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0152 BRIDLE PATH - Health
152 Br�iidle Path, Marstons Mills �r 1 ,1 Commonwealth of Massachusetts - Title 5 Official Inspection Form m o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y w ' 152 Bridle Path Property Address Chris Girard �* Owner Owner's Name information isy required for every Marstons Mills Ma. 02648 09/15/2017-h page. City/Town State Zip Code Date of Inspection 0 Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information Cl filling out forms U/ / 3 on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael T Bisienere use the return Name of Inspector key. Cape Septic Inspections Company Name 624 Old Barnstable Road Company Address Mashpee Ma. 02649 Cityrrown State Zip Code 508-280-3356 Si3938 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6 09/17/2017 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. ****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-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts 4 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 152 Bridle Path Property Address Chris Girard Owner Owner's Name information is Marstons Mills Ma. 02648 09/15/2017 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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: This 3 bedroom home has a H-10 1000 gallon septic tank and a H-10 D-Box feeding two 500 gallon leaching chambers. At the time of the inspection there were no visible signs of past hydraulic failure. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 152 Bridle Path Property Address Chris Girard Owner Owner's Name information is required for every Marstons Mills Ma. 02648 09/15/2017 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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): brokenpipe(s) are re laced Y N❑ p ❑ ❑ ❑ ND (Explain below): i ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 152 Bridle Path Property Address Chris Girard Owner Owner's Name information is required for every Marstons Mills Ma. 02648 09/15/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the.following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 152 Bridle Path Property Address Chris Girard Owner Owner's Name information is required for every Marstons Mills Ma. 02648 09/15/2017 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 152 Bridle Path Property Address Chris Girard Owner Owner's Name information is required for every Marstons Mills Ma. 02648 09/15/2017 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): < 330 GPD t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 152 Bridle Path Property Address Chris Girard Owner Owner's Name information is required for every Marstons Mills Ma. 02648 09/15/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: In 2016 72,000 gallons were used and 2015 55,000 gallons were used Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date 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 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 152 Bridle Path Property Address Chris Girard Owner Owner's Name information is required for every Marstons Mills Ma. 02648 09/15/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 152 Bridle Path Property Address Chris Girard Owner Owner's Name information is required for every Marstons Mills Ma. 02648 09/15/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information cont. Y (cont.) Approximate age of all components, date installed (if known) and source of information: New leaching installed on 1-23-2002 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 21"feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Standard H-10 1000 gallon septic Dimensions: tank Sludge depth: 1" t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 152 Bridle Path Property Address Chris Girard Owner Owner's Name information is required for every Marstons Mills Ma. 02648 09/15/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 36" Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I would recommend the new owner put the tank on a maint. plan with a local septic pumping co.The Barnstable Health Dept. has a list of local septic pumping co. 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 t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 152 Bridle Path Pro perty Address Chris Girard Owner Owner's Name information is required for every Marstons Mills Ma. 02648 09/15/2017 page. CityTTown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 Alarm present: ❑ Yes ❑ No Alarm a m level. Alarm to working order: El 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 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 152 Bridle Path Property Address Chris Girard Owner Owner's Name information is required for every Marstons Mills Ma. 02648 09/15/2017 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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 H-10 D-Box had no visible signs of leakage or evidence of past hydraulic failure. 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. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Lt5m..doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 r Commonwealth of Massachusetts w r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 152 Bridle Path Property Address Chris Girard Owner Owner's Name information is required for every Marstons Mills Ma: 02648 09/15/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: Two ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection there was ponding water in the chambers but there were no visible signs of past hydraulic failure. 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 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 152 Bridle Path Property Address Chris Girard Owner Owner's Name information is required for every Marstons Mills Ma. 02648 09/15/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 152 Bridle Path Property Address Chris Girard Owner Owner's Name information is required for every Marstons Mills Ma. 02648 09/15/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 TOWN OF et -,LGQ0, ON 137 Sri /e la>-i SEWAGE# 7DD/�/yq VILLAGE ASSESSOR'S MAP&LOT 2 /t V INSTALLER'S NAME&PHONE NO. j lPhtl`P#SA ?7/`f W SEPTIC TANK CAPACITY _JoWwl --x; hG LEACHING FACILITY:(type) size) /.� A'2 Z- NO.OF BEDROOMS_ BUILDER OR OWN/ER Wal'`.96'0 l PERMITDATE: 6IZ 8/i?1 COMPLIANCE DATE: I^13I0 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 orww 1.1 n a A-;L Po2c.k A a- 34 _ 35r z. 3 tr Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 152 Bridle Path Property Address Chris Girard Owner Owner's Name information is required for every Marstons Mills Ma. 02648 09/15/2017 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 14 plus feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: I augered a hole to 14 feet to show five plus feet of seperation . Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 152 Bridle Path Property Address Chris Girard Owner Owner's Name information is required for every Marstons Mills Ma. 02648 09/15/2017 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file S A, S o � t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE b� ' / F °I�O('AnON 1 S_2 SEWAGE # VILLAGE_ /&S/&-5 /4Jf/S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. & do&I C©/p5�`, �7/`��'✓� SEPTIC TANK CAPACITY 1,P5?al 6'115. LEACHING FACILITY: (type) Z' (size) /✓�ir`Z�iI�Z NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: ��L 8lD� 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 A z 3 I w e J y No: Fee y l THE COMMONWEALTH OF MASSACHUSETTS Entered in computes Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppricatton for Mtgool *pztem Construction 30ermit Application for a Permit to Construct grade( : )Abandon( ) ElComplete System El Individual Components Location Address or Lot No. I Owner's Name,Address and Tel.No. 2vh.erf- I-4�l l4►�cQ Assessor's Map/Parcel y Installer's Name,Address,and �0��`D�O�I Designer's Name,Address and Tel.No. 260�Aaifl-S#r�e Coss W. 73>7/,43O Type of Building: Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallong`pec day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil /� if✓ Nature of Repairs or Alterations swer wh n a plicable) 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 an not to ac the s st operation until�Certifi- cate of Compliance has been issued by this Board of al . /lZ QZ Signe Date o) Application Approved by Zw Date Application Disapproved for the following reason Permit No. . Date Issued 10 . •,.No. - - Fee ✓1� --' HE COMMONWEALTH OF MASSACHUSETTS Entered in computer: , Yes � !PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0(pprication for �Digpoar *p.5tem Construction Permit Application for a Permit to Construct( ))fie air( grade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. a t/4+ Owner's Name,Address and Tel No. Assessor's Map/Parcel t /y 0 Y1(1 r `19 .. Installer's Name,Address,and e. o. I// Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms _ Lot Size sq. ft. Garbage Grinder( ) 4 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures I Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheet s« Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil J i� f/ll4G� Nature of Repairs or Alterations(yknswer wh n a plicable) L��5 44 I � � t� ' ��1,X ���_Sonl l l t✓c ( S �-t� , La, )t 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 an not to ac the s ste an operation until 4 Certifi- cate of Compliance has been issued by this Board of seal . / /JZ eZ SigneL � Datef Q 1 Application Approved by EOL02eD to Application Disapproved for the following reasons V ` r Permit No. Date Issued —————————————————————— ——r—————————THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Cons uped( )Repaired( graded( ) Abandoned( )b 7�- BorrdL�;► / at i G14 1_/Li has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. T"/�yyy dated Installer Designer The issuance of this ermit shall not be construed as a guarantee that the systewill fu ction as designed Date �1 to 2Inspector g t —— —J—— — No. f� .--- -----------------------Fee 0 nq- I/, __ I . - THE O.�MONWEALTH OF MASSACHUSETTS f PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS �Di!6po0af *pgtem C Upgronstruction Permit .Permission is hereby granted to Construct( )Repair( ade( )Abandon( ) / System located at /.J o} /':��,4 A 41 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction mus b�co leted within three years of the date of i pe it Date: 1 / Approved by Lr v l TOWN OF BARNSTABLE LOCATION �J�Z 9"'lle A , / SEWAGE # ZeVI`4llq VILLAGE_ A f 5&P-5 ASSESSOR'S MAP & LOT i INSTALLER'S NAME&PHONE NO. AePt�hhl 6WA �7 -` w SEPTIC TANK CAPACITY IMNaV �X%S2!2t!� LEACHING FACILITY: (type) Z' S dD Ar eXa;;6 (size) l y,41GKrZ- NO. OFBEDROOMS BUILDER OR OWNER 1ol 471-5 6W PERMITDATE: ��z 8/�� COMPLIANCE DATE:I1 �I0.2 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 C A �- 34 3 ' I v 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated (e of 6 , concerning the property located at Isod I?kl 4-( A meets all of the following criteria: /This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. / • There are no wetlands within 100 feet of the proposed septic system / There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed f • There are no variances requested or needed. / The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen (14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation (using GIS information) B) G.W.Elevation +the MAX. High G.W. Adjustment. •� _ �7 DIFFERENCE BETWEEN A and B 3 p� SIGNED : DATE: [Please Sketch proposed plan of system on back]. NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert �, � y] v ,,r. ri .