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HomeMy WebLinkAbout0595 MARINER CIRCLE - Health 595 MARINER CIRCLE _- COTUIT . - --- - - - -- - - - - � A= 024-084 j - i i fME Town of Barnstable RAMSTASM M, ' Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 John Norman,Chairrman FAX: 508-790-6304 Donald A.Guadagnoli,M.D. F.P.(Thomas)Lee,P.E. Daniel Luczkow,M.D.Alt March 1, 2022 Ms. Diana Parker 595 Mariner Circle Cotuit, MA 02635 RE ExtensionAo Replace Onsrte Leaching Facility, 5957Manner Circle Cotuit A Dear Mr. Gunderson, You are granted a one year extension until January 31, 2023, to replace your onsite leaching facility at 595 Mariner Circle, Cotuit. During the public meeting of the Board of Health held on January 25, 2022, you testified the septic system has not had any sewage overflows nor any sewage back-ups. According to your email dated November 8, 2021, that the septic system was inspected in 2019 when you were contemplating selling the house. The private inspector informed you at that time, the leaching facility had failed. However, you have not seen nor experienced a septic system hydraulic failure issues. After reviewing the information provided, the Board of Health voted to grant you a one year extension, until January 31, 2023. Sincerely ohn Norman Chairman Q:WP/Septic Repair Extension Parker 595 Mariner Circle 2022.docx V rrl� Crocker, Sharon:' V J;-iJ a2sa6aA From: Crocker, Sharon Sent: Monday, November 08, 2021 9:13 AM To: Crocker, Sharon Subject: FW: Septic Leaching Field co �(..bnm� From: Diana Newton [mailto:diananewtonparkeragmail.com] Sent: Friday, November 05, 2021 4:15 PM To: Health Subject: Septic Leaching Field My name is Diana Parker and I am requesting an extension for replacing the leaching field at 595 Mariner Circle, Cotuit. I have lived in the house 40 years, most of the time alone (30 years). In 20191 was selling the house but health issues forced me to remain and I intend to remain here until I require assisted living. In preparing the house for sale in 20191 had a septic inspection by Shawn McElroy of Upper Cape Septic Services which failed. I stayed in the house and did not watch the whole time but when I came out he had a white bucket and shovel next to him and told me it failed and "don't use your washing machine, it will back up into the house". Also he said that he would bring a contract the next day for the repair. I told him no, that's a conflict of interest, no estimate needed, I would look to other companies. I have had no problems, no back-ups or sluggish drains in the 2 years since he was here. In addition to a very lightly used system I have NEVER used any fertilizer of any kind on my lawn (it looks it by the way, not like the pristine green lawns of my neighbors who pour nitrogen on several times a year). My nitrogen footprint is small and I believe will be insignificant in the next 7 months if you grant me an extension until spring. In addition to health issues I have waited because despite the website and maps I have been unable to get a clear time frame for sewering my house. I am the Mrs. Parker who made public comment about the importance of not enforcing title 5 replacements on homes going on sewer within a certain time frame at the town council meeting you were invited to attend. Anyway, I received some apologies the next day from town counselors for my being brushed off by one counselor who implied that I was ignorant for not looking my house up on the town's website. Of course I had done that, and had asked my town counselor to check as well. Even now, during my last conversation with Paul Ruszala from DPW(September 30, 2021)he only stated that it is "unlikely" houses in STAGE 2 will be sewered in 5-10 years but not impossible. They only have to come up Rte. 28 another couple miles from where they are stopping on Phase 1 to reach my neighborhood. So I still don't have a time frame, just "unlikely" to be soon. I looked into getting a grant for an alternative system (which I can't afford) from the Barnstable Clean Water Coalition and was told only Shubel's Pond area is being tested. So it looks like I am out of options and must put in the new leaching field. My main concern right now is the erosion of the sloped lawn where the septic system is located; I would prefer to wait until spring so grass can be planted and I can get someone to water and care for it. The torrential downpours lately are wreaking havoc in construction areas where ground cover is removed. I got 5 bids in Nov. of 2019 and my potential buyer agreed to pay it, but as I stated, a health crisis forced me to remain in the house and cancel the sale. In April of this year I got 5 new bids from the same companies but 3 were extremely high so I have 2 possible companies to do the job and will comply with whatever you decide...but I would appreciate an extension until June, 2022. Thank you for your consideration. Sincerely, Diana Parker 595 Mariner Circle Cotuit, MA 774-238-2843 �v Town- of Barnstable Inspectional Services Department anxrrsraeLle, 6 9. ��� Public Health Division 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4988 1043 November 4, 2019 PARKER, DIANA L P.O. BOX 276 COTUIT, MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 595 Mariner Circle, Cotuit, MA was inspected on 10/16/2019 by Shawn McElroy, 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: A Leaching facility with standing liquid level at or.above the invert pipe (per 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 ORDERQZ THE B ARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\595 Mariner Circle Cotuit.doc Town of Barnstable IARVSfABLE, 04 6 9 ► Inspectional Services Department iDTEp µp,l 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 above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool 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) aching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:ISEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts v Title 5 Official Inspection Form hI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 595 Mariner Cir Property Address ~ Diana Parker Owner Owner's Name information is required for every Cotuit MA 02635 10-16-19 page. City/Town State Zip Code Date of Inspection 4 9 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. A. Inspector Information Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 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);1 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 10-16-19 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth'& Massachusetts Title 5 Official Inspection Form ".al Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 595 Mariner Cir Property Address Diana Parker Owner Owner's Name information is required for every Cotuit MA 02635 10-16=19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System�Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 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 Commonwealth of Massachusetts , r� Title 5 Official Inspection Form :� 'ri Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 595 Mariner Cir Property Address Diana Parker Owner Owner's Name information is required for every Cotuit MA 02635 10-16-19 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 ON ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑Y ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑Y El ❑ 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts ra ,a, Title 5 Official Inspection Form C�'l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 595 Mariner Cir Property Address Diana Parker Owner Owner's Name information is required for every Cotuit MA 02635 10-16-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i� wa •_ ,01 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments T, ,> 595 Mariner Cir Property Address Diana Parker Owner Owner's Name information is Cotuit MA 02635 10-16-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems:. (cont.) Yes No ® ❑ Static liquid level in the distribution box`above,outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 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. ❑ ® 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. f ® R ❑ 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 ll 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 Commonwealth of Massachusetts r� Title 5 Official Inspection Form -li Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 595 Mariner Cir Property Address Diana Parker Owner Owner's Name information is required for every Cotuit MA 02635 10-16-19 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? ® ❑ Wasthe facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Fora �I iryi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 595 Mariner Cir Property Address Diana Parker Owner Owner's Name information is required for every Cotuit MA 02635 10-16-19, page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Description: Number of current residents: 1 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 Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 10-2019Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments • g p Y rY r U 595 Mariner Cir Property Address Diana Parker Owner Owner's Name information is required for every Cotuit MA 02635 10-16-19 page. City/Town 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----pumped 4 yrs ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts ,w Title 5 Official Inspection Fora ! h Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 595 Mariner Cir Property Address Diana Parker Owner Owner's Name information is required for every Cotuit MA 02635 10-16-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of.the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1982 Were sewage odors detected when.arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 12"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. t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts 3 Title 5 Official Inspection Form I i3 C�'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 595 Mariner Cir Property Address Diana Parker Owner Owner's Name information is required for every Cotuit MA 02635 10-16-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 6"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 4" 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 13" How were dimensions determined? Tape 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 sing of leakage. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Fora .iK Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 595 Mariner Cir Property Address Diana Parker Owner Owner's Name information is required for every Cotuit MA 02635 10-16-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) . 