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Home My WebLink About0854 PHINNEY'S LANE - Health 854 Phinney's.Lane Centerville A=251-101 No.2-153LOR UPC 12534 anum IAM • M.aa a wu 4 mums" SFI mm � P YfIV IOU S 19 in' A A A P Town of Barnstabl /' Health Inspector ours 0FtNE* Re ulator Service G office 9:30 � °w,y Regulatory 8:30-9:30 Thomas F.Geiler,Director 3:30-4:30 9 Public Health Division MASS. �A 039. Aim Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT —SEPTIC QUESTIONNAIRE Date: September 16,2011 1. General Information: Size of Property: 0.21 acre Address: 200 Oak Neck Road Hyannis,MA 02601 Map 307 Parcel 184 Name:Marc J.Donohue Phone#: 508-345-1705 2a. How many bedrooms exist at your property now?3 2b. Are you planning to add any bedrooms?NO If yes,how many? 0 2c. How many bedrooms total are proposed at this property(including the amnesty unit)?3 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all existing rooms in the home and the proposed amnesty apartment.. Provide width measurements of any open doorways. Please label each room clearly. 1 3. Is the dwelling connected to public sewer? CJ G , �j NO If the dwelling is connected to public sewer,skip questions#4 through#9 below. 4. Location of dwelling is OUTSIDE a Saltwater Estuary Protection Zone? 5 . Location of dwelling is OUTSIDE a Zone of Contribution to public supply wells? CD 6. The dwelling is connected to PUBLIC WATER h ' 7. Is a disposal works construction permit on file? YES or NO 8. If yes,how many bedrooms were approved according to this permit? Bedrooms. 9. Were any building permits obtained for construction of additional bedrooms? YES or NO 10. Is there an engineered septic system plan on file at the Health Division? YES or NO 11. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO ------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY The Public Health Division has no objection to�_bedrooms at this property. Special Conditions: SigneL_C Date: t I ( r I r " APR. 1.2005 i 9:35AM BARNSTABLE BOARD OF HEALTH NO.970 P.1/1 Health Inspector < Town of Barnsl ale p t Office flours Regulatory Services 8.30—'9:30 t Thoma$F.Geller,Director 1:00—2:00 t M P �a39, Public Health 'Division Thomas McKean,Director - 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMMSTX PROGRAM.A.PPLICANT-SEPTIC Q!&STIQnLA,JM 1. General Information: Size•ofProperty: l�� Address: &0 A01A a Map%101 Parcel Name: Phone 0: 2a. Plow many bedrooms exist at your property now? 2b. Are you planning to add any bedrooms? If yes,how many? 2c. How many bedrooms total are proposed at this rope ineludin the amnesty mat)? P P property g tY ) 2d. Please include a copy of the floor plans for the gD1 re property-showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label , each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or NO ` �-...::s.".a;:a..,.•� d, rya:,...,,,.y..,. .a ;r I:I:,f. .•e'r.: •. , i .. ?^�.Z1VlSLie. � �Y�.• 9'r�ICY'i,l�:•-_:Y.:i 1��T 11'1Tnl,�-Yan�.�1..'�t':t:.. n il' (I: iT::�"v Al•f\ • I':1• 4. Location of dwelling is INSIDE or UTSID a Zone of Contribution to public supply wells? 5. Is the dwelling connected to am OAW E WELL or to PUBLIC WATER? o 6. Is a disposal works construction permit on file? -YES or NO 6a. If yes,how many bedrooms were approved according to this permit? -Bedrooms, 7. Were any building permits obtained for construction of additional bedrooms? YE$ or NO S. Is there an engineered septic system plan on file at the Health Divisioa? YES or NO 9: Has the septic system been inspected by a DEP certified inspector within the last two years? YES or N0 r�r—r----------rrr.r.—r-- —r—.orrwrrwrrrrwwr�wur�irruwwawrruwrrw.rrrw-rrr-.w-wn---------------- FOR OFFICE USE ONLY The Public Health Division has no objection toT bedrooms at this property. Special Conditions: Signed: Date: O;/hea�th/wpfcles/amnestyapP • Town of Barnstable Health Inspector o qy, Regulatory Services Office Hours8:30-9:30 ti �.� Thomas F.Geiler,Director 3:30—4:30 BARNSTABLE. # Public Health Division 1639.�s � Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE.. Date:JULY 11,2011 1. General Information: Size of Property: .23 ACRE Address: 854 PHINNEY'S LANE CENTERVILLE,MA 02632 Map 251 Parcel 101 Name: GWENDOLYN M.BROWN Phone#: 508-367-7488 2a. How many bedrooms exist at your property now?3 2b.Are you planning to add any bedrooms?Yes If yes,how many? 1 2c. How many bedrooms total are proposed at this property(including the amnesty unit)?3 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all existing rooms in the home and the proposed amnesty apartment. Provide width measurements of any open doorways. Please label each room clearly. 3. Is the dwelling connected to public sewer? NO If the dwelling is connected to public sewer,skip questions#4 through#9 below. 4. Location of dwelling is INSIDE a Saltwater Estuary Protection Zone? 5. Location of dwelling is INSIDE a Zone of Contribution to public supply wells?GP 6. Is the dwelling connected to PUBLIC WATER? 7. Is a disposal works construction permit on file? YES `or. ? NO — F 8. If yes,how many bedrooms were approved according to this permit? Bedrooms. 1 9. Were any building permits obtained for construction of additional bedrooms? YES or NO J 10. Is there an engineered septic system plan on file at the Health Division? YES or NO w 11. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO N m ------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY .._-„T• O�� r The Public Health D*ionas no objection to bedrooms at this property. I�rV.1. 0Special C nditi S: 1: 11 ° �irc;L ,�,,� � rtn��,w,�,M 0 Signed: �s� Date: 115 ro LA Ir I E S �InXV15 Rooms S I k C, i o �i V�to vv I 44 o I Llk � � v,�6 ir Clod poll a uj- Vy\ � Th,.) t rl ' ly e a 1� C 4 �04 ' , o c� :� �� ___.� p ��---� � - Y �� . a z �. t N �€�� i; �. �� - n � _.. _._. .;; � �� t _ _ _ ,. q 4 .. � _ ... �� ti _ °t1'� _ �_ ___ _ _ . _. _ �_..� �, __..�_ �� _. . - r ,� y�, �� .. . . �" �:/ �� r� ._ _ ;: - -- . E Y ......_....,..._.._..�._...._. .� _-..., a�.�...._. a ....... . .....�_ . . _ .. ..... ..._.. _.. ... .. ... ._. .... '�'yCCy,,. ... 0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 854 Phinneys Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02601 12-30-09 every 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. A. General Information I 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 508-495-0905 S13971 Telephone Number License Number B. Certification r I ce ify that I have personally inspected the sewage disposal system at this address and that the M info6mation reported below is true, accurate and complete as of the time of the inspection. The inspection rat N was performed°based on my training and experience in the proper function and maintenance of on site „ sew ge disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of =E Title 5 (310 CM:Rk15.000).The system: CPasses ' El Conditionally Passes El Fails 4 . ❑k�Needs Further Evaluation by the Local Approving Authority r x p :'a 12-30-09 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 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. � b t5insp official document•03/08 .Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 854 Phinneys Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02601 12-30-09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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: System is in good working order with no sign of failure. 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. Answer yes, no or not determined (Y, N, ND)in the ❑ 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. ND Explain: ❑ 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 ❑ obstruction is removed t5insp official document-03108 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 854 Phinneys Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02601 12-30-09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont_): '.. ❑ distribution box is leveled or replaced ND Explain: ❑ 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 ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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. t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 T` Commonwealth of Mass achusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 854 Phinneys Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02601 12-30-09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6°below invert or available volume is less than 1/ 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. t5insp official document-03/08 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 854 Phinneys Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02601 12-30-09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): A . Yes No f.. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ E Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either`yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area —IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department: t5insp official document•03/08 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 854 Phinneys Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02601 12-30-09 every page. City/Town State Zip Code Date of Inspection I 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 i9spection? ® ❑ 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 official document-03/08 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 854 Phinneys Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02601 12-30-09 every page. City/Town State 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 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 10-09 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 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: Last date of occupancy/use: Date Other(describe): t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts u, W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 854 Phinneys Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02601 12-30-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: ' Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of-the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1980's with second leach pit added in 1992. Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 854 Phinneys Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02601 12-30-09 every page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 23 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints,venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000gal Sludge depth: 12" - Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness Distance from top of scum to top of outlet tee or baffle 6". Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape t5insp official document-0=8 We 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts 4 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 854 Phinneys Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02601 12-30-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. 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.): 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): t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection- Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 854 Phinneys Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02601 12-30-09 every page. City/Town State Zip Code Date of Inspection D. System Information (contj Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 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.): Good condition with water at working level. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp official document-03108 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 47M 854 Phinneys Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02601 12-3M9 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ® leaching pits number: 2-1000gal ❑ 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.): Both leach pits were empty and in good condition at inspection. Leach pit#1 had a stain line at 12" below inlet invert. Leach pit#2 had a stain line at 36"below inlet invert. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments U1 854 Phinneys Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02601 12-30-09 every page. City/Town - State Zip Code Date of Inspection D. System Information (cont.) 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.): 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 official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 0,r 854 Phinneys Ln - Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02601 12-30-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch 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. ' 8 D A o fS 10 0 -14 - .2? 8-A _3o, A-a` 33 ' 3y' - #� -- 30` 3el' era —q( i i i I t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 , e Commonwealth of Massachusetts f Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 854 Phinneys Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Centerville MA 02601 12-30-09 ievery page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 30' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record i 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: USGS maps show groundwater at greater than 30'. 4 t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 / TOWN OF BARNSTABLE LOCATION et/S ZY, SEWAGE # VILLAGE _. �e�7-1� v 1-1/e ASSESSOR'S YvfAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACli A G FACMi3TY: (type) c) c •(size) 1600 6,-1 NO.0F'BBDROOMS 3 -r BUILDER OR OWNER PERMITDATE: C0M,PLIAIVCE DATE Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bott i om of Leaching Facility Feet Private Water Supply Well and Leaching Fuciliey? (if any vietls exist on site or within 200 feet of leaching facility)I Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachingfacility) A'- � Feet Furnished byG�C�' C,,X TAG S LOI� Od r TOWN OF BARNSTABLE \ \ LOCATION/ /"1rn/1�G S � SEWAGE # VILLAGE ASSESSOR'S MAP & LOT__jLSLj0j INSTALLER'S NAME & PHONE NO.