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Home My WebLink About0158 MEADOW LANE - Health (2) 158 MEADOW LANE West Bamstable A= 158 -009 t� �I �I I ms ...Department ofRegulatory-See--vices _ Public Rea1th D iv sion' D,att y, 200 Main Street,Hyannis Wi 02601CO Date Scliedttled t� t I' Li . Trine 1. V Fee Pd Soil Suitah Y., Assessm f g. e _Disposal � PerformEday Yli. sled By:: yr r �?� LOCATION&GENERAL I1�TF�RMA'I'TOlV FAsse'5sor'sMap/Parcel: " 1 s58 1V1k-C,- :cl� C� Qvmcr's Name vl C'�'0 e- �f•&O�q W . +3G1�S fi C+.Zv Address i,�i '' e(2'-G• Cjc.j l,�s-. 11 0 t 4 Engineer's Name � NFW CONSTRUCTION REPAIR Telcphonen 7 — 1 Land Use s i_u t it l'11 c+i Slopes(TO) {C Surface Stoncs tGa/_ ` Distances from Open SVater$oily tTs Possible Wet Area _ft Drinking ti'Iatcr Well Drainage Way. ft Property 4ine fr .Other ft t .:a s SKETCH—.(Street name dimensions of lot,exact locations of test hales 3L perc tests,locate wetlands in pro amity toholcs) t.. r tl ; L t o } H Md s � Parcnt material(geologic) d, Depth to Bedrock Depth to Gmundwater: Standing Water in Hole:_. " ' Weepingfrom Pit.rne Estimated Seasonal High Groundwater DETERI NATION FOR SEASONAL HIGH WATER TABLE Method Wa, Depth Observed standing in obs.hole: in. Depth to Sol)MOWS: In. Depth to weeping from side of ohs.bole: in, Clronndwater Ardjustment tt. Index Well# Reading Date: lndtx Weft level _�, Ad],factor— Adj:CM3undw&cr2kVel,� PERCOLATION TEST rinte 'tnte Observation Hole# �, x lhptnafPerc- 2�' i Timeat..6." End Pre-soak l Rate MinAncti. Sit_Suitability Assessment: Site Passed L- site Failed: Additional'resdng'Needed MM Original: PdblicHealth Division. Observation Hole Data To Be Completed on Back--= -- ".If percolabon`test Is to be conducted within.100' of wetland,you must .first notify the Barnstable Conservation Division at least one(1) ,Yegk prior to beginning. O:4SEPTIOPER&ORM.DOC 7 - ; BEEP OBSERVATION HOLlE LOGHole -Depth.from Soil Horizon Soil Texture Soil,Color Soil other. Susraec(ia} (USDA) (Mansell) Mottling (Structure,Stones;Boulders. _.• Consigency. Qrgaell T' Z .tv i DEEP OBSERVATION HOLE LOG Hole# � Depth from Soil Horizon, Soil Texture Soil Color Soil Other Surface(An.), (USDA) (Munsetl) Mottling (Structure,Stones,Boulders: Consistency,Via. ravel V, KV DEEP OBSERVATIONIHOLE LOG Role# 7- Dcpth from Soil Horizon Soil Texture Soil Color Soil other Surface(in.) (USDA) I (MunSell) Mottling (Structure,Stones,Boulders. Cons' tc a ao.Gravell 5y"j t 4'T t2 ko bj DI ICU OBSERVATION ROLE LOO.. Hole Depth fiom Soit`Horizoa Soil Texture Sol!Color Sots other Surface ow), (USDA): (MtinseU? Mtottl.'tng (structure,Stories,0ouldem. Gonsi en -Q6 rav G cArUI 2 r - l Above500 yearflood boundary No._- Yes 'Within Soo year boundary No_ Yes i 1 S ?��t^ (�` ✓l Within 100 year Stood boundary No-4i Yeses ly � L t Deutli of Natcx>'auv �3crzz,x r,>=-Pervious N aterM Does ad east feet of naturally occurring pervious lnaterial-exist iTIA41 y observed Throu ghout:he area proposed for the sail'absorpdon system? -- j '=---- If nat,what is the depth of naturally eccutxing pervious material2 - Certification I certify.thai on (�� `; (date)I have passed the soil evaluator examination approved by the Dep arttuent of Environmental Protection and that the above analysis was performed by me conszstenf)vitll 'the retluired ing,expertise and experience described in 3I0 CNIR IS.OZ 1. DaEe 1 G� r Signature " '-i:.7:C Q1\SEnICTSRCF0R A.DOC _ +; • � r t t • ,' is A ,�� n Complete items 1,2,and 3. A. Sign ture n Print your name and address on the reverse t� 1/ ❑Agent so that we can return the card to you. o Attach this card to the back of the mailpiece, B• eceived y(Pn ted Name) C. Date of Delivery or on the front if space permits. V'tom- IOLA D_ls delivQr_v_address different from item 17 ❑Ye delivery address below: [ Vo VIOLA, VICTOR J SR&JEAN M& 158 MEADOW LANE WEST BARNSTABLE, MA 02668 -111�I BIl�I11�1111110�I1�f I Ill C lll�l I ll llli- _ dint Si_ ❑Registered Priority Mail Express® ❑Adult Signature ❑Registered Mai1T"+ ❑ dult Signature Restricted Delivery ❑Registered Mail Restricted 9590 9402 4798 8344 8589 78 Certified Mail® Delivery Certified Mail Restricted Delivery t�/�IReturn Receipt for ❑Collect on Delivery L Merchandise 2. Article Number(Transfer from service label) ❑Collect on Delivery Restricted Delivery ❑Signature ConftrmationTM '--A"Hall ❑Signature Confirmation 7 015 17 3 0 0001 4 9 8 7 9.590 lob it Restricted Delivery Restricted Delivery PS Form 38111 July 2015 PSN 7530-02-000-9053 Domestic Return Receipt ;� D o f7 Er •' • Ln Er 7cer-tifieddil Fee t I $ •- �� cr Extra SaNICes$Fees(check box,add fee as rate) 2(11 U ❑Return Receipt(hardcopy) $ El Return Receipt(electronic) $ ] Postmark E:3 ❑Certified Mail Restricted,Delivery $ �„...F„ 0 ❑AdOSignatureRequired $ ❑Adu`t Signature Restricted Delivery$ - v�.�_. T. � . M 8 a Ull VIOLA, VICTOR J SR&JEAN M& a 158 MEADOW LANE WEST BARNSTABLE, MA 02668 :11 1 11 111•A l oFs�T� Town of Barnstable Barnstable Inspectional Services j a`ca�j BARNS'TABLE, `s" Public Health Division Arfia�y e, 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 9590 March 19, 2019 VIOLA, VICTOR J SR& JEAN M & 158 MEADOW LANE WEST BARNSTABLE, MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 158 Meadow Lane,West Barnstable, MA was inspected on 03/12/2019 by Michael DiBuono, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system 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 in cKe n, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\158 Meadow Lane West Bamstable.doc tt� Town of Barnstable • )A�N8'fABIE, • 9.