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HomeMy WebLinkAbout0004 MINTON LANE - Health 4' 4 MINTON LANE West Barnstable A= 174 - 007 - 006 / i THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) A I I m 7��C&E DATA 7reverse • • • •Complete items 1,2,and IEli A. SignaturePrint your-name and address oX ❑Agent so that we can return the card ❑Addressee a Attach this card to the back of temapece, B. Received by(Printed Name) C. Date of Delivery or on the front if space permits. _ I 1--- --`Jnsss different from item 17 ❑Yes lelivery address below: ❑No BONAVITA, JEANNE&RICHARD I 4 MINTON LN WEST BARNSTABLE, MA 02668 — II I IIIIII IIIIIII IIII II II N11111-11-1F111-11 ❑Adu s gnat re R -rcted- 9590 9402 5225 9122 7022 36 certified Mall® , + certifled Mail Res* avfery n Receipt for ElCollect on Delivery '"' Merchandise 2..Article NUITIbeLLC[ansfer_fmrn_car�1�o.��F�"-- -- r-r ° ""Avery Restricted Delivery El Signature ConfirmationTm j I ❑Signature Confirmation f7 015 1730 0001 4988 16,0 9 :.'estricted Delivery Restricted Delivery PS Form 3811;JUIy+2015 PSN 7530-02-000190531 t Domestic Return Receipt f �F THE Tp� Town of Barnstable Barnstable �� ti4n WAmeiCaC-i Inspectional Services i1 aAMAM aris�rwdrlr Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4988 1609 September 10, 2019 BONAVITA, JEANNE & RICHARD 4 MINTON LN WEST BARNSTABLE, MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 4 Minton Lane, West Barnstable,MA was inspected on 08/25/2019 by James Ford, 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 c ean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\4 Minton Lane West Barnstable.doc f Town of Barnstable Barnstable Inspectional Services 1 erricaC"� v BA.RNkMX8,E, 6 9 a,�� Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4988 1609 September 9, 2019 BONAVITA, JEANNE & RICHARD 4 MINTON LN WEST BARNSTABLE, MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 4 Minton Lane, West Barnstable, MA was inspected on 08/25/2019 by James Ford, certified Title V Septic Inspector for the State of 1rssachusetts. �e se inspection of the tic system showed that the system "Conditionally Passes" P P +ler the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • The distribution box is rotted. I`wyea Y. Iz are ordered to.ram-replace th thin one (1)year from the date receive this notification. ure to repair/replace the septic system within the deadline period will result in future I)rcement action. LAN!, ,ORDER OF.T_ E BOARD OF HEALTH �� Th s cKean,,R.S., CHO lent of the Board of Heal h / Q:\SEPTIC\Title V Inspection Report Letters Mail ing\Conditional ly Passes Letters\4 Minton Lane West Barnstable.doc f VE Town of Barnstable Barnstable Inspectional ServicesC� x Bm"A aat 9� 6'9. ,� Public Health Division pTf°'"D�a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO PAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4988 1609 September 9, 2019 BONAVITA, JEANNE & RICHARD 4 MINTON LN WEST BARNSTABLE, MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 4 Minton Lane, West Barnstable, MA was inspected on 08/25/2019 by James Ford, 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. I`- 1 he a 9A l p4 -1'- f e a . h) You are ordered to-r4pair-er-replace th hin 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. PERWORDER OF T_ E BOARD OF HEALTH Ph� cKean, R.S., CHO ent of the Board of Heal Q:\SEPTIC\Title V Inspection Report Letters Mail ing\Conditional ly Passes Letters\4 Minton Lane West Barnstable.doc _ Town of Barnstable i MASS. i6,9• ,�� Inspectional Services Department tfp MA'�� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-8624644 PAX: 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 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 ❑ 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) OWER Repair deadline: Ile a,C Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc WE Tpp� Town of Barnstable Barnstable r KAS& Board of Health A14madcaCitv 1111., i639• rfc " 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 FAX: 508-790-6304 October 9,2012 Revised November 20,2013 Public and Environmental Health Program Policies,Procedures,and Guidelines H-10 Components Discovered Beneath Parking Areas and Driveways During Septic System Inspections Conducted Under 310 CMR 15.301,State Environmental Code,Title 5, No.2012-005 When a DEP certified inspector discovers an H-10 septic system component located beneath a parking area or driveway during a septic system inspection, conducted under 310 CMR 15.301 State Environmental Code Title 5,the system shall be deemed as a "conditional pass." The system owner will then be ordered, by the Board of Health,to correct this problem within two(2) years and will be provided several options to rectify the issue, including by: a.) replacing the septic system component with a new component relocated into another area of land which is not beneath any parking area or driveway, and properly