Loading...
HomeMy WebLinkAbout0060 MEADOWLARK LANE - Health 60 Meadow Lark Lane JI Osterville A = 117 — 171 05 A INS- r I UPC 12134 No.21�53LrGN( '°°t»sr.coN HASTINQS,MN 0 r o� L IT C�6 IA Ck v � 1 i i f u� U 'I AM ray; � Qp � W UZIa - ___� CL�TIO.N-� SEW,[�C;E_PERMIT _I..I.O._= 1p ut tacxv-U- Imo = ---.\/IILhGE --buILDER-5--DATE PERMIT n ED " �9®-jf � D ATE C0NAPLI hMcE - ISSUE® : 0� J I �5 ov No. Fee &/ 75" � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippliLatlon for -Misposal Opstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) ❑Complete System ❑Individual Components Lo11cation Address or Lot No. to() M ow Q/r Owner's Name,Address,and Tel No. ) s s ors Map/Parcel S rd i dl d. EJAI P6PL6V Installer's Name,Address,and Tel.No. Designer's 14ame,Address,and Tel.No. ,5�4w Iepy Qa 73 t--rS4a Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Re airs 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 theenmXd not to place the system in operation until a Certificate of Compliance has been issued b is Board of H I/ d Date Application Approved by - , Date Application Disapproved by Date for the following reasons Permit No. � Date Issued No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS TippIication for Misposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (cc) A4 ea ow /a r Owner's Name,Address,and Tel.No. '�seLr's Map/Parcel ,-L) ; �( Installer's Name,Address,and Tel.No. Desigr�e_r"sT4ame,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date j Title Size of Septic Tank Type of S.A.S. Description of Soil . r Nature of Repairs or Alterations(Answer when applicablr/J P j 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 Environmeg4l-C-6,4 nd not to place the system in operation until a Certificate of Compliance has been issued by his Board of H ��711ilf /�!r 7 Date _/ Application Approved by ; i Date L" Application Disapproved by Date for the following reasons Permit No. Date Issued ------------------------------------------------------------------------ 01 THE COMMONWEALTH OF MASSACHUSETTS 1"V BARNSTABLE,MASSACHUSETTS / (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(Z Upgraded( ) Abandoned( )by at 0 2G nW !f( �-olt '(e-has been cons ucted'n ac ce with the provisions of Title 5 and the for Disposal System Construction Permit No. at Installer C4 lit/v1 l l/( � tf r`y (i Designer i #bedrooms Approved desig�p'fib n gpd The issuance o this p it shall not be construed as a guarantee that the system will nction designed. ! 1 c Date C� InspectorI)nl ---- No.--------------- �- ----------------------------------------------------- -------------------Fee------------------- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal &- pstemwn C.ustruction Permit Permission-is hereby granted to Construct( )/ Rep/air(l. Upgrade( ) Abandon( ) System located at �O U l�-f 0 w (G � 4e l J i `( and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constru tionV17Vted within three years of the date of this permit. Date Approved by -' / V Town of Barnstable Barnstable AFMOWCHY Inspectional Services l BA ABLE. IV ` 9. ,�� Public Health Division �ATfO MA'S a. 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 1967 7573 May 29, 2019 EBB, RONALD G & KIMBERLY W TRS 10 CAMPUS DRIVE DEDHAM, MA 02026 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 60 Meadowlark Lane, Osterville, MA was inspected on 05/09/2019 by Shawn McElroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • The distribution box is in poor condition and cracked. 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 o — c Cean, R.S., Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\60 Meadowlark Lane'Osterviile.doc ��THE l� • Town of Barnstable BARNSTABLE, A Inspectional Services Department AT fD µp'l Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 ` FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19. DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA . ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA` ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with liquid level at or above the invert pipe (per Town Code §360-20 h) OT u 0,( . COA d e,47(/n Until C r c c Repair deadline: G, Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc f pry', Commonwealth of Massachusetts Title 5 Official Inspection Form --1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments >� 60 Meadowlark Ln Property Address ? Ronald Ebb _ Owner Owner's Name information is €. required for every Osterville MA 02655 5-9-19 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. Inspector Information Shawn Mcelroy Name of Inspector - Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 Telephone Number License Number B. Certification I certify that] am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);l have personally inspected the sewage disposal system at theproperty address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and'experience in the'proper function and maintenance of on-site sewage disposal systems.After conducting this inspection'I have determined that the system: 1. ❑ Passes 2. ® Conditionally Passes 3. ❑, Needs Further,Evaluation.by the Local Approving Authority 4. ❑ Fails r, 5-9-19- Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or ddiiffferent c(pan7,,,,Pnection ' s of use. t5insp.doc•rev.7/26/2018 v P� ' " 5'+7ffi Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts A. gv, Title 5 Official Inspection Form , rni Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Meadowlark Ln Property Address Ronald Ebb Owner Owner's Name information is required for every Osterville MA 02655 5-9-19 - page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. ' 1) System Passes:' ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. 