� SEPTIC TANK CAPACITY LEACHING FACILITY:(type) PT lJ® NO. OF BEDROOMS_ PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: •01 VARIANCE GRANTED: Yes No f Commonwealth of Massachusetts W Title 5 Official Inspection Form U Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 854 Phinneys Lane LA,M Property Address Raphael Garcias Owner Owner's Name information is required for Centerville Ma. 02632 8/29/2007 every 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. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC Company Name raa P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 314454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: r,,,, [y1 ® Passes ❑ Conditionally Passes ❑ Failts <_R ❑ oNeeasiher Evaluation b the Local Approving Authority( c,a :7: 8/29/2007 Inspre Date t-rt The system inspector shall submit a copy of this inspection report to the Appro ing 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. 854 phinneys lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Fora, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 854 Phinneys Lane Property Address Raphael Garcias Owner Owner's Name information is required for Centerville Ma. 02632 8/29/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B) System Conditionally Passes: 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 replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not'determined (Y, N, ND) in the ❑ 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. ND Explain: ❑ 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 ❑ obstruction is removed 814 phinneys lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 854 Phinneys Lane Property Address Raphael Garcias Owner Owner's Name information is required for Centerville Ma. 02632 8/29/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: t ❑ 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 ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,.safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ' ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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. f ❑ 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. 854 phinneys lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 854 Phinneys Lane Property Address Raphael Garcias Owner Owner's Name information is required for Centerville Ma. 02632 8/29/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool . ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 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. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 854 phinneys lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 854 Phinneys Lane Property Address . Raphael Garcias Owner Owner's Name information is required for Centerville Ma. 02632 8/29/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.):. Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. El ® 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.] 0 ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes".or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed..The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 854 phinneys lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 854 Phinneys Lane Property Address Raphael Garcias Owner Owner's Name information is Centerville Ma. 02632 8/29/2007 required for every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the.following have been done. You must indicate "yes"or"no" as to each of the following: Yes No ❑ ® 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)] / 854 phinneys lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 i Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 854 Phinneys Lane M Property Address _ Raphael Garcias Owner Owner's Name information is required for Centerville Ma. 02632 8/29/2007 every page. City/Town State 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): 440 Number of current residents: unknown 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 Seasonaluse? ❑ Yes ® No Water meter readin s, if available last 2 ears usage d 2006:122,000 g ( y g (gpd)): 2007:101,000 Sump pump? ❑ Yes ® No Last date of occupancy: 8/29/2007 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow'(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title'5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 854 phinneys lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'M 854 Phinneys Lane Property Address Raphael Garcias Owner Owner's Name information is required for Centerville - Ma. 02632 8/29/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy * . ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) In technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ 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 pit installed 8/17/1992 Were sewage odors detected when arriving at the site? ❑ Yes ® No 854 phinneys lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 L- Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 854 Phinneys Lane Property Address Raphael Garcias Owner Owner's Name information is required for Centerville Ma. 02632 8/29/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building.Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private.water supply well or suction line. 20'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): Depth below grade: 2' cover to grade feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ------------------------------------ ------------------------------------------------------------------------------------- Dimensions: 8'6"x4'10"x5'7" 4' Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 2' Scum thickness 2 81' Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? measured 854 phinneys lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 t Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for,Voluntary Assessments �M 854 Phinneys Lane Property Address Raphael Garcias Owner Owner's Name i information is required for Centerville Ma. 02632 8/29/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): . Pumptank every 2-3 years.Inlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. I Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: x 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.