� � Uc�� l I� l3� N 4/ 49 �- IZs�pO ti c i z6 !' , n I 1 1 ` 14 L° I� Y . � ley,• ��R'dTYw�i,4�, ,e RGP�1 S { Q• �• it but4i S No s38 o su r pLAN CERTIFIED PLOT. X �oLei ws 4 N ONLY �,�� ,ONSTRUCTIO Z FEET e� ,� IS _-- / ��_ 4� DATE T /:: TOP. OF FOUNDATION ADJACENT SCALE: . ABOVE LOB POINT OF, NOA oit 1. CERTIFY THAT TLAa IS .LOC��' O R0�►D•' /E7M THIS P UND AS INDICATES A6� - -ERING CO.IN CLIENT .. ---- SHO�PIN oa LAW:'S` i I REDGE GINS- - - - THE GRO THE ZOalaa S ON , 8'D R TO Ed_A_--_,____.-•l REGISTERED JOB NO• ` CONFORMS; yIASS .o , 4-.A.. - OF. BARNS BLE , /n � EOISTERED LAND G �- pR.BY rY� , CIVIL I SURVEYOR '. B ��� � / AND SURYeR ENGINEER REG• L 712 MAIN ST. WE MASS SHE 3 MAIN ST ET 3 N0. S, =�- Y MASS. HYANNI ARMOUT�, -. - . Apr 14 2010 5: 13PM Apcon, Inc. 508-420-9201 p. 2 ENY�OMI�RAL ,INC. 8 Dexter Road,East Providence, RI 02914 401-431-1847 (fax) 401-431-2154 Mr. Greg Russell Apr il 14 2010 Century 21 2277 State Road, Suite K Plymouth, MA 02360 RE: Final report of oil cleanup and disposal from 152 Bridle Path, Marston Mills,MA. Dear Mr. Russell, Clean Harbors Environmental Services, Inc. (CHES) is pleased to submit the following report for the work performed at 152 Bridle Path, Marston Mills, MA. My first inspection of the property was in February, 2010. At that time there was a small amount of oil floating on about 2 inches of water. I would estimate about 1-2 gallons of oil was present during my initial inspection. The oil was contained to a small utility room where the oil fire burner and oil tank were stored. 1 did not observe any other oil contamination in the basement At your request we returned to the site to remove the oil and the oil contaminated debris(wood, clothing, etc. )inside the utility room. The oil and water from in the room was vacuumed into 55 gallon drums.The concrete floor was the washed and scrubbed with a pine scented degreaser! cleaned.The floor was the rinsed and vacuumed clean. During the cleaning the basement area was monitored with a 5 gas meter.The 5 gases tested were all reading within normal clean ranges after the basement was cleaned. Oxygen................................20.8 % Carbon Monoxide...................000 ppm Sulfur Dioxide........................000 ppm LEL(flammability) ..................0.0% VOC's -organic vapor.............000 ppm Clean Harbors then returned to the site to pickup and transport the 2 drums of oily water and debris to Clean Harbors of Braintree, Inc.The drums were labeled and transport from the site on a Hazardous waste manifest Enclosed is a copy of the manifest No. 002193918FLE, this copy has been signed at the bottom as received by Clean Harbors of Braintree, Inc. Should you have any questions pertaining to this report or if I can be of any assistance, please do not hesitate to contact me at(401)265-0053. Sincerely, CLEAN HARBORS ENVIRONMENTAL SERVICES,INC. Peter &70&1#X Peter Joseph Field Service Specialist "People and Technology Creating a Better Environment" Confidential and/or Privileged Apr 14 2010 5: 130M Apcon, Inc. 508-420-9201 p. 1 -::0: ' ' Fa�. 11 S J_. ?-_a gv INC. r ' 3 t tu��t3po i "Fri <.. ,:GLvtiar ..Phase onytru.ction Of.New n Iand l' Fax Transmittal To: Health Dept Fax: 508-790-6304 Att:Donna �,igwm: Mike Santos Date: 4114/10 4N �z,'�u �`� �� .152 Bridle Path Maistons Mills Pages: 'T W pn( FY '' Tf k" V., For Review ❑ Please Commert 0 Please Reply ❑Please Recycle fly Js��+' Please find documentalzen as requested. Thank You, We Sanbs . . . . . . . . . . . . . . . . . . . . . . . . . . . . Apr 14 2010 5: 13PM Rpcon, Inc. ���y A5'0s8-4A2y0�-92F01 4^ I p. 3 •y:� {.+- r�1� if�•I�ZViV �1 �V I tr Z RI273 s�i Form Approved.OMB No.2050-0039 Please ptltt a am tiesignsd 11�use on site 12• ch �l J UNIFORM NAZAFA)M 1•Gensrator m Number 2.Pogo 1 at 3.Emengeney Respenae Phone 11arrifeR T log Mumbn KUTEMANIFEST m P!�')ft q ti 4() `d �. r `s:�+ {�- �: � 14. 0 4 93918 FLE 5. erwm Name and Nap Address (3arerabft SIIeAddivss¢f Merew Ow mai6rg adders in P-Oh N(vYrri`•`. �'1J. i .•:i1'r. ,a�0264,18 Ge neratofa Phone: rgns �1 panY errs U.S.EPAIDHunrber Clean iiartmi s ca,yimt`trns rA31!��!vieres Et c -:4 .�i.' t? :..�� �. 2 5 0 1.TramporW2Name U,6.EPAlDtdum�rCA LM esrgnaten ao aro to t7.S,EPAIDNumbe+ :Zla3n Narbafs Vt>:F341VTV`Inc M A D 0 i"ill,Avenue (n brailltree.«021S4 fedit)Is Pltona: Ci 5 00 U.S.DOT Description FnrLdn9 Proper Shipping Nerve.Haan!CIs9a Nuriba, 10.CorttaiteR 11.Totai 12.Unit 13 y �Coda ga. Oirtntlb Ylh.,9ltlL HM and Packlrj Group(deny)} No. Type HOME NOk HAZARDOUS.WTA L r-•;.-REGU141E.t?.MY /1 o IbEFRIS.RAGS),N/A 400 f 2 — i , r � , i 4. I m9 stru :ns ert0 lien and accuaoeNdesmW ebore by the props shipping non-and am dasded p��a OEN 15, ERATOR'SV REROR'S CERiF►CAIM:,hereby doom that the iWise s of this ooneigrrrrent are�Y auekw and labdeftkoarded,and are in aU respects in proper oonditlM br renaport according le applcable mlemadixW and naronal rerAlalbre•tl e�art ehtQnterx and I am 11s Prirtery Exporter,I wVy that the wnlents of gas QMOS-*ft Wb"r,ID the trarrrsof the earsated EPA Adnww#.'dgriwd of 1 q rates We. I oerery Axel o,e arils minlrn¢adonslatanem iderxtified to 40 CFR 262.27(s)(111 Bill a lar8e queneay yeneraW')m(b)f w&wY ear s F&tedTWw Name 3 a lie .a 16.In ¢ v 0�1�L ❑EXWhornUS, Pad ofo — LJ Import to U.S. D*lea' U.S.' si M(for UPOdS on 17.'henspwwAdmrmtedy+enlafReeebtafltlttteriels ^ay err ranspow, me , I � I la mom W Yew 4 Armnsp4"r2&4LJ' 18.Discrtepant:Y Partial Re)ea;m ❑Fug Redeebn 18a.Dtaereparsy Inacow space "tky ❑Type Residu6 Nanlfesl Relerenoe Nunbtr U.S.EPAO Number 1 Bb.Allemate Fadk(or Generator) J t m oay rear 18e: ro o(Anamab Faoiily(err GeMteralcQ 4 19.Na¢ardovs Vltasle FtePOM1 1,Mnagemerxt Method Codes(r.e.,codes roc hateadous v+aete froatmenrt.��i•and rexoyd�9 ) 4. 2 3. O cpvBte4 by the mer+ibest�eept ea rated in Item 18s p®y rear 20.otatnamd FaeSiry Owner or UpW.Ces*&M tl(reai�ttlt hat rtdoos trtd 1 p1 Y (,1 �, f 7 —'f ,) '"� .. ,•�''?DESMAT10M STATE(IMF REQUMM) aD 010 EFA Fem,87WZZ(Rev.: ) F)'f H s edl0ora are atsts t!I!� ere tr�i►T �� naie 08n1*S fof tee w ii wwr thy to so ;ieat;'i+Acbot�h35tger It rrnc ----_._.;�,.�.•�..s,. �,:�.•. -,:. Commonwealth of Massachusetts o o v e.b P vMMaTitle .$ Official Inspection form. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments PropeAy Address owner Owners Name b*ffwbrequired ror� VV ai S 1(� J& ✓k A-_ everytom- cKyfrown state Zip Code Date M Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way. out A. General Information forms on the computer,use 1. Inspector only the tab key to move your i cursor-do not of use the return Na knpeidpr key. Comparri Address ' CdW"n State Zip Code Terephone Aurnber License Number B. Certification _ I certify that I have personally inspected the sewage disposal system at this ad ness and thabthe o information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and.,mt3intenancg'of oriAe sewage disposal.systems.I am a DEP approved system inspector pursuant to S--on ty�'d.340 Trite 51310-CMR.15=).The system: 77 Passes ❑ Conditionally Passes ❑ Fa• w M ❑ Needs Further Evaluation by the Local Approving Authority t 0 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 is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if appiicable,and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal.System Form B. Cerfification (cons) r I11 r t�s ^f e- smfe av Cale c,�tyRown OWWs Name DaW of I Inspection Summary:Check A,B,C,D or E!a/Nrays cormlets all of Section D A) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 epst.Any failure criteria not evaluated are indicated below. Comments: cl f o) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass'section need tobe replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Air yes,no or not determkW(Y,N,ND)in the❑for the following statements.If"not defermitsd.'please exam. ❑ 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 eAtration or tank failure is imminerrL 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. ND Explain: t5a�sp doc doc.0312006 Title 5 Of6 W inspection Form:SWMufaoe Sewage Disposal SYalem Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form S. Certification (cost.) P� OW=n shft Zip Code owner's Name DEe of Inspection B) System conditionally Passes(cunt): • f" ❑ observation of sewage backup or break out 'f high static water level in the distribution box due to broken or obstructed pipe(s)or due to a en,settled or uneven distribution-box System will pass inspection N(with approval of Board Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ❑ distribution box is leveled or ND Explain: P t ❑ 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 ❑ obstrucdon is removed ND Explain: t C) Further Eval n is Required by the Board of Health: ❑ Conditions which require further evaluation by the Board of Health in order to determine if the system is 'ling to protect public health,safety or the environment. 1. System. 11 pass unless Board of Health determines in accordance with 310 CMR . 15.303(1)(b) the system is not functioning in a manner which will protect public.heaith, safety and environment: ❑ pool 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 t5i M.doc.dw•03I S Title 5 of ial Invedw Form:Subsurface Sewage Disposal Skstan- Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not.for Voluntary Assessments a Subsurface Sewage Disposal System Form B. Certification (cost.) ; MOO" Slate Z1p Code 1 Owners Name Date or I C) Further Evaluation is Required by the Board of Health corrt.}: 2. System will fall unless the Board of Halt6( Public Water Supplier,if any) determines that the system is functioning in a ner that protects the public hearth, satiety and environment: ❑ The system has a septic tank and soil rption system(SAS)and the SAS is within 100 feet of a surface water supply or tri ry to a surface water supply. ❑ The system has a septic tank and S S and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank d SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic nk and SAS and the SAS is less than 100 feet but 50 feet or more from a private supply well". MOW used to de ine distance: *�This system passes if the II water analysis,performed at a DEP certified laboratory,for oolftm bacteria indicates absent a the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: t5i W doc doc•WrAW TO 5 Offiaal Impec don Form:Subaufaoe Sewage Disposal Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cost.) A �- . M rA2 c L zad � S` state -- ^,->G 2 d o Ownees Nam Date of irsoedim 0)System Failure Criteria Applicable to All Systems: You=indicate"Yes"or"No"to each of the following fora I inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or dogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or dogged SAS or cesspool ❑ ;fr Static liquid level in the distribution box above outlet invert due to an overloaded or dogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6'below invert or available volume is less than!day flow - ❑ Required pumping more than 4 times in the last year NOT due to dogged or obstructed pipe(s).Number of times pumped: ❑ ( Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ [ Any portion of a cesspool or privy.is within a Zone 1 of a public well. ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply n. ❑ 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 araiysis and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd. 10,000gpd. Yes No ❑ tt� The system faits.I have determined that one or more of the above failure criteria east as described in 310 CMR 15.363,therefore the system fans.The system owner should contract the Board of health to determine what will be necessary to correct the failure. firosp doexim•03/2M Title 5 off spec on Form:Subsurface Sewgge Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form ? B. Certification (cons.) Pm"Addrm CVT=n sm Tip code ' I Owners Name d iron E) Large Systems: To be considered a la 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 es°or`nor to each of the following,in addition to the questions in Section D. YES NO ❑ ❑ the m is thin 4 00 feet of a surface drinking water supply ❑ ❑ the syste is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the is located in a nitrogen sensitive area(interim Wellhead Protection Area A)or a mapped Zone 11 of a public water supply well If you have answered°y 'to any question in Section E the system is considered a significant ttu+eat, or answered in D above the large system has failed.The owner or operator of any large system considered a gnificaM threat under Section E or failed under Section D shall upgrade the system in with 310 CMR 15.304.The system owner should contact the appropriate regional office of Depart rent. &M.dmdoe•03/2006 To 5 official inspection Form:SWmeboe Sewage Disposal System Page 6 of 1s i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments SubsurFace Sewage Disposal System Form C. Checklist z 9 Q �c �� � io P amn . i ._ �+-- � s� � zip code ownees t erne DatD of l Check if the following have been done.You must indicate'yes'or"no'as to each of the following: YES NO ❑ Pumping information was provided by the owner,occupant or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two ❑ !ffi' � week period? Have large volumes of water been introduced to the system recently or as part of ❑ this inspection? ,�,? ❑ Were as built plans of the system obtained and examined?(If they were not •�! available note as N/A) ,� ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? j Q Were all system components,excluding the SAS,located on site? A ❑ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption Sin(SAS)on the site has been determined based on: ❑ Existing information.For example,a plan at the Board of Health. ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] t5i w doc.doc•03006 Title 5 Olfdel Inspection Form:Subwrt3w Sevage Disposal syswn Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface SewageDisposal System Form D. System Information ., j Coe �. cow cft I-9c7490 a•- Date of Iran s Name Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): 1 DESIGN flow based on 310 CMR 15.203(for example: 110gpdx#of bedrooms): Number of current residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system?[lf yes separate Inspection required] ❑ Yes No Laundry system inspected. ❑ Yes,&No Seasonal use? ❑ Yes &rNo Water meter readings, if available(last 2 years usage(gpd)): Y Sump pump? ❑ esX No Last date of occupancy. Date Commerciallindustriai Flow Conditions: Type of Establishment / on 310 CMR 15.203: Design flow(based ) ` Galbns PerdayM4 Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ;%'� ❑ Yes ❑ No Industrial waste holding tank present? ;` ❑ Yes ❑ No • i Non-sanitary waste discharged to the Titl 5 system? ❑ Yes ❑ No Water meter readings,if available: Last date of occupancyluse: Date Other(describe): t5irtsp.doc doc•03/20M Title 5 O(fiaal ing)eCU n Forth:Submdm sewage Disposal System Page 8 d 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D.System Information (cont.) alylrown slate zip code owners Name Date of General krtormoon Pumping Records: Source of information: A 1 J Was system pumped as part of the inspection? ❑ Yes WNo If yes,volume pumped: s How was quantity pumped determined? Reason for pumping: Type of System: Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ pay ❑ Sham 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) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,date installed(if known)and source of information: 002- AZ-00 ezE- 6� MAQI Were sewage odors detected when arriving at the site? ❑ Yes, No 1Szp,doc w.03r2M Title 5 Official inspecibn Form:Subsurf!BW Sewage Disposal System Pepe 9 Of 1s Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cant.) Ve ('( "g- ,' Omperty ZS"\--6 rk i GCS M-a-olk f cam--i^^Pn-G sr�e t 12, /10 Ownees Name Date of h0com Building Sewer(locate an site plan): Depth below grade: feet Material of amstrucdon: ❑cast iron W40 PVC ❑other(explain): Distance from private water supply well or suction tine: fee. Comments(on condition of joints,venting,evidence of leakage,eta.): Sepdc Tank(locate on site plan): t A Depth below grade: feet Material of construction: Aconcrete ❑metal ❑fiberglass Q polyethylene ❑other(explain) If tank is metal,list age: yem Is age confirmed by a Certificate of Compliance?(attach a copy of ❑ Yes ❑ No -----Certificate) -------------------------------------------------------------------- Dimensions: Sludge depth: 2't Distance from top of sludge to bottom of outlet tee or baffle 2 Scum thickness Distance from top of scum to top of outlet tee or baffle tD `f Distance from bottom of scum to bottom of outlet tee or baffle NU How were dimensions determined? SW doa dw-0MW Title 5 Maw InveCtion Form:Surface Sewage Deposal System- Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cost.) r P Address v OVUM State zip code • I '., n�� � i 2� Owner's Name Date of insiectim Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidenod of leakage,etc.): U L/V n a Grease Trap(locate on site plan): Depth below grade: Material of construction: concrete metal ❑fiberglass,�'I ❑polyethylene ❑ather(explain): r Dimensions: Scum thickness Distance from top of scum to top of outlettee or baffle Distance from bottom of scum to botr�4 of outlet tee or baffle Y Date of last pumping: r Data Comments(on pumping recomr>�idations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outle nvert,evidence of leakage,eta): Tight or Holding T (tank must be pumped at time of inspection)(locate on site plan): Depth below grad Material of co n: ❑concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain): elsp.doc doc•MAN Title 5 official Inspection Form:Subsurface Sewage Disposai System- Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (oont.) Properly Address stateLl ��;Zipcode Owners Name Dale of t right or Holding Tank(cunt) Dimensions: Capacity: gallons Design Flow. gaM=per day Alarm pint ❑ Yes ❑ No Alarm level: Alarm in worldng order: ❑ Yes ❑ No Date of last pumping: lace Comments(condition of alarm and float switches.etc.): *Attach copy of current pumping contract(required).Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 4:1, /e� �� Comments(riots if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): 0 l 1/tl1 — Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No Alarms in worldng order. ❑ Yes ❑ No tWW.doc doc•03J M Title s arld l inspecdon Form:Subsurface Sewage Disposal system Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subst'rface Sewage Disposal System Form D. System Infonnafion (cost.) )Sl Property Address IM.& �c f M I us Wrow state Zfp Code Owns Name Dame of Iron Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located,explain why. Type. II ❑ leaching pits number leaching cumbers number: ❑ leaching galleries number. ❑ leaching trenches number,length: ❑ teaching fields number,dimensions: ❑ overflow cesspool number \ ❑ innovativelaitemative system Typetname of technology. Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soli,condition of vegetation,etc.): t5irr$p.dXAM•.03J2a06 Title 5 CftW Iropection Farm:Subsurface e DwposW System Page 1s of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (coat.) Pmperty Address Cftffown sfa� Mp c«d owners Nwo Date of Inspection 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 sal,signs of h ulic failure,level of ponding,condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note conditi of soil,signs of hydraulic Failure,level of ponding,condition of vegetation, etc.): t sp.doc doc•032006 Title 5 offbW Inspection Form:Sur�surfam Sewage DlsposW S��O= (yoga%of W Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cons) ndaf ON atyrrom sr�e zip cow OwWs Marne - Dabs or Inspection Sketch Of Sewage Disposal System:Provide a sketch of the sawage,disposal system including ties to at least two permanent reference landmarks or bendtmarks.Locate all GIs wifftin 100 feet. Locate where public water supply enters the building. 34 --------------------- 2-6 l ;2- r ' 13, E 9-3 �s �0oe 6 vt t5iW doc doc•MM Title 5 OWW Inspection Fmm:Subsurface Sewage Disposal Syftn Page 15 of 16 • \ Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System information (cont.) es j . CRY �% stme � Cade owr&s Name Date of I Site Exam: Slope L ��- Surface water Aj Check cellar �� Y Shallow wells Al Ul;�' Estimated depth to ground water: t� Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked,date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: Q Checked with local excavators,installers-(ate documentation) ❑ Accessed USGS database-explain: You must describe how you established the high grour(d water elevation: t5ffsp doc doc-03/2006 Title 5 offidal Iron Form:Subsurface Sewage D4osal System- Page 16Ot 16 01/FEB/2010/MON 13: 22 0-0-MM FIRE DEPT FAX No, 5087902385 P. 001 d 19 1 CENTERVILLE-OST.ERVILLE-MARSTONS MILLS FIRE DISTRICT DEPARTMENT OF FIRE-RESCUE a EMERGENCY SERVICES 1875 Falmouth Road, Rte, 28 Emergency Number: Centerville, MA 02632-3117 9-1-1 Business: (508) 790-2375 John M. Farrington Facsimile: (508) 790-2385 Fire Prevention/Administration Chief of Department Facsimile: (508) 957-8239 Dispatch Center FAX COMMUNICATION MESSAGE DATE: rvary 1 . 