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HomeMy WebLinkAbout0302 OLD MILL ROAD - Health 302 OLD MILL ROAD OSTERVILLE - - - - -- A- 142 -064 / 1 0 r9 . • rV 1 Er $ertified Mail Fee �Qq 4r6v" -r Extra Services&Fees(checkbox,add tee as'"�' prate) 1 •y�,F rq ElReReturnReceipt(hardoopY) $.- L f ' '❑Return Receipt(electronic) $ Postm - �: 1 ark t(, C ❑Certified Mall Restricted Delivery $ `� Here V Y 0 []Adult Signature Required $ f•1.Ar1 Jf.Clnnofiiro.ReMrinteri:fle0 N R-,a_. _ _ ,rr __ _ - Se�j - ra ! PERRY, ELIZABETH J ESTATE OF i-n - -- -53-TIHONET ROAD — -� WAREHAM,-MA 02571 . o � P :/1 1 11 111•1 Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label), for an electronic return receipt,see a retall ■A unique Identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipients retail associate., signature)that is retained by the Postal Service— Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders: Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is not available for requires the signee to be at least 21 years of age international mail. and provides delivery to the addressee specified ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent f with Certified Mail service.However,the purchase (not available at retail). ` of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark.If you would like a postmark on,r, ■For an additional fee,and with.a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office-for the following services: • postmarking.If you don't need a postmark on this Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion, of delivery(Including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version:For a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece; IMPORTAINr Save this receipt for your records. PS Form 3800,April 2015 fReverse)PSN 7530-02-000-9047 SECTION ONDELIVERY.," ! ■ Complete items 1,2,and 3. A. Signature ®Agent `� ■ Print your name and address on the reverse X so that we can return the card to you. ❑Addressee e Attach this card to the back of the mailpiece, B• ecely d by(PriJr ted. '` e) C. Date of Delivery or on the front if space permits. 11•20•1 1: Article Addressed to: D. Is delivery address different from item 1? ❑Yes delivery address below: p No PERRY, ELIZABETH J ESTATE OF 53 TIHONET ROAD t - WAREHAM, MA 02571 ❑Priority Mail Express® II I�III�I(�II I�III III'lll'lll��l II(I I I��I I I I III�_� 0 Adult signature ❑Registered Mail ❑Adult Signature Restricted Delivery ❑Registered Mall Restricted Certified Mail® Delivery 9590 9402 5357 9189 1904 32 Certified Mail Restricted Delivery Return Receipt for ❑Collect on Delivery Merchandise 2.Article Number transfer frnm cermra randl ❑Collect-on Delivery Restricted Delivery Signature ConfirmationTm �i. - "Mail U Signature Confirmation I , 7 015 1_7 3 0 10 0'q 1 44 9 8 8 .10 81 o)il Restricted Delivery Restricted Delivery PS Form 381 1,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt LISPS TRACKKING# L'TO`" 2„ "'= First-Class Mail Postage&Fees Paid USP t Permit No.G-10 j 9590 9402 5�tSII'89 1904 32 United States Sender:Please print your name,address,and ZIP+4®in this box• i Postal Services - --- I Town of Barnstable a Health Division 200 Main Street I Hyannis,MA02601 I Ili, 1if li1ll)111;j)l J11IIiJJll'iitIJIL,111)�.J'1'11'hiill.lIt 3 oa old m ill , bd-�-- dL t\ ` , Town of Barnstable Inspectional Services Department anztritrraBM " . ,m� Public Health Division A 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4988 1081 November 18, 2019 PERRY, ELIZABETH J.ESTATE OF 53 TIHONET ROAD WAREHAM, MA 02571 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 302 Old Mill Road, Osterville;-MA was inspected on _ 11/05/2019 by James D. Sears, 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: • System consists of two block cesspools. "Overall is full, not leaching." Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF T E BOA as c RD OF HEALTH ThomKean, R.S., C O Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mail ing\Failed or Needs Further Evaluation Letters\302 Old Mill Road Osterville.doc } TIE Tp� P` ~� Town of Barnstable • BAlLVSTABLE, � A b 9 Inspectional Services Department TFD MA'f A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-8624644 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 fze house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) aching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc l - - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments f 302 Old Mill Road Property Address P rr Estate of Elizabeth Perry Owner owners Name information is required for every Osterville MA 02655 11-5-19 page. Cityrrown State Zip Code Date of Inspection kr} Inspection results must be submitted on this form, Inspection forms may not be aRered in any way. Please see completeness checklist at the end of the form. ``d�UpuO nur�rrf��r lmportanl:When A. Inspector Information filling out forms " ` c on the computer, ` use only the tab James D.Sears 4 JA MES ',LP key to move your Name of Inspector — • _ cursor-do not `� use the return Ca ewide Enterprises 'f "? key. Company Name 153 Commercial Street Company Address Mashpee MA 02649 Cdyrrown State Zip Code - 508-477-8877 S 1623 Telephone Number License Number B. Certification I certify that:1 am a DEP approved system inspector In full compliance with Section 15.340 of Title.5 (31 D 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 elgpector's Signature — 11-5-19 Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original form should be sent to the system owner and copies sent to the buyer; if applicable, and the approving authority. Please note:This report only describes conditions at the time of Inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use, t5insp.doc rev.J128/2018 Title 5 official Inspecdon Form:Subsurface Sewage Disposal Syslem•page 1 of ie 6 t a5ed xeJ dH St,:EZ 61.0Z g0 AoN Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �• 302 Old Mill Road Property Address Estate of Elizabeth Perry Owner ner's Name information is Ow required for every Osterville MA 02655 page. ciwrown 11-5-19 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: Failed System.The system is two old block pool's. 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): t5inap.doc rev.7/28IM18 Title 5 Of ia1 Inspection Forth:Subsurfeoe Sewage Disposal system•Page 2 of lit 02 a6ed xej dH 5t7:£Z 660Z 90 AON 1 commonwealth of Massachusetts: i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form.Not for Voluntary Assessments q�,rg 302 Old Mill Road Property Address Estate of Elizabeth Perry Owner Owner's Name information is ' required for every Osterville MA 02655 11-5-19 page. CitylTown State Zip Code Date of Inspection C. Inspection Summary(Pont.) , 2) System Conditionally Passes(Pont.): ❑ Pump Chamber Pumps/alarms not operational, System will Pass with Boa rd of Health approval val ifPumps/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 in if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑: N ❑ ND(Explain below): i ❑ obstruction is removed - ❑ Y ❑' N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y• ❑ N . ❑ NO(ExP*lain.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 ❑ NO (Explain below): obstruction is removed ❑ Y ❑ N ❑ 'ND(Explain below): 3) Further Evaluation is Required by Board of Health: . ❑ Conditions exist which require further evaluation by the Board of Health in order to'determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines In accordance with 310 CMR 15.303(1)(b)that the system is not functioning'in a manner which will protect public health, r safety and the en4ironment: t5lnsp:aac.rev-712&201E + f Tibe:5 Offidal lnspectlon form subsurrace Sewaget Disposal System•Page 3 of 18.,. - <Z a6ed xed dH 5bU 6M 90 AON Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 302 Old Mill Road Property Address Estate of Elizabeth Perry Owner Owner's Name Information Is required for every Osterville MA 02655 11-5-19 page. CitylTown State Zip Code Date of Inspection C. Inspection Summary ❑ 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 mars h 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 healt safety and environment: h, ❑ The system has a septic tank and soll 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 5.nsp•doc•rev.7/20/2018 Titles official InspKtion Form:Subsurface Savage Disposal System•Page 4 of 18 ZZ a6ed xeJ dH 917:EZ 61,0Z 90 AoN- Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments `;y✓j 302 Old Mill Road Property Address Estate of Elizabeth Perry Owner Owner's Name information is required for every Osterville MA 02655 11-5-19 page. CitylTown State Z(p Code Date of lrtspection C. Inspection SUMM8ry (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes. No PA El ❑ Static liquid level in the.distribution box above outlet invert due to an overloaded or clogged SAS or cesspool' ® Liquid depth in cesspool is less than 6"below invert or available volume is less than Y day flow ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).:Number of times pumped: ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater.than 50 feet from a private water supply well with no acceptable water quality analysis_ (This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.) ® The system is a cesspool serving a facility with a design flow of 2000 gpd- gpd. ® The system falls. 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. T 5) Large Systems: Te 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 C.4; Yes No El D _ . the system is within 400 feet of a surface drinking wafer 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.7J262018' Title$Officialinspection Forth:Subsurtac a Sewage Disposal System•Page 5 of le £Z a5ed xe j dH 9t U 61,0e 90 AON Commonwealth of Massachusetts Title 5 Official Inspection Form ,UZI subsurface Sewage Disposal System Form-Not for Voluntary Assessments u 302 Old Mill Road Property Address Estate of Elizabeth Perry Owner Owners Name information is O required for everysterville MA 02655 +11-5-19 page. Cityyrrown 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 NIA) ® ❑ 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 manholes uncovered, opened,and the interior inspected for the condition of the 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 CM 15.302(5)] L5insp.doc,rev.726/2018 Title 5 OfAtial Inspection Form Subsurface Sewage Oisp0621 System•Page 6 of 18 bZ abed xej dH 9ti:£Z 6LOZ 90 ^oN Commonwealth of Massachusetts Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 302 Old Mill Road Property Address Estate of Elizabeth Perry Owner Owner's Name Information is required for every Osterville MA 02655 11-5-19 page. CityfTown state 7jp Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): NA Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Description: . Two Block Pools. Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit?. ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readin s, if available last 2 ears usage 2017-20,000Gals 9 ( Y 9 (gPd)}= 2018-71,000 Gal's Detail: r -4 Sump pump? ❑ Yes ® No Last date of occupancy: Present Date t5insp.doc-rev.70W018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 SZ a6ed xPJ dH 9t?:EZ 61,02 90 ^oN Commonwealth of Massachusetts 01 Title 5 Official Inspection Fora a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments' 302 Old Mill Road Property Address Estate of Elizabeth Perry Owner Owner's Name information is required for every Osterville MA 02655 11-5-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. CommerciaVindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatslpersons/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: NA Was system pumped as part of the inspection? ,Yes ❑ No If yes, volume pumped: 1000 Gal. gallons How was quantity pumped determined? Pump Truck Gage Reason for pumping; Port of Inspection 15insp.dw•rev,712 512 01 0 Title.9 Official Inspectlon Form:Subsurface Sewage Disposal System•Page 8018 fi gZ a5ed xeJ dH 9b:EZ 6I,0Z 90 AcN Commonwealth of Massachusetts Title .5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments " r r, 302 Old Mill Road Property Address Estate of Elizabeth Perry Owner Owner's Name information is required for every Osterville MA 02655 11-5-19 per, Otyrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ❑ Septic tank, distribution box,soil absorption system ® 111M 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 1IA 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: NA Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 20" Depth below;grade: feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction fine: feet Comments(on condition of joints,venting, evidence of leakage,etc.): Pipeing Is 4"PVC SCH-40 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Foam:.Subsurface Sewage Disposal System•Page 9 or to i LZ a5ed xe� dH 917:£Z 6XZ 90 AON Commonwealth of Massachusetts Tithe 5 Official Inspection Form Y Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ` 302 Old Mill Road Property Address Estate of Elizabeth Perry Owner Owner's Name information is required for every Osterville MA 02656 11-5-19 page. Chy/Town State Zip Code Date of Inspection D. System Information (cont) 6. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? n Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 15lnsp.doc•rev.74e12019 Title 6 Officlel Inspection Pam:Subsurface Semge 0lspwal System•Page 10 of 18 gZ abed xeJ dH LV:Q 6 XZ 90 AoN Commonwealth of Massachusetts Title 5 Official Inspection Fora 6)1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . .011 302 Old Mill Road Property Address Estate of Elizabeth Perry Owner Owners Name information is Osterville MA 02655 11-5-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cant.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal Q fiberglass ❑polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to fop 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 tSlnsp.doc•rev.7r&2018 Tine 5 official Inspection Form:Su=rfaoe Sewage Disposal system•Page 11 of 18 6Z a5ed xed dH LV:EZ 660E g0 AoN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 302 Old Mill Road Property Address Estate of Elizabeth Perry Owner Owner's Name information is required for every Osterville MA 02655 11-5-19 page. CityfTown State Zip Code Date of inspection D. System Information (cant.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level:, Alarm in working order: ❑ Yes ❑ No 1 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 No Box Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or,ouf of box, etc.): t5insp.doc•rev.R2612018 Title 8 Official Inspection forth:Subsurface Sewage Disposal System•Page.12 of 18 0£ a6ed XeJ dH LVEZ 610Z 90 ^oN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 302 Old MITI Road Property Address Estate of Elizabeth Perry Owner Owner's Name Informrequired s Osterville MA 02655 11-5-19 required for every page, CBy/Town State Zip Code Date of Inspection D. System Information (cunt.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No' Alarms in working order: ❑ Yes ❑ No' Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): "If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located,explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: �] leaching fields number,dimensions: ® overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Wnsp.doc•rev.70129f li Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 o118 L£ a5ed X2J dH ZtU 6602 90 ^oN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 302 Old Mill Road Property Address Estate of Elizabeth Perry owner Owner's Name information is required for every Osterville MA 02655 11-5-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(cunt.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Leaching is a 8'deep block pool wlcover at grade.Over flow is full, not leaching. Need to replace system. MAIM 12. Cesspools(cesspool must be pumped as part of inspection) (locate on she plan): Number and configuration 1- Depth—top of liquid to inlet invert Depth of solids layer 6,. Depth of scum layer 2" Dimensions of cesspool 8' Materials of construction Old. Block's Indication of groundwater inflow ❑ Yes ® No Comments(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.): Main c.pool is 8'deep w/cover at grade.One line in w/one line out..No tees. Level at outlet w/paper and solids on top of outlet line. a t5inep.doc•rev.7i2612018 Title 5 Of tial Inspection Form:Subsuriaoe Sewage Disposal System•Page 14 of18 Z£ a6ed XeJ dH LVE2 6i3OZ go AON Commonwealth of Massachusetts ,� Title 5 Official Inspection Form �} Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments j 302 Old Mill Road L Property Address Estate of Elizabeth Perry Owner Owner's Name Information is required for every Osterville MA 02655 11-5-19 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on-site plan)`. Materials of construction: Dimensions Dept of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I t5insp.doc•rev:M&2018 Tits 5 Official Inspection Form:Sutturlace Sewage Disposal Systa -Page 150l 18 �£ a5ed YPJ dH Lt,:EZ 660Z g0 AON Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 302 Old Mill Road V Property Address Estate of Elizabeth Perry Owner information is Owner's Name required for every Osterville MA 02655 11-5-19 page. Cityffown 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 r , o 1 a liQ p -d . ate r � 4= i7-a i t5insp.doc•reo.7/26=8 Title 50f5rial Inspection Form:Subsurface sewage Disposal System•Page is o11B b£ abed xej dH Lb:£Z 660Z 90 AoN. Commonwealth of Massachusetts 19f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 302 Old Mill Road Property Address Estate of Elizabeth Perry owner Owner's Name information is Osterville MA 02655 11-5-19 required for every page. City(rown State Zip Code Date of Inspection D. System Information (Cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells O ?ti Estimated depth to high ground water: 12+ feet. Please indicate all methods used to determine.the high ground water elevation: ❑ Obtained from system design plans on record If checked,date of design plan reviewed: pate ® Observed site(abutting propertylobservation 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: Area and abbuting property.Area down road 12'+no G.W. Bottom of pool at 8'below grade Before filing this Inspection Report,please see.Report Completeness Checklist on next page. 15nsp.doc-rev.N2612010 Title 6 Official Inspection ram:Subsurface Sewage Disposal System•Page 17 of 18 r 5g a6ed xed dH Rt,:U 6 M 90 ApN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 302 Old Mill Road Property Address _Estate of Elizabeth Perry Owner Owner's Name information a Osterville MA 02656 11-5-19 required for every page. City/Town state Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. inspector Information: Complete all fields in this section. " B. Certification: Signed&Dated and 1,2;3,or 4 checked ® C. Inspection Summary: 1,2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed D. System information: For B: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 or y pp � 7 o&L cl 7 No 7 Mnsp.doc•rev.7/26=18 Title 6 Oifidal Inspedlon Farm Subsurface Sewage.Dispossl System•Page 5a of 1e g£ abed xe� dH 8bU 6lOZ g0 AdN ,~ IV6 1�✓i/� J s NO...??..'..f 17 ig FRs/ %. . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Divi-pooal Wark.6 Tomitrurtiort Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: a' /l� e"',11<_ --.......... � .... � � -.�------- ----------------------------------------------------- L"' \ddress or Lot No. �rP ------------------------------ Owner Address W Installer Address UType of Building 55 Size Lot__ ....................Sq. feet F—I Dwelling—No. of Bedrooms.__-----____�3----------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) al Other fixtures _________________________________ _ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacitylQdQ---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........................................ aTest Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ Get Test Pit No. 2.:..............minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ------•---------------------------••--------•-------------•--------••-••-•------•---•--..._...••••••......••••-•------------•------------- ......... ------ ••-- 0 Description of Soil....................................................................................... ----------------....----.....-----------------------.....--•••-......••••.•••_.. x U •--•-...------••---...••-------•••----••-•••------••-•----•-•---••••••-•--•-•----••----•-••---------•-••----------------•---------------•----•--••-•-----•--•----------------•••-•----•-•--••-•-•-...--- W ---------- UNature of Repairs or Alteration —EIswer when applicable.- -_. ...__//. _.__�/ ... _......... Agree nt:. '✓ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed . ......_............_................. ............................._........ ....................:...... Dace Application Approved By ..... ......... -.. '±� }y---.......------------------............ ..� 1 D0 ' ace Application Disapproved for the following,reafons- ---------------------- ----- -----------.........-------------------------------------------------......---------------------------- Date Permit No. C�./ ` Issued `� �'..'�f............. Dare ------------------ ------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ce'r#ifi ate of Compliance �/ �A��, � 7%/�,•y� THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( )'or Repaired ( ) by ............................_............_....................._........_..........._.------_.