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HomeMy WebLinkAbout0071 STONEY POND CIRCLE - Health 71 STONEY POND CIRCLE MARSTONS MILLS A=065-024 Town of Barnstable Inspectional Services + BARNSTABLB. 3 9 �0� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 1715 June 10, 2020 OROURKE, ROBERT F & PATRICIA A 71 STONEY POND CIRCLE MARSTONS MILLS, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 71 Stoney Pond Circle,Marstons Mills, MA was inspected on 05/19/2020 by Chad Hathaway, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • The distribution box is rotted. You are ordered to replace the distribution box within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\71 Stoney Pond Circle Marstons Mills.doc �zwe ram, Town of Barnstable , ' ,�� Inspectional Services Department AjfA�,�A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool o Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) "0' L4e) d-4ox Repair deadline: t/ a f Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form f , Subsurface Sewage Disposal System Form- Not for Voluntary Assessments r 71 Stoney Pond Circle Property Address c, ORourke Owner Owner's Name information is `? required for every Marstons Mills Ma 5/19/2020 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information filling out forms 3 on the computer, use only the tab Chad hathaway key to move your Name of Inspector cursor-do not Hathaway Septic Inspections use the return Company Name key. � Company Address Forestdale Ma 02644 City/Town State Zip Code 774 274 2581 12866 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ® Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 5/19/2020 In ector's Sign a Date The system inspector shall mit a c py of this inspection report to the Approving Authority(Board of Health or DEP)within days ompleting this inspection. If the system has a design flow of 10,000 gpd or greater, the i ector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 71 Stoney Pond Circle Property Address ORourke Owner Owner's Name information is required for every Marstons Mills Ma 5/19/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This inspection is not a guaranteeand applies no warrantyof the described septic components in this report including but not limited to piping structual intergrity of components and life exspectancy of leaching and described components. This inspection is to describe conditions witnessed at time of inspection only. Regular tank maintenance and water conservation can prolong life of septic systems Information on care and do's and don't's can be found at town health dept or mass.gov 2) System Conditionally Passes: ® One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 71 Stoney Pond Circle Property Address ORourke Owner Owner's Name information is required for every Marstons Mills Ma 5/19/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ® distribution box is leveled or replaced ® Y ❑ N ❑ ND (Explain below): Dbox is rotted out and dirt is flowing into 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): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. - a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 71 Stoney Pond Circle Property Address ORourke Owner Owner's Name information is required for every Marstons Mills Ma 5/19/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 71 Stoney Pond Circle Property Address ORourke Owner Owner's Name information is required for every Marstons Mills Ma 5/19/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® 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 clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone 11 of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 c � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Stoney Pond Circle Property Address ORourke Owner Owner's Name information is required for every Marstons Mills Ma 5/19/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El available 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 cam, Commonwealth of Massachusetts !n ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 71 Stoney Pond Circle Property Address ORourke Owner Owner's Name information is required for every Marstons Mills Ma 5/19/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 permited Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 71 Stoney Pond Circle Property Address ORourke Owner Owner's Name information is required for every Marstons Mills Ma 5/19/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments u � 71 Stoney Pond Circle Property Address ORourke Owner Owner's Name information