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete El metal ❑fiberglass El polyethylene ❑ other(explain): 854 phinneys lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 854 Phinneys Lane Property Address Raphael Garcias Owner Owner's Name information is required for Centerville Ma. 02632 8/29/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) l Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow- gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No 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.): Box is level and has two outlets with equal distribution.No evidence of solids carryover.No evidence of leakage into or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 854 phinneys lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 854 Phinneys Lane M Property Address Raphael Garcias Owner Owner's Name information is required for Centerville Ma. 02632 8/29/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ® leaching pits number: 2-1000 gallon ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number,Jength: ❑ 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.): Sandy dry soil.No signs of hydraulic failure.No ponding or damp soil. Pit# 1 water to invert was 36" with stain line at 20". Pit#2 water to invert was 44"with no stain line. 854 phinneys lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 854 Phinneys Lane Property Address Raphael Garcias Owner Owner's Name information is required for Centerville Ma. 02632 8/29/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 ondin , condition of vegetation, ( 9 Y p 9 9 etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 854 phinneys lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 854 Phinneys Lane Property Address Raphael Garcias Owner Owner's Name information is required for Centerville Ma: 02632 8/29/2007 every page. City/Town State Zip Code Date of Inspection .D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch 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. i . I, N C> oU / f 3q o �G q 4._ 854 phinneys lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 854 Phinneys Lane Property Address. Raphael Garcias Owner Owner's Name . information is required for Centerville Ma. 02632 8/29/2007 every page. City/Town State Zip Code Date of Inspection D. System Information(cont.) Site Exam:. ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground water: Bottom of leaching 50' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: As-Built Card ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Used:Gaherty& Miller Model 12/16/94 ground water elevations. Used:USGS Observation well data June 1992. Used: Technical Bulletin 92-000-01 plate#2 annual ranges of ground water elevations. 854 phinneys lane-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 J Town of Barnstable OF THE Tp� Regulatory Services uvsrnsLE Thomas F. Geiler,Director prEo�,�A Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. T: OF BARNSTABLE BAR W Ordinance or Regulation �4 WARNING NOTICE Name tc..of Offender/Manager At Address of Offender - L �� 1 �l 1.: tq S MV/MB Reg.# Village/State/Zip Business Name "" 1 %pm; on / Z 200,5 Business Address """" " • f►- f_ % '7 Siature of Enforcing Officer Village/State/Zip ,... Location of Offense yl � � �' Enforcing Dept/Division Offense N3 i Facts . '+. ? This will serve only as a warning. At this tinie' no legal action has been taken. It isr 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 DEPDEPT._._ems.......ail.._�_-....ti�� ,..a,.: .. .. .....w,... ,s......,..:.x. .. ..v. ;. ... .. .,. ..aa.r_..::W:,sv ................ .. ................,, ..._,.. ...__. ......r..}.. _..__,«. ..... .. _...._ .. _. THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA .s•isvnp{ :!+"9.'Y,'pr?..SF.%i:'.6n.: ., .•�esi^'tiYY ±:;15`d4Ri.tnP• :a• r��,i+•.•1P'zgv}srF .(FT oa+q.:+gY ,o'6c•C ,:�hP�'+c _ �lw r..•i:a..d t. L•.4ti: , ':{' kn'ain.r.�i�7•&±. .-.a..,;,w•, TOWN. OF BARNSTABLE BAR-W '' "' � Ordinance or Regulation WARNING NOTICE Name of Offender/Manager I _ r � �.�. � ' �� ,� ' ' =:> Address of Offender ` . t:� �� sA ; MV/MB Reg.# .. Village/State/Zip l V � '_ : 'ter' S c7 Business Name i t "a`am6pm; on 1 Z. l } 20�' 1 Business Address ' . Signature of Enforcing Officer Village/State/Zip :` � z u�.%t_i �-- ..' r f Location of Offense ' ; . t .a .; d ;'t C It F...( Enforcing Dept/Division Offense Facts < l� ,:,t0i ��✓. ti`.'� ' '.. �r..:s , r y k r �, r5 .'z..'' j hh ly;•%�hwr, ',f -•' ,,,r J Y.�.,..rY s f„.', / l :�;. ?at �,.. ,.1 : ;tjr) �, '�.J ✓f:l l Lr` ti.. This will ,serve only as a warning, 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. s ".Citizen Web Request Page 1 of 2 Citizen Request Management - Internal Use Request ID: 23889 Created: 12/10/2008 10:01:04 AM Status: Assigned To Staff Assigned To: Cabot, Jaime Health Office ' Anonymous: Yes Category: Section 353-1 GarbagE and Rubbish E.C. Date: 12/26/2008 Created By: Wadlington, Ellen Citations: Health Office I Time Worked: 0 Response Time: 0 Requestor Details: Email: Request Location: 854 PHINNEY'S LANE Centerville, Ma 02632 Parcel Number: Map: 251 Block: 101 Lot: 000 Request: Litter in yard, apparently bank owned. Varmints seem to be ripping open the bags and bags are scattered. See the paperwork in on your chair. Request Work History: Internal Note History: System entry on 12/10/2008 10:01:04 AM: Assigned to Cabot, Jaime http://issgl2/IntemalWRS/WRequestPrint.aspx?ID=23889 12/10/2008 - Re man's trash isn't always another man's treasure Page 1 of 3 �h capecodtoday cape cod: 24/7 [Home I Blogs ( Links I Weather I Calendar I Movies ( Lottery Horoscope) Robbins Report To preserve and protect One man's trash isn't always another man's treasure 12/09/08'4:43 Pm posted by Peter Robbins Link to PostEmail to a�FriendJ Sometimes it's just trash t S: a z s y y% aE'F •.� mot. x h Story&Photographs by Peter Robbins i This time of the year is difficult for everyone. Some have loved ones overseas,people are out of work, uncertainty about the future abounds,and others are just trying to stay warm.With concerns such as these weighing on the mind,it is sometimes uplifting to drive around at dusk and enjoy the various decorations and lights people display on their homes during the Christmas Season. This year I noticed less home displays than in previous years. I hope people are just waiting to turn the holiday lights on closer to Christmas to save energy. Thinking about lawn"decorations", I considered the old saying "one man's trash is another man's treasure"and I came to the realization that that isn't always so. Sometimes it - s ' http://www.capecodtoday.com/blogs/index.php/2008/12/09/one-man-s-trash-isn-t-always... 12/10/2008 wOire man's trash isn't always another man's treasure Page 2 of 3 becomes a health hazard. Phinneys Lane in Centerville is one of the most highly traveled roads in the town of Barnstable. As I've driven by for weeks now,854 Phinneys Lane has been"decorated"with trash at the street side. Trash bags continue to be invaded by varmints and even though public officials drive by the home numerous times during the day,the eyesore remains. It's quite a contrast to the home decorated for the holiday just a few doors down. The house appears vacant. The front storm door blows in the breeze and other discarded items are visible in the yard. A real estate sign,bearing one Christmas color,is located next to the garbage. This would be of great concern to me if I were the listing agent,yet nothing has been done. I hope this article finds its way to the party responsible for this neighborhood eyesore or at least to the appropriate town authority for enforcement. 