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HomeMy WebLinkAbout1287 OLD POST ROAD (CT & MM) - Health 1287 Old Post Road, Marstons Mills _- --- - - - -��_ - - - - ---� A= f 1 l'_ Nil. �01 '-®36v Fee THE COMMONWEALTH OF MASSACHUSETTS Entered;n computer: c PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9ppliCAtion for BisposaY *pstpm Construction Permit jjq_,3g2--10 � Application for a Permit to Construct(. Repair Upgrade( ) Abandon( ) El Complete System Individual Components Location Address or Lot No. 12 � wner s Name,Address,and Tel.No. Assessor's Map/Parcel r 1,ck rA Wej!h Installer's Name,Address,and Tel.No. Designer's Name,Address,and Yel.No. Type of Building: Dwelling No.of Bedrooms d Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature,of Repairs or Alterations(Answer when applicable) Yc G 1 Date.last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of th E vironmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar of alth. Si ed Date t Applcation Approved by Date Application Disapproved by Date for the following reasons Permit No. l "® 3 Date Issued - -------------------------------------.._ --------------- No. C�"019-ay Fee ©a 'f i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye / PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS a � 01pplication for MispoBal 6pstetn Construction Permit -7 jq_,3 U_ Application for a Permit to Construct( ) Repair(>� Upgrade( ) Abandon( ) ❑Complete System ndividual Component Rg Location Address or Lot No. I '� OPoSt V 16W s Name,Address,and Tel.No. Assessor's Map/Parcel 6e yk P Installer's Name,Address,and Tel.No. esigner's Name,Address,.and lel.No. type of Building: coo 9 Dwelling No.of Bedrooms ? � Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) I ' Dzte last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar Hof ;ealth. Si a Date Application Approved by Date D Application Disapproved by L Date for the following reasons ti Permit No. gLol —� , Date Issued --------------------------------------------------------------------------------------------------------------------------------------- ` THE COMMONWEALTH OF MASSACHUSETTS e�_ta�`� BARNSTABLE,MASSACHUSETTS (certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed Repaired(X) Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. C 3 ated Installer 0, 1 )C(al j Designer LA v #bedrooms c' Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the syste will a is as esigne . Date �j Inspector --------•------------------------------------------------------------------------------------------------------------------------------ No. _ f l (� Fee 00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACRIVAt'-f z }' � disposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair(X) Ypgrade( ) Abandon( ) System located at y and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be co 'pleted within three years of the date of this permit. Date / 3 Approved b} TOWN OF BARNSTAi3LE LOCATION 114'D SEWAGE # VILLAGE S ASSESSOR'S MAP& LOT 05-4- 0.S"3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ,�O o® A T (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by SRO yr o 3 - y 9 oFTHE fOk Town of-Barnstable ;ryy U.S.POSTAGE>>PITNEY BOWES 1 Public Health Division 4 ' a"""sT"s`E' ' 200 Main Street (, � Hyannis,MA 02601 ;' 0ZIP 2 0260$ 006.56° 7015 1730 0001 4990 3721 I . 0000336455AUG. 16. 2017. V LAVERTY, BERNARD J JR xaQTtE- 1287 OLD POST ROAD MARSTONS MIT—._1 114-A-n')<ea_ - Z"YURNEJ— ETUk"N '70 SENDE'.R L9 N s'B I.E. TO F ORW A R D r;�� - .-.3's [T �� ...-... w�.`y .- SINw. ..�.�4..-., • •• •, • • ". j I ■ Complete item A. Signature s 1,2,and 3. ❑Agent 1 ■ Print your name and address on the reverse X ❑Addressee. l so that we can return the card to you, g .Received by(Printed Name) C. Date of Delivery I$ Attach this card to the back of the mailpiece, I or on the front if space permits. 11. Article Addressed to: D. Is delivery address different from item 1'? CJ Yes If YES,enter delivery address below: p No I 4 T pDC.6-RDA& I bars-ID�s lY��lls, h'IA-�a��� 3. Service.Type O Priority Mail Express®- , 11111110118111�1111111111111111111IIIilllillll Adult Signature TYPe ❑Registered MWIT"' ❑Adult signature Restricted Delivery O.Re,V�d Mail Restricted / rti W Mail® �}pe��um Receipt,for I 9590 9402 1934 6123 0975 17 o Certified MmZ Restricted Deliaery !—Merchandise I ❑Collect on Defvery Restricted Delivery Signature confirmation'" F2.-Article Number_YTrdnsfer f[oin 61-lce_Iahofl nail ❑Signature Confirmation 7 015 17 3 0 0 0 01 4990 3 7 21 gall Restricted Delivery Restricted Deliv , Domestic Return Receipt ry, j I PS Form 3811,July 201.5 PSN 7530-02-000-9053 i �sKE r Town of Barnstable Barnstable ok ti Regulatory Services Department AMmeicacftr RAMSTAHM "& Public Health Division FDA 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4990 3721 August 16, 2017 LAVERTY, BERNARD J JR 1287 OLD POST RD MARSTONS MILLS, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 1287 Old Post Road, Marstons Mills,MA was inspected on 07/21/2017 by James D. Sears, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Distribution box and H10 septic tank will need to be replaced with H2O. You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF E BOARD OF HEALTH omas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\1287 