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HomeMy WebLinkAbout0030 OCEAN VIEW AVENUE - Health 30 OCEAN VIEW AVEAf qff`., A=034.056 C F .03-11- as l7 Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Ocean View Ave !* Property AddressLL DavidGiller C(AAd1 l)'.WUS -G,llaf IJQnn ,tn-c-c Reek U4:hVSt Owner Owner's Name information is Cotuit Ma 02632 102-18 required for every r page.e. City/Town State Zip Code Date of Inspection , Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 33(e( on the computer, Brett Hickey use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return key. Company Name 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code n�m (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that: I 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 the property 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. ❑M Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails �enaH el9naEMBrenH�q 10-2-18 Brett Hickey e '`•Ozle:1 810.0019:4 1 Mtl0 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 of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ` 30 Ocean View Ave Property Address David Giller Owner Owners Name information is Cotuit Ma 02632 102-18 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, o'r 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: The system was in working order at the time of inspection. 2) 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �- le Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Ocean View Ave Property Address David Giller Owner Owners Name information is Cotuit Ma 02632 102-18 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 ❑ N ❑ 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:Subsurtace Sewage Disposal System•Page 3 of 18 c Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 30 Ocean View Ave Property Address David Giller Owner Owner's Name information is Cotuit Ma 02632 102-18 required for every 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 � ' ID 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 L Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Ocean View Ave v� Property Address David Giller Owner Owner's Name information is Cotuit Ma 02632 102-18 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 ❑ El Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ O Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow ❑ ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ El Any portion of the SAS, cesspool or privy is below high ground water elevation. El El tributary portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. El a Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. El El Any of a cesspool or privy is within 50feet of a private water supply well. ❑ O 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.] ❑ Q' The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. El ❑ ' 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 . l Commonwealth of Massachusetts Title 5 Official Inspection. Form <. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Ocean View Ave Property Address David Giller Owner Owner's Name information is Cotuit Ma 02632 102-18 required for every 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 E ❑ 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? 0 ❑ Has the system received normal flows in the previous two week period? ❑ a 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) ❑, E] Was the facility or dwelling inspected for•signs of sewage back up? Q ❑ Was the site inspected for signs of break out? E ❑ Were all system components, excluding the SAS, located on site? El ' ❑ 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? ❑ ElWas the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? F The size and location of the Soil Absorption System(SAS)on the site has been determined based on: E ❑ 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 ❑ El approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Ocean View Ave u Property Address r David Giller Owner Owner's Name information is Cotuit Ma 02632 102-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 4 4 Number of bedrooms(design): Number of bedrooms(actual): 440/gpd DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Description: 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes No Does residence have a water treatment unit? ❑ Yes Q 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 [E No See below Water meter readings,.if available (last 2 years usage(gpd)): Detail: "'2016-114,000gallons 2017-113,000gallons— t Sump pump? 4._. ❑ Yes 0 No current Last date of occupancy: Date t5insp.doc-rev.RM2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 c� Commonwealth of Massachusetts �- Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Ocean View Ave v Property Address David Giller Owner Owner's Name information is Cotuit Ma 02632 102-18 required for every page. Cityf town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: , NA 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: e 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:— Owner- Owner- last pumped 1 year ago Source of information: Was system pumped as part of the inspection? ❑ Yes ❑■ No If yes, volume pumped: gallons g.How was quantity pumped determined? Reason for pumping: l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form } Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Ocean View Ave Property Address David Giller Owner Owner's Name information is Cotuit Ma 02632 102-18 req&ed for every , Zip Code Date of Inspection City/Town/Town State p p page. Y D. System Information (cont.) u 4. Type of System: El 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: 1998 Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ` ❑■ 40 PVC' ❑ other(explain): Town water ,' Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 i- Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Ocean View Ave L , Property Address David Giller Owner Owner's Name information is Cotuit Ma 02632 102-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ■❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 1500gallon Dimensions: 4,� Sludge depth: 3211 Distance from top of sludge to bottom of outlet tee or baffle On Scum thickness NS Distance from top of scum to top of outlet tee or baffle NS- Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank-was in working order at the time of inspection. The tank is not in need of pumping at this time but should be pumped every two years for maintenance. t5insp.doc-rev.7/26/2018 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Ocean View Ave v Property Address David Giller Owner Owner's Name information is Cotuit Ma 02632 102-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA 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): NA 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 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form -_ la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Ocean View Ave Property Address David Giller Owner Owner's Name information is Cotuit Ma 02632 102-18 required for every 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): o" Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The d-box was in working order at the time of inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 c Commonwealth of Massachusetts �w Title 5 Official Inspection Form I� Subsur face Sewage Disposal System Form -Not for Voluntary Assessments 9 p Y rY 30 Ocean View Ave Property Address David Giller Owner Owner's Name information is Cotuit Ma 02632 102-18 required for every 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 R No* Alarms in working order: ❑ Yes 0 No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * 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; 1 ❑ leaching,pits number: ❑ leaching chambers number: ❑ leaching galleries number: (5)infiltrators 10AW Q 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 Offidal Inspection Form: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 30 Ocean View Ave v� Property Address David Giller Owner Owner's Name information is Cotuit Ma 02632 102-18 required for every 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.): staining at time of inspection. The leaching was In working order and was 1/2 full with no high sta g p 12. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): NA Number and configuration Depth-top of liquid to inlet invert Depth of solids layer • f, 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.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts ' �e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Ocean View Ave Property Address t. David Giller Owner Owner's Name information is Cotuit Ma 02632 102-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): NA Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 4 t5insp.doc-rev.7/26/2018 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form ,- I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments -u� 30 Ocean View Ave Property Address David Giller Owner Owner's Name information is Cotuit Ma 02632 102-18 required for every 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: n hand-sketch in the area below . ❑ drawing attached separately Asbuilt Ground Water tU v V y 9" C Garage 25" D A 1 infiltrators 8511 Cl-35' D1-10' _ Al-T8" B1.241" 5, A2-10' B2.25' A3-12' 83-176' l Ground water t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 i Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Ocean View Ave v� Property Address David Giller Owner Owner's Name information is Cotuit Ma 02632 102-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ■❑ Check Slope ❑■ Surface water ❑■ Check cellar ❑■ Shallow wells F below SAS Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: Q Obtained from system design plans on record 4-6-98 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: A plan on file with the Board of Health was used. 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 I - c� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Ocean View Ave Property Address David Giller Owner Owner's Name information is Cotuit Ma. 02632 102-18 required for every 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 0■ 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 } 15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Town of Barnstable jHE Regulatory Services Thomas F. Geiler,Director da Public Health Division � �r �> Thomas McKean,Director 9SS. 1 200 Main Street Hyannis,MA 02601 A�A�-�iAp�ei Phone: 508-862-4644 Email: health antown.barnstable.ma.us Fax: 508-790-6304 Office Hours: M-F 8:00—5:00 July 23,2004 Mass Electric Construction Company(MECC) Attention: Tim Tangeman, Safety Manager 180 Guest Street Boston,MA 02135 RE: Hydraulic oil spill from Mass Electric Const. Co. service vehicle at Ocean View Avenue Dear Mr. Tangeman: This letter contains follow up information pertaining to the hydraulic oil spill on.Ocean View Avenue in Cotuit,MA on July 20,2004. At this point,the spill is believed to have been caused by a malfunction of one of your service vehicles while your project manager worked on a utility line at this location. The information in this letter is intended to inform you that the actions committed by your project manager/staff violate Article 39 of the Town of Barnstable Ordinance: The Control of Toxic and Hazardous Materials(copy enclosed). It should be standard operating procedure by MECC staff that those responsible for any hazardous material spill or contamination have one hour to report this incident to the local Fire Department and local Health Department. This spill was never