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HomeMy WebLinkAbout0236 MEGAN ROAD - Health 236 Megan Road. , § A T f Hyann § v.. A = 291. 269 y ` � v P I9 1 A • Y o 0 0 'u 6 TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE ASSESSOR'S MAP.&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /p LEACHING FACILITY:(type) 4001,7 (size) NO.OF BEDROOMS _3 OWNER C Q� w - P OAP14ANeE DATE: J,—.P—,,,e Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on` site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY-���/�` ' f'6� �Y�� T/®�✓ r I tr Town of Barnstable Inspectional Services Department MASS.'M ' Public Health Division 9� tb 9 �0� D 3" 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 8074 October 23, 2020 MARTUCCI, THIAGO M 236 MEGAN ROAD HYANNIS, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 236 Megan Road, Hyannis, MA was inspected on 10/08/2020 by Thomas Roux, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per r' Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF HE BOARD OF HEALTH Thomas McKean, R. ., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\236 Megan Road Hyannis.doc Town of Barnstable BARNFrABM 039. s Inspectional Services Department lED MA'S Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts °?9�'"' o2&5 Title 5 Official Inspection Form F Subsurface Sewage Disposal System Form Not for Voluntary Assessments r 236 Megan Road Property Address Thiago Martucci r Owner Owners Name information is required for every Hyannis ✓ Ma 02664 October 8, 2020 ' page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information S/sr filling out forms on the computer, use only the tab Thomas Roux key to move your Name of Inspector cursor-do not use the return Company Name key. 89 Mayflower Lane Co � Company Address East Wareham Ma. 02538 City/Town State Zip Code 774-678-9066 S14531 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);I have personally inspected the sewage disposal system at theproperty address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails r Oc oL4-'� 47 202 0 Inspectors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report'to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7126=18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . � 236 Megan Road Property Address Thiago Martucci Owner. Owner's Name information fo ie Hyannis Ma. 02664 October 8, 2020 required for every y page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary. Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"ConditionalPass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑N ❑ ND(Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Megan Road Property Address Thiago Martucci Owner Owners Name information is Hyannis Ma. 02664 October 8, 2020 required for every page. City(Town State Zip Code. Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑Y ON ❑ ND (Explain below): ❑ obstruction is removed ❑Y ❑N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts. Title 5-Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Megan Road Property Address Thiago Martucci Owner Owner's Name information is Hyannis Ma. 02664 October 8, 2020 required for every page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® El clogged of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Megan Road Property Address Thiago Martucci Owner Owner's Name information is required for every Hyannis Ma. 02664 October 8, 2020 page. Cityrrown State Zip Code Date of Inspection C: Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form 1' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L<� 236 Megan Road Property Address Thiago Martucci Owner Owner's Name information is required for every Hyannis Ma. 02664 October 8, 2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® El information facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue ❑ ® approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Megan Road Property Address Thiago Martucci Owner Owner's Name information is required for every Hyannis Ma. 02664 October 8, 2020 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): No design Number of bedrooms(actual): 2 DESIGN flowbased on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): +220 gpd Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date t5insp.doc•rev.7126=18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 236 Megan Road Property Address Thiago Martucci Owner Owner's Name information is required for every Hyannis Ma. 02664 October 8, 2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 7 t5insp.doc-rev. /26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Tithe 5 Official Inspection Form 1' 4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 236 Megan Road Ili Property Address Thiago Martucci Owner Owner's Name information is required for every Hyannis Ma. .02664 October 8, 2020 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® -Other(describe): Septic tank and single pit. Approximate age of all components, date installed (if known)and source of information: 47 years, house was built in 1973. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2.2'feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: +10' feet Comments (on condition of joints, venting, evidence of leakage, etc.): c � t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . Y 236 Megan Road Property Address Thiago Martucci Owner Owner's Name, information is required for every Hyannis Ma. 02664 October 8, 2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1.2 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'L x 5.67'W x 5.6TH Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle 31" 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? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface.Sewage Disposal System Form-Not for Voluntary Assessments 236 Megan Road Property Address Thiago Martucci Owner Owner's Name information is required for every Hyannis Ma. 02664 October.8, 2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,V 236 Megan Road Property Address Thiago Martucci Owner Owner's Name information is required for every Hyannis Ma. 02664 October 8, 2020 _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): " Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert N/A 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.): There is no D-Box. I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 236 Megan Road Property Address Thiago Martucci Owner Owner's Name information is required for every Hyannis Ma 02664 October 8, 2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): " If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: The pit was dug up and inspected. The pit was filled to the top with water. The pit is not draining. This is a hydraulic failure. Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Megan Road Property Address Thiago Martucci Owner Owner's Name information is required for every Hyannis Ma. 02664 October 8, 2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The pit was dug up and inspected. The pit was filled to the top with water.The pit is not draining. This is a hydraulic failure. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Megan Road Property Address Thiago Martucci Owner Owner's Name information is required for every Hyannis Ma. 02664 October 8, 2020 page.. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) .13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Megan Road Property Address Thiago Martucci Owner Owner's Name information is required for every Hyannis Ma. 02664 October 8, 2020 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately I S 'e t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 TOWN OF BARNSTABLE f LOCATION -i SEWAGE# VILLAGE ASSESSOR'S MAP.&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEAcEaNG FACILITY:(type) (size) NO.OF BEDROOMS _3 OWNER C & DATE: Separatian Disum Betweea the: MaximumA4asted QvondwaterTable to the Bottom of Leaching Faa'lityr Feet Private Water Supply Nell and Leaching Facility(Ifauy was=btant' . site ar withm 200 feet ofbaci ft Eacgity) _Fat Edge of Welland and I=chingFaaOityr(Ifany watiands exist within 300 feetofleacbioglr) Feat XW"e t; E Commonwealth of Massachusetts �y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Megan Road Property Address Thiago Martucci Owner Owner's Name information is required for every Hyannis Ma. 02664 October 8 2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 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: Groundwater contour map (From previous Title 5 report). ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: From previous Title 5 report. A test hole would have to be dug to determine the actual G.W. table depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 c Commonwealth of Massachusetts g Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,J 236 Megan Road Property Address Thiago Martucci Owner Owner's Name information is required for every Hyannis Ma. 02664 October 8, 2020 -- page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ® D. System information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 0?9/-0&y Commonwealth of Massachusetts ®Aa H Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments / 236 Megan Road c Property Address p.a Judy and James McCarthy Owner Owner's Name information is required for every Hyannis annis MA 02664 August 8 2016 -6 _ page. City/Town State Zip Code Date of Inspection IU Inspection results must be submitted on this form. Inspection forms may not be altered in filly way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, v use only the tab 1. Inspector: key to move your cursor-do not David B. Mason use the return Name of Inspector key. David B. Mason r� Company Name 4 Glacier Path Company Address Run East Sandwich MA 02537 Cityrrown State Zip Code 508-367-1617 S1287 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority August 8 2016 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 236 Megan Road Property Address Judy and James McCarthy Owner Owner's Name information is Hyannis MA 02664 Au ust 8, 2016 required for every y 9 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 conditions of the septic system observed represent only those conditions at that moment of the inspection and does not guarantee the continued operation of the system into the future. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official InspectionForm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 236 Megan Road Property Address Judy and James McCarthy Owner Owner's Name information is Hyannis MA 02664 August 8, 2016 required for every y g page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND.(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 236 Megan Road M Property Address Judy and James McCarthy Owner Owner's Name information is Hyannis MA 02664 August 8, 2016 required for every y 9 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 236 Megan Road Property Address Judy and James McCarthy Owner Owner's Name information is Hyannis MA 02664 August 8, 2016 required for every y 9 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 236 Megan Road Property Address Judy and James McCarthy Owner Owner's Name information is Hyannis MA 02664 August 8, 2016 required for every y 9 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)] 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 exam ple:.110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 236 Megan Road Property Address Judy and James McCarthy Owner Owner's Name information is August 8, 2016 Hyannis MA 02664 Au required for every H-y 9 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage Yes 9 ( Y 9 (gpd))� Detail: 2014; 44,000 gallons and 2015;49,000 gallons Sump pump? ❑ Yes ® No Last date of occupancy: currentDate Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ® No Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 236 Megan Road Property Address Judy and James McCarthy Owner Owner's Name information is Hyannis MA 02664 August 8, 2016 required for every y 9 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Board of Health Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank„Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 236 Megan Road Property Address Judy and James McCarthy Owner Owner's Name information is Hyannis MA 02664 August 8, 2016 required for every y 9 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: constructed 1973 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Typical Sludge depth: 3" t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 236 Megan Road Property Address Judy and James McCarthy Owner Owner's Name information is Hyannis MA 02664 August 8, 2016 required for every y 9 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 36" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 3" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Scour Stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Effluent level with outlet invert. Tank is 12 inches below grade. Outlet tee in place Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 236 Megan Road Property Address Judy and James McCarthy Owner Owner's Name information is Hyannis MA 02664 August 8, 2016 required for every y 9 page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as,related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•,Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 236 Megan Road Property Address Judy and James McCarthy Owner Owner's Name information is August 8, 2016 Hyannis MA 02664 Au required for every H_Y g page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Not Applicable. Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box does not exist. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located,explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 236 Megan Road Property Address Judy and James McCarthy Owner Owner's Name information is Hyannis MA 02664 AU required for every y gust 8, 2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 4 foot pit with 2' stone. There is an indication of staining 24 inches from the bottom of the leach pit. leach pit is 24" below grade. No standing effluent in leaching pit. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 236 Megan Road Property Address Judy and James McCarthy Owner Owner's Name information is Hyannis MA 02664 August 8 2016 required for every y 9 , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5ins•3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �.� 236 Megan Road Property Address Judy and James McCarthy _ Owner Owner's Name information is Hyannis MA 02664 August 8 2016 required for every y _ _ 9 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below.- El hand-sketch in the area below ® drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 236 Megan Road Property Address Judy and James McCarthy Owner Owner's Name information is Hyannis MA 02664 August 8, 2016 requireYd for every _ 9 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: 18 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: Groundwater Contour Map ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater Contour Map -- - 'Before filing this Inspectio n Report, see Report Completeness Checklist on ne xt page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 236 Megan Road Property Address Judy and James McCarthy Owner Owner's Name information is Hyannis MA 02664 _Au ust 8, 2016 required for every Y 9 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins'3/13- Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE LOCATION SEWAGE# ASSESSOR'S MAP,&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY lD Q o dc.f1. LEACHING FACILITY:(type) ��'`'G� G�/T (size) NO.OF BEDROOMS -3 OWNER C PL"RAUT D ATC Cam' DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist or, site or within 200 feet of.leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) n Feet FURNISHED BY ltjd'1/�`��jj�,f'4J� �yt'Q�G��TiO!