............. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- tt Date Permit No. ......Cf.--s----- --::.)......q--a---------- ------- Issued Date 00 yj i O � r V t � T Y s��