�, ' Regulatory Services Department Public Health Division---_ - 200 Main Street,Hyannis MA 02601 Office: 508-8624644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 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 ONE 1 YEAR DEADLINE CRITERIA Static liquid level in the distribution box above outlet invert due to an overloaded or Static SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 158 Meadow Ln Property Address Victor Violas Owner Owner's Name information Is Barnstable Wg Ma 02668 3/12/19 =� required for every page. City/Town State Zip Code Date of Inspection �e 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 filling out forms A. Inspector Information on the computer, use only the tab Michael DiBuono key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return Company Name key. 35 Content Lane r� Company Address Cotuit Ma 02635 City/Town State Zip Code 508-364-9587 SI 13522 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 3/13/19 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 r , Commonwealth of Massachusetts Title 5 Official Inspection Form 'a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 158 Meadow Ln Property Address Victor Viola Owner Owner's Name information is required for every Barnstable Ma 02668 3/12/19 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: System contains a Gallon 1000 septic tank as well as a concrete leach pit and a field of infultrators in stone. 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 158 Meadow Ln Property Address Victor Viola Owner Owner's Name information is required for every Barnstable Ma 02668 3/12/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 158 Meadow Ln Property Address Victor Viola Owner Owner's Name information is' Ba required for every rnstable Ma 02668 3/12/19 page. Citylrown 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 aseptic 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 Y 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 l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 i Commonwealth of Massachusetts 3 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 158 Meadow Ln Property Address Victor Viola Owner Owner's Name information is required for every Barnstable Ma 02668 3/12/19 page. Cityrrown 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 Y day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 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 II of a public water supply well t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 158 Meadow Ln Property Address Victor Viola Owner Owner's Name information is required for every Barnstable Ma 02668 3/12/19 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? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 c Commonwealth of Massachusetts yF Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 158 Meadow Ln Property Address Victor Viola Owner Owner's Name information is required for every Barnstable Ma 02668 3/12/19 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 2 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: 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 158 Meadow Ln Property Address Victor Viola Owner Owner's Name information is Barnstable required for every Ma 02668 3/12/19 page. Cltyfrown 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 trapresent? p El Yes ❑ No Water treatment unit resent? p ❑ 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: Not provided 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 �a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4� 158 Meadow Ln Property Address Victor Viola Owner Owner's Name information is required for every Barnstable Ma 02668 3/12/19 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: Infultrators installed in 1991 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 158 Meadow Ln Property Address Victor Viola Owner Owner's Name information is Barnstable required for every Ma 02668 3/12/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 6. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 Gallon If tank is metal, list age: - years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: 3 . Distance from top of sludge to bottom of outlet tee or baffle 2411 Scum thickness 3„ 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 30" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet inver, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 158 Meadow Ln Property Address Victor Viola Owner Owner's Name information is required for every Barnstable Ma 02668 3/12/19 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form (/pia Subsurface Sewage Disposal System Form -Not for Vol u ntary.Assessments 4' 158 Meadow Ln Property Address Victor Viola Owner Owner's Name information is Barnstable required for every Ma 02668 3/12/19 page. Cltyrrown 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 