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): D-box needs to be replaced. II t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts r� 3 Title 5 Official Inspection Form, �I �;�M Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Meadowlark Ln Property Address Ronald Ebb Owner Owner's Name information is required for every Osterville MA 02655 5-9-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ' ❑ broken pipe(s) are replaced ❑ Y ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ON ❑ ND (Explain below): ❑ distribution box is leveled•or replaced ❑Y ❑ N E]"ND (Explain below): i ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑Y ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑Y El ❑ ND (Explain below)- 3) Further Evaluation is Required by the Board of Health:, v£ ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protectpublic health,'safety or"the environment.' ' ' a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning_ in a.manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form wa i�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Meadowlark Ln Property Address Ronald Ebb Owner Owner's Name information is required for every Osterville MA 02655 5-9-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ' ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: , You must indicate "Yes"or"No"to each of the following for all inspections: ` Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts - '. • .: Title 5 Official Inspection Fora C�i; Subsurface Sewage Disposal System.Form -Not for Voluntary Assessments _ . . ► " > 60 Meadowlark Ln .� Property Address , Ronald Ebb Owner Owner's Name r information is required for every Osterville MA 02655 5-9-19 ' page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure.Criteria Applicable,to All Systems: (cont.),,, Yes No ❑ ® `` Static liquid level in the distribution box above outlet'invert'due to an overloaded or clogged SAS or cesspool ❑. E Liquid depth in cesspool is less than 6" below invert or available volume is less than '/-day flow A El ® Required pumping more than 4 times in the last"year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool.or privy is below high"ground water elevation. El, ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® 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 T 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 16,000 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 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Meadowlark Ln Property Address Ronald Ebb Owner Owner's Name information is required for every Osterville - MA 02655 5-9-19 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 aH 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? f ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® Wasthe facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection .Form- N Subsurface Sewage Disposal System Form -Not,for Voluntary Assessments r a " •;_ °'' 60 Meadowlark Ln Property Address -- Ronald Ebb Owner Owner's Name + information is required for every Osterville MA 02655 5-9-19 , page. City/Town 1 State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 5 Number,of bedrooms (actual): 5 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#.of bedrooms): 550 Description: Number of current residents: ; :; 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ,t ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? El Yes ® No Last date of occupancy: � � � 2018 Date t5insp.doc•rev.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7,of 18 c Commonwealth of Massachusetts 3 Title 5 Official Inspection Form i► Subsurface Sewage Disposal System Form Not for Voluntary Assessments 9 p Y rY 60 Meadowlark Ln Property Address Ronald Ebb Owner Owner's Name information is required for every Osterville MA 02655 5-9-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: —~ t5insP.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Fo��i I NI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , � ._ 60 Meadowlark Ln Property Address Ronald Ebb Owner Owner's Name t. information is required for every Osterville r MA 02655 5-9-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® -Septic tank, distribution box, soil absorption system ; ❑ Single cesspool ❑ Overflow cesspool , ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract . ❑ Tighttank.Attach a copy of the DEP approval. _ ❑ Other(describe): Approximate age of all components,.date installed;(if known) and source of information: 1980's Were sewage odors detected when arriving at the site?