reported to the Town of Barnstable Public Division of Health on July 20;2004. This violates Section 6-5,paragraph(E) of Article 39. The hydraulic oil spill from the MECC service vehicle also violates Section 9-1 of Article 39. If you and your project manager determine that the hydraulic oil tank on the service vehicle that worked at this location on July 19,20, and 21'released any portion of an uncontained spill onto the ground at this location,you are liable for any contamination that occurs as a result of any follow up water and soil testing. Mass Electric Construction Company may be required to contribute to cleaning up the site of this oil spill. Therefore,the Public Health Division recommends that you consider retaining a Licensed Site Professional(LSP)at this time to oversee any needed assessment or cleanup at the street location of 30 Ocean View Avenue,which abuts this contaminated site(i.e.the street and curb in front of this property). You can obtain general information about your obligation from the Department of Environmental Protection. You may also obtain advice about Mass Electric Construction Company's legal obligations from an attorney who is knowledgeable about the 21E program. From this point forward, it is recommended that MECC comply with the Control of Toxic and Hazardous Materials ordinance(Article 39)in order to prevent contamination of Barnstable's existing and future drinking water supply, as well as prevent environmental contamination which can bankrupt site owners,lower or destroy land values,drive out residents and industry,depress local economies and endanger public health. If you have any questions about this spill incident or the recommendations mentioned above, please do not hesitate to contact the Public Health Division. Sincerely, Thomas A.McKean RS CHO .Director of Public Health cc: Bryan Greene,MECC New England Area Manager Enc. Article 39 (copy) Spill site photos DEP Waste Site Clean Up information s es 4 Notes from 30 Ocean View Avenue, Cotuit Hydraulic Oil Spill 7/20/04 — 7/21/04 7/20/04 Complaint received from resident at 30 Ocean View Avenue, Cotuit that "in front of his house there is hydraulic fluid that was dumped from Mass Electric Const. Co. This occurred while they were trying to repair a transformer. He stated that there is a storm drain about 50 feet away. He is concerned that this will pose a risk to his pet. He was unsure of the amount of the spill." • 7/20/04 Called property owner for more info on spill. He did not know how much had spilled. Stated that the workers from MECC put absorbent on it and cleaned it off the street. Stated that they changed the hydraulic line in the truck there on the street while using buckets to contain the oil. He watched from his deck while this all took place. Stated there was a lot of residue on the ground but it was hard to tell if it was still oil or oil and absorbent. MECC worked at this same location on July 19, 20 and 21st. • .7/21/04 7:45 am First site visit by AW. Took notes and observed a very large petroleum stain on the ground. Looked to be about 12 z feet long by 6 feet wide. Smelled the sand on edge of road — it smelled of oil. The stain indicated that the oil had flowed off the asphalt into the sand/ground. r The spill was from an MECC service truck. Seems they cleaned up the spill but neglected to contact Cotuit fire (confirmed they did not call on 7/21/04 with Cotuit Fire Dept.), Y neglected lected to call the 9 Dept. of Health, and they did not clean the spill up properly because the sand/soil on edge of road smelled of oil. • 7/21/04 9:17 am Second site visit to 30 Ocean View Ave. Measured spill approx. 15 feet long and 5-6 feet wide. Section where oil went off road is 4 inches wide and 3 feet long. • Took photos and three soil samples. Labeled samples completely and gave to Dale Saad for refridgeration the morning of 7/21/04. • 7121/04 1:50 pm Follow up call with property owner at 30 Ocean View Ave. Went over what he saw once more. He gave me DOT # for the truck:.363 062. He stated that Barnstable Police were there at the beginning of the spill but left soon after and did not see severity'of the spill and did not advise MECC employees to do anything because he did not see what happened. Owner is on town water. Not upset. Thanked me for follow up and information on what was being done. AW told him I would call if any other issues or info is needed. • 7/21/04 2:20 pm Called Safety Manager of Mass. Electric. Const. Co. in Boston: Tim Tangeman. 617-254-1015, Ext. 302 Explained situation and that the spill did occur by his staff and it was no handled properly. Gave him all relevant info and told him the call was a warning that they did not respond correctly. He apologized twice and said he was going to call the field project manager working on the power line in Cotuit. • 7/21/04 4:15 pm Called Cotuit Fire Dept. to confirm that they were not called for response to this spill on 7/20/04. • Cotuit Fire Dept. confirmed the spill was not reported to them. Because of this they "were unable to clean it up properly." Confirmed with Joan Geggatt of Cotuit Fire Dept. (business office). • Left all info in a message for Cotuit Fire Chief via Joan Geggatt on 7/21/04. • AW wrote a follow up letter to MECC/Mr. Tangeman on 7/21/04. • Gave follow letter to Dale Saad, substitute supervisor for Tom McKean, Director of Public Health on 7/21/04 at 4:00 pm. Waiting her o.k. to send letter to MECC/Mr. Tangeman. ,t I Town of Barnstable THE T Regulatory Services Thomas F. Geiler,Director Public Health Division * sARvsrns Thomas McKean,Director 9 MASS. 4j 039. 