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.): l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 158 Meadow Ln Property Address Victor Viola Owner Owner's Name information is required for every Barnstable Ma 02668 3/12/19 page. Cityrrown 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: FAILED Type: ❑ leaching pits number: 1 Failed ❑ leaching chambers number: ® leaching galleries number: INFULTATORS FAILED ❑ 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 - Title 5 Official Inspection Form ? T Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 158 Meadow Ln Property Address Victor Viola Owner Owner's Name information is required for every Barnstable Ma 02668 3/12/19 page. CityrTown 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.): Leach pit is full, Infultrators are also full and no longer leaching. 12. Cesspools (cesspool must be pumped as part of inspection) (loc ate on site plan): Number and configuration t 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 El Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 158 Meadow Ln Property Address Victor Viola Owner Owner's Name information is required for every Barnstable Ma 02668 3/12/19 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.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts . l Title 5 Official Inspection Form le Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 158 Meadow Ln Property Address Victor Viola Owner Owners Name information is required for every Barnstable Ma 02668 3/12/19 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 I l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 158 Meadow Ln Property Address Victor Viola Owner Owner's Name information is required for every Barnstable Ma 02668 3/12/19 page. Cityrrown 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: 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: 1991 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: TBD at time of perc test 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 158 Meadow Ln Property Address Victor Viola Owner Owner's Name information is required for every Barnstable Ma 02668 3/12/19 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 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 AsBuilt Page 1 of 1 TOWN OF BARNfSTABLE �} LOCATION -/00 SEWAGE 4 �� II � VILLAGE WeS-( .&,f k)s A b�e ASSESSOR'S MAP LOT 16 E-0 U INSTALLER'S NAME & PHONE NO. A & B CANQ 775-6254 SEPTIC TANK CAPACITY LEACHING FACILITY:( pe).L,v ' (dw) NO.OF BEDROOMS VATE WELL R PUBLIC WATER BUILDER OR OWNER- DATE DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED• VARIANCE GRANTED: Yes_ No G !oo, a, o� 10(9 h http://issgl2/intranet/propdata/prebuilt.aspx?mappar=l 58009&seq=1 3/19/2019 TOWN OF BARNSTABLE iI.00ATION 153 Pleaddow T,aje.,jLR;arnstableSEWAGE # VILLAGE W. Barnstable _ ASSESSOR'S MAP & LOT 158-009 INSTALLER'S NAME & PHONE NO. Vetorino Bros. Inc. 362-3665 SEPTIC TANK CAPACITY 1000 gal.septic tank/100 gal. leaching pit LEACHING FACILITY:(tppe) stone packed . (size) 100 gal. NO. OF BEDROOMS PRIVATE. WELL OR PUBLIC WATER BUILDER OR OWNER :lark Gilbert DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED_ VARIANCE GRANTED: Yes No IV C. 5 776 TOWN OF BARNSTABLE LOCATION / V 1ieacxd(--J /*/G0-SEWAGE# VILLAGE W2S1� .P,c�siA g ASSESSOR'S MAP A LOT INSTALLER'S NAME 6& PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY _ LEACHING FACILITY:( pe)-1-,u F;)/ 16 r (size) 0 , X NO. OF BEDROOMS_ VAT`E WELL R PUB LIC WATER BUILDER OR OWNER i/ DATE PERMIT ISSUED: �� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No too '.l, cOC9 . �o60 . :• J, -o8 4 No .. Fnx..2..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Selnstab/e '4ppR TOWN OF BARNSTABL �onsar�a�Ep Appliration for Biipuoa1 Workii Toms i# ° "'Gat Application is hereby made for a Permit to Construct ( ) or Repair Individual Sew isp ssal System at: ................................... -•--- ------------ ------------ Location-Iva— ...................... .or Lot No. ....V.. �.�........................................................ ............................... Owner Address a ............. Installer Addre s Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.__.................. .._..Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Otherfixfures ----------------------------------------------------------------------------------------------------------------------------------------------------- w Design Flow...........................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width-______-_-__--- Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) . Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date--------------........------------------ Test Pit No. I................minutes per inch . Depth of Test Pit.................... Depth to ground water--_________-_-_--_--___. Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water........_....._......__. a -----------------------------------•---------------------........--------------------.......----...........--•---.............. :.--------- 0 Description of Soil...............................................................................----------------------------------------•-----------•---•---------...._----------------- x U .--------------------------•-------------....