0�0 TO rltrq �' Qo(�} PHeNE; ATTN: FROM: WE ARE SENDING �OUr ( `T ) PAGES, INCLUDING THIS COVER SHEET. PLEASE CALL (508)790-2375 IF YOU DO NOT RECEIVE THE TOTAL NUMBER.OF PAGES, CONFIDENTIALITY NOTJCE: This fax transmission may contain confidential information belonging to the sender and such information is legally privileged and is intended only for the use of the individual or entity named above. Any copying, disclosure, disiribution or dissemination of this information or the taking of any action based on the contents of this communication Is strictly prohibited. If you have received this transmission in error, please notify us immediately by telephone and return the original transmission to us by mail or delivery at our address above. We shall cover the cost of return mall. Thank you) 01/FEE/2010/ICON 13: 22 C-0—MM FIRE DEPT FAX No, 5087902385 P, 002 A MM DD yyyy ❑Delete NFIRS -1 101920 U 011 LBO] 2010 13 10-0000271 000 ❑Chang¢ Basic FDID —* state* Incident Data * Station Incident Number * Exposure ❑No ACLlvlty ❑cheek this bat to Indicate that the add[- foe chla incidage in pjovyded co toe mildiand Fire Ceneue Tract Location* "dule in a.cciee a "nit.cnsci, Location 3p.c}9ic.tiaq^. vas only for wildlane:lice. I� f ®street address 152 I I (BRIDLE-PA ❑Interaeation Number/Mile oat Frrvfix p Street or Highway Street Type suffix ❑In front of I I , ���—J I ❑ u Rear of 1MARSTONs MILLS ' mA 02648 -1 []Adjacent t0 Rpt./Suite/Room City State Zip Code []Directions Crave street or directions as apvlicable C Incident Type * $1 Date & Times Midnight is 0000 E2 Shift 6 Alarms 413 oil or other Combustible li id Check boxes if Local option �- tN � Month Day Year Hr Min Soo S.dares are [Re' I r COM31 Incident Type same as aAlarmthe always required 1 L_l Aid Given or Received Date, Alarm * 01 30 2010 115:00:27 D * , Shift or Alarms District Platoon 1 ❑Mutual aid received ARR1vAL required, unless canceled or did not arrive I JU 2 ❑Automatic aid recv. ❑ Arrival * 01 30 2010 15.10:50 E3 (heir FDID Their State CONTROLLED optional, Except for wlldland tires Special Studies 3 ❑haltual aid given p 4 ❑Automatic aid given I I ❑Controlled " L-1 11I Local option 5 ❑other aid given Their LAST UNIT CLEARED, required except for vlldland fires I _ I [ I Incident Number Last Unit � p�� N QNcne i --J 1 301 2010 [15:32:25 special c dyaiDo Study value❑ Cleared F Actions Taken* G1 Resources* G2 Estimated Dollar Losses & Values QCheck this box and skip this LOSSES: Required for all fires if known. Optional section if an Apparatua or 86 l Investigate I Personnel form is used_ for non fires. None Primary Action Taken (1) Apparatus Personnel Property ert 000 0001 � y U� ❑ �� suppression �� 0004 Contents $�J 000 000 Additional Action Taken (2) I EMS PRE-INCIDENT VALUE: optional ❑ I - - I Other 0002 L,� Property ��� � 000 000 ❑ Additional Action Taken 13) ❑ Check box if resource counts include aid received resources. Contents su u, 000 000 u ❑ Completed Modules Hl*Casualtiesg]None H 3 Hazardous Materials Release I Mixed Use Property Fire-2 Deaths Injuries N ❑None NN Not Mixed ❑ 1 ❑ .ation. Structure-3 Firm ' 1 I Natural ..look, .a.v.v.eion Gas: ,l a:na�t 10 Assembly on use service I 1 2 0 Educati use ❑Civil Fire Cos.-4 2 ❑Propane gas: aZ,la. tank (ac in home BBQ grill) 33 Mediaai use ❑F1re serv_ Cas.-5 Civilian�� �J 3 ❑Gasoline: vehlelm sari j:_k er pare.hl.contain.: 40 Residential use ❑EMS-6 4 ❑Kerosene: 1a.1,ofil i t or portable storage 51 Row of stores Detector "g"g"�Oi ❑Hazlet-7 ese fuel/fuel :,ehsol:£rntl task at ._.,� 53 Bus. & R mall Required for Confined Fired. 5 ❑Di l oil 5$ Bus, 6 Residential ❑Wildland Bire-8 ❑ 6 ❑Household solvents: haa_i.:tit.. il, as Office use 1 DYteCkor alerted owuHents Pi P°n7y 59 NApparatus-9 7 ❑Motor oil: tram eneloo oa portable oontalner 60 Industrial use ©Personnel-10 Z Detector did not alert team ❑ 63 Military use ❑ 8 Paint: from Dainh con.totaling<55 g.11o" 65 Farm use ❑Arson-11 U❑unknoem 0 ❑other: sgd•1 Roam.eauao•r.quwd ar aBill>669a1., 00 other mixed'use die• mko,, Me e.aaac form J Property Use* Structures 341❑Clinic,clinic type infirmary 5 39 ❑Household goods,sales,repairs 342❑Doctor/dentist office 579 []Motor vehicle/boat aaies/repair 131❑Church, place of worship 3 61❑Prison or jail, not juvenile 571 ❑Gas or service station 161 ❑Restaurant of cafeteria 41 9 9 1-or 2-family dwelling 599 ❑Business office 162 ❑Bar/Tavern or nightclub 42 9❑Multi-family dwelling 615 ❑Electric generating plant 213 ❑Elementary school or kindergarten 43 9❑Rooming/boarding house 629 ❑Laboratory/science lab 215 ❑High school or junior high 449❑commercial hotel or motel 700 ❑Manufacturing plant 241 ❑college, adult education 459[]Residential, board and care 819 ❑Livestock/poultry storage(barn) 311 ❑Care facility for the aged 4 64❑Dormitory/barracks 882 ❑Non-residential parking garage 331 ❑Hospital 519❑Food and beverage sales 891 ❑warehouse Outside 93 6 ❑vacant lot 981 ❑Construction site 124 []Playground or park 938 ❑Graded/care for plot of land 984 ❑ Industrial plant yard 655 []Crops or orchard 946 ❑Lake, river, atream 669 r-lForeat (timberland) 951 ❑Railroad i1 ht Of way Lookup and enter a Property use code only if g y you have NOT checked a Property use box: 807 ❑Outdoor storage area 960 []Other street Property Use 1419 919 []Dump or sanitary landfill 961 ❑Highway/divided highway 931 []open land or field 962 ❑Residential street/driveway 11 or 2 family dwelling NFIR3-1 Revision 03 GarIto p COMM Fire Department 01920 Y10-00010271 01/FEB/2010/MON 13: 23 C-0—MM FIRE DEPT FAX No. 5087902385 P. 003 K1 Person/Entity Involved I I 1 -1 -1 Local option ( Buelneae name (if applicable) Area Code Phone Number Check This BOX if I I LJ Bank owned same addres I s as -•Ms., D9rs. First Name MI Last Name Suffix incident location. Than skip the three 152 �� IBRIDLE PA duplicate address Number Preti; Street or Highway street Type linos. yp Suffix IHOLLAND,_ ROBERT J IMARSTONS MILLS Post office BOX Apt./Suite/Room City L�� 102648 -U State Zip Code More people involved? Check this box and attach Supplemental Forms (NFIRS-IS) as necessary Same as person involved? R2 Owner � I — Then cheek this box and skip Th¢ Zest or thls settlon. 1� u Local Option Business name )if Applicable) Area Code Phone Number I I I U I I " Check this box if Nr.,Ne., Mrs. rirat Name MI cast Name suffix name address as incident location. I I u I I Then skip the three U duplicate address Number Prefix Street or Highway Street Type suffix lines. Post Orfice Box Apt./Suite/Roam City state zip Code L Remarks Lccai option Caller Name : WALKIN TO STA 1 Caller Phone : 508-654-4359 Caller Address : DONNA SAWYER OIC : CAPT. FIELD Pats. . 0 wmonroe ; 2010/01/30 15:10:50 - 303 AT EVENT MANNING IS 3 wmonroe ; 2010/01/30 15:11:48 - 321 AT EVENT MANNING IS 1 wmonroe ; 2010/01/30 15:02:28 REALTOR REPORTS FLOODED BASEMENT SMELL OF OIL AT VACANT HOUSE wmonroe 2010/01/30 15:05:49 LOCK BOX ON FRONT DOOR COMBO 1-6-2-0 wmonroe 2010/01/30 15:10:58 303 ON LOC INVESTIGATING wmonroe ; 2010/01/30 15:26:21 SAME CONDITION AS ON LAST VISIT, NOTHING IN NEED OF ADDRESSING AT THIS TIME Dispatch received a walk in report from a realator stating that the house at 152 Bridle Patch had a possible oil spill in the basement. I responded in 321 along with engine 303. Upon arrival we gained access using the lockbock combo given us by the realestate agent and we found that the house had frozen up previously and that water and utilities had been L Authorization 18270 I I FIELD, PHILIP H.JR. I ICAPT I I IL01J LLOJ2010 Officer in charge ID Signature Position or rank Assignment Month Day Year Check Box li 270 ® 8 I I FIELD, PHILIP H.JR. ICAPT ( I U 2010 game Position or rank Aasignment month Da Year as Officer member making report ID signacura Y in charge. COMM Fire Department 01920 01/30/2010 10-0000271 01/FEB/2010/MON 13: 23 C-0—MM FIRE DEPT FAX No. 5087902385 P. 004 MM DD YYYY 01920 � �� 30 2010 3 J 10-0000271 000 Complete * aFDID � state* incident Date * Station Incident Number Narrative * Exposuxe Narrative: Caller Name : WALKIN TO STA 1 Caller Phone : 508-654-4359 Caller Address : DONNA SAWYER OIC : CAPT. FIELD Pats. . 0 wmonroe ; 2010/01/30 15:10:50 - 303 AT EVENT MANNING IS 3 wmonroe ; 2010/01/30 15:11:48 - 321 AT EVENT MANNING IS 1 wmonroe ; 2010/01/30 15:02:28 REALTOR REPORTS FLOODED BASEMENT SMELL OF OIL AT VACANT HOUSE wmonroe ; 2010/01/36 15:05:49 LOCK BOX ON FRONT DOOR COMBO 1-6-2-0 wmonroe ; 2010/01/30 15:10:58 303 ON LOC INVESTIGATING wmonroe ; 2010/01/30 15:26:21 SAME CONDITION AS ON LAST VISIT, NOTHING IN NEED OF ADDRESSING AT THIS TIME Dispatch received a walk in report from a realator stating that the house at 152 Bridle Patch had a possible oil spill in the basement. I responded in 321 along with engine 303. Upon arrival we gained access using the lockbock combo given us by the realestate agent and we found that the house had frozen up previously and that water and utilities had been secured. While there was an odor of oil in the home there did not seem to be a spill of any significance. Instead the empty oil tank had fallen over when the water floated it in the basement. This created a sheen on the water but no significant oil amount. We then cleared the scene. COMM Fire Department 01920 01/30/2010 10-0000271 U� D�� C Town of Barnstable 2 y` Regulatory Services r r r r 9snnNKAMate r Thomas F. Geiler,Director i639 �0 '�FON,a�o Public Health Division Thomas McKean,Director' 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 14, 2002 Mr. Robert J. Holland 152 Bridle Path Marston Mills,MA 02648 and Mr. Freeman Watson 152 Bridle Path Marston Mills, MA NOTICE OF PUBLIC HEARING DUE TO RECURRING VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE, AND 105 CMR 410.00 STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property owned by you located at 152 Bridle Path Marstons Mills, Ma was again inspected on December 5, 2001 by David Stanton Health Inspector for the Town of Barnstable, because of a complaint. The following violation of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code II -Minimum Standards of Fitness for Human Habitation.was observed: 105 CMR 410.300 AND 310 CMR 15.02 (207): Raw sewage observed on top of the ground behind the dwelling. A large dark colored puddle of sewage was observed adjacent to piles of debris and branches. 105 CMR 41-0.600 And Board of Health PART VII, SECTION 1.00, NUISANCE CONTROL REGULATION #1: Several torn open bags of refuse on the ground adjacent to a plastic refuse container. Several discarded cups, food containers, papers, boxes, and other debris observed on the ground. The violation of 105 CMR 410.300 (overflowing sewage) was observed on May 31, 2001, June 4, 2001 June 5, 2001, June 6, 2001, June 7, 2001, June 12, 2001, June 26, 2001, December 4, 2001, and on December 5, 2001. Several non-criminal ticket citations were issued to the owner and order letters were mailed via certified mail. The violations of 105 CMR 410.660 (rubbish and garbage) was observed on May 31, 2001,June 12, 2001 Attached are copies of letters, reports, ticket citations, and warning.regarding these violations. a On January 23, 2002, at 7:00 p.m. the Board of Health will hold a public hearing at the Barnstable Town Hall, Second Floor Conference Room, 367 Main Street Hyannis Massachusetts to consider issuing a finding that the dwelling is unfit for human habitation. This finding may result in an order of condemnation requiring the owner to secure the dwelling and requiring the occupants to vacate the dwelling. In the meantime, you are directed to hire a licensed septage hauler to pump the overflowing cesspool within twenty-four (24) hours.of receipt of this letter. You are also directed to keep the on-site sewage disposal system pumped as many times as necessary to keep from overflowing onto the ground. PER ORDER OF T E BOARD OF HEALTH Thomas A. McKean Director of Public Health Cc:.Peter Daigle Town of Barnstable Ftti Regulatory Services Thomas F. Geiler, Director • snit STABLE, b ,erg Public Health Division �FOMy..a Thomas McKean, Director 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 31, 2000 Robert J. Holland 152 Bridle Path Marston Mills, MA 02648 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE AND 105 CMR 410.00 STATE SANITARY CODE H- MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property owned by you located at 152 Bridle Path, Marstons Mills listed as Parcel 140 on Assessor's Map 149 was inspected on August 25, 2000 by Donna Miorandi, R.S. Health Inspector for the Town of Barnstable, because of a complaint. The following violation of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code H- Minimum Standards of Fitness for Human Habitation was observed: REGULATION 310 CMR 15.02 (207) AND 105 CMR 410.300: Overflowing sewage onto the ground. This violation is a serious public health hazard. 