6 comments Blog posts and comments are entirely the thoughts and ideas of the people who write them and in no way represent the views of CapeCodToday.com,eCape,Inc.,or its employees or owners. capedoggie[Member]writes: 12/09/08 @ 5:29 pm If the trash in the driveway is such an eyesore,and you have driven by it for weeks,couldn't you or someone from"down the street"call the listing agent and tell them to get off their fat ass,clean up the mess,and get ready to get their 6%commission on this"desirable Cape in Centerville" Thanks for listening Dog [Show all comments by this user] karent2[Member]writes: 12/09/o8 @ 9:26 pm� Never mind the private call.This is even better.Embarassment works better tha civility in cases like this.Too bad we don't know the name of the real estate company.Anyone from the area know the sign? [Show all comments by this user] somebunny[Member]writes: 12/o9/o8 @ io:16 pm karent2,it looks like Brazilian real estate.If I'm not mistaken,I've walked by it on W.Main in Hyannis. [Show all comments by this user] somebunny[Member]writes: 12/o9/o8 @ 10:17 pm I think it also says viviane on the sign...as the contact. [Show all comments by this user] murrbuck[Member]writes _12/1o/o8 @ 7:118 am This is a bank owned property for sale,some loser dumped their trash there.and isn't the police station on that road?Why wouldn't they see the creeps who did this?call the real estate co.that has it for sale and demand that it be removed.simple. and maybe the neighbors should keep a better eye out on what's happening around them.p.s.the house is for sale for:$2o9,000.00 any takers? [Show all comments by this user] 1 murrbuck[Member]writes: 12/10/08 @ 7:26 am 1 My oops!listing says it's still a short sale...Are the people really still in it,though?I didn't think they were-but whatever.I'm j j sick of people dumping sh*t all over the place.It really bugs me.If the people are still in it then if anyone calls these people http://www.capecodtoday.com/blogs/index.php/2008/12/09/one-man-s-trash-isn-t-always... 12/10/2008 .-r ne man's trash isn't always another man's treasure Page 3 of 3 ! on this then you know where all of it will be when they do move out:All over the inside of the house.The auction sale date is: 20og at u:oo.But a call to the real estate company that has it wouldn't hurt. [Show all comments by this use ] IMPORTANT NOTICE FOR COMMENTORS&BLOGGERS:CapeCodToday now requires a one-time validation of your account email.When logging in or registering for the first time,you will be emailed a link to click that will validate your email and complete your login.The link in the email must be clicked in the same session when you are logged into the site for security purposes(i.e.retrieve the email right away and do not close your web browser). This is a one-time-only process(or if you change the email on your account),and will help CCToday keep out the spammers.If you cannot validate your email because it is invalid,and you are a legitimate user,feel free to contact us and we will update your account to your current email. Please Lo ig_n or Register to leave a comment.There are 2,151 registered commenters! CapeCodToday requires readers register an account with us in order to post comments.Become a trusted commenter and receive the benefits of posting instantly throughout the site.It's quick and easy! Please note:If you are a CapeCodToday registered blogger,you can use your blogger login.Your login for the blogs is separate from your CapeCodToday main site login(if you have one). Previous/Next posts in this blog Look out Barnstable,here comes the dredge! VJAJ doe http://www.capecodtoday.com/blogs/index.php/2008/12/09/one-man-s-trash-isn-t-always... 12/10/2008 -Z�tl ! o I RECEIVED DATE : 10/20/ 3 NOV 13 2003 PROPERTY A D D R E S S : -854 -Phinneys Lane I Tow HEALATHN A BARI�STAB E - - - ---- ----------- .t Centerville UEPT. Mass 02632 -- - - - ------------------- On the above date, I inspected the septic systern-at the above address. Tnis system consists of the following: 1- 1000 gaPPon aept.ic tank. '. 2- 1000 ga eion /?2ecaet Jeaelz.ing /a.itz. 1ZS 1-Dizt2.ieat.ion Pox. MAP Baseo on my inspection, I certify the Iollowing conditions: PARCEL 7h.i-3 1,3 a t.iiie Live 6egt.ic 6y,3tam. ( 78 Code) LOT The ae/zt.ic .eyztem .ih .in /22opea woak.ing oade2 at the gae,6ent time. Inzs aPPed one 6/2eed .Peveeelz to equa.P.ize the Peow to the two Peaching /2.itz. Inzta ied one covet on /2.it #1. ( coven wa, &zoken SIGNATUR /, Fame _ _'__ P_ _Macomber- - - - - -- - ompany : )91tphM�S4m��r b_ Son, Inc . COreSS : _ _@Q� ..... . . ..... P ^.one _ _508 • ) ) 5_ ) ) )8 __ __ _ -__ T„'S CERTIFICATION GOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBM & SON, INC. Tank s-CeI spools•leochllelds Pumped & Instilled Town Sower Connections P 0 Box 66 Centerville. MA 0263?•0066 275.3338 115.6412 s COMMONWEALTH OF MASSACHUSETTS = EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:854 Phinneys Lane Centervi e Owner's Name: _Lillian Jones Owner's Address: same Date of Inspection: 10 Name of Inspector: (please print) J.P. MaeomberJr Company Name: _Joseph P. Macomber & Son Inc Mailing Address: Box 66 ' Centerville Telephone Number: 5nR-775_ 3-3R CERTIFICATION STATEMENT I certify that 1 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/too Section 15.340 of Title 5(310 CMR 15.000). The system: ✓/ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: The system inspector shall bmit 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. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOL UNTARY ASSES SMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 854 Phinneys Lane Cen ervi e Owner: Lillian Jones Date of Inspection: 10 7 21 03 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D Syste asses: 1 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: 7hv .svR#�.s.�� tem to a2oRe2 wo2kine o/zde/z Q4 46 Q12DA0Q4, fimo 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. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If"not determined"rmtned" please &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. ND explain: 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 obstruction is removed distribution box is leveled or replaced ND explain: 4 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 obstruction is removed ND explain: 2 Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 854 Phinnevs Lane CJnteryille Owner: TJ 1 1 i a Date of inspection: 1 0/21 03 t.... C. Further Evaluation is Required by the Board of Health: A)d 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. I. 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: W, 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 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: 10 The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a ''su//rface water supply or tributary to a surface water supply. vd The system has a septic tank and SAS and the SAS is within a Zone I 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 I0,0,feret but 5 et 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: 3 Page 4 of 1 I ; OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 8.54 Phinneys Lane Centerville Owner: T.i 1 1 i an Jo�,�� r.., Date of Inspection: 1 90/ D. System Failure Criteria applicable to all systems: You must indicate"yes" or"no" to each of the following for all inspections: Yes N ackup 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 /logged SAS or cesspool �/ Static liquid level inQhe distribution box above outlet invert due to an overloaded or clogged SAS or /cesspool / fj,,f J11 ) iquid depUiJn4*#&pee4-is less than 6" below invert or available volume is less than h.day flow — Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ). y 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. Sny portion of a cesspool or privy is within a Zone I of a public well. �/ y portion of a cesspool or privy is within 50 feet of a private water supply well. y 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] (Yes/No)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• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 11 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. 