- ❑ Yes ® No 5. Building Sewer(locate on site plan): 16" Depth below'grade: feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from-private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 c Commonwealth of Massachusetts 3 Title 5 Official Inspection Form i�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Meadowlark Ln Property Address Ronald Ebb Owner Owner's Name information is required for every osterville MA 02655 5-9-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 8" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: 12" Distance from top of sludge to bottom-of outlet tee or baffle 20" 1n Scum thickness Distance from top of scum to top of outlet tee or baffle 6" 11 Distance from bottom of scum to bottom of outlet tee or baffle .` 15 How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts k+ .� ,w Title 5 Official Inspection Form (�M Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments 60 Meadowlark Ln Property Address Ronald Ebb Owner Owner's Name information is , required for every Cisterville MA 02655 5-9-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: _ feet E Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑.polyethylene ❑ other(explain): Dimensions: - Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related'to outlet invert,'evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material.of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i r�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Meadowlark Ln Property Address Ronald Ebb Owner Owner's Name information is required for every Osterville MA 02655 5-9-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) ' Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box in poor condition and cracked. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts wr Title 5 Official Inspection Form pi Subsurface Sewage Disposal System Form Not for Voluntary Assessments _. r a <, j� , o J , 60 Meadowlark Ln Property Address Ronald Ebb , Owner Owner's Name information is Osterville MA 02655 5-9-19, 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''' ❑ No* Alarms in working order:` " ` ' ❑- Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a'conditional pass.- r•, 11. Soil Absorption System (SAS) (locate on site plan, excavation not required)-:-- If SAS not located, explain why: Type- 2-1000 gal ® leaching 'pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 c Commonwealth of Massachusetts r) Title 5 Official Inspection Form if I, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r N . 60 Meadowlark Ln Property Address Ronald Ebb Owner Owner's Name information is required for every Osterville MA . 02655 5-9-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Both leach pits in good condition and empty at inspection. Stain line in pit"4" at inlet invert. Pit"5" had no visible stain lines. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts _ ;w r Title 5 Official Inspection Form`Ins p I'I i;l Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments .• a /t 9 �1.. ? 60 Meadowlark Ln Property Address Ronald Ebb Owner Owner's Name information is Osterville MA 02655 5-9-19 required for every � - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) rp ' 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding; condition of vegetation, etc.): t 1 t I • t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,ro Fr_ 60 Meadowlark Ln Property Address Ronald Ebb Owner Owner's Name information is required for every Osterville MA 02655 5-9-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately e r�� a _ . r A C. y( r t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 s r, Commonwealth of Massachusetts 5 1� ;w Title 5 Official Inspection foemn . hI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Meadowlark Ln •� � :, Property Address - Ronald Ebb Owner Owner's Name . fr i In o mat on is , required for every Osterville MA 02655 5-9-19 page. City/Town State Zip Code Date of Inspection D. System Information (Cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar 4ti; E ❑ Shallow wells , Estimated depth to high ground water: 20'. feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed:. Date' ® •Observed.site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town map show groundwater at 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form w� i i.'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Meadowlark Ln Property Address Ronald Ebb Owner Owner's Name information is Osterville MA 02655 5-9-19 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist pp Complete all applicable sections of this form inclusive of: p ® 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 60 MEADOWLARK LANE Property Address DAVID AND DIANE RICHARDSON Owner Owner's Name information is required for every OSTERVILLE MA 02655 07/24/2014 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not JOHN GRACI use the return Name of Inspector key. GRACI SEPTIC INSPECTIONS, LLC ,� Company Name PO BOX 2119 Company Address TEATICKET MA 02536 City/Town State Zip Code 508-641-6694 S 1468 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Furthe luation by the Local Approving Authority w - 07/24/2014 Inspector's Signature Date The system insp ctor shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time:This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspecti o .Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts 1 � A W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 MEADOWLARK LANE Property Address DAVID AND DIANE RICHARDSON Owner Owner's Name information is required for every OSTERVILLE MA 02655 07/24/2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM APPEARS TO BE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): NA t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-.Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 60 MEADOWLARK LANE Property Address DAVID AND DIANE RICHARDSON Owner Owner's Name information is required for every OSTERVILLE MA 02655 07/24/2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): NA ❑ 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): NA C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR - 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 60 MEADOWLARK LANE Property Address DAVID AND DIANE RICHARDSON Owner Owner's Name information is required for every OSTERVILLE MA 02655 07/24/2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: NA k D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for-all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or,' clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c�M 60 MEADOWLARK LANE Property Address DAVID AND DIANE RICHARDSON Owner Owner's Name information is OSTERVILLE MA 02655 07/24/2014 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No - ❑ ❑ the system is within 400 feet of a surface drinking,water supply ❑ ❑ the system is within 200 feet of.a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i ^M 60 MEADOWLARK LANE Property Address o P Y DAVID AND DIANE RICHARDSON Owner Owner's Name information is required for every OSTERVILLE MA 02655 07/24/2014 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,'excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: ' Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 60 MEADOWLARK LANE Property Address DAVID AND DIANE RICHARDSON Owner Owner's Name information is required for every OSTERVILLE MA 02655 .07/24/2014 page. City/Town State Zip Code Date of Inspection D. System Information Description: 1500 GALLON SEPTIC TANK, DISTRIBUTION BOX AND (2)TWO THOUSAND GALLON LEACH PITS. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d TOWN 9 ( Y 9 (gp ))� Detail 2012 -44000 2013 -47000 Sump pump? ❑ _Yes ®- No Last date of occupancy: OCCUPIED Y Date Commercial/Industrial Flow Conditions: Type of Establishment: NA 'Design flow(based on 310 CMR 15.203): NA per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): NA Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: NA t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts w . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 60 MEADOWLARK LANE Property Address DAVID AND DIANE RICHARDSON Owner Owner's Name information is required for every OSTERVILLE MA 02655 07/24/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): NA General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: g NA llons How was quantity pumped determined? NA Reason for pumping: NA Type.of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 60 MEADOWLARK LANE Property Address DAVID AND DIANE RICHARDSON Owner Owner's Name information is required for every OSTERVILLE MA 02655 07/24/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1975 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: (1) ONE FOOT(8) EIGHT INCHES feet Material of construction: ❑ cast iron ❑ 40 PVC 2-40 PVC ® other(explain): Distance from private water supply well or suction line: GREATER THAN 10' feet Comments (on condition of joints, venting, evidence of leakage, etc.): i T i I Septic ankI(locate on site pl an): a ): Depth below grade: feet ONE FOOT(2)TWO INCHES Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: NA years Is age confirmed by a Certificate of Compliance? (attach"a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 GALLON Sludge depth: (6) SIX INCHES t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 60 MEADOWLARK LANE Property Address DAVID AND DIANE RICHARDSON Owner Owner's Name information is required for every OSTERVILLE MA 02655 07/24/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle (28)TWENTY EIGHT INCHES Scum thickness (1) ONE INCHE Distance from top of scum to top of outlet tee or baffle (6) SIX INCHES Distance from bottom of scum to bottom of outlet tee or baffle NA m How were dimensions determined? MEASURED Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): SEPTIC TANK APPEARS TO BE STRUCTURALLY SOUND AND FUNTIONING PROPERLY AT TIME OF INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS. Grease Trap (locate on site plan): Depth below grade: NA p g feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: NA Scum thickness NA Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA Date of last pumping: NA Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form m? Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 60 MEADOWLARK LANE Property Address DAVID AND DIANE RICHARDSON Owner Owner's Name information is required for every OSTERVILLE MA 02655 07/24/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): NA r Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: -- - ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): NA Dimensions: NA Capacity: NA gallons Design Flow: NA gallons per day Alarm present: ❑ Yes ❑ No Alarm level: NA Alarm in working order: ❑ Yes ❑ No Date of last pumping: NA Date Comments (condition of alarm and float switches, etc.): NA *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 -Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 60 MEADOWLARK LANE Property Address DAVID AND DIANE RICHARDSON Owner Owner's Name information is required for every OSTERVILLE MA 02655 07/24/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert DID NOT INSPECT Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): DISTRIBUTION BOX LOCATED UNDER DRIVE WAY 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.): NA " If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why:. NA t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form I o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 60 MEADOWLARK LANE Property Address DAVID AND DIANE RICHARDSON Owner Owner's Name information is OSTERVILLE MA 02655 07/24/2014 required for every page. CityFrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 2- 1000 GALLON LEACH PITS APPEAR TO BE STRUCTUARLLY SOUND AND FUNCTIONING PROPERLY AT TIME OF INSPECTION LEACHING PIT A FULL AT TIME OF INSPECTION LACHING PIT B EMPTY AT TIME OF INSPECTION. RECOMMED RAISING COVERS. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth —top of liquid to inlet invert NA Depth of solids layer NA Depth of scum layer NA Dimensions of cesspool NA Materials of construction NA Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 60 MEADOWLARK LANE Property Address DAVID AND DIANE RICHARDSON Owner Owner's Name information is required for every OSTERVILLE MA 02655 07/24/2014 page. City/Town State Zip Code Date of Inspection D. System Information(cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)-. NA Privy (locate on site plan): Materials of construction: NA Dimensions NA Depth of solids NA Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): NA t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 60 MEADOWLARK LANE Property Address DAVID AND DIANE RICHARDSON Owner Owner's Name / information is OSTERVILLE MA 02655 07/24/2014 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately FRONT- �, WIN //�� nn G, M� 1500 GA I N 3 D-BOX 0 NMR 0R1 EYVAY W 2 -PiTA 5 4 1060C 4-L 1000 6AL Pi TA FULL A 1- 2lp a g 1359 . 2 g2. 3(o (0 ,44378 ez} 505 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 <C�X, Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,., 60 MEADOWLARK LANE Property Address DAVID AND DIANE RICHARDSON Owner Owner's Name information is OSTERVILLE MA 02655 07/24/2014 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: GREATER THE 14 FEET 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: PRIOR AS-BUILT : ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USG database-explain: You must describe how you established the high ground water elevation: AUGER Before filing this Inspection Report, please see Report Completeness Checklist on next page.. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 ti Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 MEADOWLARK LANE Property Address DAVID AND DIANE RICHARDSON Owner Owner's Name information is required for every OSTERVILLE MA . 02655 07/24/2014 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed - ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on`page 15 or attached in separate file .5Ins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 New boiler and indi Storage tank UMY eeCroomB F—A"°°" Unfinished So= t,rft W�d Unfinished Wit„„„,Oa Slab above Layout to remain-new fixtures tub and tol Basement 60 MEADOWLARK LN OSTERVILLE OAK DEVELOPMENT • 't r 1 1 q New toilet,shower,vani and fixtures Heeler Beth UAW�oyre New Kitchen layout see plan . a.mmp.nmrmesegmn _ Navw Ityllx mmmdbMt (aCJO)ICO a - %aD Olws Aetl tlwet vAm ewbb moAl � Master - Renww mdeUnp dmeb—��' --- mem�vAuim.Iano�smlm omum� Manny . .� 69np Nan %) ova sty SD First Floor 60 MEADOWLARK LN OSTERVILLE OAK DEVELOPMENT �o Layout to remain New toilet vanity tub And fixtures 00 Reoonflgure layout Bedroom 3 00 Remove tub Jack and Jill SD 0 Bedroom 2 SD/CO eed m a SD SD seed opening - Office Unfinished storage Second Floor 60 MEADOWLARK LN OSTERVILLE OAK DEVELOPMENT �w ONADE- sip- I Town of Barnstable t r ! ~° Public Health Division �+ + lf } 11.S.P OSAGET »Pi T NEYBO WEs BARN maw.LE. 200 Main Street �bp�EU MP'�p� Hyannis,MA 02601 ZIP 02601 006.800 7015 1520 0000 1967 '7573 I 02 03 000 0.3.36455 MAY .30. 