----••--•--...------------------------....----------------------------------•-••--------•--------- ......................................................... ------ ------ -------- �7 U Nature of a'rs or Alteration —Ans er when applicabl ............... . ... f Agree en The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State En n itntal Code e undersigned further agrees not to place the system in operation until a Certificate of Co Ti�n�as been is a by the board of health. Signed - �.... . ...'n3.�.: --- ------ ----- Date Application Approved BY -- ----- - - -- ------ - ------ -- - Date Application Disapproved for the following reasons- ------------- --------- -------------------------------- -------- - ........................................................ ---------------------------------------- --- ------ .... --.---...---....------. ------- ......------------- ---- � Date Permit No. ... Issued ........t/. -- --- ------- Date 1 n C-10 i � a .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diu as al Works Ton#r tnn� ernti# Application is hereby made for a Permit to Construct ( ) or Re jir (1,,e n'Individual Sewage Disposal System at: X - A,D4 w Lu . 5 p2►��S'p LL- ..!, : .._.......... ............ .... �-. ........................... ...........--•-........--------�------...-s.•-•--------------............------............. Location-Address or Lot No. ...��... /.G rz"T'— , ...........------.........---------..........----•---.............---............................_. Owner Address W 1� Ce/ La_.?o�c.�4P, ! _ /W 21nn A T"1-� ,-a . f - --•---....... - t--•--•-------- d----------- ---------------------------- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.._,'3.....................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building No. of persons............................ Showers Pa yP g ---------------•--•--------• P ( ) — Cafeteria. ( ) Q' Other fixtures ..................................(................... W Design Flow............................................ga116us per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter----------------- Depth................ x Disposal Trench—No. .................... Width-,:................. Total Length.................... Total leaching area....................sq. ft. j�: Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( •-) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date---------------- ...................... Test Pit No. I ................minutes per inch Depth of ,Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ix ••••--••--••----------------•••••••-•••------•-•---•---•••-•-•-------........-------•-•••--•---......-------------•----.....---•.......---•--...........-•-•- 0 Description of Soil........................................................................................................................................................................ W U Answer when applicable` U Nature of Repairs or Alterations— -------- � �� -cr�rsc -"'�` ��✓t' 1 . .! ------------------ ------�>---------------------------•--� -------------------- !-------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued-by the board of health. :- - -1...- 1. .:'�� ....... - -- ' /`, -1 �/ /Y( • =/-!A7�T„,,,- -.II-� Date Application Approved By -y...::... /....:. �... t Date Application Disapproved for the following reasons- ----------------------........................................................ ....... --------------............................. .................................-- -1...-. ..............-------- ---------------- ' Jr"-------�---- - ems:-- Hate Issued I ..............................................�� J Permit No. .. ---------------------- --------- .. Dare ' THE COMMONWEALTH OF MASSACHUSETTS f f r•i BOARD OF HEALTH TOWN OF BARNSTABLE &r#tftratr Df (gontlatianre . THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( f•�) by---------.6.` 7S-------.<- .. .��-------------------------- --- ------------------------------------------------------------------------------------------------------------------------------------- Installer at ....../57.-------t)r7n9J..b..0A&.>.......... m.kvo....... C' / 1, ..... - .---.------------------------- has been installed in accordance with the provisions of TITLE 5 of.The State Environmental Code as desc ibed in the application for Disposal Works Construction Permit NO. ........ 1- j .-... dated ....� -.�Ir --�. .!...-- THE ISSUANCE OF THIS/CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY., l nl Inspector /l/I V/V4 - ------=-- t - L. r t'DATE.. - f------------- THE COMMONWEALTH OF MASSACHUSETTS �.t f f' 'fl, BOARD OF HEALTH Cqj t TOWN OF BARNSTABLE No...r. ......! FEE...3 ........... Disposal Works Tun#rnr#iun Famit Permission is hereby granted...... . Rl ---••-•----------•--------•----••---•••••••--•--•------••-.......--•........................... to Construct ( ) or Repair (L,)-an Individual Sewage Disposal System at No......4=r_F........ . AL! t c/ apR O: Street !-� f A A ✓ -•_�. - �' as shown on the applicatio for Disposal Works Construction Permit No.............._.... Dated..... .... •••--•---•---•----------•- Board of Health �" v DATE.---••-•--- .. ......./.....•�-• .....----- FORM 36508 HOBBS&wARREN.INC..PUBLISHERS