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HomeMy WebLinkAbout0034 EDGEWOOD ROAD - Health (3) 34.��dge�odd Road Hyannis A = 248 141 Town of Barnstable Inspectional Services Department Public Health Division �p .9 i63 �� rF 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7021 0350 0000 1549 3617 June 21, 2021 ANTIL, PAULINE J 34 EDGEWOOD ROAD HYANNIS, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 34 Edgewood Road, Centerville, MA was inspected on 05/05/2021 by Troy Williams, 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: • Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow. You are ordered to repair or replace the septic system within one (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH c ean, R.S., CHO i Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\34 Edgewood Road Hyannis.doc ��"� Town of Barnstable BA�MASS 111spectional Services Department f0►AA Public Health Division 2011 Main Sweet; Ilyannis MA 02601 I homas A ML Kcal. tlflicc 5118hb2 164a FAa 5UR-790-6304 Feb 6, 2007 Rev. 4/26/19 DEADLINES TO1REPAIR FAI Is.(1(►u>LEDI) SYSTEMS (,I*n\.\m Code §36( All ,,x': marked in the a ;s the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA o Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged oi- obstructed pipe. !-I Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE l YEAR llEAULINI? CR11'ER1A n Static liquid level Ill tile distribution fox is above t he outlet mve17 due to an overloaded or clogged SAS or ce.s{ u A portion of the SAS. cesspool. or privy is below the high groundwater elevation A portion of the cesspool i-s located within a lone 1 to a public well A portion i,f�the cesspool is located within Sll feet st of a private step, asses if the water,an I�Is;s with no acceptable water qual;I� aMi'I)S S. 1 I hI. 1 p indicates the well is free from pollution► 2 YEAR DEADLINE CRITERIA Single Cesspool systems" (broken cover. relocatmn of a pipe.. n relocatio Any ..conditirnnally passed of a drivewa� flue to I l-10 components. etc) Leaching facility with Standing liquid level at or above the inv ert pipe (per l own Code §360-20 h) OTHER ^ II I^ / OSenT`nCe �'p✓1'I�Ir 0 +SEPIICIDEADLINES 10 REPAIR FAILED SYSIENAS dOC Commonwealth of Massachusetts aL48- 14l , Title 5 Official Inspection Form L . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 Edgewood Road, Hyannis M -248, P - 141'.` mot,, Property Address 1 Pauline Antil Owner Owner's Name information is6 required for every 34 Edgewood Road, Hyannis MA 02601 . May 5, 2021 . page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Informationrjl�s �5yya filling out forms on the computer, use only the tab Troy Williams key to move your Name of Inspector cursor-do not Troy Williams Septic Inspections use the return Company Name key. 19 Hummel Drive r� Company Address South Dennis MA 02660 IL- Cityfrown State Zip Code (508) 385- 1300 S1682 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. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails May 5, 2021 Inspector's Signatu a 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. r Please note: This report only describes conditions at the time of inspection and under the i 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 �_•u 34 Edgewood Road, Hyannis M -248 P - 141 Property Address Pauline Antil Owner Owner's Name information is 34 Ed ewood Road, Hyannis MA 02601 May 5, 2021 required for every g y y 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 "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 r ; r c Commonwealth of Massachusetts,. : Title 5 Official Inspection Form 1. Subsurface Sewage. Disposal System Form - Not for Voluntary Assessments 34 Edgewood Road, Hyannis M -248 P- 141 u� Property Address Pauline Antil Owner Owner's Name information is required for every 34 Edgewood Road, Hyannis MA j 02601 May 5, 2021 page. Cityrrown 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 0 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. l `a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 , Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Ie Subsurface Sewage Disposal System Form Not for Voluntary Assessments 34 Edgewood Road, Hyannis M -248 P- 141 Property Address Pauline Antil Owner Owner's Name information is 34 Ed ewood Road, Hyannis MA 02601 May 5, 2021 required for every g Y Y page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated,wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates.absent and the presence of ammonia nitrogen and nitrate nitrogen is equal r 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: b 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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Edgewood Road, Hyannis M -248 P- 141 Property Address Pauline Antil Owner Owner's Name information is 34 Edgewood Road, Hyannis MA� 02601 May 5, 2021 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 NAStatic liquid level in the distribution box above outlet invert due to an