200 Main Street, Hyannis,MA 02601 Phone: 508-862-4644 Email: health(o)town.barnstable.ma.us Fax: 508-790-6304 Office Hours: M-F 8:00—5:00 July 23,2004 Mass Electric Construction Company(MECC) Attention: Tim Tangeman, Safety Manager 180 Guest Street Boston,MA 02135 RE: Hydraulic oil spill from Mass Electric Const. Co. service vehicle at Ocean View Avenue Dear Mr. Tangeman: This letter contains follow up information pertaining to the hydraulic oil spill on Ocean View Avenue in Cotuit, MA on July 20,2004. At this point,the spill is believed to have been caused by a malfunction of one of your service vehicles while your project manager worked on a utility line at this location. The information in this letter is intended to inform you that the actions committed by your project manager/staff violate Article 39 of the Town of Barnstable Ordinance: The Control of Toxic and Hazardous Materials (copy enclosed). It should be standard operating procedure by MECC staff that those responsible for any hazardous material spill or contamination have one hour to report this incident to the local Fire Department and local Health Department. This spill was never reported to the Town of Barnstable Public Division of Health on July 20,2004. This violates Section 6-5,paragraph(E) of Article 39. The hydraulic oil spill from the MECC service vehicle also violates.Section 9-1 of Article 39. If you and your project manager determine that the hydraulic oil tank on the service vehicle that worked at this location on July 19,20, and 2 1"released any portion of an uncontained spill onto the ground at this location,you are liable for any contamination that occurs as a result of any follow up water and soil testing. Mass Electric Construction Company may be required to contribute to cleaning up the site of this oil spill. Therefore,the Public Health Division recommends that you consider retaining a Licensed Site Professional,(LSP)at this time to oversee any needed assessment or cleanup at the street location of 30 Ocean View Avenue,which abuts this contaminated site (i.e. the street and curb in front of this property). You can obtain general information about your obligation from the Department of Environmental Protection. You may also obtain advice about Mass Electric Construction Company's legal obligations from an attorney who is knowledgeable about the 2 1 E program. I f From this point forward,it is recommended that MECC comply with the Control of Toxic and Hazardous Materials ordinance (Article 39)in order to prevent contamination of Barnstable's existing and future drinking water supply, as well as prevent environmental contamination which can bankrupt site owners,lower or destroy land values,drive out residents and industry,depress local economies and endanger public health. If you have any questions about this spill incident or the recommendations mentioned above, please do not hesitate to contact the Public Health Division. Sincerely, Thomas A. McKean,RS,CHO Director of Public Health cc: Bryan Greene,MECC New England Area Manager Enc. Article 39 (copy) Spill site photos ; DEP Waste Site Clean Up information s f "ox-7 y Health Complaints 204ul-04 Time: .11:55:00 AMA Date:- --7/20/2004Complaint Number: 17579. Referred To: Amy Wallace Taken By: Sally Shea Complaint Type: Article X Detail: Business Name: . Number:'30 Street:'Ocean View Ave ti Village: COTUIT Assessors Map_Parcel: i Complaint Description: In front of the caller's house he states there is Hydraulic fluid that was dumped from Mass Electric construction Co. This occurred while they were trying to repair a transformer. He \ lj states that the Electric Co.was trying to catch it with buckets and they tried to clean it up with sand. He states that there is a storm drain about 50 feet away. He is concerned that this 0: will pose a risk to his pet. He was unsure of the amount of the spill. �( Actions Taken/Results: Investigation Date: Investigation Time: '7- Z( —6 ��►'h Si�Q 1/is j — ems 7- z )-- 01 eau �v�3a o Li - I_ • r cr.7a �- 1 • r 1 ` �-V✓ V f� 'C�- � CSC �" Z O ''y 6 . ,� ��1.�✓� �`, -3 c� �cep �f��� -�..$`�° ; t, w aL vo�kt {�.,,� ,(�oez� '• � �n of � � e�� �e� . �, —� S �✓�s .cal e G��edi � ��- w 0-77.. . 3 t Welcome to the Mass. Electric Construction Co. Web Site Page 1 of 3 Vaitayl . . fQuality .E.1ectrical Contracting ` r.ce . 2 Home m Offices Overview lz � Markets & Portland, Old Projects j Boston, rJA News .Providence, Ri ► Sacrerrento, CA`' ;,., �aF er�� Yorl<, NY Faces Oak F'kriladelPlia, PA C�akland;CA m Y 3 a tv , Equipment ` v ; `"}` ra`+r ` ' :��� �y Baltimore, l�.D 4 I A3� Careers Los Y3CIetCi's Links San Diegcs, G� � � �k lanta, GA da ndo, FL FL Corporate Headquarters Driving Directions 180 Guest Street Boston, Massachusetts 02135 617/254-1015 fax 617/254-0706 Rick.._Lanoha, President Thomas_Waltner, Director of Administration John Ablondi, Chief Estimator Tim_Tang.. an, Safety Manager , Guy_Ca.ge le., Quality Manager New England Area r ! 180 Guest Street Boston, Massachusetts 02135 617/254-1015 fax 617/254-0706 Bryan Greene, New England Area Manager New England Area Offices Boston Office 180 Guest Street Providence Office Boston, Massachusetts 02135 1473 Elmwood Avenue 617/254-1015 fax 617/254-0706 Cranston, RI 02910 Jonathan Wienslaw, Manager 401/461-9699 fax 401/461-9890 Richard Schneider, Manager Matt_Swanson, Manager Fred_Hammel, Manager http://www.masselec.com/offices.htm 7/21/2004 Welcome to the Mass. Electric Construction Co. Web Site Page 2 of 3 New York & Mid-Atlantic Area 150-50 14th Road Whitestone, NY 11357 718-747-5133 fax 718/747-5151 Fred.Zambon, New York& Mid-Atlantic Area Manager Mid-Atlantic Area Offices 180 Guest Street Boston, Massachusetts 02135 617/254-1015 fax 617/254-0706 Richard__Federico, Mid-Atlantic Area Sponsor Philadelphia Office Baltimore Office 5301 Tacony Street- Building#250 713 E. Ordnance Road#310 Philadelphia, PA 19137 Baltimore, MD 21226 215/831-8102 fax 215/831-8101 410/590-0155 fax 410/590-4860 Rick._Alexander, Manager Brian__S.a...rro, Manager Southe ast Area 3403 NW 55th Street Fort Lauderdale, FL 33309 954/485-3974 fax 954/485-3975 AlSori,Southeast Area Manager Southeast Area Offices Miami Office Orlando Office 3403 NW 55th Street 1900 Premier Row Fort Lauderdale, FL 33309 Orlando, FL 32809 954/485-3974 fax 954/485-3975 407/855-1746 fax 407/855-0971 Will.iam.._P...._Breen,.._Sr„ Manager S#eve Smith, Manager Southeast Area Major Project Offices San Juan, Puerto Rico Atlanta, Georgia 787/309-8485 404/898-0501 contact: Brian Hunter contact: Israel Simoes Midwest Area 7200 South Alton Way, Building A, Suite#310 Centennial, CO 80112 3031930-9100 fax 3031930-9101 William._P.J...._Breen, Midwest Area Manager http://www.masselec.com/offices.htm 7/21/2004 i Welcome to the Mass. Electric Construction Co. Web Site Page 3 of 3 .. Midwest Area Offices Denver Office Dallas Office 7200 South Alton Way 11076 Grader Street Building A, Suite#310 Dallas, TX 75238 Centennial, CO 80112 214/343-1044 fax 214/343-1110 303/930-9100 fax 303/930-9101 Kevin ton Manager Rick Caramante, Manager Harrin g 9 West Cast Area 2976-D Alvarado Street San Leandro, CA 94577 510/483-7094 fax 510/483-8873 Tony._Forsyth_.e,West Coast Area Manager Cell. 617/510-8369 West Coast Area Offices Northern California Office Southern California Office 2976-D Alvarado Street '11151 Palmer Avenue San Leandro, CA 94577 South Gate, CA 90280 510/483-7094 fax 510/483-8873 562/904-3601 fax 562/923-2661 Joseph Murphy, Manager H._Richard_Case, Manager ., West Coast Area-MajorProject Offices Portland, Oregon San Diego, California 503/235-7200 619/444-6322 contact: Chris Barker contact: Jack Oram Sacramento, California San Jose, California 916/857-1704 408/298-6943 contact: Greg Winn contact: Te_r_ry Phelps http://www.masselec.com/offices.htm 7/21/2004 NO. % Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for ;Digoga16petem Construction Verutit Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (!ao acev'/� I J0`1'ei a Owner's Name,Address and Tel.No. Assessor's Map/Parcel �D/ _ k �y a5 Installer's Name Address,and Tel.No. ✓ Designer's Name,Address and Tel.No. 7 / - Type of Building: q Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(__eo Other Type of Building of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank O Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue y this o of Health. / Signed Date <g Application Approved by Date --Application Disapproved for the following reasons Permit No. Date Issued N.. { ':, Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - � Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS V _r t 01ppYication for Misspaal *pgtem Construction Permit Application for a Permit to Construct( )Repair(t )Upgrade( )Abandon( ) El Complete System ❑Individual Components t Location Address or Lot No. �© OCe►Q y# I?W v,4e Owner's Name,Address and Tel.No. Assessor's Map/Parcel /�O�''/! /V7 - Installer's Nam Address,and Tel.No.( Designer's Name,Address and Tel.No. �Ol 7 ) 1 - 93 9 Type of Building: (� Dwelling 1 No.of Bedrooms / Lot Size sq.ft. Garbage Grinder(_A!!�le Other Type of Building e8� ��AC�No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 114 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank S �094 Type of S.A.S. eo 0VaX,1,091/ZeP , ;. Description of Soil Nature of Repairs or Alterations(Answer when applicable) r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue y thW!;oZ of Health:- =o� l Signed Date l" Applicat on Approved by Date" Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS _ Certificate of Compliance THIS IS TO CE TIFY that the On-JJs��'te��Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by 4��O lf/ C AKK115 at ®G'�ll'l/l//�'L��1Y/ ' /o XG/7 7— has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. "Z 6'_dated Installer Designer The issuance of this�e/rmit shall not b`econstrued as a guarantee that the system will function as designed. Date '�t off. D Inspector No. / 0 Zd / ------- 03 ��0�� Fee S�v"-'•" THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpogal *pgtem on0truction Permit Permission is herebyranted to Construct Repair(VolUpgrade Abandon( ) P ( ) Pg ( ) ( ) System located at granted 41_Cef4PA! 41le 6e l and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this p t. / Date: G �� Approved by W' to19/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) herebv certify that the application for disposal works permit signed by me dated �l2`QV , concerning the construction p - . property located at AD �Ge4'��%Z°�/ � meets all of the following criteria: v/ There are no wetlands located within :oo fee:of to or000sed lescaing facility ' V There are no private wells within i:o lest of the or000sed Septic system y There s no increase in :low and/or"ange in le or000sed 6i ner e are no variances requested or needed. Q•' If the proposed ieacain� ac:iiry will -e 'ocatec--vithin _0 Sect of,nv weaanas. the hot em of:he proposed leaching facility wiil nott -�e :ocated less:han :ourreen.i,:-? :eet above ,he :nax.mu, odius,e:: groundwater tab. elevation. Please complete the following: A)Top of Ground Elevation(according:o the Engineering Division G.I.S. nap) Zy� B)Observed Groundwater.',abie Elevation(according to Health Division well map) DATE: SIGNED: ' LICENSED SEPTIC SYSTEM INSTALLER 1N THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan. this plan should be submitted]. _ :%G 4F ham hmw.am �p f - V v wJ _ r �� Z TOY1N OFBARNSTABLE ` ''I:OCATION ® O Ce4?fl 02:!'4/ e, SEWAGE ASSESSOR'S MAP & LOT e 3'11-05 6 :':'INSTALLER'S NAME&PHONE NO. SEPTIC AN CAPACITY Ird0 GaG LEACHING FACILITY: (type) Z;akl-a Ad CS) (size) /0, 0,X0 1`10.OF BEDROOMS BUILDER G(J�L COMPLIANCE DATE: Separation Distance,Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility S—t Feet :Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) .`:'Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) �f� Feet Furnished by • I _-- -- -- �30 y R�r �� ;B 00 • ; 9z-rA �. 43•iA'6' ` c;� Town of Barnstable J/�w �tHe Department of Health,Safety,and Environmental Services • Public Health Division BAxrrMatE. MAM 367 Main Street,Hyannis MA 02601 � 039. Office: 508-790-6265 Thomas A.McKean,RS, FAX: 508-790-6304 Director of Public Health October 8; 1997 Carol L. Wilgus 30 Oceanview Ave. Cotuit,MA 02635 ORDER TO COMPLY WITH 310 CMR 15.00,THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 30 Ocean View Avenue, Cotuit was inspected on June 6, 1997 by Robert Bortolotti, a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: • The first cesspool had no outlet tee. The second cesspool was "not in good physical condition." You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office(Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code,Title 5 within(60)sixty days of receipt of this notice. You are also directed to bring the septic system into compliance within ninety (90) days of receipt of this order letter by installing a replacement septic system. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thom cKean,R.S.,C.H.O. Agent of the Board of Health q\hea Ith\dbfi les\title5 i.doc Z 203 � 498 864 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sentto Street&Num er t✓ Poostt & P ode Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to Whom&Date Delivered o, Return Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $ Postmark or Date ti a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). In a) 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Q) return address of the article,date,detach,and retain the receipt,and mail the article. Q LO 3. If you want a return receipt,write the certified mail number and your name and address rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse.front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the I G O addressee,endorse RESTRICTED DELIVERY on the front of the article. M 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. I ti 6. Save this receipt and present it if you make an inquiry, 102595-97-B-0145 d Town of Barnstable dam . 0 Department of Health, Safety, and Environmental Services s Public Health Division • e�Ewsresi& 367 Main Street,Hyannis MA 02601 EDM�A Office: 508-790-6265 Thomas A. McKean, RS, FAX: 508-790-6304 Director of Public Health October 8, 1997 Carol L. Wilgus 30 Oceanview Ave. Cotuit, MA 02635 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 30 Ocean View Avenue, Cotuit was inspected on June 6, 1997 by Robert Bortolotti, a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: • The first block-style cesspool was full of wastewater effluent. The liquid depth was less than 6 inches below the invert. Also, this cesspool had no outlet tee. The second cesspool was "not in good physical condition." You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within(60) sixty days of receipt of this notice. You are also directed to bring the septic system into compliance within ninety (90) days of receipt of this order letter by installing a replacement septic system. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE ARD OF HEALTH omas A. McKean, R.S., C.H.O. Agent of the Board of Health q\health\dbfiles\title5 i.doc lye Town of Barnstable Department of Health, Safety, and Environmental.Services Mom.BARNSTABMPublic Health Division s6Sq. � ,etFDp 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKeM RS,CHO FAX: 508-790-6304 Director of Public Health TO: 0�fo '30 oee:5:4 V)w Pry e DATE: sai l`R-1 C M A- 0 2r 3S ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. :d"J M4 The septic system owned by you located at 30 fir'► was inspected on Jn2 Co, 1�17 by F gor(�(� a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (31.0 C - S -10 4- �✓� J, receipt are directed to hire a licensed Town of Barnstable septic system installer to submit a �Jn°R h diagram of a proposed system to the Town of Barnstable Health Division Office c o' `-61"r n Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance 10 CMR 15.00, The State Environmental Code, Title 5 w-ithin ( n days of t of this notice. �re also directed to bring the septic s stem into compliance within - ys of of this order letter. b� �^s ( <�,. C5(7 Po a( You are further directed to maintain the system by hiring a licensed septage hau ,d pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided,for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health y�haltM�filaLLjtleSi.doc 0 0 3� a b. BORTOLOTTI CONSTRUCTION, INC. m IftQ17w- 7G5 WAKEBY ROAD MARSTONS MILLS ,MA 02648 J UL 508-771-9399 508-428-8926 -FAX: 508-428-9399. 1 0 lg9 r off, 7 � yOCFBA SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM TyoRf NPS TA B1 f T PART A, �. CERTIFICATION Property Address. a_0L yl., Date of Inspection: Inspector' ame: r _ AD"ere's N e andAddress': ✓ Of zzzz � oC` �j CERTIFICATION STATEMENT• I certify that.I have personally inspected the sewage disposal system at this address'and that the informa- tion reported below is true,accurate and complete as of the time of inspection. The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The System: Passes Conditionally Passes Needs.F . Evaluation By the Local Aproving Authority 's Fails / � Inspector's Sigrt�atur -�_Date:__ ` e 16e The System Inspector shall submit a copy of this inspection report to the Approving authority within thir- ty(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 Department of Environmental Protection. The original should be sent to the system owner and'copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY* t. A)SYSTEM PASSES: I have'not found any information which indicates that lite system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system,upon comple- tion of the replacement or repair, passes inspection: Indicate yes,nor,"or not determined(Y,N,OR ND).Describe basis of determination in all instances. If not determined",explain why not. The septic tank is metal,cracked, structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep- ' ` tic tank is�replaced with a conforming septic tank as approved by The'Board of Health. Sewage backkup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): - 1 - p„P � w 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) r • Broken pipe(s)replaced • Obstruction is removed f Distribution Box is levelled or replaced The System required pumping more than four times a year due to broken or obstructed pipe(s). ,. The system will pass inspection if(with approval of The Board of Health): , Broken pipe.