1) You are directed to hire a licensed septage hauler to pump the overflowing cesspool within twenty-four(24) hours of receipt of this letter. 2) You are also directed to keep the on-site sewage disposal system pumped as many times as necessary to keep from overflowing onto the ground. 3) You are further directed to contact and hire a licensed Disposal Works Installer within seven (7) days of receipt of this letter in order to repair this system or connect to town sewer. You may request a hearing before the Board of Health if written petition requesting same is received within seven (7) days after the date the order is served. Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with an order shall constitute a separate violation. F THE BOARD OF HEALTH Thomas A. McKean Director of Public Health houand/wp/g/ts apIKE T Town of Barnstable Regulatory Services + BAMSMBLE, MAss $ Thomas F. Geiler, Director 1639. �0 lfo rug° Public Health Division Thomas McKean,Director 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 9,2001 . Mr.Freeman Watson 152 Bridle Path Marstons Mills,MA 02648 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE, AND 105 CMR 410.00 STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. ., The property owned by you located at 152 Bridle Path was inspected on June 26, 2001 by . Donna Miorandi,R.S.,Health Inspector and Thomas McKean,CHO for the Town of Barnstable,because of a complaint. The following violation of 3.10 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code 11-Minimum Standards of Fitness for Human Habitation was observed: REGULATION 310 CMR 15.02(207)AND 105 CMR 410.300: Overflowing sewage onto the ground. This violation is a serious public health hazard. 1) .You are directed to hire a licensed septage hauler to pump the overflowing cesspool within twenty-four (24)hours of receipt of this letter. 2) You are also directed to keep the on-site sewage disposal system pumped as many times as necessary to keep from overflowing onto the ground. This system is required to be pumped daily if necessary. 3) You are further directed to contact and hire a licensed Disposal Works Installer within seven(7)days.of receipt of this letter in order to repair this system. You may request a hearing before the Board of Health if written petition requesting same is received within seven(7)days after the date the order is served. Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with an order shall constitute a separate violation. 'PER ORDER-OF THE BO RD OF HEALTH Thomas A.McKean Director of Public Health Health Complaints 05-Dec-01 Time: . 2:00:00 AM Date: 12/4/2001 Complaint Number: 3187 Referred To: DAVID.STANTON Taken By: FLORENCE SMITH Complaint Type: TITLE V.. SEWAGE Article X Detail: UNSANITARY CONDITIONS Business Name: Freeman.Watson Number: 152 Street: Bridle.Path 1 Health Complaints 18-Sep-01 Time: 1:15:00 PM Date: 5/31/01 Complaint Number: 2883 Referred To: DONNA MIORANDI Taken By: DONNA MIORANDI Complaint Type.: -NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: Business Name: . Number: 152 Street: Bridle Path Village: MARSTONS MILLS Assessors Map-Parcel: o e j F Town of Barnstable Regulatory Services r • 9' `�g' Thomas F. Geiler,Director 1639• ♦0 Public Health Division Thomas McKean,Director 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 14, 2002 Mr. Robert J. Holland 152 Bridle Path Marston Mills,MA 02648 and Mr. Freeman Watson l k Bridle Path Marstons Mills, MA NOTICE OF PUBLIC HEARING DUE TO RECURRING VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL. CODE TITLE V:. MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE, AND 105 CMR 410.00 STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property owned by you located at 152 Bridle Path Marstons Mills, Ma was again inspected on December 5, 2001 by David Stanton Health Inspector for the Town of Barnstable, because of a complaint. The following violation of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code II-Minimum Standards of Fitness for Human Habitation.was observed: 105 CMR 410.300 AND 310 CMR 15.02 (207): Raw.sewage observed on top of the ground behind the dwelling. A large dark colored puddle of sewage was observed adjacent to piles of debris and branches. 105 CMR 410.600 And Board of Health PART VII, SECTION 1.00, NUISANCE CONTROL REGULATION #1: Several torn open bags of refuse on the ground adjacent to a plastic refuse container. Several discarded cups, food containers, papers, boxes, and other debris observed on the ground. The violation of 105 CMR 410.300 (overflowing sewage) was observed on May 31, 2001, .June 4, 2001 June 5, 2001, June 6, 2001, June 7, 2001, June 12, 2001, June 26, 2001, December 4, 2001, and on December 5, 2001. Several non-criminal ticket citations were issued to the owner and order letters were mailed via certified mail. The violations of 105 CMR 410.660 (rubbish and garbage) was observed on May 31, 2001,June 12,2001 Attached are copies of letters, reports, ticket citations, and warning regarding these violations. a On January 23, 2002, at 7:00 p.m. the Board of Health will hold a public hearing at the Barnstable Town Hall, Second Floor Conference Room, 367 Main Street Hyannis Massachusetts to consider issuing a finding that the dwelling is unfit for human habitation. This finding may result in an order of condemnation requiring the owner to secure the dwelling and requiring the occupants to vacate the dwelling. In the meantime, you are directed to hire a licensed septage hauler to pump the overflowing cesspool within twenty-four (24) hours. of receipt of this letter. You are also directed to keep the on-site sewage disposal system pumped as many times as necessary to keep from overflowing onto the ground. PER ORDER OF T BOARD OF HEALTH Thomas A. McKean Director of Public Health Cc:.Peter Daigle Town of Barnstable F rati Regulatory Services Thomas F. Geiler, Director Public Health Division FDMA� Thomas McKean, Director 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 31, 2000 Robert J. Holland 152 Bridle Path Marstons Mills, MA 02648 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE, AND 105 CMR 410.00 STATE SANITARY CODE H- MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property owned by you located at 152 Bridle Path, Marstons Mills listed as Parcel 140 on Assessor's Map 149 was inspected on August 25, 2000 by Donna Miorandi, R.S. Health Inspector for the Town of Barnstable, because of a complaint. The following violation of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code H- Minimum Standards of Fitness for Human Habitation was observed: REGULATION 310 CMR 15.02 (207) AND 105 CMR 410.300: Overflowing sewage onto the ground. This violation is a serious public health hazard. 1) You are directed to hire a licensed septage hauler to pump the overflowing cesspool within twenty-four (24) hours of receipt of this letter. 2) You are also directed to keep the on-site sewage disposal system pumped as many times as necessary to keep from overflowing onto the ground. 3) You are further directed to contact and hire a licensed Disposal Works Installer within seven (7) days of receipt of this letter in order to repair this system or connect to town sewer. You may request a hearing before the Board of Health if written petition requesting same is received within seven (7) days after the date the order is served. Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with an- order shall constitute a separate violation. JOF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health hoUand/wp/q/Is 1 P�oE�HE Teti Town of Barnstable Regulatory Services 9$"" `��' Thomas F. Geiler,Director TE1659. Public Health Division Thomas McKean,Director 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 9,2001 . Mr.Freeman Watson 152 Bridle Path Marstons Mills,MA 02648 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V• MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY . SEWAGE AND 105 CMR 410.00 STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The. property owned by you located at 152 Bridle Path was inspected on June 26, 2001 by . Donna Miorandi,R.S.,Health Inspector and Thomas.McKean,CHO for the Town of Barnstable,because of a complaint. The following violation.of 3.10 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code H-Minimum Standards of Fitness for Human Habitation was observed: 10 CMR 15.02 207 AND 105 CMR 410.300: REGULATION 3 ,.. Overflowing sewage onto the ground. This violation is a serious public health hazard. 1) .You are directed to hire a licensed septage hauler to pump the.overflowing cesspool within twenty-four (24)hours of receipt of this letter. 2) You are also directed to keep the on-site sewage disposal system pumped as many times as necessary to keep from overflowing onto the ground. This system is requited to be pumped daily if necessary. 3) You are further directed to contact and hire a licensed Disposal Works Installer within seven(7)days.of receipt of this letter in order to repair this system. You may request a hearing before the Board of Health if written petition requesting same is received within seven(7)days after the date the order is served. Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDE. F THE BO RD OF HEALTH Thomas A.McKean Director of Public Health Health Complaints 05-Dec-01 Time: . 2:00:00 AM Date: 12/4/2001 Complaint Number: 3187 Referred To: DAVID.STANTON Taken By: FLORENCE SMITH Complaint Type: TITLE V.. SEWAGE Article X Detail: UNSANITARY CONDITIONS Business Name: Freeman.Watson Number: 152 Street: Bridle.Path 1 Health Complaints 18-Sep-01 Time: 1:15:00 PM Date: 5/31/01 Complaint Number: 2883 Referred To: DONNA MIORANDI Taken By: DONNA MIORANDI Complaint Type,: -NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: Business Name: . Number: 152 Street: Bridle Path Village: MARSTONS MILLS Assessors Map-Parcel: o - 1 Health. Complaints 05-Dec-01 Time: . 