2019. I c,E:�:Y:.�t'*:.�'9:°3�'if.�;=":'fA(,�*,."�YfiX;tutb�•���vt.!�!k+A�+N,p+ra`aZ.18:x"'J�'.{*'ki:N _ - ... ..-=._ .. _ _.-.. s--��. _. I � -4 EBB, RONALD G&KIMBERLY W TRS o, URN � ' 10 CAMPUS DRIVE a LC DEDHAM, MA 02026 FI Crt INT, i f Ill if If If If IIIINI if f f f f f t f f !.��r�,.�� (4 0441 i-0 )+,���+��1:1�,l+,+11 11P"l++-li"+lip++++�+lire+►I+�l��:l�ll++i� 4 _ r '' .• . USPS TRACKING# =No.G _ s. ) e j 9590 9402 4798 8344 8739 40 1 . S i •sander_Please_orint vour_name,address,and ZIP+4®in this box* d� r� United States Postal Servicc I Town of Barnstable {' Health Division 200 Main Street �t Hyannis,MA 02601 1 i - f Town of-Barnstable Barnstable Inspectional Services �a BARNbTASLEB 9� b 9 Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 1967 7573 May 29, 2019 _a _ EBB-;RONALD-G &KIMBERLY W TRS 10 CAMPUS DRIVE DEDHAM, MA 02026 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 60 Meadowlark Lane, Osterville, MA was inspected on 05/09/2019 by Shawn McElroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • The distribution boxis in poor condition and cracked. 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 �oc n, R.S., Agent of the:Board of Health t ._ . Q:\SEPTIC\Title V Inspection Report Letters Mail ing\Conditional ly Passes Letters\60 Meadowlark Lane Osterville.doc Engineering Dept. (3rd floor) Map Parcel �I Permit# 71� House# oe"6 Date Issued -30'� a� Board of Health(3rd. oor)(8:15 -9:30/1:00-�@) "7J-�/Sr �l '� Fee G--d onservation Office (4th floor)(8:30-9:30/ 1:00-2:00) '�r7�!�t✓ tom._ C? SEPTIC S ulEau-rr_' PlanningDept. 1st floor/School Admin. Bldg.) 1 " "`' P ( g) INSTAL ,- �1PLIANL,� Definitive Plan oved by Planning Board 19 5 ENVIR� , ODE AND f TOWN OF BARNSTABLE TO ` a ' `` Building Permit Application Pro jec�dress Village Owner \J I D C s 'R I CHA- ,&)4 Address o e x (0(0 b , O 5 t e-r-WI - Telephone -5?d 7 Permit Request 4,41 (Aige � 0rst Floor � � square feet Second Floor , �� 0 square feet onstruction Type 1/U�O f� F�AMC— stimated Project Cost oning District C. Flood Plain N Water Protectionot Size 1 �C�e Grandfathered ❑Yes (&.No welling Type: Single Family ( Two Family ❑ Multi-Family(#units) of Existing Structure 23, 'JC-F}do & Historic House ❑Yes ANo On Old King's Highway ❑Yes 1,rNo asement Type: [Full ❑Crawl J(Walkout ❑Other asement Finished Area(sq.ft.) O 0 Basement Unfinished Area(sq.ft) Z O umber of Baths: Full: Existing_ New (} Half: ' Existing _ New p o.of Bedrooms: Existing 'J New (-Garage: l Room Count(not including baths): Existing ?> New © First Floor Room Count Type and Fuel: ,Gas ❑Oil ❑Electric p Other ral Air ❑Yes �No . Fireplaces: Existing New �_ Existing wood/coal stove ❑Yes A.No p Detached(size) Other Detached Structures: ❑Pool(size) ,attached(size) 40 rri ' ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) i Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes f No If yes, site plan review# Current Use PRI NcIPA L Rt✓SIDt-,,i LC- -Proposed Use J99-►11JCI Pq-L_. A E-S-OEavC.E Builder Information Name Telephone Numbe Address License# Home Improvement Contract Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS L AS PROPOSED STRUCTURES ON THE LOT. ` ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO (�)s4A1J SAC A) SIGNATURE P DATA" 3 0 9� BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) �- - 74- R9, I 2 / .�1.� A41 0., ,_ ;mow•- � l� � NO..----i --•--• Fsic. �.�................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ...... .... ..___.........O F......................................................................................... h G4 � Appliration -fear 4%ipviitt1 parks TattstrurtiouVrrniition is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal �� ` ------------------- -------------------------- L io.�l s• / or Lot No. !�l1 s�.�t t. � ................... �Q�AFr. .�f✓�-�/ - �f°�`2`may.-----i C•4. 5, --•-• -------- / caner ............................................Address nstaller Address ................•__-_••----.........__.--- Q Type of Building Size Lot..........................:.Sq. feet DwellingA!�'No. of Bedrooms--------------- ------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ----.-_--_--------------- No. of persons.---____-_-_____-_----_--- Showers ( ) — Cafeteria ( ) pa Other fixtures ------------------------------ w Design Flow..............SQ-.---_--:._---..__._gallons per person per day. Total daily flow........ WSeptic Tank-Liquid capacitVXWgallons Length................ Width................ Diameter---------------- Depth---------- x Disposal Trench—No. .................... .Width .__. tal Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No.._..`2—__--_--•- Diameter-__ �_._`'W11P elow i et_____..__.�....... Total ing area-------________._sq. it. z Other Distribution box ( ) Dosing tank ( ) i Off'^ •� Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................... ----------- ,a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water_----.