✓ �I 3� 1 ` .1 BIKE Town of Barnstable Barnstaabbblle KASS.EAMSTABL& ' Board of Health ,111I.F i6g9 #1� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi Public and Environmental Health Program February 15,2012 Policies,Procedures,and Guidelines Septic Systems Documented as Failing fo Protect Public Health'and"Safety and the Environment by a DEP Approved,System Inspector,Later,Documented to have;a.P,assed. Inspection for the Same System Conducted by a DEP Approved System Inspector#"2012-01 (Section 15.305 of the State Environmental Code, reads as follows `if a system is failing to protect public health, safety, welfare, or the environment as set forth in 310 CMR 15.303(l)or 15.304(1), the owner or operator shall upgrade the system within two years of discovery unless:(a)a shorter period of time is set by the local Approving Authority or the Department based upon the existence of an imminent health hazard;or(b)the continued use of the system is permitted by the local Approving Authority in accordance with the provisions of an enforceable schedule for upgrade.] The Town of Barnstable Board of Health will consider permitting the continued use of a septic system which has been documented to "fail" to protect public health, safety, and the environment but later documented to "pass" an inspection by an approved System Inspector conducted in accordance with 310 CMR 15.302 and local Health Regulations. To consider such an extension, the applicant is required to provide the Board two passing inspection reports conducted by two independent or separate DEP certified inspectors. The two independent passing inspections shall be conducted at least six months to one year apart. The following procedure shall be followed for consideration by the Board to grant an extension or to overturn a failed septic system inspection report: 1. The applicant shall submit four copies of the failed and passed inspection reports to the Health Division Office (200 Main Street Hyannis Ma) at least thirty days before the established deadline to repair the failed system. These documents will be forwarded to the Board members for review prior to and during the next regularly scheduled public meeting. , [NOTE: At properties used for seasonal use,inspections should be conducted during periods of heavy usage] 2. During the public meeting, the Board will determine whether or not the application would qualify for an extension. The Board will also determine whether or not to require or recommend another septic system inspection which shall be conducted six to twelve months after the first passing inspection. The Board may require the additional inspection(s)to be conducted during a specific time period(i.e. during summer months)at seasonal properties. 3. Immediately after the third inspection is conducted(six to twelve months later)the applicant shall provide the Health Division four copies of the third septic system inspection report, regardless of whether it's a passed or failed result. The Health Division will forward the documents to the Board members for review prior to and during the next scheduled public Board of Health meeting. At that meeting, the Board will determine whether or not the application would qualify for any additional extensions and/or determine whether or not two passing inspection reports would overturn the failing inspection originally submitted. i Wayne Miller,M.D. Junichi Sawayanagi Paul Canniff,DMD Q:\POLICIES\FailedSepticSystemsWithPassingReports.doc 91 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' t' 236'Megan Road ` N Property Address a. 'Thiago•Martucci Omer Owners Name :;- information is r required for every Hyannis Ma 02601 10/15/2020 i City/Town state Zip Code Date of inspection f `j Rage Inspection results must be submitted on this form. Inspection forms may not be altered°in any ¢,, Way.Please see completeness checklist at the end of the form. r -important-When A. Ins p /w � . actor Information #� �R filling out forms on the'computer,- use onty tlfe tab Sean` .Jones key to rn?ye your Name of Inspector cursor:-do not. S:M.Jones Title V Septic Inspection use the return Company:Name key: 74 Beldan Lane Company Address ` Centerville Ma 02632: Cityrrown State Zip Code ' g 774-248-4850 smjonesfitte5@gmaii.com, Si 4522 ` seas smjonestitle5.com r License Number B.,Certification I certify that: i am a DEP approved system inspector in full compliance with Section 16.340 of.Title 5. s . (310:CMR 15.000); [have personally inspected the sewage disposal system at the property address:_ r listed above;the information reported below is true, accurate and complete as of the time of my w_ inspection; and the inspection was,performed based on my training and experience in the proper function and-.maintenance of on-site sewage disposal systems.After conducting this inspection 1 have,detemined, , that the system: 1. Passes 2. ❑, Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4, ❑ ,Fails 10/1512020 s :Inspector's Signature Date ' The system inspector.shalt submit a copy of this inspection report to the Approving Authority(Lioardh , of;Health oc DEP)within 30 days of completing this inspection. If the system has a design'flow,of ._.