overloaded SAS or cesspool ® ❑ Liquid depth in cesspoo Is ess an 6" below invert or available volume is less than '/z da flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is,below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000 gpd- ❑ ® 10,000 gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of tp a 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 El the system is located in a nitrogen sensitive area(Interim Wellhead Protection T-IArea—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 Commonwealth of Massachusetts Title 5 Official Inspection , Form Subsurface Sewage Disposa[System Form - Not for Voluntary Assessments 34 Edgewood Road, Hyannis M -248 P- 141 Property Address Pauline Antil Owner Owner's Name information is required for every 34 Edgewood Road, Hyannis MA 02601 May 5, 2021 page. Cityrrown 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? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® El 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)] 1 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u, -248 P - 141 34 Edgewood Road, Hyannis M Property Address Pauline Antil Owner Owner's Name information is 34 Edgewood Road, Hyannis MA 02601 May 5, 2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on-310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: N/A Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 20=48,000 gals. 19-51,000 gals. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date t t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 f c Commonwealth of Massachusetts _. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 Edgewood Road, Hyannis M -248 P- 141 Property Address Pauline Antil Owner Owner's Name information is 34 Ed ewood Road Hyannis MA 02601 May 5 2021 required for every g � y y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: N/A Design flow(based on 310 CMR 15.203): N/AGallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: N/A Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available:, N/A Last date of occupancy/use: N/A Date Other(describe below): N/A 3. Pumping Records: Source of information: No pumping info available. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.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 +' i1a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V 34 Edgewood Road, Hyannis M -248 P- 141 Property Address Pauline Antil Owner Owner's Name information is 34 Edgewood Road, Hyannis MA 02601 May 5, 2021 required for every 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: Cesspools are original to home. Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ® cast iron ®40 PVC Orangeburg ® other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Lines were found clear at the time of inspection. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection form le Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 Edgewood Road, Hyannis M -248 P- 141 Property Address Pauline Antil Owner Owner's Name information is 34 Ed ewood Road, Hyannis MA 02601 May 5, 2021 required for every g y page. Cityrrown 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) • e If tank is metal, list age: years /Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: N/A N/A Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A How were dimensions determined? N/A Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): N/A t5insp.doc-,rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form iSubsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 Edgewood Road, Hyannis M -248 P- 141 Property Address Pauline Antil Owner Owner's Name information is 34 Ed ewood Road, Hyannis MA 02601 May 5 2021 required for every gy page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): , Depth below grade: N/A feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A _ N/A Scum thickness Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/ADate Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): N/A 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): i Depth below grade: N/A Material of construction: ❑ concrete. ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/A Dimensions: Capacity: N/A p �' gallons Design Flow: , N/A gallons per day t5insp.doc•rev.7/26/2l)18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 �. i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments l; - 34 Edgewood Road, Hyannis M -248 P- 141 v Property Address Pauline Antil Owner Owner's Name information is 34 y Ed ewood Road, Hyannis MA 02601 May 5, 2021 required for every, g page. Cityrrown State Zip Code Date of Inspection M.'System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: N/A Alarm in working order: ❑ Yes ❑ No Date of last pumping: N/A Date Comments (condition of alarm and float switches, etc.): N/A *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): I Depth of liquid level above outlet invert N/A Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): N/A I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection. Form