is required for every Marstons Mills Ma 5/19/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 1994 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer,(locate on site plan): Depth below grade: 1.75' feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): no signs of poor venting or leaks t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts �d Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 71 Stoney Pond Circle Property Address ORourke Owner Owner's Name information is required for every Marstons Mills Ma 5/19/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1500 gal H10 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'6"5'6" Sludge depth: 10" Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 6" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 12 How were dimensions determined? tape and 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.): tees in place tank at working level. recommend pumping tank over due for maintenance t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w � 71 Stoney Pond Circle Property Address ORourke Owner Owner's Name information is required for every Marstons Mills Ma 5/19/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 71 Stoney Pond Circle Property Address ORourke Owner Owner's Name information is required for every Marstons Mills Ma 5/19/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Dbox is rotted out and needs replacement l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts gp Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Stoney Pond Circle Property Address ORourke Owner Owner's Name information is required for every Marstons Mills Ma 5/19/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 71 Stoney Pond Circle Property Address ORourke Owner Owner's Name information is required for every Marstons Mills Ma 5/19/2020 page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 6'x6' precast pit camera inspected . water level 1.5' below invert 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 cam, Commonwealth of Massachusetts f p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Stoney Pond Circle Property Address ORourke Owner Owner's Name information is required for every Marstons Mills Ma 5/19/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 71 Stoney Pond Circle Property Address ORourke Owner Owner's Name information is required for every Marstons Mills Ma 5/19/2020 - page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 6 J - gD-- 3 S- Kl � 0 0 5 p v Q a t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Stoney Pond Circle Property Address ORourke Owner Owner's Name information is required for every Marstons Mills Ma 5/19/2020 page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) . 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 30'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: town GIS mapping You must describe how you established the high ground water elevation: lot el. 80' low in area (little pond)el. 50 t Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 ` a c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 71 Stoney Pond Circle Property Address ORourke Owner Owner's Name information is required for every Marstons Mills Ma 5/19/2020 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 No. / Fee ?L� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZippliLation for Disposal Opstem ConstCUttlon 3dErmit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location A d Lot Nol/ fj' euvt e W/ wner's Name,Address,and Tel.No. As o ap cel Installer's Name,Address,and Tel.No _?C V g S Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank l ��y Type of S.A.S. ��j Description of Soil Nature of Repairs or Alterations(Answer when applicable) Ke Date last inspected: 2 v O 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 syste eration until a Certificate of Compliance has been issued by this Board of Health. / P Sig Date v— o l�D Application Approved by - Date �® Application Disapproved by Date for the following reasons Permit No. Date Issued ��—l� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1.r�^ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppIitation for Misposar *pstem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components r Location Add s$I Lot No7/ Sf co?4� �,n C;ye'l @Dwwn�er's Name,Address,and Tel.No. Asse ors ap cel 65 "� /�' or✓ '� A�fc�� t✓ /rT Installer's Name,Address,and Tel.No.3�09.:C�l 4 Designer's Name,Address,and Tel.No. PIP/ V' Y'Q SPi•��--� .a.11 Type of Building: ` Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures i Design