�.: 10000 gpd or greater;the inspector and the system owner shall submit the report'to the appropriate` : = regional office of the DER The original form should be sent to the system owner and copies sent tD'.' ' ~. the buyer, if applicable, and the approving authority. Please note:This report only describes conditions at the time of inspection and under,the conditions of use at.that time.This inspection does not address how the system will perform In the future under the same or different conditions of use. t5insp.dor•rev.7rM=8 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' N. 236'Megan Road Property Address - Thiago"Martucci ', Owner OWneei Name w rnformatioli is f� required for euery 'Hyannis.. Ma 02601 10/15/2020. r .page Cityrrola+n State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1,2, 3, or and-all of 4 and 6. 1), System Passes:. - I:have not found any;information which indicates that any,of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below: Comments: F t The property located at 236 Megan Rd Hyannis is served by a Title V septic system consisting-of-a- , 1000 gallon.septic tank and a 1000 gallon precast leach pit. Although the system was found to be in`- proper working condition at the time of inspection this report does not guarantee future perforih-6rice' `under similar or increased,usage. a , • 2) System Conditionally Passes: Q One or more system components as described in the"Conditional Pass"section need to be,_ replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board.of Health,will pass. Check the box for"yes", "no":or"not determined"(Y, N, ND)for the following statements.if"not:; �'determined,"please-explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not);is structurally''Y r 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. s _ Y El Y O N ❑ -ND,(Explain below): _ t tSinsp:doc-rev.7126=18, Title 5 Official Inspection Fam Submelaace:Sevwap Disposal Systam-Page 2 or 18 `( Commonwealth of Massachusetts Title. 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments f 236 Megan Road 1 - 3 *�' Property Address v ° Thiago,Martucci " _--Owner Owner's.Name � informationis " required for every Hyannis Ma 02601 10/15/2024 ° t •`page. C�+lrowm'" State Zip Code Date of inspection � r C. Inspection Summary (cont.) ' 2) System Conditionally Passes(cont.):- , Pump£hamber,pumps/alarms not operational. System will pass with Board of Health approval rf r - pumps/alarms are repaired. Observation of sewage backup or break out or high static water level in the distribution box due: to broken or obstructed pipe(s)or.due to a broken, settled or uneven distribution box pSystem-will" s pass inspection if(with approval of Board of Health): El broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): obstruction is removed ❑ Y ❑ N ❑ ND(Explain below)..- El distribution box is leveled.or replaced ❑ Y ❑ N ❑ ND(Explain below) ❑ The,system required pumping,more than 4'times a year due to broken or obstructed pipe(s).:The, system will pass inspection if(with approval,of the Board of Health): broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below) El obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):, A , { - r '> 3) Further Evaluation is.Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if", the system is failing to protect public health, safety or the environment. r a. System will pass unless Board of Health determines in accordance with 310 C1111W . - a 15.303(1)(b)that the system is not functioning in a manner which willprotect publichealth� a_ safety and the environment: t5"msp.doc•-rev.7/28/218 Title 5 OfFdW Inspection Form:Subsurface Sewage Deposal System,Page 3 of Is f Commonwealth of Massachusetts Title 5 Official Inspection Form to .. Subsurface Sewage Disposal System.Form-Not for rVolunta y Assessments 236 Megan Road ' Property Address ' Thiago Martucci ft' g4*_$ Ownec :Owners Name { q-r I inloimation is - Hyannis Ma 02601 10/15/2020 ,required-for every. y `r* Page Cily/Town State Zip Code Date of Inspection 'C. Inspection summary (cone) , Cesspool or privy is within 50 feet of:a surface water 11 �{ •0; Cesspool or privy is within 50 feet of a bordering vegetated wetland or a sift marsh k .r b. System will fail unless the Board,of Health(and Public Water,Supplier, if any) t _ determines that the system is functioning in a manner that protects the public health,,. •,gyp `µ 'safety and environment; f. The system'has a septic tank and`soil'absorption system(SAS)and the SAS is within: ,. 10.0 feet of a surface water supply or tributary to a surface water supply. 0` The system has a septic tank and SAS and the SAS is within a Zone 1 of a publicwater,- Supply. El The system has a septic tank and SAS and the SAS is within 50 feet of a private water- s supply well. - n The system has a septic tank and SAS.and the SAS is less than 100 feet but 50 f_eet or:` More from-a,private water supply well". - Method used to determine distance R ' **This system passes if the well,water analysis, performed at a DEP certified laboratory;for fecal w ' coliform bacteria indicates absent and'the presence of ammonia nitrogen,and nitrate nitrogen is'.equal",.'.� 3 to or less than ppm, provided that no other failure criteria are triggered.A copy of the analysis must: be attached to this form. .tr� C. Other: r. s 4)x 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 oEl r 0 clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground surface waters El due to an overloaded or clogged SAS or cesspool ftlsp.doc rev.Z/28=8 Title 5 offidal Inspection Form:Subwface Sewage Disposal System•Page 4 of le x _ - Commonwealth of Massachusetts Y Title 5 Official Inspection Form `- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments, )'':jam• - , '.i - J '236 Megan Road' " v - . Property Address `"a Thiago Martucci s owner Owner's Name _ f• mot. f information is �,rt• Hyannis Ma 02601 10/15/2020 ;``=arrequired focevery �'� Page. 'City/Town state Zip-Code Date'of Inspection C.Anspection Summary (cunt.) , u 4), System FailureCriteria Applicable to All Systems:(cunt.) - - Yes No Static liquid level in the distribution box above outlet invert due to amoverioaded El ® or clogged SAS or cesspool Liquid depth'in cesspool is less than 6"below invert or available volume is, . than 7z day flow r Required pumping more than 4 times in the last year NOT due to cloggetl or r 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. "R _ ❑ ® Any portion of a-cesspool or privy is within a Zone 1 of a public water supply_ well. ❑ 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well- .. ❑ 0 Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet y from a dvate water su well with no acceptable water quality ana sls hls 1. P pplY p g ty, IY .,IT ._.r system passes N the well water analysis,performed at a DEP certified y " laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm, provided that no other failure criteria are triggered:A copy of the analysis g, and chain of custody must be attached to this form.] — The system is a cesspool serving a facility with a design flow of'2000 gpd _ 10000 gpd: The system fails.I have determined that one or more of the above failure; " criteria exist as described in 310 CMR 15.303,therefore the system falls ,,The. . _ system owner should contact the Board of Health to determine what will'be` F H ' necessary.to correct the failure." ` 5) Large Systems: To be considered a large system the system must serve a:facility with a} ` ..' • ,` design flow of 10000 gpd to 15,000 gpd. For arge systems, you.,must indicate either"yes"or"no"to each of the following, in addition to,the., , questions-`in Section.C.4. `� Yes No t � .. x t - ❑ the system is within400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection;. Area—IWPA)or mapped Zone II of a public water supply well t5insp:doc•.rev.MAW 8 Title 5 Offir al Inspection Form;Subsiaface Sewage Disposal System•Page 5 of 18 f j , < .Commonwealth of,Massachusetts -# Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for'Voluntary Assessments ` 236 Megan.Road { Property Address Thiago Martucci Owner s information ts;' , Owner's Name s, , Hyannis Ma 02601 10/15/2020 regwred fore"very H Y r„ page. Citylrown State Zip Code Date of Inspection -" r ,t °C. Inspection Summary (cont.) '. If you have answered"yes"to any question in Section C.5 the system is considered'a signik nit e threat; or answered"yes"to any'question in Section C.4 above the large system has failed'.The ' j ci­1- owner-or operator of-any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in.accordance with 310 CMR 15.304.The system owner' ; should contact the appropriate regional.office of the Departrnent. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No 0 ❑ Pumping information was provided by the owner, occupant, or-Board of Health K., 0 0 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? t Have large volumes of water been introduced to the system recently or as part of xs s ` this inspection? a Were as'built plans of the system obtained and examined?(If they were not_ r ® available note as N/A) ' . r Was the facility,or dwelling inspected for signs of sewage back up? ® F1 Was the site inspected for signs of break out? j (] Were all system components,,excluding the SAS,located on site? ,. +' E El Were-the septic tank manholes uncovered,opened, and the interior of the tank', 'o n inspected for the condition of the baffles or tees, material of construction, , ,+`'a: dimensions; depth of liquid; depth of sludge and depth of scum? '= w Was the facility owner(and occupantsif different from°owner)provided with.;,. ' ®' El mformatlon on the proper maintenance of subsurface sewage'disposal systems, . 4._ The size and location of the Soil Absorption System(SAS)onahe`site has, " been_determined based on: -0 ❑ 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)] • t tSkM.doo•mv.72 MIS Title 5 Offidai Inspection Form:Subsurface Sewage Disposed System•Page of 18 Commonwealth of Massachusetts ` Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ". � ,236MeganRoad Property Address Thiago.Martucci Owner Owner's Name a information is Hyannis Ma 02601 101.15/2020 f`w germs for every CityfTown State Zip Code Date of Inspection ; R ms D. Sy tem Information t. Residential Flow Conditions: ,k 4 ~, Number of bedrooms(design): 2 Number of bedrooms(actual): T2 DESIGN flow based on 310 CMR 15.203(for example 110 gpd x#of bedrooms); 220 gpd g._ s 6 Description: Number of current residents: 3` Does residence have a garbage grinder? ❑ Yes ® vNo Does residence have awater treatment unit? ❑ Yes ® ',NQ ` -If yes,discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® l No .: information in this report.) Laundry system inspected? ❑ `Yes ® No - _.Seasonal use?, El es ®w No;, _` Water meter readings, if available(last 2 years usage(gpd)): - Detail: r Sump pump? ❑ Yes Noss_ current, Last'date of occupancy: Date , t _ Mnsp:doc•rev.7426 M 8 