--._..-_.--.--._. �14 Test Pit No. 2................minutes per inch Depth of Test Pit.--___-___-..__-___- Depth to ground water--.--.---__------------- O Description of Soil------- x w U Nature of Repairs Alte tions—Answer when applicable._...................... ........................................._.--_--_...-___-------.._.. ---------------------- - . •-- ... . . •. Agreement: #---k1fi- ---7X-----------MA The undersigned agrees to instal the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of healtl fined. 1 . • ........................ � 7 r Date Application Approved By---------- ----- - ----- ---•------- - - - --- ----- --- ------//� D�e�--7.�_ Application Disapproved for the following reasons-------------------------------(7----------------------------------------.............................. -------------•---•-----•------------------------------------------------..--•-------------•--------------•----•--•-•------------•----------------•-•----------------------•------..--._--.-------------- Date PermitNo........................................................ Issued..../.A...... � 70•------------------ Date No...... Fsa.....t.. .... ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... -_.................OF................................ .... _....- ..-.... ....-.-.-.-.-- ApV irtttiuu -fur Uhipuottl Workii Towitrurtion Prruiit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sgsate: fJ!!�r�.__1/A r� .......................... / 3 / — Locatbon dressy or Lot No- ..................................... ne��rjj ---•-••--•----•----••-----------------------Address nstaller Address Q Type of Building Size Lot............................Sq.'feet Dwelling '?No. of Bedrooms---------------/-----------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 0.i Other fixtures ------------------------------------------------ w Design Flow............... ....._________.______gallons per person per day. Total daily flow........� _d._______._____-__-._-_-.gallons. W Septic Tank--I Liquid capacity/ allons Length................ Width..............-- Diameter----:---_-...__ Depth---------------- x Disposal Trench—No.____________________ Widtt I. .. . . .. _ . al Length.................... Total leaching area--------------------sq. ft. Seepage Pit No _ 2--_______ Diameter-l.- ___4�below i et_______________• Tot 1 lea n - ---- g area-----------------sq. tt. z Other Distribution box ( ) Dosing tank ( ) I G,- 73 / C aPercolation Test Results Performed by----------------------------------------------------------------.......... Date_____----------------------------------. Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water-----------.___---__--. fs, Test Pit No. 2................minutes per inch Depth of Test Pit..------------------ Depth to ground water-..--------------------- __-- ODescription of Soil--------- ------------------------------------------------------------------------------------- _------------------ ---------------------------- x U -------------- w UNature of Repairs Alter ions—Answer when applicable_________________________ __...-...............................................__----_______----- Y 737. Agreement: The undersigned agrees to install he aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue by the board of health Date Application Approved By----------- - ­--- ---- ---•------ -- - - --- -�� �.--_..-.--- ........ t- � 7 S_ Date Application Disapproved for the following reasons:-------------------------------- ----------------------------------_-------------------------------------_.--_- ---•--------------•---------•---•--•--•••----------------------------------------•-----------•-•-•-•---------------------------------------------------•---------------------------------------------- Date PermitNo........................................................ Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH %rrtif iratr of fW"ompliaurr THIS TO C %Y, That the Individual Sewage Disposal System constructed ( or Repaired ( ) Ins at------- XV 1t '� has been installed in accordance with the provisions of Ar cle, I of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. _l--_ •_ //_ ``_-___- dated_-_.... ...__�•_�-Z-"__-..7. 1.�- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------- ......../-- --------_---------_-_------ Inspector==--------- ---- ��•/'�j . i THE COMMONWEALTH OF MASSACHUSETTS 3 BOARD O HEALT No.---•----................ OF FEE..../ ........... Dinpotial rkq T �t trurtion rrmit . rt Permission i he eby granted-._._"__._. _. __ rf_._______ �.�(°.: -- .. .---- - .._... to Constrat or e an Indio• ua Sewage ispos Syste j at No - - / 'cr (-y/� �f'�.- ------ --- -- Street 2 S as shown on the application for Disposal Works Construction Permi o_ ______________ __ __ /-''`________•_______-_••---- ----------------• ------ - rP- ---------------•-••-------------- Board o Health DATE...... .-------------- --r- -....----- / FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS