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Home My WebLink About0141 BRACKEN FERN ROAD - Health N � A=042-033 e THE COMMONWEALTH OF MASSACHUSETTS -3 3 U q?) BOARD OF HEALTH OLJ;� I I ...........7oW.47................OF.........B(%r.45*b1C.................................................. Appliratiou for Dispaiial 19orka Tonstrurtion ramit Application is hereby made for a Permit to Construct (K) or Repair an Individual Sewage Disposal System at: C.Z.e ...;a �..... ....... ........ ...................................................................... Location-Address or Lot No. ................... ................ .............................................. Owner 96WZT�13�"U'I'L C_.,C,_Q Address ................ ....... ......................... .....................................r.1/s...................................................... Installer Address Type of Building Size Lot.....13+5Q4.....Sq. feet U ..TvIrx-e--_-----------------------Expansion Attic Ole) Dwelling—No. of Bedrooms-- Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers Cafeteria P4Other fixtures ...................................................................................................................................................... Design Flow................................ .....gallons per person per day. Total daily flow........................3.3.0. ........gallons. 1:4 Septic Tank—Liquid capacity.IC6(agallons Length.$...(6..... Width.4_-.A0----- Diameter.-77=..... Depths'........ Disposal Trench .................... Width.................... Total Length.......... Total leaching area....................sq. f t. Seepage Pit No.-.Pr.w---------- Diameter------LC)-. Depth below inet....A............ Total leaching area...?.. . ....sq. f t. Z Other Distribution box (7(% ) Dosing tank ( ) Percolation Test Results Performed ............................................. Date... L F/&6............ Test Pit No. 1..... -.......minutes per inch Depth of Test Pit-----f........... Depth to ground water..__.._ .. Test Pit No. 2................minutes per inch Depth of Test Pit..._..........__.... Depth to ground water., )kAF ................................................................................................................................. . .................. 0 Description of Soil....j0:7��., .............................................................................. STEPHEN X L_i H1 oil YN".. U ................................ .................................................................................. ...-..ALL WILSM4--- .......................................................................................................................................... ................................. Nature of Repairs or Alterations—Answer when applicable...................................................................I AP U ............................................................................................................................................................................. Agreement: C-e V,4o The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in ac ordance 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 een issued by the board of health. Signed ................ .......... ..... ... ..I ....... ....---------- ----------_--- ......Z/......................... 0" Date .................. Application Approved By ................. ........... ................................................... ......../V=_741- Mte Application Disapproved for the following reasons: ........................................................................................................................................ ..............I---------------------------------............................................................................................................................................................... ........................................ Date PermitNo- -----0..------................................................. Issued -------------------------------------------------------------------- Date ----------- .• x s --- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - /.Uwe................OF.........�Jr?r�Isfq.61C....................................................... Appliratiun for Dhipulittl Works Tonutrnrfiurt ramit Application is hereby made for a Permit to Construct (Ke) or Repair ( ) an Individual Sewage Disposal System at: ........ .....................a a. ............... ---....--••-------------------•--••------- _ Location-Address or Lottr No. ue SNI t�.. '......c?COLfr? l/•r%...did............................................... .................. ......:..................... ...........:....................... . _............_.............._.._..._. Owner jry K��j > r j i t�r t.c L v rl Address ,ram .............................. ..... t PQ Installer Address Q Type of Building Size Lot......3.;.--`-04.....Sq. feet U Dwelling No. of Bedrooms..TA,rc G.....................g— Expansion Attic (Al,,) Garbage Grinder (alb) Other—T e of Building No. of persons..,......................... Showers — Cafeteria PI Other fixtures ------------------------• ..........................,............................. .............................................I W Design Flow................................5-;_....gallons per person per day. Total daily flow....................... AQ.........Olons. WSeptic Tank—Liquid capacity.-I gallons Length_? .-(-"... Width.a�'_I®...__ Diameter................ Depths ......... Disposal x Disposal Trench—No..................... Width.................... Total Length.......... Total leaching area....................sq. ft. Seepage Pit No....O. - Diameter......!.S?...._._._ Depth below inlet....A............ Total leaching area...L 7.___sq. ft. Z Other Distribution box (& ) Dosing tank ( ) 0-4 Percolation Test Results Performed bY.._ ____ U_ o ±............................................. Date...i/Z_?Tl -----_-___0_4 . ,4 Test Pit No. I...... ..._..minutes per inch Depth of Test Pit..... ........._. Depth to ground water...... 0-4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water A� --;---------•--• ------------•--••••-••--••-•-•...............••--•..._..._..._............---...--•-------•---.....---.. 0 Description of Soil..__©.7..�_' 0 �,0,1+I1 50 ksOI! STEPHEN x P v E7�r-------------X5---------------------------------•-•-----------•---------•----•-•--••-•-------•--•----•---•-- . .................... U .................................. . .•(_... .... llc !d''?9____"___�!9(.I• �1 ------ wrrsorr.._ -, ............... ........••---------•-------•------•-----------------••--------_--_------------•--•------•-•--•-------•-----------------•----------••-------•----•-•-----• Mo:3Q 6 U Nature of Repairs or Alterations—Answer when applicable-------------------------------................................. ... ,c�� $►\? -•-•..............•-•--•----•-•-•--....----------•--•------•---•--••-•--•-•----•----•------•-............---...-----------------•-•-•-----•-----...._..................•.•••••• /VFfiiL' � Agreement: 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 opera ion until a Certificate of Compliance has_ een issued by the board of health. 14 Signed .-.... .%/ , Application Approved By J J -- ._..... -------------------------------------- --------/=-t7. -' Application Disapproved for the following reasons: ........................ .......................................... ------ . . . -- --- ------------------------- ----------------------------------------------------------------------------------------------------- ------------------------------------------------------------- -------- -----...................... --- - ------------------------------ Date PermitNo. .....I?-� 7--------------------------------- Issued -....------------------.D ate. .....................--- ------------ ate t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /. ................................ OF ... ?...*'c�td e dulertifiratt of (111antylianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ` -<orRepaired ( ) by ....... . -� ........ .... ..... ....... . .... .......... —_I.""" has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. -----`^ T"..7....-. dated ----------------- ----------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............. ....................... .. ...... .. .. .................---------- Inspector .........----------- --------.. ---------•-- ................-------- --...--------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH FEE-/ ....... l Permission is hereby granted......... j -_' : ` % to Construct (�✓j or Repair ( ) atf�Individual Sewage Deposal System Street as shown on the application for Disposal Works Construction Permit -•j7Q N . ..7-__ Dated.......................................... o...--------•---•. -- •-•• .............................................. DATE...............- L " a dof Health I, FORM 1255 HOBBS & WARREN. INS.. PUBLISHERS - I jj 170 . •gore-ay 49c,Q, 7 •�� ` �; 79 O�c, � = /%n� Z Mir/.•a,2�L,_c� x-OF � D STEPHEN. o+ A. ��` ALLYN w ILsoN y BAXTER No.30216No 240411 N L�N6 � �� j �� 111f8 S�� •- .. In/5rA(-1-pcG, 1n//[.s4✓-E/6. G.GZ, .. 1eisGe ro Gv/77-//n/ /a-Z7-87 jZ'/�e I 7 �✓r�5o%�, Top ;' � ' z,p CLAY -- � 'GIF ' r �/.� S.EPr�'G �i%8 ►.• s i 5/ � : R •� r . 5;,2lo�v /-z r AAvg �tvtj z'�---C" Z• . ' L oG_ /�,t STb�✓S /l- S U.VsviT-.5Ga1.5 Llnaj .� • /o:gTlyuyoic-b(/c%,tryre� ..' / F��sao .�,�E.�Eov co�►lP�.ys wiry/THE•sid��i�E A.V,d 0E`r-VGl .�EQV/�'EtiJ�NrS 7,V .C�E6isr�ecO.t�.vo.s�,e,�Eyo TOWiv GE• Awl /S /vo7 -25 - Gt//7W/N Ti�/.E �LG1opoL4/it/. E 1 n•3©-$� ( G� �u�Z•--. -A C/cny>`-• T.vE y ;l CommonweaM of Massa chusetts Executive Office of Environmental Affairs Department of Environmental Protection Wulam F.Wend (j*V41fW Trudy Coxe A►9eo P Ceiiucci s.Gw.ry LL DavM B.Struhs Canumw ww I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A " ✓�1 CERTIFICATION _ Props °! d tS I-,A f Cr A-- ��t /S 1?'1.: �. + Address of Owner. Date of Inspection: `� n �, J! ' (If different) l Name of Inspector. ?;. p°Q W.E. Robinson SR Company Name,Address and Telephone Number. ( 5 0 8 ) 7 7 5-8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA CERTIFICATION STATEMENT 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: asses _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: 6�11 Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A,B, C,or D: Al SYS PASSES: . �/ I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. JB7"W4 CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. y ,no,or not determined(Y, N, or ND). Describe basis of determination in all instances. If"not determined",exp�n why not) The septic tank is metal,cracked,structurally unsound, shows substantial infiltration or exfiltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with aponforming septic tank as approved by the Board of Health. 1 3/95) 1 One Winter Street 0 Boston,Massachusetts 02108 0 FAX(617)556-1049 0 Telephone(617)292-5500 • G SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: ' 13 12.,4 e A A-- Owner. r`c G Ci Date of Inspection: JC. B] CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C) THER 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. Z) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or low than 5 ppm. 8) OTHER (revised 11/03/95) 2 tT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: I ''/ ! cv A< K A,A,- /-"1r 1`7 Owner. /'� e:e4 Date of Inspection: 5-3 0—c_ D) SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 16.303. The basis for his determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the Backup of sewage into facility or system component due to an 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 cese pool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARG SYSTEM FAILS: e following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public h and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner r operator of any such system shall bring the system and facility into Rill compliance with the groundwater treatment program requireme of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.. (revised 11/03/95) 3 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address~ f IL I I J J ?A c: �4C 9 r,7 a ✓1� Owner. A C C--4 Date of Inspection Check if the following have been done: ` Pumping information was requested of the owner, occupant,and Board of Health. _None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates t period. volumes of water have not been introduced into the m recently or as of this inspection. during that pe I,as'Be system Y P� P� l/As built plans have been obtained and examined. Note if they are not available with N/A. L41U facility or dwelling was inspected for signs of sewage back-up. 4Aie system does not receive non-sanitary or industrial waste flow _Jhe site was inspected for signs of breakout. the Absorption System, have been located on the site. /�11 m components,excluding h Soil Aba rp y tad _ �� Po _Ae septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or r tees, material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. =The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 yf i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: % :^ Owner. Date of Inspection: 3 9 , FLOW CONDITIONS RESIDENTIAL Design flow:,-.j d jpllons Number of bedrooms:_`-/ Number of current residents: C� Garbage grinder(yes or no):__& Laundry connected to system(yes or no):Z— Seasonal use(yes or no): A.,," Water meter readings,if available: Last date of occupancy: 1 - `� f•� CO WCIAL INDUSTRIAL Type of tablishment: Design fl :�gallons/day Grease t p present: (yes or no)_ Industrial Waste Holding Tank present: (yea or no)_ Non- waste discharged to the Title 5 system: (yes or no)_ Water eter readings, if available: Last Jdaof occupancy:OTH (Descrbe) Last of occupancy: GENERAL INFORMATION PUMPING RECORD and sp of information: System pumped as part of inspection: (yes or no) 4- If yes,volume pumped: t[allona Reason for pumping- TYPE OF�YSTEM . 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) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: %�' l� v 2 S 5 A S v A-�� r Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95) 6 - I . L _ b SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: , '' 'a r n. !� r� ,� )�� ✓1�1 Owner: r�C� y Date of Inspeotion: SEPTIC TANK:_ (locate on site plan) D 1 Depth below grade: Material of oonstniction: dooncrete_metal FR.P—other(explain) Dimensions: ' Shidge depth: '3 Distance from top of sludge to bottom of outlet tee or baffle: 'V �% L Scum thickness: 0 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:. I Comments: (recommendation for pumping,condition of inlet and outlet tees,of baffles depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) -1 ��- 1�- �� :�"�'�/ .n:� r Q ' I�[- sa: ti GREASE _ (locate on ai plan) ` Depth below e: Material of co on:_concrete_metal_FRP" other(explain) Dimensions: Scum thicku Distance top of scum to top of outlet tee or baffle: Distance fro bottom of scum to bottom of outlet tee or baffle: Comments: (recommen 'on for pumping,condition of inlet and outlet tees.or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of ,etc.) (revised 11/03/95) e G• 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: / '7' Ig /i IC C^- l-!i!L J?;� , I�✓J Owner. Date of Inspection: l._3 e, q, (, TIGE OR HOLDING TANK:_ (locate site plan) Depth be grade: Material construction:_concrete_metal_FRP_other(explam) Dimensions: Capacity: ono Design flo ¢allono/day Alarm 1 1: Comments: (condition of et tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX:`! (locate on site plan) Depth of liquid level above outlet invert: 0 Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) A GA ) ems' rS . C) PUMP C ER_ (locate on plan) Pumps in rking order:(pes or no) Comments: (note co 'on of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: `// ,( u is _ c` �- /G • l''7 Owner. 9 .5 t�-1 Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):_✓ (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits, number: J leaching chambers,number:_,•,, leaching galleries,number: leaching trenches,number,length: leaching fields, number,dimensions: overflow cesspool, number: Commen not condition f soil,s' of hydraulic failure, level of ponding, condition of vegetation,etc.) c.`CAL1 p 3 6 r1 3 6 c PooLs:_ (locate n site plan) Number d configuration: Depth-to of liquid to inlet invert: Depth of lids layer: Depth of layer: D' of cesspool: Mate ' of construction: Indite of groundwater: ow(cesspool must be pumped as part of inspection) CommeII :(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) PRIVY: (locate on plan) Materials o construction: Dimensions: Depth of Commen (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) (revised 11/03/95) 8 " SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:- Owner. 1Q = t/ Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100, 10 I h, . f� L ? 4 ' M DEPTH TO GROUNDWATER Depth to groundwater. /-'f feet _ �3 l� r method of determination or approximation: D (revised 11/03/95) 9 No. 6 Fee 40 .00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplicatiou for Xkgool *pgtem Cougtructfon Permit Application is hereby made for a Permit to Construct( )or Repair( x)an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 141 Brackenfern Mel Reed Marstons Mills 159 Donegal Circle Centerville Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. W.E. robinson Septic Sery P.O. Box 1089 Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder(Io) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) install a new Title 5 l e a c h t r e n ch consisting of 3 stonepacked #330 high capci y infiltrators Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this B d ealth. Signed L Date 7 Application Approved bye--� ��- G Application Disapproved for the following reasons I Permit No. T& -a a:,r Date Issued ———————————————————————————————— J_1 a3v 40.00 No Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEAtTK,-DIVI§ION,_1-..TOWN OF BARINSTABLE., MASSACHUSETTS Rppfirattorl for .,Dtopogai *p.5tem Con!gtrurtion Permit Application is hereby made for a Permit to Construct or Repair( X)an On-site Sewage Disposal System at: Location Address or Lot No. _, Owner's Name,Address and Tel.No. 141 Brackenfern Mel Reed Marstons Mills 159 Donegal Circle Centerville Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. W.E. robinson Septic Sery P.O. Box 1089 Genterville q A!1 17 1' Type of Building: f 0 Dwelling No.of Bedrooms 3 Garbage Grinder IRO) I Other Type of Building No. of Persons Showers Cafeteria( Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Sod sand Nature of Repairs or Alterations(Answer when applicable) install a new Title 5 leachtrench consisting of 3 stonepacked #330 high capcity infiltrators 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 En 'ronmental Co e and not to place the system in operation until a Certifi- cate v r I 11� I cate of Compliance has been issued by this B ealth. N, 4d? le, —9� Signed Date 15 Application Approved by U U Application Disapproved for the following reasons Permit No. -Z,C Date Issued --— - —————— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed or repaired/replaced� on by W.E. Robinson Septic Sery far Mel Reed as 141 Brackenfern has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.X.1, r� —dated Use of this system is conditioned on compliance with the provisions set forth below: No. 11'tl, - C2 Fee 40.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 1wtopool *raem Con5trurtton Permit Permission is hereby granted to W-E. Robinson Septic Sery to construct( )repair( X)an On-site Sewage System located at 141 Brackenfern and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within two years of the date below. Date: Approved by Mel Reed f f � a A CERTIFICATION OF SKETCH AND APPLICATION IFOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) �1 x v3 I, ,hereby certify that the application for d)sposal works construction permit signed by me dated j"oZ , coe the property located at rK .C i � �-�✓ Oz A-- fit Wl of the following criteria: ' • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. iy 6 A SIGNED: v L DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses s certified plot pine, this plan should be submitted). a x i i ' S.s.M i �, to+x' ♦ ':C= . �. } ,� K .. �. � *. A � �. .. l� c �� sv L _� �__ ,�_� l __ �� , � / O �� _ .,.. - ... ems.-. ..�, ._ - .._s.:.+: -� ��_ _ _ il _ ��.. _ -". Crocker, Sharon From: McKean,Thomas Sent: Thursday, September 03, 2020 4:51 PM To: Crocker, Sharon;Tripp,Vanessa Subject: 3 Bedrooms Not 4/Corrected Title 5 Inspection Report for 141 Bracken Fern Road in Marstons Mills, MA Attachments: T5 - Marstons Mills-141 Bracken Fern Road - Corrected on 9-3-20.pdf From: Fuller, Kelly [ma i Ito:kfuller@wrenvironmental.com] Sent: Thursday, September 03, 2020 4:22 PM To: McKean,Thomas Cc: c.j.odonnell@comcast.net; DeCosta Jr., Mike; Waters, Amy Subject: Corrected Title 5 Inspection Report for 141 Bracken Fern Road in Marstons Mills, MA Good Afternoon Thomas, Attached, please find a corrected Title 5 Report for 141 Bracken Fern Road in Marstons Mills, MA. This inspection was performed on 06/18/2020. Our initial report incorrectly listed the actual bedroom counts as 4. The attached report has been amended to reflect that both the design and actual bedroom counts are 3. This revision was done on behalf of the inspector Michael DeCosta,Jr. Mike can be reached at (508) 400-8083. He is also copied on this email as is the homeowner, Christopher O'Donnell. Please confirm receipt and let us know if this email is sufficient or if you would like me to put a hard copy in the mail to your office as well. Thank you, Kelly Fuller I Title 5 Preparation,Massachusetts I Branch Admin: NESE,NECC, NESC,NESO&NERI Wind River Environmental 245 Plymouth Street,Carver, MA 02330 P: 978-562-4500 x5162 I C: 508-468-8612 kfuller@wrenvironmental.com I www.wrenviromnental.com N"NORWER l"N V I RON ME N T A l Your full-service liquid waste company CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! 1 i Town of Barnstable Inspectional Services BMA BM "9. �� Public Health Division ID 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-79)-6304 CERTIFIED MAIL#7015 1730 0001 4987 9101 July 23, 2020 ODONNELL, CHRISTOPHER J 141 BRACKEN FERN ROAD MARSTONS MILLS, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 141 Bracken Fern Road, Marstons Mills was inspected on 06/18/2020 by Michael DeCosta Jr., 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: • Need to cap off old system and lower the line to "new" system (1996). You are ordered to 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 THE BOARD OF HEALTH r r� Thomas McKean, R.S., CHO Agent of the Board of Health fie:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\141 Bracken Fern Road Marstons Mills.doc Town of Barnstable • BARN STABLE, ' 6 9 ,�� Inspectional Services Department ArfD MP'�s Public Health Division 200 Main Street, Hyannis MA 02601 C{ffi ce: 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 is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well - ❑ A portion of the cesspool is located 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 standing liquid level at or above the invert pipe (per Town Code §360-20 h) 0 ER �! J 1� o S ✓� Dwe/' I I'ne. 2 M l �) Repair deadline: r r Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc L O 3 Commonwealth of Massachusetts Title 5 Official Inspection Form 5'�2 -1033 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Bracken Fern Road e i-b� Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is Owner's Name required for every page. Barnstable MA 02648 June 18, 2020 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 e 1. Inspector: Michael DeCosta, Jr. Name of Inspector Wind River Environmental Company Name 46 Lizotte Drive Suite 1000 Company Address Marlborough MA 01752 City/Town State Zip Code (508)400-8083 SI 13230 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: ❑ Passes 0 Conditionally Passes ❑ Needs Further Evaluation by the Local Approving Authority ❑ Fails June 18, 2020 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 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. t5ins.doc ,ev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18,2020 City/Town State Zip Code Date of Inspection C. Inspection summary Inspection Summary: Complete 1, 2, 3,or 5 and all of 4 and 6. 1)System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 2)System Conditionally Passes: 0 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. 0 Y ❑ N ❑ ND (Explain below) The septic tank has one from the original system put in when the home was built and one outlet from a new system that was installed in 1996 after the original system failed Title 5.The original system line must be capped off and a line to the new system must be dropped 1-2"to ensure that all flow goes to the new system. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 C , Co nmonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18, 2020 City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) 2)System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a.System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5ins.doc rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18, 2020 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 ❑ z Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ z Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments o 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18,2020 City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ Q Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Q Liquid depth in cesspool is less than 6" below invert or available volume is less than'/z day flow ❑ Q Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Q Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Q Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Q Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Q Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Q 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.] ❑ z The system is a cesspool serving a facility with a design flow of 2000gpd-10,000gpd. ❑ Q The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you musli 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 t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 Prcperty Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18, 2020 City/Town State Zip Code Date of Inspection G. 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" 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 Q ❑ Pumping information was provided by the owner,occupant, or Board of Health ❑ Q Were any of the system components pumped out in the previous two weeks? Z ❑ Has the system received normal flows in the previous two week period? ❑ Q Have large volumes of water been introduced to the system recently or as part of this inspection? Q ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) Q ❑ Was the facility or dwelling inspected for signs of sewage back up? Q ❑ Was the site inspected for signs of break out? Q ❑ Were all system components, excluding the SAS, located on site? Q ❑ 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? [J1 ❑ 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: Q ❑ Existing information. For example, a plan at the Board of Health. Q 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)] i Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 ` t5ins.doc �rev.7/26/2018 9 P Y 9 l Cotnmonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18,2020 City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(dssign): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 GPD Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes Q No Does residence have a water treatment unit? ❑ Yes Q No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes Q No information in this report.) Laundry system inspec_ed? ❑ Yes Q No Seasonaluse? ❑ Yes Q No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Detail: Unavailable Sump pump? ❑ Yes Q No Last date of occupancy: Current Date t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts f Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments GSM SyO y`0i 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18, 2020 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): General Information 3• Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes Q No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Lt5ins.d.. rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18,2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: 21 Septic tank, distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,date installed (if known)and source of information: 1996 per plans Were sewage odors detected when arriving at the site? ❑ Yes 0 No 5. Building Sewer(locate on site plan): Depth below grade: 1.8 feet Material of construction: ❑ cast iron 0 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage,etc.): All the joints are sealed and there are no leaks. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 18 Cornmonwealth of Massachusetts \ F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments W Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18, 2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: 0 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: 8'x 5'x 4' Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 38" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The covers are 1' below grade.The tees are good. There is no filter installed on the outlet.The liquid level is normal with minimal solids and sludge.The septic tank has two outlets: one from the original system put in when the home was built and one from a new system that was installed in 1996 after the original system failed Title 5. All flow is going to the original system. The original system line must be capped off and a line to the new system must be dropped 1-2"to ensure that flow goes to the new system. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 • Commonwealth of Massachusetts W Title 5 Offic'ial Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Chr stopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18, 2020 City,Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumpinc 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 t5ins.doc 0 rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 18 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18, 2020 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.): The distribution box is 16"below grade and 16"x 20".The box has one outlet to the leach chambers. The box is empty and dry and has not seen any flow.The box is in good structural condition. t5ins.doc 0 rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 f Commonwealth of Massachusetts F Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '4�M SV 6 y`e 14' Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for eve Owner's Name q every page. Barnstable MA 02648 June 18,2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 10, Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No' Alarms in working order: ❑ Yes ❑ No' Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): ' If pumps or alarms are not in working order,system is a conditional pass. 11. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: 2 leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: 15ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments o 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner C-iristopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18, 2020 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.): Chambers are empty and dry.There are no signs of any flow. The soil is dry and sandy with no ponding and no signs of hydraulic failure. The vegetation is normal. 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.): t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18, 2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.): t5ins.doc rev.712612018 Tide 5 official Inspection Form:Subsurface Sewage Disposal System*Page 15 of 18 l , Commonwealth of Massachusetts \ w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Ow-ier's Name page. Barnstable MA 02648 June 18, 2020 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 a'I wells within 100 feet. Locate where public water supply enters the building.Check one of the boxes below: Q hand-sketch in the area below ❑ drawing attached separately e 'e ... ... . ..... m H.......... 5w- t5ins.doc rev.7/26/2018 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 • Commonwealth of Massachusetts W Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18, 2020 Ciiy/Town State Zip Code Date of Inspection D. System Information cont. 15. Site Exam: Q Check Slope Q Surface water Q Check cellar Q Shallow wells Estimated depth to high ground water: 61+ 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 Q 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: Dug a small hole off the side of the leaching area with a hand auger.The hole was approximately 6'below grade with no indication of groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins.doc 9 rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System 9 Page 17 of 18 Commonwealth of Massachusetts W Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner CI-ristopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18,2020 City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: Q A. Inspection information: Complete all fields in this section. Q B. Certification: Signed&Dated and 1, 2, 3, or 4 checked Q C. Inspection Summary: 1, 2,3,or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed Q D. System Information: For 8:Tight/Holding Tank-Pumping contract attached For 15: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 16: Explanation of estimated depth to high groundwater included t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 18 of 18 Crocker, Sharon From: Stanton, Margaret Sent: Thursday, September 03, 2020 5:05 PM To: Health; Crocker, Sharon Subject: payroll Payroll w/e 9/3/2020 Fri 8/28 w 6 h ( 8AM-12N;3:30pm-5:30PM ) Mon 8/31 w 5.5h (8AM-12:30PM;3PM-4PM) Tues 9/1 w 6.5 h (8AM-1:30 PM;3:30PM-4:30PM) Wed 9/2 w 4.5 h (8AM-12:30PM) Thurs 9/3 w 4.Oh (8AM-11AM;4PM-5PM ) Totai = 26.5 H ( 6.5 h over) Thank You Margaret A Stanton RN Margaret A. Stanton Town of Barnstable Health Division Public Health Nurse 200 Main St. Hyannis MA 02601 508-862-4648 508-862-4713 margaret.stanton(town.barnstable.ma.us 1 � I { e)—U �U t Tripp,Vanessa From: McKean,Thomas Sent: Thursday, September 03, 2020 4:51 PM To: Crocker, Sharon;Tripp,Vanessa Subject: 3 Bedrooms Not 4/Corrected Title 5 Inspection Report for 141 Bracken Fern Road in Marstons Mills, MA Attachments: T5 - Marstons Mills-141 Bracken Fern Road - Corrected on 9-3-20.pdf From: Fuller, Kelly [ma i Ito:kfuIlerCalwrenvironmenta1.com] Sent: Thursday, September 03, 2020 4:22 PM To: McKean, Thomas Cc: c.j.odonnell(acomcast.net; DeCosta Jr., Mike; Waters, Amy Subject: Corrected Title 5 Inspection Report for 141 Bracken Fern Road in Marstons Mills, MA Good Afternoon Thomas, .Attached, please find a corrected Title 5 Report for 141 Bracken Fern Road in Marstons Mills, MA. This inspection was performed on 06/18/2020. Our initial report incorrectly listed the actual bedroom counts as 4. The attached report has been amended to reflect that both the design and actual bedroom counts are 3. This revision was done on behalf of the inspector Michael DeCosta,Jr. Mike can be reached at (508) 400-8083. He is also copied on this email as is the homeowner,Christopher O'Donnell. Please confirm receipt and let us know if this email is sufficient or if you would like me to put a hard copy in the mail to your office as well. Thank you, Kelly Fuller I Title 5 Preparation,Massachusetts I Branch Admin: NESE,NECC,NESC,NESO &NERI Wind River Environmental 245 Plymouth Street, Carver, MA 02330 P: 978-562-4500 x5162 I C: 508-468-8612 k.fuller@wrenviro.nmerital.com I www.wrenvironmentat.coni ND R r) ENVIRONMENTAL Your full-service liquid waste company CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! 1 Commonwealth of Massachusetts Ole?-033 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments (C 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MM MA 02648 June 18,2020 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 1. Inspector: Michael DeCosta,Jr. Name of Inspector Wind River Environmental Company Name 46 Lizotte Drive Suite 1000 Company Address Marlborough MA 01752 City/Town State Zip Code (508)400-8083 SI 13230 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed Lased 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: ❑ Passes Q Conditionally Passes ❑ Needs Further Evaluation by the Local Approving Authority ❑ Fails D . June 18, 2020 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 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 iinspection does not address how the system will perform in the future under the same or different conditions of use. I t5ins.doc 0 rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is Owner's Name required for every page. Barnstable MA 02648 June 18, 2020 City/Town State Zip Code Date of Inspection C. Inspection summary Inspection Summary: Complete 1, 2, 3,or 5 and all of 4 and 6. 1)System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 2)System Conditionally Passes: Q 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) The septic tank has one from the original system put in when the home was built and one outlet from a new system that was installed in 1996 after the original system failed Title 5.The original system line must be capped off and a line to the new system must be dropped 1-2"to ensure that all flow goes to the new system. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System 9 Page 2 of 18 Commonwealth of Massachusetts f Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is Owner's Name required for every page. Barnstable MA 02648 June 18, 2020 City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) 2)System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3)Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18, 2020 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 ❑ R) Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments e c, 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18, 2020 City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ Q✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Q Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow ❑ Q Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped:_ ❑ Q Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Q Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Q Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Q 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.] ❑ Q The system is a cesspool serving a facility with a design flow of 2000gpd-10,000gpd. ❑ Q The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5)Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped Zone II of a public water supply well t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18, 2020 City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat,or answered"yes" 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 Q ❑ 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? Q ❑ Has the system received normal flows in the previous two week period? ❑ Q Have large volumes of water been introduced to the system recently or as part of this inspection? Q ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) Q ❑ Was the facility or dwelling inspected for signs of sewage back up? Q ❑ Was the site inspected for signs of break out? Q ❑ Were all system components,excluding the SAS, located on site? Q ❑ 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? Q ❑ 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: Q ❑ Existing information. For example, a plan at the Board of Health. ❑ Q 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)] t5ins.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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 Froperty Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18,2020 City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Corditions: Number of bedrooms;design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 GPD Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes Q No Does residence have a water treatment unit? ❑ Yes Q No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes Q No information in this report.) Laundry system inspected? ❑ Yes Q No Seasonaluse? ❑ Yes Q No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Detail: Unavailable Sump pump? ❑ Yes Q No Last date of occupancy: Current Date t5ins.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18,2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishmen:: 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): General Information 3. Pumping Records: Source of information Was system pumped as part of the inspection? ❑ Yes 0 No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System a Page 8 of 18 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18, 2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: Q Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed(if known)and source of information: 1996 per plans Were sewage odors detected when arriving at the site? ❑ Yes Q No 5• Building Sewer(locate on site plan): Depth below grade: 1.8 feet Material of construction: ❑ cast iron Q 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): All the joints are sealed and there are no leaks. t5ins.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 I Commonwealth of Massachusetts F Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 'roperty Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18,2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: Q 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: 8'x 5'x 4' Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 38" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): The covers are 1'below grade.The tees are good. There is no filter installed on the outlet.The liquid level is normal with minimal solids and sludge. The septic tank has two outlets: one from the original system put in when the home was built and one from a new system that was installed in 1996 after the original system failed Title 5. All flow is going to the original system. The original system line must be capped off and a line to the new system must be dropped 1-2"to ensure that flow goes to the new system. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System*Page 10 of 18 t L I Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c�M 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18, 2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5ins.doc rev.7/25/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 18 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c, 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18, 2020 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.): The distribution box is 16"below grade and 16"x 20".The box has one outlet to the leach chambers.The box is empty and dry and has not seen any flow.The box is in good structural condition. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System 9 Page 12 of 18 Commonwealth of Massachusetts f 'Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments <c 141 Bracken Fern Road Corrected on 9/3/2020 'roperty Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18, 2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located,explain why: Type: ❑ leaching pits number: [Q leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5ins.doc rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System Page 13 of 18 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18,2020 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.)-. Chambers are empty and dry.There are no signs of any flow.The soil is dry and sandy with no ponding and no sians of hydraulic failure.The vegetation is normal. 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.): t5ins.doc rev,7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System*Page 14 of 18 i I Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18, 2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): t5ins.doc 0 rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18, 2020 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: Q hand-sketch in the area below ❑ drawing attached separately rX I , - I i I t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 18 Commonwealth of Massachusetts _ F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c, 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18, 2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: Q Check Slope Q Surface water Q Check cellar Q Shallow wells Estimated depth to high ground water: 6'+ 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 Q 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: Dug a small hole off the side of the leaching area with a hand auger.The hole was approximately 6'below grade with no indication of groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 17 of 18 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Bracken Fern Road Corrected on 9/3/2020 Property Address Owner Christopher O'Donnell information is Owner's Name required for every page. Barnstable MA 02648 June 18, 2020 C ty/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: Q A. Inspection information: Complete all fields in this section. Q B. Certification: Signed&Dated and 1, 2, 3, or 4 checked Q C. Inspection Summary: 1, 2, 3,or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed Q D. System Information: For 8: Tight/Holding Tank-Pumping contract attached For 15: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 16: Explanation of estimated depth to high groundwater included l5ins.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 TOWN OF BARNSTABLE LOCATION i � i2�Cl,iL9� , ��.'�.� i] V%EWAGE# VILLAGE SESSOR'S MAP&PARCEL 0 — O INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) 3 f4-1,C NO.OF BEDROOMS 3 'o k t;' tPZL'--''A't !� OWNER C� �! 9.�f�L_ BAN 6<_'0 - Ze*_ PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 13.c.Z � a TOWN OF BARNSTABLE LOCATION 1±J1 15'%EWAGE# �4 ©--J�-N VILLAGE .� < ESSOR'S MAP&PARCEL D y 2- O3 n INSTALLER'S NAME&PHOJNE SEPTIC TANK CAPACITY L'5n Firr LI t LEACHING FACILITY:(type) F.AC O c i W e., (size) .3 4-1•GAi" 1I NO.OF BEDROOMS i OWNER a&.6#J �, •1Ar Ai l�BTU �- 34* PERMIT DATE: 'q a COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 13.C.,L t�c,u4,Q II LA � 0 1 - -� o u ` No. �/� Fee THE COMMO_RWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIPPlitation for Misposar 6pstem Coneitruttion 3permit Application for a Permit to Construct( ) Repair(i,j Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. j // & .j r, qe -,n IM. Owner's Name Address,and Tel.No.�'08- 3 7 Oa';..$ Assessor's Map/Parcel U tf�-033 MarSilo nS Ai i j 1S;A4 J - l y l01 Installer's Namee Address,and Tel.No. �jS-qvv -81 Q40 Designer's Name,Address,and Tel.No. ij Type of Building: Dwelling No.of Bedrooms 3 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�i�`y)� e.61 Type of S.A.S. Description of Soil Nature of Repairs or Alterations_(Answer when� app�liicable)q t."exIe—In T { /I! S OX A p� g10� vtR �,217 jCnL tP6 1 Rc��Ct�� C3Et .(1 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code ce the system in operation until a Certificate of Compliance has been issued by this Board of Heal- Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No.�/ � � Date Issued i .� � No. � '•.i�s%' � Fee THE COMMQ�N !VEALTH OF MASSACHUSETTS Entered in computer: L PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE;;MASSACHUSETTS YeST application for MispoBal *pstrm (Construction permit Application fora Permit to Construct( ) Repair(V) Upgrade( ) Abandon( ) ❑Complete System ❑u°. Individual Components Location Address or Lot No. i yj e c e n, t e Owner's Name 1Address,and Tel.No. O% !C t7.'.(rF Assessor's Map/Parcel 0�l •03 IInstaller's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. a A�L1 f�.�rA11Q. f k A . N A o&,,I/O'S Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other; - Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures i Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title / Size of Septic Tank i ,-.P �,,,V_ Type of S.A.S. - ��/to ., 1,x l �:o'+ Nn� -•, 1 � J t I _ Description of Soil r Nature of Rep-a�irs or Alterations(Answer when applicable) F 5 �C'n-A y.,.1�.c�a' ^;-r ri rs A"r'rn 1 •_._I��I r r- '�r• V'lrter Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and.not•to place the system in operation until a Certificate of . Compliance has been issued by this Board of Health.---'" -k Signed '"".M�`"" ,��.�....,_ C ""'""""'""`,,+,,. Date r r,9 Application Approved by _ Date /f dX Application Disapproved by �`�"'"•ter Date for the following reasons Permit No. Date Issued 11 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS "" a.. (Certifitatr of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ') Upgraded( ) Abandoned( ')by a4t)fo` a r at / .,r ,`p Fv r'n i..J. 0 W ,sS brf Flies has been constructed in accordance o o oa—o , ,f� h with the provisions of // Title 5 and the for Disposal System Construction Permit No., dated Installer f k4'a*_it/',44�r r,L em r Y? Designer AAA #bedrooms Approved design flow ('` �.. and The issuance of this permicshallrrnot be construed as a guarantee that the system will function a esig ed., Date 1 Inspectors No Fee ,..� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS Bisposal 6pstem Construction°j)ermit _ Permission is hereby granted to Construct(��-^) Rep��ajji�(✓ Upgrade( ) Abandon( ) d System located at 1 q1 A rel e 1,/10►,, T`e h/loll py l. At u y 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. F Provided:Construction/ust b�e_co�mypleted within three years of the date of this pert Date ! �CT(�Jac Approved by (, w .�'• -w-"^``, r Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE L ATION FzTAI. SEWAGE#- ) VILLAGE G ASSESSOR'S MAP&LOTA 2'!3 INSTALLER'S NAME&PHONE NO. lj�l�I E, o0/A!z�o nI. 77 s ,F�ry� SEPTIC TANK CAPACITY �r ? III LEACHING FAcmrrY:(type)t3 F//6 e �e&e) NO.OF BEDROOMS f BVU23ER OR OWNER Zvf 1, ? e_o.cy PERMITDATE: COMPLIANCE DATE: - _ Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leach�pg facility) Feet Furnished by �J it https://www.town.bamstable.ma.us/Departments/Assessing/Property_Values/HMdisplay.a... 7/17/2020 Commonwealth of Massachusetts Title 5 ffeceal Inspection ®gym Subsurface Sewage Disposal System Form -Not for Voluntary Assessments " 141 Bracken Fern Road Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Earnstable MA 02648 June 18, 2020 City(Town State Zip Code Date of Inspection C. Inspection summary Inspection Summary: Complete 1,2, 3,or 5 and all of 4 and 6. 1)System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 2)System Conditionally Passes: 0 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. 0 Y ❑ N ❑ ND(Explain below) The septic tank has one from the original system put in when the home was built and one outlet from a new system that was installed in 1996 after the original system failed Title 5.The original system line must be _capped off and a line to the new system must be dropped 1-2"to ensure that all flow goes to the new system l5ins.doc o rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System o Page 2 of 18 Commonwealth of Massachusetts W `title 5 Official, Inspection or Subsurface Sewage Disposal System Form Not for Voluntary Assessments 141 Bracken Fern Road Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18, 2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: Q 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: 8'x 5'x 4' Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 38" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): The covers are 1'below grade.The tees are good.There is no filter installed on the outlet.The liquid level is normal with minimal solids and sludge.The septic tank has two outlets:one from the original system put in when the home was built and one from a new system that was installed in 1996 after the original system failed Title 5. All flow is going to the original system.The original system line must be capped off and a line to the new system must be dropped 1-2 to ensure that flow goes to the new system. t5ins.doc a rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System a Page 10 of 18 Commonwealth of Massachusetts Title 5 urricial Inspection Form Subsurface Sewage Disposal Sy§tem Form -Not for Voluntary Assessments 141 Bracken Fern Road Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18,2020 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.): The distribution box is 16"below grade and 16"x 20".The box has one outlet to the leach chambers.The box is empty and dry and has not seen any flow.The box is in good structural condition. t5ins.doc o rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System a Page 12 of 18 L Commonwealth of Massachusetts This 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /e 141 Bracken Fern Road Property Address Owner Christopher O'Donnell information is required for every Owner's Name page. Barnstable MA 02648 June 18, 2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(Cont.) Comments(note condit on of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Chambers are empty and dry.There are no signs of any flow.The soil is dry and sandy with no ponding and no signs of hydraulic failure. The vegetation is normal. 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 cond tion of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.): t5ins.doc a rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System o Page 14 of 18