(s)are replaced Obstruction is removed 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 'i,4he system is,failing to protect the public,health, safety and the environment, s 1);SYSTEM;WILL PASS UNLESS BOARD OF HEALTH DETERMINES,THAT THE , 4*,%S,YSTEM,IS NOT.FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 wctland.or,a salt marsh. y" 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE; ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 Feet to a surface; water supply or tributary to a surface water supply. ? The.system has aseptic tank and soil absorption system and is with a Zone I of a public 3. water,supply,well. The system has a septic tank and soil absorption system and is within 50 Feet of a private,•;,,. water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet.but 50.. Feet or more from a private water.supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution,from .., • the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 pp►m• D)�'YSTEM FAILS: ✓ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Healthf; should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent to the surface of the ground or surface waters due to an IV; overloaded or clogged SAS or cesspool. Static liquid level.in the distribution box above outlet invert due to an overloaded or clog- :;;;• ged.SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped -2- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: n' The following"criteria apply to a large system in addition to the criteria above:' {' F The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant;,_ threat to public health and safety and the environment because one or more of the following conditions exist: 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 p x (IWPA)or a mapped Zone II of a public water supply well. The owner or operator of any'such system shall bring the system and facility into full'compliance with the,- groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check`if the following have been done: Pumping.information was requested of the owner,occupant,and Board of-Health. None of the system components have been pumped for atleast two weeks and the system has e been receiving normal flow rates during that period. Large volumes of water have not been -. introduced into the system recently or as part of this inspection. VAs-built plans have been obtained and examined.. Note if they are not available with N/A: __Ie::::fhe facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow.. __j�ffhe site-was inspected for signs of breakout. - r 'All system components,excluding the Soil Absorption System, have been located on site. The septic tank manholes were uncovered;opened,and the interior of the septic tank was m j >,?a / spected for condition of baffles or tees,material of construction,dimensions,depth of liquid, r , depth of sludge,depth of scum. __Jeffie size and location of the Soil Absorption System on the site has been determined based on ' h existing information or approximated by non-intrusive methods. -3- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B . CHECKLIST(continued) r,,,The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION FLOW CONDITIONS RESIDEIYTIALiV/I" Design Flow: gallons Number of Bedrooms: Number of Current Residents: zheAOC4 Garbage Grinder: Laundry Connected To System: Seasonal Use: Water Meter Readings, ' av!RiIlaAb1l,e: Last Date`of Occupancy: , k)C) Type of Establishment: Design Flow: ' ''i `gallons/day Grease Trap Present: (yes or no) Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings,,If Available: _ Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: t GENERAL INFORMATION PUMPING RECORDS and source of informa on �yes. System Pumped as part of inspection: ume roped: gallonsir Reason for pumping: TYPEOF1SYSTEM: 6!Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy <. Shared System(If yes,attach pr ous inspection records, if any) Other(explain):/��i/1� 1Q�ll/tse �l�%_� j �►.��d2c� Q.��Cl�lt� APPROXIMATE AGE of all components,date installed(if known)and source of.=information: Sewage odors detected when arriving at the site: -4- r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 'GENERAL INFORMATION (continued) M; SEPTIC TANK: ,. Depth'below grade: Material of Construction: concrete metal FRP_Other : y (explain) z Dimisions: Sludge Depth: Scum Thickness: Distance from top of sludge to bottom of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments:'(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) GREASE TRAP: Depth Below Grade: Material of Construction:—concrete_metal_FRP—Other nw , (explain) Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or baffle: Comments:(recommendation for pumping,condition of inlet and outlet tees or baffles,Aepth of liqui&4'A li4in�relatioifto outlet invert,structural integrity,evidence of leakage,etc.) TIGHT,OR HOLDING TANK d < __ Depth-Below Grade: Material of Construction: concrete metal FRP_Other(explain) a