4 Page S of I I 1• OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECT' ON C) ' PART B CHECKLIST Property Address: 854 Phinneys :Lane Cen eryi e Owner: Lillian Jones Date of lospectloo: 1 b Check if the following have been done. You must indicate` res"or"no" as to each of -.-e f Yes No/' v Pumping information was provided by the owner,occupant,or Board of Hcalth , zWcrc any of the system components pumped'out in the previous two w,c.s ? Has the system received normal flows in the previous two week period ? ZH&vc large volumes of water been introduced to the system recently or as p:�-s Were as built plans of the system obtained and examined?(lf they were not Was the facility or dwelling Inspected for signs of sewage back up? Z_ Was the site inspected for signs of break out ? 141 Were all system components.44ccluding the SAS, located on site ? Were the septic tank manholes uncovered,opened,and the interior tisc of the baffles or tees, material of construction, dimensions, depth of l: uid, c Z. Was the facility owner(and occupants if different from owner)provijcJ maintenance of subsurfat:e sewage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been Yc� no ., _ Existing information. For example, a plan bt the Bold of Determined in the field(if any of the fz!ilurd criteria rcl_:ed t %cY C :r is unacceptable) (310 CMR 15.302(3)(b)) S Page 6 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 854 Phinneys Lane Centervi e Owner: Lillian Jones Date of Inspection: FLOW CONDITIONS RESIDENTUL Number of bedrooms (design): —�—' Number or bedrooms (actual): ,,� DESIGN flow bued on 310 CM} 15.203 ((or example: 110 gpd x it of bedrooms): � , -I Numbcr of current residents: I _ Does residence have a garbage grinder(yes or no):A14 Is laundry on a separate sewage systcm (Yes or no):; (if yes separate inspection required) Laundry system inspected (yc or no): Seuonal use: (yes or no): �>e) Water meter readings, if availab le (last 2 years usage (gpd)):200I=58, 000 y¢PPorz.6=158. 9 1 913D Sump pump(Yes or no): .17�� `"�" _ ¢2 eOrt.6= 123 29 C/DD Lut date ofoccupancy: COMM ERCLAUINDUSTRIAL Type of esublishrnent: Design now (based on 310 CM 15.203): d Basis o(dcsign flow(scats/persons/sgft,ctc.): Grcue nap present (yes or no): Aff Industrial waste holding unk present(yes or no): Non-sanitary waste discharged to the Title 5 systc (yes or no): Water meter readings, if available: ) Last date of occupancy/use: OTHER (describe): YIN Pum ping Records GENERAL INFORMATION Sourcc o(in(ormation: Wu System pumped as pan of the inspection(yes or no): WE- If yes, volume pumped: C2galions •• How was quantity pumped determined? lu6 � Rcuon for pumping: TYP OF SYSTEM Septic uxdk distribution box, soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no)(if yes, atuch previous inspection records, if any) lnnovative/Allcmative technology. Attach a copy of the current operation and maintenance contract (to be obtained bom systcm owner) /Tight unk -i)iQAtucb a copy of the DEP approval �D Other(describe): Z A m e as?e ofill components date installed ( f o ) and sou ee of in or�naiiory1 Were sewage odors detected when arriving at the site (yes or no): _ 6 Page 7 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 854 Phinneys Lane Centerville 0woer. ' Date of Inspection: 1 0 21 03 h' BUILDING SEWER (locate on site plan) Depth below grade: `t11 � Materials of construction: cut von A-40 PVC AJeotherr(explain): Distance from private water supply well or suction line: Comments (on condition ofjoints, venting, evidence of leakage, etc.): 1o.ir #,s n1212vril? ghi— No evidence olf .leakage Su.6fern 1.6 ven.ted th2ough .the zoo/ vents. SEPTIC TANK: ✓(locate on site plan) Depth below grade: /'; 'f Material of construction: �ncrete A�-Imetal,�fiberglass4/dpolyethylene �othcr(cxplain) i/,�� If tank is metal list age: W14— is age confirmed by a Certificate of Compliance (yes or no)Ag(attach a copy of certificate) A A Dimensions: J✓' �i�� Sludge depth: � Distance from toLof sludge to bottom of outlet tee or baffle: Scum thickness: Distance (Tom top of scum to top of outlet tee or baffle: Distance bom bonom of scum to bottom 01 outlet tee or afl;le: How were dimensions determined: Comrrmsnts (on pumping recommendations, inlet and outlet tee or baffle condition, structural integriry, liquid levels as related to outlet invcn, evidence of.leakage, etc.): tank eve/cu 2- 3 uea2a Zneet 9 outiei tees pp --- r,nn in n0ri�o_ 7ho 4rinit a s /,2''_/!_r�riU1?a�Yy `,Sound and 6hobb no evidence o� Peakage Liquid .Peve.P a e out ,)et .irive2t i'6 GWEASE TRAPlocatc on site plan) Depth below grade:, Material of construction:,Clconcretezgmeta(f-/4fiberglass polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet fee'or baffle: Distance from bonom of scum to bottom of outlet tee or baffle: �/� Date of last pumping:�j Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integriry, liquid IcvcLs as related to outlet invert, evidence of leakage, etc.): C12eabe t2aR le no /22e.6en . 7 Page 8 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 854 Phinneys Lane Centerville Owner:Li l l ' n Joiles Date of Inspection: 1 0— 21 03 TIGHT or HOLDING TANM)dA an' k must be pumped at time of inspection)(locate on site plan) Depth below grade: A)4 Material of construction: dIA concrete metal eQ_fiberglass jV,4polyethylene other(explain): w2A Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes r no):297 Alarm level: /i Alarm in working order(yes or no): Date of last pumping: A4 Comments(condition of alarm and float switches, etc.): 7,ight oa ho / ' a taak,6 alza not Rag-3 nt DISTRIBUTION BOX: 2(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.): [�ist2t�utiorz kox has .two eat a-e.6 No evidence oz '30Pid'6 rr/2,2U nU0.2,- No D jclP-nr,,Q�fgak:rir�Q i_nt_o o/? o u Y 04 .fhe. Po PUMP CHAMBER (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Pum,12 rhnmP.vp jA nQ1 nno,svni r 8 Page 9 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 854 Phinneys Lane Centerville Owner: Lillian Jones Date of Inspection: 1 0 . 