2:00:00 AM Date: 12/4/2001 Complaint Number: 3187 Referred To: DAVID.STANTON Taken By: FLORENCE SMITH Complaint Type: TITLE V.. SEWAGE Article X Detail: UNSANITARY CONDITIONS Business Name: Freeman.Watson Number: 152 Street: Bridle.Path Village: MARSTONS.MILLS Assessors Map Parcel: 1 Health Complaints 18-Sep-01 Time: 1:15:00 PM Date: 5/31/01 Complaint Number: 2883 Referred To: DONNA MIORANDI Taken By: DONNA MIORANDI Complaint Type.: -NUISANCE CONTROL REG. 1 RUBBISH Article X"Detail: Business Name: . Number: 152 Street: Bridle Path Village: MARSTONS MILLS Assessors Map_Parcel: " o 1, L 2001, December 4, 2001, and on December 5, 2001. Several non-criminal ticket citations were issued to the owner and order letters were mailed via certified mail. The violations of 105 CMR 410.600 (rubbish and garbage) was observed on May 31, 2001, June 12, 2001 Attached are copies of letters, reports, ticket citations, and warning regarding these violations. On January 23, 2002, at 7:00 p.m. the Board of Health will hold a public hearing at the Barnstable Town Hall, Second Floor Conference Room, 367 Main Street Hyannis Massachusetts to consider issuing a finding that the dwelling is unfit for human habitation. This finding may result in an order of condemnation requiring the owner to secure the dwelling and requiring the occupants to vacate the dwelling. In the meantime; you are directed to hire a licensed septage hauler to pump the overflowing cesspool within twenty-four (24) hours of receipt of this letter. You are also directed to keep the on-site sewage disposal system pumped as many times as necessary to keep from overflowing onto the ground. joPER ORDER THE BOARD OF HEALTH mas A. McKean Director of Public Health Cc: Peter Daigle Town of Barnstable oFTHE 1ph, Regulatory Services �7 Thomas F. Geiler, Director � MASS. $ Public Health Division ArFnnnA'�°i Thomas McKean, Director 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 31, 2000 Robert J. Holland 152 Bridle Path Marstons Mills, MA 02648 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE,AND 105 CMR 410.00 STATE SANITARY CODE H- MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property owned by you located at 152 Bridle Path, Marstons Mills listed as Parcel 140 on Assessor's Map 149 was inspected on August 25, 2000 by Donna Miorandi, R.S. Health Inspector for the Town of Barnstable, because of a complaint. The following violation of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code II- Minimum Standards of Fitness for Human Habitation was observed: REGULATION 310 CMR 15.02 (207) AND 105 CMR 410.300: Overflowing sewage onto the ground. This violation is a serious public health hazard. 1) You are directed to hire a licensed septage hauler to pump the overflowing cesspool within twenty-four (24) hours of receipt of this letter. 2) You are also directed to keep the on-site sewage disposal system pumped as many times as necessary to keep from overflowing onto the ground. 3) You are further directed to contact and hire a licensed Disposal Works Installer within seven (7) days of receipt of this letter in order to repair this system or connect to town sewer. You may request a hearing before the Board of Health if written petition requesting same is received within seven (7) days after the date the order is served. Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with an order shall constitute a separate violation. F THE BOARD OF HEALTH Thomas A. McKean Director of Public Health holland/wp/q/ls I 1 °FINE T Town of Barnstable Regulatory Services a s 9 MASS. � Thomas F. Geiler, Director 1639. ♦0 rEv Mnt° Public Health Division Thomas McKean,Director 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 9, 2001 . Mr.Freeman Watson 152 Bridle Path Marstons Mills,MA 02648 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE AND 105 CMR 410.00 STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property owned by you located at 152 Bridle Path was inspected on June 26, 2001 by Donna Miorandi,R.S.,Health Inspector and Thomas.McKean,CHO for the Town of Barnstable,because of a complaint: The following violation of 3.10 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code H-Minimum Standards of Fitness for Human Habitation was observed: REGULATION 310 CMR 15.02(207)AND 105 CMR 410.300: Overflowing sewage onto the ground. This violation is a serious public health hazard. 1) .You are directed to hire a licensed septage hauler to pump the overflowing cesspool within twenty-four (24)hours of receipt of this letter. 2) You are also directed to keep the on-site sewage disposal system pumped as many times as necessary to keep from overflowing onto the ground. This system is required to be pumped daily if necessary. 3) You are further directed to contact and hire a licensed Disposal Works Installer within seven(7)days.of receipt of this letter in order to repair this system. You may request a hearing before the Board of Health if written petition requesting same is received within seven(7)days after the date the order is served. Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDE F THE BO RD OF HEALTH Thomas A.McKean Director of Public Health M Town of Barnstable Regulatory Services BAMffABLK v NAM $ Thomas F. Geiler,Director Public Health Division Thomas McKean, Director 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 14, 2002 Mr. Robert J. Holland 152 Bridle Path Marston Mills,MA. 02648 and Mr. Freeman Watson 152 Bridle Path Marstons Mills, MA NOTICE OF PUBLIC HEARING DUE TO RECURRING VIOLATIONS OF 310 CMR:, 15.00 THE •STATE-ENVIRONMENTAL:CODE.TITLE-V:-- MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE, AND'105 CMR 410.00 STATE SANITARY CODE II MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property owned by.you located at A 52 Bridle Path' Marston Mills, Ma was again inspected on December 5, 2001 by David Stanton Health Inspector for the Town of Barnstable, because of a complaint. The following violation of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code II -Minimum Standards of Fitness for Human Habitation was observed: E t I 105 CMR 410.3"00 AND 310 CMR 15.02 (207): Raw sewage observed on top of the ground behind the dwelling. A large dark colored puddle of sewage was observed adjacent to piles of debris and branches. 105 CMR 410.600 And Board of Health PART VII, SECTION 1.00, NUISANCE CONTROL REGULATION #1: Several torn open bags of refuse on the ground adjacent to a plastic refiise 'container" Several.discarded cups, food containers, papers, boxes, and other,debris.observed on.the ground. . The-,violation of 105'CMR' 410.300 overflowin sewage)-was-observed on: May 31; 2001'.;june`�4;2601-,June 5; 2001, June- 6;:2001. June 7,F-2001,"June 12;,2001,' June26, Safe Earth Systems,, Inc., %cad t P.O. Box 1359 - ti Marstons Mills, MA 02645 (508) 477-2999 0 (508) 420-2803 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR R PART A CERTIFICATION .' Property Address: 152 Bridle Path, Marstons Mills Address of Ov,n:;r:f>Fliggins >treet Date of Inspection: 6/7/96 Johnston, R1 02,319 Name of Inspector: Michael J. DiMaggio Company Flame, 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 cif insrperc;tion. The inspection was performed based on my training and experience in the Fraper f-Irict.ion and maintenance of on-site sewage disposal systems. The system: x Passes __ Conditionally Passes __ Needs Further Evaluation By the Local Approving Authorit'; Fails Inspector's Signature:0 Date: JUI1E! 10 , 19E)6 The System Inspector shall submit a copy of this inspection report to the ApproOng Authority within thirttr(30)days of completing this inspection. If the system is a shared sjstern c-r has a design flow of 10,000 gpd cr greater,the inspector and the system owner shall s:utornit .h; n p)rl:1.!) 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 applit:aib8e and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D. A] SYSTEM PASSES: x__1 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 acre in(Fcated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes, no, or not determined(Y, N or ND). Describe basis of determination in all insta,ncl:Is. If"not determined", explain why not. _The septic tank is metal,cracked, structurally unsound,shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the exisling septic tank is replaced with a conforming septic tank as approved by the Board of Health. 1 Jul. SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 152 Bridle Path Owner: Robert Mazur Date of Inspection: June 7,1996 B] SYSTEIU.I CONDITIONALLY PLISSES(continued) —.Sewage backup or breakout or high static water level obsewed in the distribution I cr;(is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution bcx. 11he syslen-r will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced) obstruction is removed distribution box is leveled or replacsed The systern required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in orclr;;r to determine if the system is failing to protect the public health, safety and the erivirornTrN if:, 1) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATE R, SUPPLIER, IF APPROPRIATE:) DETERMINES THAT THE SYSTEM IS FUNCTIONIfkIG 114 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 ;'_one I of a public: watery supply well. _The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The systern has a septic tank and soil absorption system and is less than 100 faet 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 tyre presence of ammonia nitrogen and_nitrate nitrogen is equal to or less than 5-pprn. - D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure oriteda,as defined in 313 CMR 15.303. The basis for this determination is identified be:lou✓. Thr Board of Health should be contacted to determine what will be necessary to correct the-failure. ___Backup of sewage into facility or system component due to in overload or clogged GAG or cesspool. —Discharge- or ponding off effluent to the surface of the ground or su face "later;:, due: to rn overloaded or clogged SAS or cesspool. 2 SUBSURFACE SEWAGE DISPOSAL S`fS'rEM INSPECTION FORAtl PART A CERTIFICATION(continued) Property Address: 152 Bridle Path Owner: Robert Mazur Date of Inspection:6/7196 D] SYSTEM FAILS(continued): _Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. _Liquid depth in cesspool is less than 6" below invert or available volume iv, less, th,:In 112 day flow. _Required pumping more than 4 times in the last year NOT due to cloc:ged or c)bstructed pipe(s). NUITIber of times pumped Any portion of the Soil Absorption System, cesspool or privy is below then hitch 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 podion of a cesspool or privy is less than 100 feet but greater then 50 feet frc>rrr a Dived water supply wall with no acceptable water quality analysis. If the well has been analyzed to he acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater(Large System) and the sirstem is ;a significant threat 10 public health and safety and the environment because one or more of the following conditions exist: _the systen 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 or operator of any such system shall bring the system and facility into full c:ornpliance with the groundwater treatment program requirements of 314 CMR 5.00 and'S.0i.1. Please consult the local regional office of the Department for further information. 3 ,SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORI:bI PART B CHECKLIST Property Address: 152 Bridle Path Owner: Robert Mazur Date of Inspe!c:tion:6/7/96 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 reCe:iving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ✓ As built plans have been obtained and examined. Note if they are not available with MA. J The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. _Z_AII system components, excluding the Soil Absorption System, have been located on the site. _,tThe septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or 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 detrerrnined baked on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with irilorrnation an the proper maintenance of Sub-Surface Disposal System. 