Fro Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 Edgewood Road, Hyannis M -248 P - 141 Property Address Pauline Antil Owner Owner's Name information is 34 Ed ewood Road, Hyannis MA 02601 May 5, 2021 required for every g y y page. Cityfrown 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.): N/A * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: leaching fields number, dimensions: ' �® overflow cesspool number: 5 X 5' ❑ innovative/alternative system ` �1 Type/name of technology: I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 , i J Commonwealth of Massachusetts Title 5 Official Inspection Form i� Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 34 Edgewood Road, Hyannis M -248 P- 141 Property Address . Pauline Antil Owner Owner's Name information is 34 Ed ewood Road,.Hyannis MA 02601 May 5, 2021 required for every g Y Y 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.): Soil was sandy. Cesspool'was found less than 1/2 day flow available. / 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration main cesspool 5' Depth`—top of liquid to inlet invert Depth of solids layer 01, Depth of scum'layer 2 Dimensions of cesspool 5' X 5' ' Materials of construction cesspool block Indication of groundwater inflow' ❑ Yes ® No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Cesspool was with evidence of back up in the past. Cesspool crown was unstable and starting to . cave in. Cesspool needs to be upgraded to Title V at this time. i I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 c�� Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M !% 34 Edgewood Road, Hyannis M -248 P - 141 Property Address Pauline Antil _ Owner Owner's Name information is 34 Edgewood Road, Hyannis MA 02601 May 5, 2021 required for every — page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: N/A Dimensions .N/A Depth of solids N/A Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 c Commonwealth of Massachusetts V Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 Edgewood Road, Hyannis M -248 P - 141 Property Address Pauline Antil Owner Owner's Name information is 34 Ed ewood Road, Hyannis MA 02601 May ,5 2021 required for every g y ----- page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately I � I ' I i i a t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 Edgewood Road, Hyannis M -248 P- 141 Property Address Pauline Antil Owner Owner's Name information is required for every 34 Edgewood Road, Hyannis MA 02601 May 5, 2021 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: 12.0+ 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: maps You must describe how you established the high ground water elevation: USGS maps estimate water at over 20.0'. Bottom of leaching at 8.0'was found not to be located in the high groundwater elevation at the time of inspection. t 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 �1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments x V 34 Edgewood Road, Hyannis M -248 P - 141 Property Address Pauline Antil Owner Owner's Name information is 34 Ed ewood Road Hyannis MA 02601 May 5, 2021 required for every g � Y Y page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist A 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� J TOWN OF BARNSTABLE LO.ATION 7 G E w ° v SEWAGE# Z003 VILLAGE ASSESSOR'S MAP& LOT Zz(g/q INSTALLER'S NAME&PHONE NO. J4 Y-,d C14 N C C s 0 S 7 9 S'2 8'o a SEPTIC TANK CAPACITY LEACHING FACIL=: (type) (size) NO.'OF BEDROOMS BUII.,DER OR OWNER � L PERMIT DATE: COMPLIANCE DATE: I 1 a v� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by M �-v PID o �o y O � ✓ y� 1 � 0 t � No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppfication for ]i9po!6af 6pgtem Construction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) El Complete System dividual Components Location Address or.Lot No. 7 Owner's Name,Address and Tel.No. Assessor's Map/Parcel 2 q?- I 7 `, E N Z�©0 2) � Installer's Name,Address,and Tel.No. o Z' 7�f—�- $�0 0 Designer's'Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms u S Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.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 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) R /0 C F /9,�F/,I/N /ti F_ Date last inspected: Agreement: 1 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 d not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of He Signe Date Application Approved by Date Application Disapproved for the following reas s v Permit No. ( Date Issued NO. Fee Entered in computer: THE COMMONWEALTH�OF-MASSACHUSE.TTS Yes PUBLIC HEALTH DIVISION -TOWN,'OFBARNSTABLE, MASSACHUSETTS Zipplication for Miqonl P.5tem Cbnelruction Permit Application for a Permit to Construct Repair( k1lupgrade Abandon Complete System 41rdividual Components it Location Address or Lot No. Owner's Name,Address and Tel.No. rj Assessor's Map/Parcel Installer's Name,Address,and Tel.No.50 jr- Designer's Name,Address and Tel.No. Type of Building: . Z Dwelling No.of Bedrooms 0 5 Lot Size sq.ft. Garbage Grinder( Other Type of Building No.