21 /03 SOIL ABSORPTION SYSTEM (SAS): _Z(locate on site plan, excavation not required) 2- 1000 as Peon R2eca.6.t .1eachina Rat If SAS not located explain why: In ra i Pr): .Spp 12a gp 70 Type leaching pits, number:_It Vb leaching chambers,number:_(D leaching galleries,number: 0 46 leaching trenches,number, length:_0 ZY leaching fields,number, dimensions: O �overflow cesspool, number: �_ /UU innovative/alternative system Type/name of technology:/�,�>oi Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): �nmy .6and to medium eine aand No a.igne o;e hydaaueic laiiu2e o2 Ponding. So ci.e a2e cl2u. Vegetation t.6 now CESSPOOLS,4 uV-(cesspool must be pumped as part of inspect ion)(locate on site plan) Number and configuration: O Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum laver: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): rP�ePooP� ate not P•ze,3ent PRIVY4&A O (locate on site plan) Materials of construction: Dimensions: i9 Depth of solids: Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): P/zivu -i not R2eaent 9 Page 10 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 854 Phinneys Lane Centerville Owner: Lillian !ones Date of Inspection: 1 0/21 /03 ` SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. o / Z 10 i i o � q6 qq / 0 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE.... Biupnstt1 nrkii Tunitrnr#i.un rnntif Permission is hereby granted.......J. P- .Nl !:.�"�:�?e r J r. .............................................................................. .......................... to onstzuct ( ) or Repair (X ) an Individual S",age Disposal System at No,—. '.''.......Pninne,;'S...Lan.e...Center.:li.11e...... Street as shown on the application for Disposal Works Construction Permit No../c�-.�Cc.yy.. .M. Dated.......................................... . .......... .... DATE............. ...:'. ...` Board of...H H.ea. ........................................lth ' FORM 36308 HOBBS 6 WARREN.INC..PUBLISHERS THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gertifirate of Qlamplian ie THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ) by ....`..........:_ao: o Aber Jr. ............................................................................................................-................................................................................................................. r. Ins�aller pn -nne ,rs Lane Centerville at ........................................................................................................................ .... .... a t ....:.............................................................................................. .... has been installed in accordance with the provisions of TITLE S of The St Environmental Code as described in the application for Disposal Works Construction Permit No. ........�o�..-...iT, f.......... dated .......................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SA ISFACTORY. DATE .................�f.............[7....... ..�....................................... Inspector ..............� ......................................................... Page I I of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C > SYSTEM INFORMATION (continued) Property Address:854 Phinneys Lane Centerville Owner: Lillian an Jones Date of Inspection: 10,21 /0 3 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 2t� feet Please indicate (check) all methods used to determine the high ground water elevation: l Obtained from system design plans on record - If checked, date of design plan reviewed: 14LS Observed site(abuning property/observation hole within 150 feet of SAS) ! $Checked with local Board of Health-explain: S a,6 &uiit Checked with local excavators, installers- (attach documentation) �ESAccessed USGSdatabase-explain:htt/2:Iltown, &a2n,3tagie. ma. ub. You must describe how you established the high ground water elevation: 11.6ed: Gah_Qe.t_u X 17i2Pe2 Node—P. 12116194 Ground wate2 eeevat.ion,6 agovehea ieveP. Uzed: CL 92-000- 7 P-Rate #2 Rnnua aanyeh o g2ouacL ate2 e-eevaiione. anuazy t vp ory Leaching Pit •cct /T Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frim ter P p Method Therefore, the vertical separation distance between the bonorry, 6 i of the leaching pit and the adjusted groundwater table is (cc(. II .n r-. n.-rr�rr...T:wn•nTinr.rn.n..n.i..nrn.•++.wr..w.Tw.n..r.•+-.ur�wT�nw�. .. 1'ONN OF BARNSTABLE WARD OF HEALTH j 0 SII1JSUf?PACF 9FWAGF DISPQSAL SYSTEM INSPECTION FORM - PART D .- CERTIFICATION �•T•1•T••-•..1—T.III.�.�T1•Tt r�l-N1rITR1�IR'�T1'T—t-I r1V'T77'R�P"1'�T�I/TI��\ tw1 _. -TYPE OA PRINT CLEARLY- PI?OPERTY INSPECTED STREET ADDRESS 854 Phinneys Lane Centerville ASSESSORS MAP , DLOCK AND PARCEL OWNER' s NAME Lillian Jones a� PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J P Macomber & Son In(f. COMPANY ADDRESSBox 66 Centerville Mass . 02632 Street Tovn or City 9ta59 COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 -1 578 tiP R CERTIFICATION STATEMENT " I certify that I have personally inspected the sewage dieposa7 system nt this address and that the information reported is true , accurate , and omplete as of the time of -inspection , The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Check one ; .`L/System PASSED i The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 16 - 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , System FAILED* The inspection whic), I have con cted has found that the system fails to Protect the i-itiblic health and the environment in accordance with Title 5 , 3.10 CMR 15 - 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , "r , Inspector Signature Date : 7 ne copy of this c rt.ification must be provided to the OWNER, the BUYER ( where applicable ) and the DOARD OF ti$AL'I'!I, * If the inspection FAILED, the owner or"`oporator shall u aYste within one year of the date of the inspection , unless alloweddorPgr ' the requiredm .otherwise as provided in 3.10 C1•IR 16 . 306 partd . doc l TOWN OF BARN STABLE I,oCATION 7 ��e�5 SEWAGE # -- VII.LAGE rreo el-y a a ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO_ SEPTIC TANK-CAPACITY LEACEM-4G FACII<M: {tyF.c) a ` le el.c �� S (sue) 6 o U Ge, NO.OB'BIEDROOMs 3 BMDER OR OWNER PERMITDATE: CO#�LlANCE DATE:-- Separation Distance Between the: �i Maximum Adjuster}Groundwater Table to the Bottom of beaching Facility ___- Feet W 11t ,t Private dater Supply Well and Leaching Facility. (if any quells exist on site or within 200 feet of leaching ffec ility)� Fit Edge of Wetland and Leaching Fae ity(If any wetlands exist within 300 feet of leaching facility) ;`/'! , Feet Furnished by .331 od � - -E- 1 TOWN OF BARNSTABLE LOCATIONgrl-i in/1Uc S L SEWAGE VILLAGE_ ASSESSOR'S MAP & LOT J � n INSTALLER'S NAME & PHONE NO. �r / a-r44 hG SEPTIC TANK CAPACITY f` LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNERki DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: / �- VARIANCE GRANTED: Yes No�/ l 3�i Iti Ix. f � o ASSESSORS MAP NO: q PARCEL NO: .C2 .1 THE COMMONWEALTH OF MASSACHUSETTS APPRVE BOARD OF HEALTH Barnstable Conserr0 t on Departmeiit TOWN OF BARNSTABL A 1 ifiPFI toY1 for Dts IIiiFBl Workii t'1!y$t'5 Urt Si rrmit p Application is hereby made for a Permit to Construct ( ) or Repair YXX) an Individual Sewage Disposal System at: _ .. Phinneys _Lane Centerville ..._ ...---•-------•................................. .....