Dimensions: Capacity: gallons Design Flow: gallonstday Alarm Level: '; u >,_Comments: (condition of inlet tee,condition of alarm and float switches;ctc.)r DISTRIBUTION ISTRIB U ON BO .X• d Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP CHAMBER:) Pump is in working order: Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) -5- .L• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS):_Iz .r. (Locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: 3.s 'Leaching pits,number: Leaching chambers,number: Leaching galleries,number: Leaching trenches, number,length: Leaching fields,number,dimensions: Overflow cesspool,number: 1 Comm ts: (note condition of soil,signs of hydraulic failu level of nding,condition of vegetation, etc1 ' O �g `41� CESSPOOLS:/ i Number and configuration: - S.r y Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of Cesspool: 'k Materials of construction, /' 4 Indication of groundwater: Inflow(cesspool must be pumped as part of inspection) Comn�tts- te condition of s ilk, signs of hyd a lic failur , level of p ding,condition of vegetation,etc.) V� - L PRIVY. Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) .p, -6 - r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (conlinned) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. i DEPTH TO GROUNDWATER: Depth to groundwater: Feet ,�" O Meth of Determination or Approxim 'on: /T -7 TOWN OF BARNSTABLE LOCATION O 0(7. SEWAGE # VILLAGE ASSESSO 'S MAP & LOT 5Co ZNSOk7OR'S %NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER O OWNER PERMUDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 ... � . l,G� -� �'�` ��u �� '� .'. � �� /vt ati.., � PAR Real Estate System - General Property Inquiry Help Parcel Id'. 034 056- - Account No: 2014 Parent: Location: 30 OCEAN VIEW AVE Neighborhood: 07AA Fire Dist: CT Devel Lot: Lot Size: . 36 Acres Current Own: WILGUS, CAROL L State Class: 101 30 OCEANVIEW AVE No. Bldgs.' I Area: 166C-) Year Added: COTUIT MA 26-35 Deed Date: 040190 Reference: 71:35/122 January 1st: WILGUS, CAROL L Deed MMDD: 0490 Deed Ref: 7135/122 Comments: Values: Land: 16 32:-'Cd 0 Buildings: 70300 E..-<tra Features." 4600 Road System". 30 Index: 1136 (OCEAN VIEW AVENUE ) Frntgg 241 Index". ) Frntg: Control Info." Last Auto Upd-' 050695 Status". C Last TACS Update: 080390 Land Reviewed By: Date. 0000 Bldgs Reviewed By: Date: 0000 Ta.-...-. Title: Account. Taken: Account Status: Hold Status: Cancel Press XMT for more data Next screen PAR Action Owners Name Road Inde.,.:: Road Name Parcel Number 034 057 -> TOWN OF BARNSTABLE LOCATION SEWAGE# Z® V,11LAGE ASSESSOR'S MAP & LOT ®3'-t*952� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY M-00 Gat ' LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER PERMIT DATE: `� '�� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility �t 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) r� Feet Furnished by r lair to 09 00 a. B3•ra'� �+ 4 w K TOWN OF BARNSTABLE LOCATION. SEWAGE # VILLAGE ASSESSOR'S & LOT rn r- IIS FRS NAME&PHO SEPTIC TANK CAPACITY LEACHING FACILITY: (type) / (size) NO.OF BEDROOM BUILDER O OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 bye+ I I d f •� n1 1• , COTUIT PLAN REF- PLAN OF LAND IN COTUIT SEPT. 1923 STAMPED BY THE TOWN OF BARNSTABLE D.P. W. MAD CB/DH P� A.M. 34 LOT 57 SCHOOL CO101, ti yy N13�o sTizEEr s- 165�pLAN �a�• ti OCEAN 163 61 ��"ALC. / ENUE NAM/'UCKET SOUND A.M. 34 LOT 55 0� �c �Z� `.� n1 LOCUS MAP 0 `% � �' DEED REF.' 7135/122 •lS i 7 ```\` ASSESORS MAP. 34, LOT 58 cS- ♦ ♦ ��������� ZONING. RF" 1 PROPOSED ,, ,,,,,,,, � � ♦0 .............. FLOOD ZONE: 'C" y�� AyG GARAGE ' ............. 1♦ ♦ COMM. PANEL ♦ ���������������������������� 250001 0018 D 4 G •�? ♦ ♦ (� ������� ���. CA U DATED.• 7/2/92 � HOUSE���� DECK OVERLAY AP" #30,...... W r01 A.1Lp 34 LOT 56 I .•••••••••••••••••• ........ AREA= 16,149f S.F. PORCH ........ CIS CB/DH SB/DH 34 ' CBIDH (PLAN) NO R=392.89' L=216.66' R=402.45' L=217.45' PLOT PLAN OF LAND (CALC.) LOCA TED A T.• 30 OCEAN VIEW AVE OCEAN VIEW AVENUE COTUIT, MA. PREPARED FOR.• I CERTIFY THAT ANDIN ACCORDANCE WITH THEVEY PROCEDURALNAND TEWERE CHNICAL LA CADINOS BUILDING STANDARDS FOR THE PRACTICE OF LAND SURVEYING IN AND DESIGN INC. T MMONWEALTH OF MASSACHUSETTS. 1•�/k�`-`-- Llx,� PA UL A. MERITHEW, P.L S. DATE MAY 1, 2003 GRAPI-fIC SCALE so ° '° z° 40 80 YANKEE SURVEY CONSULTANTS UNIT 1, 40B INDUSTRY ROAD P. 0. BOX 265 NOTE• A PLAN SUITABLE FOR RECORDING AT THE IN FEET ) MARSTONS MILLS, MASS. 02648 REGISTRY OF DEEDS IS RECOMMENDED 1 inch, = 20 ft. TEL• 428-0055 FAX 420-5553 J# 53309A u0 `- S + l o O LJ x " t a: v M v ":r `? CL n � O o @ t '7y w o Lagadinos Building and Design Inc. A o z Project: Wilgus/ Tobojka Home L4 r Custom Homes, Additions, Remodeling d w 13 Thankful Lane Cotuit,MA 02635 Tel.508-428-4097 Fax 508-428-7709 t L �J RH F J 0 � O F uT1 ' O O R Lagadinos Building and Design Inc. N" ACpProject: Wilgus/ Tobojka Home rCustom Homes, Additions, Remodeling d 13 Thankful Lane Cotuit,MA 02635 Tel.508-428-4097 Fax 508-428-7709 f ƒ X c & \ƒ \ / I E $ / ƒ 7J- ` \ /{ \ { § » > . \ . \ - . . 105 my t }_ Lagan Building and Design r ' Project: Wilgus TObo k3 Home � J ` Custom Homes, Additions, Remodeling / 13 Thankful Lanec ,MA 02635 21.gy428-4097 Fax s an -8-779n 5 \z > d M -51 I y .n M U) CD � \ � : � \ (D { ° \ \ \ \\ \ � (D > CD 0 :3M X cn i-10" >0"1 0 Cn w =- 0 § 1 0 CD Lagadinos Building and Design Inc. 0 Project: Wilgus/ Tobojka Home 6 z Custom Homes, Additions, Remodeling 13 Thankful Lane Cotuit,MA 02635 Tel.508-428-4097 Fax 508-428-7709 \ ) . ^0 t ) 2 73 \ 10 LO 0 \ $ 7\ } > \\ \\ ® ` ~. \ 2 1 3 -Ai -2 ( \ { Cr @ ® ? m 2 ¢ k Lagadi nos Building and Design Inc. J - ° ( { § Project: Wilgus/ T0b0 ka Home § > Custom Homes, Adito% Remodeling / 13 Thankful Lane Co ,MA02635 al.sE428-4097 Fax , an -@779n R