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 -----Type of S.A.S. Description of Sod Nature of Repairs or Alterations(Answer when applicable) .74 Date last inspected: Agreement:, The undersigned agrees to ensure the construction and maintenance of the'af6re 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 beenjl5ss d b s Board of Heal Re y this Signed, Date 40 0 Application Approved by /.1_177_A_­'Z2,. ate D Application Disapproved for the followingreasa s Permit No. Date Issued ————————— ————I—————————— ——— ————————-- - - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed Repaired Upgraded Abandoned 1 by 4 P4 It.-r o :?_ra gy,41,,t- --377- at Z) d: "10 0- .0-3 has been construct iq accordance with prgyA w ith the lions of Title 5 an I System Construction Permit No.203-S69 dated ;?O/CL? d the for Disppsa Installer Designer The issuance of this ytsh�aojl , t be construed as a guarantee that the system ill p Sig Date Inspector ��`_'--�.—�,/rr')�j�x-----------.------------Fee=� No. TH MMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Ii!5pool *p!5tem Con!6truction Permit Permission is hereby granted to Construct( , )Repair( 4Mpgrade( )Abandon System located at !Fi/ zoo< z 4VO03 /F2) 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: Constructio4mus.t le completed within three years of the date of this Date: Approved by I TOWN OF BARNSTABLE LOCATION 3 7 1E D G E w o o a fc SEWAGE# oo 3—5t 9 /(7r ASSESSOR'S MAP&LOT 249-1 qi VILLAGE s. $ INSTALLER'S NAME&PI4ONE NO.44 CAN C i , c M , 1 �v �- SEPTIC TANK CAPACITY � ePLA Z. Aiti L LEACHING FACILrrY: (type) (size) P NO.OF BEDROOMS BUILDER OR OWNER k;L PERMIT DATE:.L L J 0 "a 3 COMPLIANCE DATE: I Z® �� Separation Distance Between the: . Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility.(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by ii 4. I 2 R 1 , r(O �s �fLOCATION SEWAGE PERMIT ' Edgewood Drive e VILLAGE Hyannis, MA 02601 INSTALLER'S NAME & ADDRESS A & B Cesspool 128 Bishops Terrace Hyannis MA 02601 BUILDER OR OWNER Paul J. Antil 3 Edgewood Drive, Hyannis, MA 02601 DATE PERMIT ISSUED 5/29Z81 DATE COMPLIANCE ISSUED cn, t S �r M a " i r �" i ^ � }' No..----81 27�- FEim........$..: .,.QQ.... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ....... -----T.own----OF.......% stable---------------------------------------••-------......._.. , pplira#ion for Uiipoiial Workti Too,itrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal System at: ..34..Frl.gEw.aiA.DriyaL...Hyanni-s-,---02601................. .............•------------------•---•------••---...-------••---...------..............----------- Location-Address or Lot No. P8111._.L...Ant1.1........--••......................•--............................ -%..Eclgew.QQri.I)riva,..Hyann-is.,-.ZA....Q26.Q1......---- owner Address a ..A•A.3...CesZPaQ1.3Q.sxiCJe........................................... 128...Biahaps..TerracJ,...4annls.,..ZA....0.2601..... Installer Address dType of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms.....................3.....................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons........5..........._.__.. Showers ( ) — Cafeteria ( ) Q' Other fixtures ................................. . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth_-__-___-__--__. x Disposal Trench—No..................... Width_•.-_____-_-__-___.- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit---------_---------- Depth to ground water--___-_--_______--_____. (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --••---••--•-•--------------------------•---••------...-----•••--•----•--------......--------•------.............................I Descriptionof,Soil........Sand...................................................................---------------------- x V ---•---•-•-•••••--••••-----------•--••----•••---•-----•-••--•--•-•--•-------•-•-••--•--........-•--•--•-•-•••-------•••----•----•-•---••-•--•----•-----••----•--•--•---•-••----•---•---•-----•---•••-... W UNature of Repairs or Alterations—Answer hen applicable.___-installation of -- 1,000 gallon pre-cast, stone packed leach pit (overflew . ........-.........................................------------------------•-----......----------------------------------------------------------------•-----------------------------------••---•--..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'i LE y g g p y of the State Sanitary Code—The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the board iealth. . Sign ��// :. ..5/29 81...- D to Application Approved By................... --- � ,2981 Date Application Disapproved for the following reasons_____________________________________________________________ ..................................................... ------------•--------•-----•---•••--•••....--•----••••-•-----••----•••--------•...............•-----.......