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: 'Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): ' 8. Tight or Holding Tank (tank must be pumped,at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form C�'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments g p Y ry 595 Mariner Cir Property Address Diana Parker Owner Owner's Name information is required for every Cotuit MA 02635 10-16-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box had water at working level with stain lines above inlet invert. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 r Commonwealth of Massachusetts ,Pill Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 595 Mariner Cir Property Address Diana Parker Owner Owner's Name information is required for every Cotuit MA 02635 10-16-19 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: 1-1000 gal ❑ 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 Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts r� 4. ,w, Title 5 Official Inspection Form iol► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 595 Mariner Cir Property Address Diana Parker Owner Owner's Name information is required for every Cotuit MA 02635 10-16-19 page. City/Town 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.): Leach pit had water level at 3" below inlet invert with stain lines above inlet. 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 it Commonwealth of Massachusetts Title 5 Official Inspection Form ' i► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 595 Mariner Cir Property Address Diana Parker Owner Owner's Name information is required for every Cotuit MA 02635 10-16-19 page. City/Town 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.): r ' 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 �i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 595 Mariner Cir Property Address Diana Parker Owner Owner's Name information is required for every Cotuit MA 02635 10-16-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100,feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately (D) 1 r 1 _ -�` - 7 - - � . t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 ram, Commonwealth of Massachusetts Title 5 Official Inspection Fora iI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 595 Mariner Cir Property Address Diana Parker , Owner Owner's Name information is required for every Cotuit MA 02635 10-16-19 page. City/Town 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: 20 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: USGS and town maps show groundwater at greater than 20'. 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 Commonwealth of Massachusetts Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments > ra 595 Mariner Cir Property Address Diana Parker Owner Owner's Name information is required for every Cotuit MA 02635 10-16-19 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 i l Old BAMSTAME - — LOCAInON S� MUAG . Cd f a A.ss Res � D SULI EWS ItlAlldJB PIKOIJE PIO. 5BF'1C TASYF CAPAOd CI'CX - L, ��rta 1tlppttt pt� cr . .. D .. CO1vB'"1.IMCE DATE. ftis blI Dist a Bstvieetn k �: Maulrnutm.Ad�uiW:Graua watgrTabletotheBottorrto£),eucEtmgl!Sic:iUty P� e'��t�Sully yYc�i�zd t.eucl��ng l?ac�ltry':{��Y_�re��x� Foot ate sstG ce within 2A0 fait s►f tncbla$f �Il#y): i t c� iNet�and od uwhlhgftalty.([fany exist i•�lttanl';14Q�e tcx�cing nary.? w .-..—�&�ee d i w l d U D w 90 o v \ l i f , v �� L O A YN SEWAGE PERMIT N0. VILLAGE , ��d, m4 INSTA LL MS ZNAME i ADDRESS 0 UIlD R OR OWNER, DATE PERMIT ISSUED DATE COMPLIANCE ISSUED /S/�,� er w � �. qr .,- No.........7....a'... ... .F� o_--...._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Q e 13r- �w .................OF....'Rau .......................................... Appiiration for Dispuutal Works Tons rurtiun ramit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at* - �. ,,.� • •. ............. ocatio ddeess or iv"il.............. ... ... ...........a..-- - - ................_. .. ...................... ...... -------- - - /11 Lot No. Ow er r •• ------------------- ......... ....... ..........................-------------.--- Installer � Address Type of Building Size Lot_ .6Y/-.--Sq. feet Dwelling—No. of Bedroo .........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ... No. of ersons.......6..._ _..... Showers — a YP g ---•- - P ------ ( ) Cafeteria ( ) Otherfixtures -------------------------------------------••--------......----------....------------------.............-------•----------..........•............ W Design Flow............... ......._••..gallons per person per�day. Total dail� flow.........3s�Q......................gallons. WSeptic Tank—Liquid'capacity,/dldigallons Length._,/��... Width._.,......... Diameter................ Depth................ x Disposal Trench—No..................... Width..._.. ....... Total Length..__.____. �t_:...Total leaching area.... - Seepage Pit No._..._.._..�.._.._._ Diameter.__... .__..._ Depth below inlet_._./g ......... Total leaching area.. ft. Z Other Distribution box Dosing tap ( ) Percolation Test Results Performed b ._ 1�-l/n �._ � Y --- - -• -- •------- - •-•- --- -••--•-------.............. Date...... � ---��---... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground ___-. fs, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water.:f/�'•-------- l- _. . .. �:.__....: O — �f 7 f Description of Soil.... ............... .-.... �YIC - - L-- -- ...... x 3.-AIZ - C K � �L x , ..�lY. 1'�' v`� - - U Nature of Repairs or Alterations—Answer when applicable.___............................................................................................ ..•................