TiNe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18' Commonwealth of Massachusetts Title 5 official Inspection Form ' v Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �` k 236 Megan Road r Property Address r` ." Thiago Martucci i f owner Owner's Name information is Hyannis, Ma- 02601 10/15/2020 required for ev Hery y page: Cityfrown state Zip Code Date of Inspection ati�= D. System lnforrnation�(cont.) 2. CommerciaUlndustrial.Flow Conditions: 'm, Type of Establishment Design flow(based:.on 310 CMR 15.263):. Gallons per day(spd) 5gsis of design flow(seats/persons/sq.ft, etc.): f Grease trap present? ❑ Yes ❑'' No Water treatment unit present? ❑ Yes ❑' No ; If yes, discharges to: % �F n Industrial waste holding tank present? ❑' Yes ❑ No;. Non=sanitary waste discharged to the Title 5 system? El Yes ,❑ ,.No a Water meter readings, if available: Last date of occupancy/use:' Date Other(describe below): .3. Pumping Records: Source of information: _ Y ` Was system pumpedas'part of the inspection? ❑ Yes R. No - If yes, volume pumped: gallons How was quantity pumped determined? - ' T Reason.for pumping: E 66sp.duc-rev.7r26=18 Title 5 Official Inspection Form:Subsurface Sewage Dlsposai System-Page 8 of.18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Megan Road Property Address Thiago Martucci Owner Owner's Name information is required for every Hyannis Ma 02601 _ 10/15/2020 page. cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: original system 1973 _ Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 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.): Inlet cover is under deck with no access t5lnsp.doc•rev.7/26)2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Megan Road Property Address Thiago Martucci Owner Owner's Name information is Hyannis Ma 02601 10/15/2020 required for every y _.� page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons 5" Sludge depth: --- Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and took j measurements _ 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 does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. t5insp.doc-rev,7/262018 P� Title 5 Official Ins ion Form:Subsurface Sewage Disposal System•Page 10 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Megan Road Property Address Thiago Martucci Owner Owners Name information is Hyannis Ma 02601 10/15/2020 page. for every Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural"integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5tnsp.doc•rev.71AW16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System form-Not for Voluntary Assessments r 236 Megan Road Property Address Thiago Martucci Owner Owner's Name information is required for every Hyannis Ma 02601 10/15/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert N/A 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.): t5insp.doc•rev.7/26=18 Idle 5 Official Inspection form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Megan Road Property Address Thiago Martucci Owner Owner's Name information is Hyannis Ma 02601 10/15/2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number. 1 ❑ leaching chambers number: El leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: 15insp.doc•rev.7f26/2018 Title 5 Official Inspection Fong:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Megan Road Property Address Thiago Martucci Owner Owner's Name information is required for every Hyannis Ma 02601 10/15/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System(SAS) (cunt.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit was located and excavated and found with 3'standing water and a stain line 2'higher approx 12"below inlet invert. 12. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): t5insp.doc-rev.728M118 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts IFTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Megan Road Property Address Thiago Martucci Owner Owner's Name information is required for every Hyannis Ma 02601 10/16/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.MWOI8 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 118 Commonwealth of Massachusetts Title 5 official Inspection Form kq Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Megan Road��Wwvi Property Address Thiago Martucci /-Owner Owner's Name information is required for every Hyannis Ma 02601 10/15/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 10Zv4 c r , O U � A Z6 A2- t32 3L ('0 t5insp.doc•rev.7/AW18 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Megan Road Property Address Thiago Martucci Owner Owner's Name information is required for every Hyannis Ma 02601 10/15/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water. 12'+ 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: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5insp.doc•rev.M2612D18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Megan Road Property Address Thiago Martucci Owner Owner's Name information is required for every Hyannis Ma 02601 10/15/2020 page. Citylrown State Zip Code Date of inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information.Complete all fields in this section. ® B. Certification: Signed & Dated and,1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included I t5insp.doc•rev.7/260)18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18