••--•••---•---•-•---•---•-•...-•---••-•----------•-----•------•-----••---------•---•---------- Date Permit No.........81-........................................ Issued..........5/29/81............................ Date No...... 1--_2Z- FEB ... :�.QQ.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................TOwII.._.OF....Barnstable.................................................................. Appliration for Uiipoial Works Tomitrurtion Prrmit . Application is hereby madg for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal System at: .. ..1♦,dean,�a..n�i� ¢.. nis,_o26ol................. .................................................................................................. Location-Address or Lot No. ..Pai]1. J..._.A)nt J I....---•---•.......................••--•--------------•------.... .34.. dgew_a6d..Dr—i v_,.-Rya nis.,_. 1A....Q�-E of......... Owner Address a A. ;..D.. esspaQl. ez�rice........................................... 12$_..Di hop .' e x :�l,:.. ....9z691._... Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms----------------_--3-------_.._..--__.___Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons--------5......----------- Showers ( ) — Cafeteria ( ) Q' Other fixtures .................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter................ Depth.............. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------_--------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit-------------------- Depth to ground water_____________-_______._. fi Test Pit No. 2________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---•--------------------------- ---•-----•---------•----....---•------------......_..........._............................................................. 0 Description of Soil------ Sand...............................................................................................................-................................... x U W Y ----- - --- --- g p , x ins•tanati on or a 1 000-----a11 on re-cast U Nature of Repairs o: Alterations—Answer hen applicable---------------------------------------------------------------------------------------------- stone packed leach pit (overfl; a1 . ------------------------------------------•-----•-----------------------------------....--•------------------------------------------•-----------------•--------------------------------•--............ m"Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE, y g g p y of the-State Sanitary Code—The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the board o -health. . � 2 81 Signe .- ..'...... f:...:..._.. ?'�f�l�t ..5� 9, ............ D Application Approved BY ..... •'- •'-../ ............... 5�29 1 Date Application Disapproved for the following reasons:...................................................................... .......... ......................... -----------------------------•----•-•-------......-----------•------------•-----------.......-----------------------•----•---------...--------------------...------------------------------------------ Date Permit No.........81-........................................... Issued.--------5�29/81............................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................T own............OF............Barnstable................................................................... %rrtifiratr of Tontplianrr THIS IS TO CERTIFY, .That the Individual Sewage Disposal System constructed ( ) or Repaired (M ) by..A--`&---B•-Cesspool-Service_[ 128 Bishc-ps Terrace Hyannis.- MA----02641------------------------------------------- Install r at....34 Edgewood Drive, Hyannis 02601 Paul J. Antil -- -------- ------ -------- ---------------------------•------------------------------------•--•-------------- has been installed in accordance with the provisions of T-ITLE j of The State Sanitary Code a5 described in the application for Disposal Works Construction Permit No. 1-.__ .................. dated__...5p?18.1 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 5 29 81 DATE__... �................ Inspector_... .....---...... ............................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH. 81- ........................`y own ......0F..Barnstable...........-----....... $ 5.00 No................. FEE........................ Disposal Nab Tonotrnrtion rantit Permission is hereby granted......A. E Cesspool SeryiCe l Bishops Terrace, 1. nnis©2601 to Construct ( ) or Repair (X) an Individual Sew aye Disposal System at No.. ._Ed ewood 17rive, Hyannis, lyA 02611 - Paul J . Antil -------------------•-----------------•---•--•----•---•--••---------•-------•-•----•....--••-- Street as shown on the application for Disposal Works Construction Permit No.8................. ated.._....5L2918x.................. 5 and of Health /29/81 _ DATE______________ ---...-•----•----•----•------•.............................•..... FORM 1255 .HOSES & WARREN. INC., PUBLISHERS