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C' SYSTEM INFORMATION Property Address: 152 Bridle Path Owner: Robert Mazur Date of Inspection:6/7/96 FLOW CONDITIONS RESIDENTIAL: r Design flow 300 gallons Number of bedrooms: 2 , Number of current residents: 2 Garbage grinder(yes or no): NO Laundry connected to system(yes or no): ves Seasonal use(yes or no): NO_ Water mete readings,ifavailable: N/A Last date of occupancy:June.1996 COMMERCIALIINDUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present:(yes or no) Industrial Waste Holding Tank present: (yes or no) Non-sanitary waste discharged to the Title 5 system: (yes or no) Water meter readings, ifavailable: Last date of occupancy: Describe I OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no) no _ If yes,volume pumped gallons Reason for pumping _ TYPE OF SYSTEM J 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: Sewage odors detected when arriving at the site: (yes or no) no 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM a . F PART C SYSTEM INFORMATION(continued) Property Address: 152 Bridle Path Owner: Robert Mazur Date of Inspection:6/7/96 SEPTIC TANK: / (locate on site plan) Depth below grade: 8" Material of construction: x_concrete _metal _FRP _other(explain) Dimensions: 6'x10'x6' Sludge depth: _ 2" Distance from top of sludge to bottom of outlet tee or baffle: 12" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: N/A Distance from bottom of scum to bottom of outlet tee or baffle: N/A Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) Condition 6�od. No Recommendation. GREASE TRAP: (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP _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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) ' 6 JOHN R.PERCHARD,JR. LIEUTENANT COLONEL US ARMY(RETIRED) �1 POSTMASTER UNITEDSTATES POSTAL SERV 802 MAIN EET CHATHA A 02633-9998 508�- 5-0615 , ,-9945-6054 ° i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORDO PART C SYSTEM INFORMATION(continued) Property Address: 152 Bridle Path, Marstons Mills, MA Owner: .Robert Mazur Date of Inspection: 6/7/96 TIGHT OR HOLDING TANIK: (locate on site plan) Depth below grade: Material of construction: _concrete _metal -FRP other (explain) Dimensions: Capacity: _gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX: ✓ (locate on site plan) Depth of liquid level above outlet invert: 0 Comments: (condition of inlet tee,condition of alarm and float switches,etc. CONDITION GOOD PUMP CHAMBER: (locate on site plan) Pumps in working order(yes/no) Comments: - (note condition of pump chamber,condition of pumps and appurtenances,etc.) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 152 Bridle Path, Marstons Mills, MA Owner: Robert Mazur Date of Inspection: 6/7/96 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: 1 leaching chambers, number: leaching galleries, number: leaching trenches, number, length: leaching fields, number,dimensions: overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) No signs of failure CESSPOOLS: NIA (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(cesspoolmustbepumpedaspartofinspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) PRIVY: (location 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.) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 152 Bridle Path Owner: Robert Mazur Date of Inspection:June 7, 1996 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 394 50+ 3+ GXX41 Future Expansion 31+ 20+ F-t-- Town Water+ DEPTH TO GROUNDWATER Depth to groundwater: 40 feet method of determination or approximation: 9 t I f r Town of Barnstable Regulatory Services Thomas F. Geiler, Director a M i BAR ` KA �SS. ' Public Health Division �b ie;q. Alfp►�,�a Thomas McKean, Director 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 31, 2000 Robert J. Holland 152 Bridle Path Marstons Mills, MA 02648 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE, AND 105 CMR 410.00 STATE SANITARY CODE H- MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property owned by you located at 152 Bridle Path, Marstons Mills listed as Parcel 140 on Assessor's Map 149 was inspected on August 25, 2000 by Donna Miorandi, R.S. Health Inspector for the Town of Barnstable, because of a complaint. The following violation of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code U- Minimum Standards of Fitness for Human Habitation was observed: REGULATION 310 CMR 15.02 (207) AND 105 CMR 410.300: Overflowing sewage onto the ground. This violation is a serious public health hazard. 1) You are directed to hire a licensed septage hauler to pump the overflowing cesspool within twenty-four(24) hours of receipt of this letter. 2) You are also directed to keep the on-site sewage disposal system pumped as many times as necessary to keep from overflowing onto the ground. 3) You are further directed to contact and hire a licensed Disposal Works Installer within seven (7) days of receipt of this letter in order to repair this system or connect to town sewer. You may request a hearing before the Board of Health if written petition requesting same is received within seven (7) days after the date the order is served. Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with ar, order shall constitute a separate violation. F THE BOARD OF HEALTH Thomas A. McKean Director of Public Health holland/wp/q/ls J ' ," �"✓� Gyps � ��„�ndFMap,Parcel 149140 � n, Owner Parceli! . 149140 DeJ p/ V 'Ac ount Na 000863 ta" 0000000 „ t De swum LOT 14 O r, pruawn, HO-LAND,ROBERT J y s fak 1 11 %� I No Bldgs 1 Arearf 00001344 152 BRIDLE PATH ark d ed` 00 f MARSTONS MILLS MA 02648 s, w accty 00-0000 000 �Deed Date � 080196 � eferer�ee C141745 � �� ry��� � � � � r atuaryls HOLLAND,ROBERT J < ,Dee Ml'Y 0896 Dee of C141745 i ! t eS Land,% 000030000 Q ,� Ittg _ 000067300 EX r ea#ure y, 0000000000 ' y a � t ocalt obi 152 BRIDLE PATH o tln„, 0184 �, 0125 � � 9 .p r �' FFc 4� Fs D st COWvS n 0000 Frritg 0000 MEN � i r ✓ ( 0 Health Complaints 04-Dec-01 Time: 2:00:00 AM Date: 12/4/01 Complaint Number: 3187 Referred To: DONNA MIORANDI Taken By: FLORENCE SMITH Complaint Type: TITLE V SEWAGE Article X Detail: UNSANITARY CONDITIONS 1 1 Health Complaints 18-Sep-01 Time: 1:15:00 PM Date: 5/31/01 Complaint Number: 2883 Referred To: DONNA MIORANDI Taken By: DONNA MIORANDI Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: Business Name: ' Number: 152 Street: Bridle Path Village: MARSTONS MILLS Assessors Map_Parcel: Health Complaints 18-Sep-01 Time: 1:15:00 PM Date: 5/31/01 Complaint Number: 2883 Referred To: DONNA MIORANDI Taken By: DONNA MIORANDI Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: Business Name: ' Number: 152 Street: Bridle Path Village: MARSTONS MILLS Assessors Map-Parcel: °- 1 °F11HE T Town of Barnstable Regulatory Services i ♦ t BA"917ABM v MASS. Thomas F. Geiler,Director �p 1639. ♦0 Tfv►��" Public Health Division Thomas McKean, Director 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 9,2001 . Mr.Freeman Watson 152 Bridle Path Marstons Mills,MA 02648 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE, AND 105 CMR 410.00 STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. .. The property owned by you located at 152 Bridle Path was inspected on June 26, 2001 by Donna Miorandi,R.S.,Health Inspector and Thomas McKean,CHO for the Town of Barnstable, because of a complaint. The following violation of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code H-Minimum Standards of Fitness for Human Habitation was observed: REGULATION 310 CMR 15.02(207)AND 105 CMR 410.300: Overflowing sewage onto the ground. This violation is a serious public health hazard. 1) You are directed to hire a licensed septage hauler to pump the overflowing cesspool within twenty-four (24)hours of receipt of this letter. 2) You are also directed to keep the on-site sewage disposal system pumped as many times as necessary to keep from overflowing onto the ground. This system is required to be pumped daily if necessary. 3) You are further directed to contact and hire a licensed Disposal Works Installer within seven(7)days.of receipt of this letter in order to repair this system. You may request a hearing before the Board of Health if written-petition requesting same is received within seven(7)days after the date the order is served. Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDE F THE BO RD OF HEALTH Thomas A.McKean Director of Public Health i Health Complaints -18-Sep-01 Time: 1:15:00 PM Date: 5/31/01 Complaint Number: 2883 Referred To: DONNA MIORANDI Taken By: DONNA MIORANDI Complaint Typo: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: Business Name: Number: 152 Street: Bridle Path 0 1 Health Complaints 05-Dec-01 Time: 2:00:00 AM Date: 12/4/2001 Complaint Number: 3187 Referred To: DAVID.STANTON Taken By: FLORENCE SMITH Complaint Type: TITLE.V . SEWAGE Article X Detail: UNSANITARY CONDITIONS Business Name: Freeman.Watson Number: 152 Street: Bridle.Path 1 P. 1 ! f COMMUNICATION RESULT REPORT ( FEB. 3.2009 2:52PM ) TTI BARNSTABLE BOARD OF HEAL-1-1 OPTION ADDRESS (GROUP) RESULT PACE T?; 9508 r 9A2:385 OTC P. 3/3 s�r s e: .;i - ------------------ - REr'f.SJH FOR ERROR E-1) HAI`G UP OR LINE FAIL E-2) BUST E-3) ANSWER E-4) NO FACSIMILE CONNECTION t, °down of' rnsta" Regulatory Sakes ft MAD HAIM TWomas McKean,Director 200 Main Street, Hyannis, MA 02601 N-Al t' MaUl 01?PAGES TO FOLLOW: FROM M146 al/. NE �pp a 7'ti 4.�Sf�ai�r� � .,°�4"iY�`° l%�T?+��iA�'s�?:�'a1t?v�ln2 �,:(88YZe'; 7,;'1�111.ii;7tsr.�Tersas zean�icse+rzr..mcar*.uarwrc is Town ofBarnstable ,U,„STABM Regulatory , g atory Services 9 .. SS: Thomas ¢ 9. F. Geiler Dire s � ctor Public Health Division Thomas,McKean, Director. 200 Main Street, Hyannis, MA 02601 DATE: NUMBER OF PAGES TO FOLLOW: C — TO: FPO- �/ FROM: D /V�V /O(- 1 PHONE: PHONE: (508)862-4644 FAX PHONE: FAX PHONE: (508)790-6304 80 F— MORE NOTES/COMMENTS: C 0 p C QAFax Form.aoc. Citizen Web Request Page 2 of 2 http://issgl/intemalwrs/VVRequestPrintPub.aspx?ID=24185 2/3/2009 Drop-off locations and times Drop-off locations and times Bring your full sharps containers. You will Bring your full sharps containers.You will receive a new sharps container in return. receive a new sharps container in return. THINK Barnstable. Harwich Transfer Station C-O-M-M Fire Headquarters 209 Queen Anne Road 1875 Falmouth Road, Centerville 8-4 every day 508-430-7558 9-3 Mon-Fri 508-790-2375 ` Mashpee Department of Public Works Cotuit Fire Department 350 Meetinghouse Road 64 High Street 7:30-3:30 Mon-Fri 508-539-1420 DISPOSAL 8:30-4:30 every day 508-428-2210 Orleans Fire Department West Barnstable Fire Department 58 Eldredge Park Way 2160 Meetinghouse Way 8-4 Mon-Fri call first 508-255-0050 24 hrs every day 508-362-3241 Provincetown Fire Department A. GUIDE T O SAFE Bourne Fire and Rescue 25 Shank Painter Road 130 Main Street, Buzzards Bay 24 hrs every day call first 508-487-7023 DISPOSAL OF 24 hrs every day 508 759 4412 HOUSEHOLD SYRINGES Truro Transfer Station Brewster Fire .Department Truro Dump Road, off Route 6 AND LANCETS 1657 Main Street 7:30-3:30 every day 508-349-6339 A FREE PROGRAM FOR CONSUMERS ,8-4 Mon-Fri call first 508-896-7018 Wellfleet Fire Department Chatham Fire and Rescue 35 Lawrence Road 135 Depot Road 24 hrs every day 508-349-3754 8-6 every'day 508-945-2324 Yarmouth _ C Dennis Health Department 'Yarmouth Fire Department 465 Main Street, Dennisport 96 Old Main Street South Yarmouth 8:30-9:30 &3:30-4:30 Mon-Fri .508-760-6158 24 hrs every day 508 398-2212 a Eastham Fire Department Recycling & Residential Drop-off Area 2520 State Highway 606 Forest Road, South Yarmouth 8-4 Mon-Fri 508-255-2324 7:30-3:30 every day 508-760-4804 OF Un ' . BUrnsinEc Cou ly :ter a HA7ARDOL,S MATERIALS PROGRAM '• � Ir, waGo ar, wh the U. nrt lY o IAaxtatA DLO I.i n.On6M ' 800-319-2783� 508-375-6699 Cape Cod Cooperative Extension A collaboration of PO Box 367 Barnstable,MA 02630 Barnstable County, Cape Cod' owns www.capecodextension.org and Cape Cod Healthcare. MILLIONS OF PEOPLE USE SYRINGES WHAT YOU SHOULD DO DO NOT PUT SHARPS INTO AND LANCETS TO MANAGE THEIR BETWEEN DROP-OFFS CONTAINERS THAT CAN BE HEALTH-CARE AT HOME. THESE PUNCTURED OR BROKEN, SUCH AS: SYRINGES AND LANCETS ARE CALLED Put used syringes and lancets in a sharps HOUSEHOLD SHARPS. 