•-------•--------•--------•-•-•-----•••--------••-•-----------•----•--•--•--•-----...-----••---••. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'HE 5 of the State Sanitary Code—The undersigned further-agrees not to place the system in operation until a Certificate of Compliance has been' sued by the d of l ealth.�,ri� d , Si ned.. .--- ......................•-- at Application Approved BY ,-� ...1144-• -------------------------------- -----C .y_e7/.--�.---- Date Application Disapproved for the following reasons-----------------------•----------------•---------------------------------------•-------------------------•-•--- .......-•------•-••.......-----••-••-•----•--------•-•_.._--••---••-•••-••---•-•---•--•---•-••.....-•-•...---------•---•-••-••--•------------•--------•-••--------------•--------•-••--••----------....._ Date PermitNo......................................................... Issued....................................................... Date a THE,COMMONWEALTH OF MASSACHUSETTS BOAR '�OF HEALTHa,e, is ; el, . Ao-,, 4, .......... ................OF..... ..................../.Gy'� `�- Appfiration for Disposal Works Tonstrnrtion ramit Application is hereby made for a Permit to Construct (1) or Repair ( ) an Individual Sewage Disposal System at: Loc'atiioin_Address or Lot No. Gc. (...................... ............................... :t.. . s� e---- es •---____»-•z_:--•----...--•-•------•---------- -------••--•--------- ------------_____---- --•--•--•-------------____--------•-•-----___.-d- ess-______.____—�_____ Installer Address Type of'puilding -� Size Lot__��1_y/....Sq. feet U Dwelling—No. of Bedrooms..__..._.__,_ ___________________________Expansion...Attic ( ) Garbage Grinder ( ) Other—Type of Building �ll< �__._ No. of persons.....__................ Showers ( ) — Cafeteria ( ) Q' Other fixtures . ----------- *------------•=--•--------------•--------------- -- W Design Flow...............�_.��__._.............gallons per person per day. Total daily flow.......... _�o.....___._______.___gallons. WSeptic Tank—Liquid capacity./gallons Length___/l_�,___ Width................ Diameter________________ Depth................ x pisposal Trench—No_____________________ Width_______r.................... Total Length._______.__t-__ Total leaching area.......... m.s , f 'Seepage Pit No----------- ------- Diameter----...,�' --_. Depth below Inlet---- -• ------ Total leaching area._:�. �� 'G Z Other Distribution box ( /) Dosing tank ( ) ` '-' Percolation Test Results Performed by...........i r/Nrv?:../. !` i/1)C _� ______________ Date__.___/Z 4 _.._7f...... � &Test Pit No. l................minutes per inch Depth of Test Pit-----i,.............. Depth to ground water.._____ ------- (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._/j//`'(h._ -- ------------------------------------•--------- O Description of Soil _-._ ... -j Gir,v� ._..-- - I..0 ' ry jr -•- UNature of Repairs or Alterations—Answer when applicable__._�__________________________',,_!_:___....______..__._________...____._.__._._.____________... -----------------------------------------------------------•---•--•----•-------------------------------------------- .......................v.............................................. Agreement: The undersigned agrees to install the aforedescribed•Individual.Sewage Disposal System in accordance with the provisions of T?T LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. , Signed... / "•' _ /s� }` / �i111111/ -11 ,-; ate Application Approved By------ . ' -- ----------------------------- Application Disapproved for the following reasons:........... --•------•-----••________________________________ ____....._______- i ___________________________________________________________________________________________ ................................................__--------------------------------------- Date Permit No..... ... Issued....................... . Date E , THE COMMONWEAVTH OF MASSACHUSETTS BOARD OF HEAL ' (9rdtftrtttr of Tnntpftanr'rf THIS IS TO CERTIFY, That the Individual Sewage Disposal System%',onstructed ) or Repaired ( ) �� .f.,� 3 Ito ns ller at_ l �.1 uc�l, !� iY�. r ........................ ............................................................. has been installed in accordance with the provisions of "� 1 r of The State Sanitary Code � desc -be in the aa �}} application for-Disposal Works Construction Permit N -.•7`S.............. �'_____________ dated-. _``r�...__�`.� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM V!lI FUNCTIONS SATISFACTORY.,,' DATE.. •#. 5 } :.: Inspector....... --------- ................... 3Lr; f - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - ....._.. No......................... FEE........................ Disposal Works TonstrAdion ramit Permission is hereby granted__��_-!-��_. �- !J.�c�_.�. ---- -'--:----•-o ',,�- ......................................... to Construct ( e) or Repair ( . ) an,Individual Sewage Disposal System at No. I� f `� � " - ---- �� '---•----•-------•------------------------------------------- -- ---4- -vU street / as shown.on the application for Disposal Works Construction Pe o.__ ________ -ated...._..................................... Board of Health DATE`` ------------- FORM 12!r HOBBS & WARREN, INC., PUBLISHERS � Via_ _ L/• _ ICJ OTES _ -- O\,✓ti A" MEA." SEA �. BA'`.�EU o•� v.S.C � G .5 t�-rvM C3..�..J E. ---•+ -.- (D^-- 1P t tG La A L.�- t.,i J E S P, "I"j , "ONA o Fr t/b" V� A. 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