Flow(min.required) a gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title �c Size of Septic Tank J -U� Type of S.A.S. �, ' t Description of Soil ? s Nature of Repairs or Alterations(Answer when applicable) C fae 'C_ -� 9 Date last inspected: ��t -Z O Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described otprsite sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the peration until a Certificate of Compliance has been issued by this Board of Health. (ter Si d Date �20 Application Approved by Date � C Application Disapproved by < Date 4 N� for the following reasons Permit No. ��� � Date Issued C~"} THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS - Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sew aje,,Dis'posal system Constructed( ) Repaired( 9XUpgraded( ) Abandoned( )by C)1, 3 y-J Y�-o � -�"' ",,- r A, d ,L, at�r S+0 n e r rD Ate' e has been constructed in accordance with the prod ions of Title 5 and the f isposal System Construction Permit No y /7'Qated n (S Installera�P L+ -P�� -� "s'a Designer 3#bedrooms Approved desigriflowA gpd The issuance oft is Permit shall not be construed as a guarantee that the system wi)ll functio" as designecd/. Date 1, o2 0 Inspector -- / No." "" ? J Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS ' � J �is�losaY �pstem OnstCUttion �ermit ; Permission is hereby granted to Construct( ) Repair( - Upgrade( ) Abandon( ) System located at !21 wf���✓L�'C 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 e c {nplete/d within three years of the date of this perm Date 6 1 Approved by C) E� Ln •. • � r N OFFICIAL 43 Certified Mail Fee iTj $ Extra Services&Fees(check box;add fee as appropdate) rq ❑Return Receipt(hardcopy) $ ❑Return Receipt(electronic) $ POStRIa []Certified Mail Restricted Delivery $ Here ❑Adult Signature Required $. -- ❑Adult Signature Restricted Delivery$ / m - r` ' TROUT, ROBERT&A N MARIE a 75 STONEY POND CIRCLE MARSTONS MILLS, MA 02648 I i 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. LISPS(ID-postmarked Certified Mail receipt to the_ ■A record of delivery Qncluding the recipients retail associate. signature)that is retained by the Postal Service— Restricted delivery service,which provides C a 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 t ■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 notavailabie for requires the signee to be at least 21 years of age. International mail. and provides delivery to the addressee specifie ■Insurance_coverage is notavallable for purchase by name,or to the addressee's authorized age' with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is Insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark.If you would like a postmark on I' 1 ■For an additional fee,and with a proper this Certified Mail receipt,please present your -11 endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarking.If you don't need a postmark on this Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery Qncluding the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. - electronic version.For hardcopy return receipt, d complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece; IMPORTAN11 Save this receipt for your records. Ps Form 3800,April.2015(Reverse)PSN 7530-02-000.9047 - SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS ON DELIVERY ■ Complete items 1,2,and 3. A. Signature ■ Print your name and address on the reverse X 0 ent so that we can return the card to you. Vj7ddressee ■ Attach this card to the back of the mailpiece, B. Received by( ame) C.D e of Delivery or on the front if space permits. �}h►-7 Yes;ess different from item 1? .livery address below: ❑No VROUT'ROBERT&ANN MRIE i _= 75 STONEY POND CIRCLE i � � j e� iU AMARSTONS MILLS, MA 02648 i II I�III�I(�I)I�I I IIII II II I I I I�I II IIII II I I I u �clnco ,yp'�'� ❑Priority Mail Express Adult Signature ❑Registered ® ❑ Registered Mail*^^ ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted ❑Certified Mall® Delivery 9590 9402 5745 0003 5532 43 ❑certified Mail Restricted Delivery ❑Return Receipt for ❑Collect on Delivery Merchandise 2. I Icicle Number fTransfersrnm tea" r-gin-- —- - r'' " '- very Restricted Delivery ❑Signature Confirmation*'" { 7 015 t 7 7 3'10'0 014 4 9 8 7 t 8;4 S6 t 1 t t t t� 4 10 Signature Confirmation { _ estricted Delivery Restricted Delivery over 0) PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt I I USPS TRACK NG# A F[ t Glas . ail _ Postage ees Paid ASP it No: 100 9590 9402 5745 0003 za JuN - - - —: United States •Sender:Please print your name,address,and ZIP+4®in this box" Postal Service n of Barnstable lth Division Main Street Hyannis,MA 02601 I � I I � I I I. p a ., Ln III ca Certified Mail Fee `Er $ _r Extra Services&Fees(check box,add lee as appropriate) ❑Return Receipt(hardcopy) $ C3 ❑Return Receipt(electronic) $ Postmark li C3 .