•--•----------------••-••-----------------•-----•---•-------••--------------..............--- Lillian JoneS Location-Address or Lot No. ......................_--........................................................................ ------------...................................................................................... Owner Address a J.P.Maconber Jr. Installer Address Q Type of Building Size Lot............................Sq. feet V Dwelling Y_No. of Bedrooms.............?------------•----.--------.•Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers a YP g -------•-------------------• P ( ) — Cafeteria ( ) Other fixtures W Design Flow............................................gallons per person per day. Total.daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width--.......--..--. Diameter--...........--. Depth.............. x 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 b ...... ...... Date........................................ ,4 Test Pit No. 1................minutes per inch Depth of Test Pit--------._.--.------ Depth to ground water...---.................. (i Test Pit No. 2................minutes per inch Depth of.Test Pit..................... Depth to ground water..--.................--. P4 ............................................. ............................................................................................................... 0 Description of Soil.......................................................................................................------------------------....................................... x Sand & Gravel --------------------------•--- v --••-n W --------------------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------- U Nature of Repairs or Alterations—Answer when applicable-1 ...ga,.11on....laaching...�.11.t-a................ ----------------------------•------.....----------------....---•--------•--....-----............ ---------------I'll------------------------------•••-•--................................... 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 e has b en jfsued by the boar of hea Signed .. /J 7�1�92 ----- --------------------------------- Date Application Approved By ............. ---- Date Application Disapproved for the following reasons- .....................................................--------- ------------------------------ ------------------- ------------ -------- ---------------------------- ------ -- ---------------------------------------------------------------------------------- -- -- ------- -- ------- ------------------------------- .................Da-ce-------------------- r� Permit No- ------ q------/ r------�-9,?................. Issued ......................................................... QQ pp poi THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE '-�' Appliration for Dispaaal Warks C om4rurtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair :;X)j an Individual Sewage Disposal System at: • 85?+ Ph3.naga,5-..!Ana„Centerville.... ... ---•------------------------------------------- Lillian Jone s Location-Address or E No. ......................---------..........---•------............---------.._....•----• ............................................... Owner Address w. ....Macomber Jr. Installer Address U Type of Building Size Lot...........................Sq. feet Dwelling *Nr, No. of Bedrooms..............?_...........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures -------------------------------- -------------------------------:....--------------...-----------------------------------•----••...---•........---- W Design Flow............................................gallons per person per day. Total,daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length..............*, Width----------_..... Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length---__----__---a--__- Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by.......................................................................... Date........................................ 04 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------------------------- Ix ----------------------------------- •------- •------- ----------------------------------------- --------------------=.................................... O Description of Soil ----- •------------------ ------------------- --------- ------------- =---------------------------------------------- V Sa.t�d. ..�r�:mf .............................................................................................................................................................. x .------•----•-----------------------•-------------•--•--------------------------•-------•••--------------•--------------------•----•-------------•----••-----•-•----•-•-•-•------•---...---...... -•-•- V Nature of Repairs or Alterations—Answer when applicable.___l.!n10r 7__-ga I 1 G_Q...Ian - i g.--,, y__............... -----•---•----•-------------------•••---••-•-------••-•---•--------••-•------•••----.....--••----------------•--------------•----•-----•-•--••-•-------•---------•--•--•........-----••-•--............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b-en issued by the boar Hof heal.6 Signed///4--- _ . . ...''-- ...x�-t'- - 7/1/t9.2... Application Approved By .. ..... ----- - ------------ Date Application Disapproved for the following reasons: --- _.-.- ............................. air Date Permit No- --------------- - Issued .------------------------------ Date s THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 101ertif ra e of Cnxttplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repairedy(XX ) by J.P._Macomber Jr. ---------- ------- -- - -------- -- -------------------- ------------------------------------------------------------------------------------------- -- ---------- -------------------- Installer at -_-854...Ph nneya...Lane_--Centervi.11e_----Inga..-._.- ----- -- -- ------------ ----- --- --- -------- ......------------.--- has been installed in accordance with the provisions of TITLE 5 of The St at Environmental Code as described in the application for Disposal Works Construction Permit No. --:-----q .--.- - -..--.--- dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.DATE.............. ..-- Y. ` G1�{ ---------------------- Inspector ........... .......�---------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �7 pq TOWN OF BARNSTABLE No....9a.. 1.[.. FEE....,-... 0.1.9 Disp aiial Works %'-p wAriirtivit amit Permission is hereby granted.......J.P.Ma C omb e r Jr. to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at No....B54... hijaPf?Zs...Laxle Gez�teru J:�e Street C -2 .. as shown on the application for Disposal Works Construction Permit No............. .�_ Dated.......................................... -------•-••-•-------------- -- -- ................... DATE............-7-=--��-------��-,- ......................................... v Board of Health FORM 36508 HOBBS&WARREN,INC..PUBLISHERS - "-` .. .. � �. v �N , r y } y