--------------------ler.._._........._..........._..........................._..............................--------------------------- at ............................ .--......o/l� ilk//�. - '� ._.... has been installed in accordance with the provisions of TITLE of The State Environmental Code as described in the application for Disposal Works Construction Permit No. dated --- ... PP P ► THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON TRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...... .......................... _- ------------------...---------------------------- Inspector .............................................:--------------------------------------------------- -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 19 �j TOWN OF BARNSTABLE ...1J 1 FEE... � 9 �is�oottl orko �rr�totr�rtiori �rrntit Permissionis hereby granted---------------------------------•---------------•--•---------•-•-----------...--•---•----•-----•----•----------••-...� ......... ....... to Construct (V) or Repair ( an Individual Sewage Disposal System (/Pi�— f , i e ;r;/�� dr ----------------••---•-------------•-------- ----•----._.......•.•- Street p , as shown on the application for Disposal Works Construction Permit No._/ '"Dated.._ :..''�. .".!5? I Board of Health DATE--------------------------------•-----------•------------------------------•---- � I FORM 36508 HOBBS&WARREN.INC..PUBLISHERS - IN a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE AV# iratinit for Di-nlangttl W.PrIm Tnnitrnr#inn Vantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: --�9.---.. 1. ....lfiA ......... j����Ili Location lddress or Lot No. .....FX1 5 ........., �_�1- ------------------ ....................................................... Owner Address W T i Installer Address UType of Building Size Lot-.1,J .......Sq. feet t t Dwelling—No. of Bedrooms..--.-------I---------------------------Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building =-------------------------- No. of persons------.-..--_.-.------------ Showers ( ) — Cafeteria ( ) QI Other fixtures --------------_--.-.----.- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity/00...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........................ Li, Test Pit No. 2................minutes per inch Depth of Test Pit....-..----.-----.-. Depth to ground water........................ P ....................•--------...........................--••---•-------•••......••------------............................................................... 0 Description of Soil................................................................................x x ------------------ -------------------------------------------------------------------------------------------------------- ----- - U RepairsAlterati t wer when applicable. �/.1,1 �Y ••-•--.. N/l��I . .....-i� The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accoedance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ------------------------------------------------------------------------------------------------------ .................................:...... Date Application Approved By ---- ------ /, -- ------ A""_.._.." .:.................... ........ ............................- Date Application Disapproved for the following re ns. .............-----------------------------""- ------- .................... -------------------------------- --------------------------------------------------------------------------- ---- ----- ------------------------------------------------------------------------------ ........................................ Date �_ Permit No. ..%.-.'�`...''..... .� Issued � --/._ -............... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance � �A We, THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( )'or Repaired ( ) by-----------------------_-----------------------------------------------_-------_------------------.....-----------------------.-------- ------------------------------------------- --_-----------_--------------------- -Y at ---------...�-D�` ©/� �/-/._ . _....� /_//'!LL.'K .. ---------------------------------------...._------------------------------ has been installed in accordance with the provisions of TITLE of The State Environmental Code as described in the application for Disposal Works Construction Permit No. � � dated _. -:• .��1^..a�T� PP P �..._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUEA AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE----------------------------------------------------------------------- --- ------------ ------ Inspector -----------------------.----------- ...:.----------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No._...._._T.:....:........ FEE ...........:.. 5 Rapnout lVorkii Tunitrinnintn urrmit Permissionis hereby granted........................................... ---------------•--------------------- ............................... ✓.. to Construct (V ) or Repair ( ) an Individual Sewage . isposal System at No.-----�G1------(214-----zw jj/...X0;---..:Qf v�/ .............?5w-r ..-. Street as shown on the application for Disposal Works Construction Permit No.- '. ^'! ......................... .....................•-••--..........--•--•---•••-----..-----•-----........-•------•-......•-•--•--.•--- Board of Health DATE-------------------------------------------------------------------------------- FORM 36508 HOBBS R WARREN,INC..PUBLISHERS _ -..