❑Certified Mail Restricted Delivery $ Here O ❑Adult Signature Required $ []Adult Signature Restricted Delivery$ JJ p Pect— M r rl \ OROURKE, ROBERT F 8r PATRICIAA rr-1 71 STONEY POND CIRCLE C MARSTONS MILLS, MA 02648 Certified Mail service provides the following benefits: a 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 IN Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to tfie ■A record of delivery pnciuding the recipient's retail associate. signature)that Is retained by the Postal Service- Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders: Adult signature service,which requires the ■You may purchase Certified Mall service with signee to be at least 21 years of age(not First-Class MOO,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ■Certifufd 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., a Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent'; with.Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the a To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bears 1 certain Priority Mail items. USPS postmark.If you would like a postmark on r1 j ■for an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Past Office-for the following services: postmarking.If you don't need a postmark an this Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion, of delivery(including the recipient's signature), of this label,affix it to the mailplece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailplece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Retum Receipt;attach PS Form 3811 to your mailpiece; IMPORTARY:Save this receipt for your records. Ps Form 3800,April 2015(Reverse)PSN 7530-02-000-9047 COMPLETE • ■ Complete items 1,2,and 3. A. Signature ■ Print your name and address on the reverse X E3 Agent so that we can return the card to you. ❑Addressee ■ Attach this card to the back of the mailpiece, Received by(Printed Namej C. Date of Delivery or on the front if space permits. k c( - Y,v • t f ss different from ltem 1? ❑Yes livery address below: ❑No I _ `OROURKE, ROBERT F&PAT CIAA '_. 71 STONEY POND CIRCLE + M MARSTONS MILLS,MA 02648 i 4. — --- - - - 3:-Servicelype ❑Priority Mail Express@ II I�Iilll leli Ili I IIII III 1111111111 IN 11111111 ❑Adult Signature ❑Registered MailTM duR Signature Restricted Delivery ❑R�Qistered Mail Restricted el 9590 9402 5745 0003 5532 36 Certified Mall Restricted Delivery Detur^Receipt for ❑Collect on Delivery erchandise ❑Collect on Delivery Restricted Delivery lignature ConfirmationTM 2,n.,;..;e ni,�mhor/Transfer from_service label} � � � ,- ❑Signature Confirmation 7 015 1730 0 0 01 4988 1715., .: �l Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt First-Class Mail Postage&Fees Paid USPS i Permit No.G-10 9590 9402 5745 0003 5532 36 United States •Sender:Please print your name,address,and ZIP+4®in this box" Postal Service Town of Barnstable Health Division 200 Main Street Hyannis,MA 02601 lip! zHIIl!!jllIj7f}Ilill111ti1I:II)liflll��t'�f�i�lifl' ✓1 TOWN OF 13ARNSTABLE LOCATION VILLAGE �/h ASSESSOR'S MAP & LOT �® INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY /, im O r LEACHING FACILITY:{type) ?/.T— (size) /, NO. OF BEDROOMS PRIVATE WELL OR PPUB�LIC�WATER BUILDER 6AR WO NER 6 ,r2a a=,'' DATE PERMIT ISSUED: C?- --- • DATE COMPLIANCE ISSUED: 24wj 7 Z- VARIANCE GRANTED: Yes No 67 t � L - No... ...... .. F.Rz 100 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application is hereby made for a Permit to Construct (A or Repair an Individual Sewage Disposal Systesp at: Address .......xc� V Installer �iw Address Type of Building Size Lot.... ....Sq. feet U of Bedrooms............. Expansion Attic Garbage Grinder 6etjj�s\� ------------------------ Z Other Distribution box ( ) Dosing tank ( ) Test Pit No. I....7 minutes per inch Depth of Test Pit....1_7 ........ Depth to ground waterOY��KA � -'_-----_'---_------_-'-_--_---_-__-'____.'--___'___--_-_--_'___-'----.--._-____._ Agreement: The undersigned agrees m install the afore6esoibe6In6ivi6ual Sewage Disposal System io accordance with �.� THE COMMONWEALTH OF MASSACHUSETTS BOARD--OF HEALTH .......I.O.sAJ---tj.............OF........�.,%? t .:1 ?. .. t ' .- ............................... Appliration for Disposal Works Ton,strurliun Prrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: f. ( a Locati Address - or Lot No. — t- l> ' •..Gil✓ ` ......