0- SODA CANS container, or a puncture resistant rigid plastic container. Label the bottle: 10- COFFEE CANS r Contains Sharps. r GLASS JARS MILK CARTONS WHO USES SHARPS ON CAPE COD? KEEP SHARPS AWAY FROM JUICE CARTONS .,,w.,w Diabetes Patients CHILDREN AND PETS! 0- PLASTIC SODA BOTTLES Rheumatoid Arthritis Patients ✓ PUT USED SHARPS IMMEDIATELY r PLASTIC JUICE BOTTLES IN YOUR CONTAINER. Hemophiliacs y Wyk ✓ KEEP CONTAINER CLOSED Pet Owners :' BETWEEN USES. Farmers - ✓ BRING A CONTAINER WITH YOU ,re WHEN YOU TRAVEL. And others ' ✓ STORE CONTAINER IN A SAFE Children, teenagers, adults and seniors PLACE. all participate in home-health care z management of their illnesses. Those who use sharps MUST properly store and discard them after use. THE CENTERS FOR..DISEASE CONTROLS NATIONAL GOAL ::shall be that no syringes are discarded In"' the trash, or in public locations, such`as.parks, buildings or in the FOR INFORMATION: streets... WHAT YOU SHOULD NOT DO ON CAPE COD WE SHARE THIS GOAL TO: ♦ Call the Town Recycling Center,. ; BETWEEN DROP-OFFS Health or Fire Department in your . Protect childreri,and pets. town for details about drop-offs: f" k DO NOT FLUSH SHARPS DOWN e E Protect solid Wast6. d1SpOSa1 workers. THE TOILET. Cape Cod Cooperative Extension ® Prevent re-use or sharing of sharps 508-375-6690 X DO NOT DROP SHARPS INTO that Can transmit 1rifeCtlOUS diseases. STORM DRAINS. WWW.capecodextension.org Protect our environment. under "Environmental Programs" X DO NOT CLIP, BEND OR RECAP SHARPS. L•U CAT ION SEWAGE PERMIT• VILLAGE ,��,9/rS7o.vs /�7•//s I INSTA LLER'S NAME i I,ADDRESS BUILDER OR OWNER � /l0 i.AG�ov7� �P.�TPitvi//e DATE PERMIT ISSUED _a6_ 7k DAT E COMPLIANCE ISSUED F. �: `� .,, S i , . @� .. 01? I No................ .1' Fps..�� ............._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® 9F HEALTH ............ OF......f ... .-,--------------.......................................... ApplirFation for DiiivniiFal Workg Tnnitrnrtion ramit Application is hereby made for a Permit to Construct (/or Repair ( ) an Individual Sewage Disposal System ate . y. .�� .- 1 °T,���o y -------------- ...... .. .. •--ocation- ..� ... .._..= ........... r --..o.. =- � d y7� W Owne ; ......... r _ ____-_•-•............. `!._ _�' ..A Install Address ype of Building Size Lot.... feet feet Dwelling No. of Bedrooms---__. _________________________________Expansion Attic � Garbage Grinder (� Other—T e of BuildingNo. of persons............................ Showers — Cafeteria a Other fixtures ---------------------------••-•• - W Design Flow........... ......................gallons per person per day. Total daily flow--------3-2-P-_........................gallons. WSeptic Tank—Liquid*capacity/Magallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet�- _ Total leaching area..................sq. ft. Other Distribution box ( ) Dosing to Z Percolation Test Results Performed b ---------------------------------------- Date-----S.'_ _li'_-7�.'---. Test Pit No. 1...,�? "minutes per inch epth of Test Pit____________________ Depth to ground water........................ w Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil--•--- � 0...�.z -•- y----a-- --•-- U -------------Id-------I A ....(.: en ..... •-•------------------•--------------------------------------...-------..._._....._..---...-------- ---•-----------------------------------------------------------------------------------•----------------------------------------------------------------------------------------------------•----_------ U Nature of Repairs or Alterations—Answer when applicable.......�C--1�Q-------------------------------------------------------------------- --•••-•-•-••-••---••••-•-•••••---•---•-•---••---•••-•-••••-•--•••-••••=-••-••--••-•-••-••-------------•-•••-•--•------•-••------•••-•-•-•--•-••--•-•••-••--------•-•-•-••--•-•-•--•--••..._......-••••-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI:'E 5 of the State Sanitary Code—The undersigned further agrees t to place the system in operation until a Certificate of Compliance has been issued by the board ,of he t Signe - ---•• ......... . .....l7'x._.. ....---------- ------• ----••-• Application Approved BY----- _�-�•---- ---- ... .. - --.....1/G-`• ............. ` -� -�� Date Application Disapproved for the following reasons:----••••---------• ------------------------------------------•-------------------------..._.-- -----------------•--•-••----••---•------.....-.------•--•---•---------...--••----•---.........--..........--•-•------------------•----•--------•------------------------••...••-•--- ••--•-•------- Date PermitNo......................................................... Issued....................................................... Date No................. FEic...!;.St ............ THE COMMONWEALTH OF MASSACHUSETTS ..... , BOARD OF HEALTH ...................................................... Appliraft'O' n for Uhiputial Works Tow3uurtion Vamit Application isikhereby made fof a Permit to Construct or Repair an Individual Sewage Disposal System at: ............ z ................ . ....4. ........................ .... � tion C , 0,t:P 4d 44�----------......_..... .... .!,.................... ......... 0..... ... W.......... ............. ...�7 (owner Ad s............. . .... ...... ... ..................... 4--V Install Address ype of Building S e of Build* 00' Size Lot....A../ 16q. feet U "', Garbage Grinder Dwelling PNoo.' of Bedrooms--`., ...............................:Expansion Attic (ej?),6 a Other—Type of Building------------------------ ..... No. of persons..........._.._._._...._.__. Showers Cafeteria Other fixture's -----------------------------------------------------*--------------------------------- -------------------------------------------------------- Design Flow..............srs-11.................. g'11lons per person per day. Total daily flow--------3 2.0........................gallons. 1:4 Septic Tank—Liquid capacity/M.0galions Length................ Width..............._ Diameter-----___---_---- Depth....._......._.. Disposal Trench—No. .................... Width.................... Total Length.................._. Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.._--___-__-.--__--- Depth below inlet... .__. al leaching area........... Other Distribution box Dosing a .......sq. f t. Percolation Test Results Per-formed by.._...... . ......................................... Date..... as Test Pit No. I.../ _--minutes per inch )epth of Test Pit.................... Depth to ground water.._................_.__. Test Pit No. 2................minutes per inch Depth of Test Pit...__..........._... Depth to ground water....:................... ................. ........................ ............................ ........ Description of Soil-------*,. . . .... .....0........... 0 4i.-i T -------------------- ........................... U ...../V......X_t... ...... ... .............................................................................................. .......................................................... .......................................................... .............................................................................. U Nature of Repairs or Alterations—Answer when applicable_......45k4. ................................................................... ................................................. .................................................................................................. ................... .............................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage I?isposal System in accordance with the provisions of T I T LE 5 of the State Sanitary Code'—The undersigned further agrees n to place the system in operation until a Certificate of Compliance has been issued by the board of li S* ------ igne ........ .... ......... ........... .. ........ .......... Application Approved By---- ....... ...... .... ... . ................ Date Application Disapproved for the following reasons:.................... ......................... ..........1z.7-1----------------------------------------------- ................................................................................................................ ............................................................................... Date PermitNo........................................................ Issued................------......--------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O7'>IEALTH ........................................ ..V.. ...........OF........... ...... ...................... Prfifiratr of Toutphaurr' T S IS C FY, That the Individual Sewage Disposal System constructed �/— or Repaired .... ....... ... ............. ....... .................... b ..... -------4"'A" y ........... ------- at...!n-. .. ..........#.00 ---------- has been installed in accordance with t e provisions ofj 5 of The State unitary y C.0 as described in the application for Disposal Works Construction Permit ...... ..... A-1.......... dated....... ----- THE ISSUANCE OF THIS CERTIFICATE SHA NOT,BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FYNCTION !&*TISFACTORY �- DATE........ 10..........1..................................................:. Inspector....._..:..' ...... ...............................THE COMMONWEALTH OF MASSACHUSETTS 4�R7G l BOARD ff HEALTH ....4Z .........OF....----- . . . .. ................................................. No .... FEE... Permissione granted.... ......... ............ .... .... .............. ...... .... .................. ..... .......................... idu Sewage., isp fit to Construct epair ( ) I Di y . 44Z.&V .... -at No...".....,. . . ..... - -- --------- . Permission y e . .0k�o Street as shown on the application for Disposal Works Construction Permit at IN, .................... Board of.He Ith DATE.......Ij.—. ............................................................ FORM 1255, HOBBS & WARREN. INC.. PUBLISHERS + f• � LL tT i 1e �S/�� X�1� Af'_r r j.,�P�,� .. ¢ ' __.,�.,.-„ t „" r .. E' •• / ¢ 4 • x`�y � k°ii 4.. 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