0ld Post Road Marstons Mills.doc COMMONWEALTH OF MASSACHUSETTS I� EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION NITER STREET. BOSTON. �tA 0_108 6 11-292-5500 1 O. E ~ Al � �T'�I,DY COXE a'ILLIAM F.VELD �� �l/ Secretar. Govemar 350 MAIN STREET WEST YARMOUTH, MA , � °- , O DAVIDeB,STRUHS ARGEO PAUL CELLUCCI Lt.Govcmor onmissioncr�99� 4SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO. RM PART A CERTIFICATION 8 MAP 056-PAR 053 PROPERTY ADDRESS: 1287 Old Post Road, Marstons Mills ADDRESS OF OWNER: DATE OF INSPECTION: February 12, 1998 Pinkofski NAME OF INSPECTOR : James D. Sears I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.000) COMPANY NAME: A&B Canco MAILING ADDRESS: 350 Main Street, West Yarmouth, MA 02673 TELEPHONE NUMBER: (508)775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X PASSES CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS INSPECTORS SIGNATURE: DATE: February 17, 1998 The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B SYSTEM CONDITIONALLY PASSES: N/A 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 b the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or NO). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached) indicating that the tank was installed within twenty(20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank is failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. Page 1 of 10 (revised 04/25/97) DEP on the World Wide Web:http://www.magnet.state.ma.un/d SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (CONTINUED) Property Address: 1287 Old Post Road, Marstons Mills Owner: Pinkofski Date of Inspection: February 12, 1998 B] SYSTEM CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS)and the SAS 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 the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1287 Old Post Road, Marstons Mills Owner: Pinkofski Date of Inspection: February 12, 1998 D] SYSTEM FAILS: You must indicate either"Yes" or"No" as to each of the following: N/A I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303.The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an over- loaded 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 '/z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s) Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: You must indicate either"Yes" or"No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: N/A The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 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 compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1287 Old Post Road, Marstons Mills Owner: Pinkofski Date of Inspection: February 12, 1998 Check if the following have been done: You must indicate either"Yes" or"No" as to each of the following: Yes No X Pumping information was provided by the owner, occupant, or Board of Health. X None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. N/A As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components, including the Soil Absorption System, have been located on the site. X The 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 determined based on: X The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. X Existing information. Ex. Plan at B.O.H. X Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable)[15.302(3)(b)] (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1287 Old Post Road, Marstons Mills Owner: Pinkofski Date of Inspection: February 12 1998 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 g.p.d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: YES Garbage grinder(yes or no): YE S Laundry connected to system (yes or no): NO Seasonal use(yes or no) NO Water meter readings, if available(last two(2)year usage(gpd): 1995-96 9,000/1996-97 7,000 Sump Pump(yes or no): NO COMMERCIAL/INDUSTRIAL: 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, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: N/A System pumped as part of inspection:(yes or no) NO If yes, volume pumped: gallons Reason for pumping TYPE OF SYSTEM X 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known)and source of information: AGE UNKNOWN AROUND 1980 Sewage odors detected when arriving at the site: (yes or no) NO (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1287 Old Post Road, Marstons Mills Owner: Pinkofski Date of Inspection: February 12, 1998 BUILDING SEWER: N/A (Locate on site plan) Depth below grade: Material of construction cast iron 40 PVC other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: X (Locate on site plan) Depth below grade: 12" Material of construction X concrete metal Fiberglass Polyethylene other(explain) i If tank is metal, list age Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: 1,500 GALLON PRE CAST Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 25" Scum thickness: 0 Distance from top of scum to top of outlet tee or baffle: 14" Distance from bottom of scum to bottom of outlet tee or baffle: 18" How dimensions were determined TAPE 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.) TANK AT WORKING LEVEL, OUTLET BAFFLE, TANK AND COVERS 12" BELOW GRADE. GREASE TRAP: N/A (locate on site plan) Depth below grade: 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: 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.) (revised 04/25/97) I Page 6 of 10 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1287 Old Post Road, Marstons Mills Owner: Pinkofski Date of Inspection: February 12, 1998 TIGHT OR HOLDING TANK: N/A (Tank must be pumped prior to, or at time, of inspection) (Locate on site plan) Depth below grade: Material of construction concrete metal Fiberglass Polyethylene other(explain) Dimensions: Capacity: Design flow: gallons/day Alarm level: Alarm in working order _ Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert: 0 Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc,) D-BOX IS 16"X21", BOX IS 18" BELOW GRADE, BOX IS LEVEL AND SOLID, ONE LINE IN, ONE LINE OUT, NO EVIDENCE OF SOLID CARRY OVER. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1287 Old Post Road, Marstons Mills Owner: Pinkofski Date of Inspection: February 12, 1998 SOIL ABSORPTION SYSTEM (SAS): X (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, alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 1.,000 GALLON PRE CAST, PIT IS DRY, WALLS ARE CLEAN, LIKE NEW. PIT AND COVER T BELOW GRADE. CESSPOOLS: N/A (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(cesspool must be pumped as part of inspection) Comments:: (note condition of soil, signs of hydraulic failure, , level of ponding, condition of vegetation, etc.) PRIVY: N/A (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.) (revised 04/25/97) Page 8 of 10 o SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1287 Old Post Road, Marstons Mills Owner: Pinkofski Date of Inspection: February 12, 1998 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100(locate where public water supply comes into house) FRa Al h 3 0 yS_�+ 01 y9 O (revised 04/25/97) Page 9 of 10 • 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1287 Old Post Road, Marstons Mills Owner: Pinkofski Date of Inspection: February 12, 1998 Depth to no groundwater 12 feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained fro Design Plans on record X Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) NOTE: HAND DUG TEST HOLE, NO WATER FOUND AT 12'TEST HOLE 3' BELOW BOTTOM OF PIT. (revised 04/25/97) Page 10 of 10 l- ti .. m C3 Q' Certified Mail FeeEr zr F-xtra Services&Fees(check box,add fee as appropriate) `t7� rVim, rl ❑Return Receipt(hardcopy) $ C•" Q. r ❑Return Receipt(electronic) $ Postmark {— O ❑Certified Mail Restricted Delivery $ _ Z Here C3 ❑Adult Signature Required $ ❑Adult Signature Restricted Delivery$ O Postage _ - frl $ �260'v- rqTotal Postage and Fees Ln Sent To rq C --------- -- --- r. -.. °'�I�Q�f -- 1---- - ------- `` crud +4lG�S,�1.S / Gbtld�$ Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this- delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipients retail associate. s signature)that is retained by the Postal Service' Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders. Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not '+ First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age international mail. and provides delivery to the addressee specified I r Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent 7 with Certified Mail service.However,the purchase (not available at retail). C+ of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark.If you would like a postmark on"" ■For an additional fee,and with a proper this Certified Mail receipt,please present your —1 endorsement on the mailpiece,you may request Certified Mail item at a Post Office'"for '-, the following Arvices: postmarking.If you don't need a postmark on this Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion.t' of delivery(including the recipient's signature). otthis label,affix it to the mailpiece,apply i-- You can request a hardcopy return receipt or an 1,`appropriate postage,and deposifthe mailpiece.f t electronic version.For a hardcopy return receipt, r� _ complete PS Form 3811,Domestic Retum' 1' Receipt attach PS Form 3811 to your mailpiece; IMPORTANR Save this receipt for your records. i Ps Form 38OO,Apri=5(Reverse)PSN 753o-o2-000.9047' ' ' f VKME Town of Barnstable Barnstable ti : Re ulatorY Services DepartmentA14 'caCft BA:RNSABM 1 1 . 039. Public Health Division m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4990 3721 August 16, 2017 LAVERTY, BERNARD J JR 1287 OLD POST RD MARSTONS MILLS, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 1287 Old Post Road, Marstons Mills, MA was inspected on 07/21/2017 by James D. Sears, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Distribution box and H10 septic tank will need to be replaced with H2O. You are ordered to repair or replace the septic system within two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF E BOARD OF HEALTH omas McKean, R.S., CH0 Agent of the Board of Health f Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\1287 Old Post Road Marstons Mills.doc f Town of Barnstable - 6¢ Regulatory Services Department °lEa raxt�' Public Health Division 200 Main Street,Hyannis MA•02601 Office: 508-862-4644 Richard Scab,Director FAX: 508-790-6304 Thomas A McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES T.O'REPAIR FAILED-SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) _ An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground w . ❑Pumping more than 4 times during the last year not due to clogged or obstructed Pipe = ❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA q m e esspoo - �(Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to.H-10 components, etc) o Leaching pit or cesspool with high liquid level, <12"below inlet (per Town Code §360-9.1) ❑Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER "O� Repair deadline: Q:ISEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc f Jul 30 2017 2033 HP Fax page 18 � C73 Commonwealth of Massachusetts Title 5 Official Inspection Form P� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1287 Old Post Road Property Address Vincent Dimanto Owner Owner's Name / �y Information is arson MillsV MA 02648 7-21-17 required for every M page. Cityrrown State Zip Code Date of Inspection - Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When61aut forms A. General Information olntng the computer, �����N,,iH Of I MA►�������i use only the tab 1. Inspector: key to move your 2 ti cursor do not ,James D.Sears =� ,LAMESuse M ke the return Name of Inspector :y Y Capewide Enterprises ,a Q Company Name 153 Commercial Street Company Address Mashpee MA 02649 CitylTown State Zip Code 508-477-8877 S1623 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 16.000).The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority LOA4.,O-, . 7-21-17 -149 pector'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. t3(ns.doc•rev,fi/16 Title 5 Oifidal Inspection Form:Subsurface Sewage Disposal System-Pape 1 of 17 I �o VS Jul 30 ;2017 20:34 HP Fax page 19 Commonwealth of Massachusetts WTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1287 Old Post Road Property Address Vincent Dimanto Owner Owner's Name information is required for every Marston Mills MA 02648 7.21-17 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15,304 exist. Any failure criteria not evaluated are indicated below. Comments: Conn pass H-10 Tank in drive way- D Box.The system is a 1500 Gal. Tank D Box and pit. 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): Septic Tank H- 10 in Drive way. Need to replace tank w/H-20. t6ins.doc-rev.6116 Title 5 Official mpecton Forth:Subsurface Sewage Disposal System-Pape 2 of 17 i f Jul 30 2017 2034 HP Fax page 20 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °f 1287 Old Post Road Property Address Vincent Dimanto Owner Owner's Name information is required for every Marston Mills MA 02648 7-21-17 page. Cityrrown 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): Need to replace D Box. ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 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 151ns.doc•rev.8116 Title 5 Official Inspection Form:Subsufa:e Sewage Disposal Systar•Page 3 of 17 Jul 30 2017 20:35 HP Fax page 21 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1287 Old Post Road Property Address Vincent Dimanto Owner Owner's Name information is required for every Marston Mills MA 02648 7-21-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fall 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 ill!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 ink is less than 6" below invert or available volume is less than '/day flow Pt'r' t5lns.0oc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Jul 30 2017 20,35 HP Fax page 22 e,\ Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1287 Old Post Road Property Address Vincent Dimanto Owner Owner's Name information is Marston Mills MA 02648 7-21-17 required for every Pap. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal collform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 MR 15.304. The system owner should contact the appropriate regional office of the Department. Pa t5lns.doc•rev.6116 Title 5 Offidal Inspection Form.Subsurface Sewage Dlsposel System• 9e 5 0f 17 Jul 30 12017 20:35 HP Fax page 23 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments " 1287 Old Post Road Property Address Vincent Dimanto Owner Owner's Name requiredion Marston Mills MA 02648 7-21-17 required}orevery page. City/Town State Zip Code pate 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 NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the 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): NA Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins,doc-rev.6116 Title 5 Offdel Inspection Form:Subsurface Sewage Disposal System-Page 6 o1 17 f Jul 30 2017 20:36 HP Fax page 24 Commonwealth of Massachusetts Title 5 Official Inspection Form F C Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1287 Old Post Road Property Address Vincent Dimanto Owner Owner's Name information is every Marston Millsrequired for eve MA 02648 7-21-17 page. CityfTDwn State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal. Tank D Box and pit Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2015-25,000Gais Detail; 2016-33,000Gal's Sump pump? ❑ Yes ® No Last date of occupancy: NA Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.N,, 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: tsins.doo•rev.&16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Pape 7 of 17 Jul 30 2017 20:36 HP Fax page 25 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 1287 Old Post Road Property Address Vincent Dimanto Owner Owner's Name information is required for every Marston Mills MA 02648 7-21-17 page. Cityfrown State Zip Code Date of Inspedlon D. System Information (cont.) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: Source of information: NA 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) ❑ InnovativelAl tern ative 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 IfA system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5lna.doc-rev.6116 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 8 of 17 I Jul 30 2017 2037 HP Fax page 26 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments F 1287 Old Post Road Property Address Vincent Dimanto Owner Owner's Name information is required for every Marston Mills MA 02648 7-21-17 page. Clty(Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Around 1980 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 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.): Pipeing is 4"PVC SCH-40. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ®concrete ❑metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast H-10 Sludge depth: 3° t8ins.doc•rev 6118 Tlse 5 Official Irspection Form Subsurface Sewage Disposal System-page got 17 I Jul 30 2017 2037 HP Fax page 27 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1287 Old Post Road Property Address Vincent Dimanto Owner Owners Name -- requrired for every ration is Marston Mills MA 02648 7-21-17 requi page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 17 How were dimensions determined? Asbuilt-Tape- Past Report 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,): Tank at working level. H-10 Tank in drive way. Need to replace tank w/H-20. 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 15ins.doc -ev.6116 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Pape 10 of 17 f Jul 30 2017 2037 HP Fax page 28 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1287 Old Post Road Property Address Vincent Dimanto Owner Owner's Name information is required for every Marston Mills MA 02648 7-21-17 page. Cityrrown 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 level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doo•rev,6/16 Title 5 Official Inspection Form SuDsunlace Sewage Disposal System Pape 11 or 17 Jul 30 2017 20:37 HP Fax page 29 Commonwealth of Massachusetts I , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1287 Old Post Road Property Address Vincent Dimanto Owner Owner's Name information is required,for every Marston Mills MA 02648 7-21-17 per. Cltyr town State Zip Code Date of Inspection D. System Information (cunt.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x 21"-18" Below grade on edge of drive way.Wall's are gone on box. Need to replace box w1H-20. Pump Chaimber(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' 15ins.doc-rev.6116 Title 5 Official Inspeclon Form:Subsurface Sewage Disposal System•Page 12 of 17 Jul 30 2017 2038 HP Fax page 30 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `f 1287 Old Post Road Property Address Vincent Dimanto Owner Owners Name information is requiredevery Marston Mills for eve MA 02648 7-21-17 page. CltyrTown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ inn ovativelaltemative system Typeiname of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is a 1000 Gal. precast pit. Pit and cover at 3' below grade. 6"water in pit w/stain line at 6" above water level. 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•toy.6116 Title 5 Official Inspect on Form;Subsurface Sewage Dlsposel system•Page 13 of 17 Jul 30 2017 20:38 HP Fax page 31 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1287 Old Post Road Property Address Vincent Dimanto Owner Owner's Name information is required for every Marston Mills MA 02648 7-21-17 page. CitylTown 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.): t5 ns.doc•rev.6110 Title 5 Official Inspection Form:Svbswrace Sewage Disposal System•Page 14 of 17 Jul 30 2017 20:38 HP Fax page 32 N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '( 1287 Old Poat Road Property Address Vincent Dimanto Owner Owner's Name information is Marston Mills required for every MA 02648 7-21-17 page. Citylrown 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 8 11peA L 0 0 13- 3 15ins.doc-rev.6116 Title 6 Official Inspection Form:Subsurface Sewage Disposal Systerr Pape 15 of 17 Jul 30 2017 20:39 HP Fax page 33 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1287 Old Post Road Property Address Vincent Dimanto Owner Owner's Name information is required for every Marston Mills MA 02648 7-21-17 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Na Estimated depth t high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting propertylobservation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Past report on file. ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Past report on file 2-17-98 - Hand Auger T.H. 12'+ no G.W.. Bottom of pit at 9'below grade. Bottom of pit at 3'above T.H. Depth. 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 Disoosel System-Page 16 of 17 Jul 3C 2017 20:39 HP Fax page 34 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments z 1287 Old Post Road Property Address Vincent Dimanto Owner Owner's Name information is Marston Mills required for eve MA 02648 7-21-17 page. Citylrown 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 t5ine,doc•rev.6✓16 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 17 of 17