-7 �?. ._ .......... ............... er ! Address a �. _... .�_ ._... Y•-- ..... ------------------------------------------------ Installer Address Q Type of Building .•, Size Lot.... .....Sq. feet U Dwelling— o. of Bedrooms - . •----Expansion Attic ( ) Garbage Grinder �CR Other—Type of Building --__•-----_-•-_-__-____-_- No. of persons____________________________ Showers 6( ) Cafeteria ( ) al Other fixtures ............................... ... W Design Flow.....................`aif ................gallons per person per day. Total dai}y..fiow------------_ -�...... ..........gallons. C� Septic Tank—Liquid capacity..15E:' allons Length./4-4!.... Width...:j..�"=_�`,___ Diameter________________ Depth .' .... Disposal Trench—No......... ..... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No-----------/------- Diameter.....La Depth below inlet... ........... Total leaching area. Z§.....sq. ft. Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by........ --- ---••------...-•------................a..................... Date........................................ ,.a Test Pit No. I...7dTv:.....minutes per inch Depth of Test Pit----�_.EL....... Depth to ground water6_"''✓___7.L_- rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 '.........y-•--._ :n...-------•--------X-------•-------------------------•...................._........-------•--..._.....------•-------._...----....-- Description of Soil �J 3..... € p t '4 .......+.:� ter-------------- ----------------------------------------------------------------- U --------•-•----•--------•-------•• -•-- I.`------.. . . .....1.� ......-----•--------------------•-•---------•-----------------------•---•--•----•-------•-•-•--•---" W UNature of Repairs or Alterations—Answer when applicable............................................................................................... -•-•---•----••-----•---------------------------•----..............--...........---••--•-----------•T....__...........---•----•--•-•----•------------•---••---•--••-•-•--•-...........-••---•--•--..._.. Agreement: 1 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce een >ssu by t oard of health. Signed �! ............ /. ' '- .. �...-- . _�.... (!!._ ......... .......'----/ r Date , Application Approved B � .�:.lr �-- % �� � � ��'...-- .:=: PP pp Y ------------�..- . ....................... �. .... �..-•t!��'rM'=--"-'- r�'� -- --- ----- -- ......r...I Application Disapproved for the following reasons: kf----------------------------------------------------------- [J .............. I.............................................. ................ .........................` =----ice`---_-.-....-.--.- .......................----.----............--......... [ _!...G'.. ........................................ Date Permit No. ! --- Issued .-, 71�%/'�' -� ...... .'! V v ' ....,-�--i,�;;a----�----Date--------<.:✓.......................... THE COMMONWEALTH OF MASSACHUSETTS ......... .T . BOARD�O H.EAITTH l�ffJy l. �....��.. J r4 . ............ CITErtifirate of C oraptianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) r n --------------------- .-• -- 1 le.---- ....... -----------------------------------------------------.............. T rI C has.been installed in accordance with the''provisions of TITLE 5, f 'l�he Sta e vironmental C d as d c•bed in the application for Disposal Works Construction Permit No. --.. �.:G:.. .... ......... dated --- ---.... f ;0... •� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE I.VNSTRU AS A GUAR EE THAT THE SYSTEM WILL FUNCTION$ATISFACTORY. DATE------------------ - --------.� a.o -... c.. ---------------------_- Inspector ........N........---...............------------------------------- THE COMMONWEALTH OF MASSACHUSETTS ^�I , POARD OF HEA .............................t ; F"` i.�ll _�1�a.;!..'. ............ No..... ......I... FEE.... ................ Disposal Works Tonstr ion rruti# Permission is hereby granted.................... ...........................................................T------- .................................................... to Construct ( �e(S or Repair (_ an ndividual Sewag Disposal tem,, , at No -� / ` `\l- _ et as shown on the applicati n for isposal Works Construction P i No..�%�r _:------ , t� / Board of ealt DATE................ .v�...._.-_F•-.....•--- ................................. FORM 1255 HOBBS & WARREN. INC PUBLISHERS G/i/ Z2A 7",Q 4T__�axtnun� _��•j�slcc�_C�cvv.�cOwc,.l>✓r�.. _. 5%%gc Fev"ily 3 ac irogmS DAILY t=Low 110 x 3 = 33O Gpd 5t74 Ttc. 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