abandoning the discovered H-10 component; or by b.) replacing the septic system component with an H-20 component beneath the parking area or driveway, and properly abandoning the discovered H-10 component, (or in the case of leaching pit, replacing the top of the leaching pit with an H-20 slab top); or by c.) relocating the parking area or driveway in such a way that no vehicle will have access or the ability to drive over the existing H-10 septic system component. If it is unknown whether or not a particular system component which is located beneath a parking area or driveway, is H-10 or H-20(for example: a leaching pit is located beneath a paved driveway without an accessible steel cover to grade and there are no records on file indicating whether the system component is H-10 or H-20),_the system shall also be deemed as a "conditional pass". In this case,.the seller must make the potential buyer(s)aware of the "conditional pass" status,the unknown construction of the septic system component(s),'and it's safety concerns. Wayne Miller,M.D. Paul Canniff,D.M.D. Junichi Sawayanagi Q:\POLICIES\H I OComponentsBeneathDriveways&ParkingAreasRevised2O l3.doc 1 i Commonwealth of Massachusetts Title 5 Official Inspection Form `I. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 Minton Lane £� Property Address R l Richard Bonavita Owner Owner's Name information is required for every West Barnstable MA 02668 8/25/2019 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: forms When fillip out f A. Inspector Information on the computer, James Ford use only the tab key to move your Name of Inspector cursor-do not Ford Septic Services, LLC use the return Company Name key. P.O. Box 49 Company Address Osterville MA 02655 Cityrrown State Zip Code 508-862-9400 S 12482 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 9/3/2019 Inspe o's Signature Date The s em inspect r 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts l� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 Minton Lane Property Address Richard Bonavita Owner Owner's Name information is required for every West Barnstable MA 02668 8/25/2019 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: 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 I- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 Minton Lane Property Address Richard Bonavita Owner w O ner's Name information is required for every West Barnstable MA 02668 8/25/2019 page. Cityfrown 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 D-box is broked down, concrete sides are gone, needs replacing. Also the infiltrators are in the driveway and no way to confirm if H-20. ❑ 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 b the Board of Health: q Y ❑ 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 r c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 Minton Lane Property Address Richard Bonavita Owner Owner's Name information is required for every West Barnstable MA 02668 8/25/2019 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 ApplicableY 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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 Minton Lane Property Address Richard Bonavita Owner Owner's Name information is required for every West Barnstable MA 02668 8/25/2019 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 '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 4 Minton Lane Property Address Richard Bonavita Owner Owner's Name information is required for every West Barnstable MA 02668 8/25/2019 page. Cityrrown 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? ❑ iE 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) ❑ -Z Was the facility or dwelling inspected for signs of sewage back up? ® I�1 Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? W® El Were the septic tank manholes uncovered opened, and p p 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 Minton Lane Property Address Richard Bonavita Owner Owner's Name information is required for every West Barnstable MA 02668 8/25/2019 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): b p{r as- Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: Number of current residents: 0 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: unknown Sump pump? ❑ Yes ® No Last date of occupancy: unknownDate t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L., 4 Minton Lane Property Address Richard Bonavita Owner Owner's Name information is required for every West Barnstable, MA 02668 8/25/2019 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: Unknown 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 s 4 Minton Lane Property Address Richard Bonavita Owner Owner's Name information is required for every West Barnstable MA 02668 8/25/2019 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) t ❑ 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: 1997-per as built 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 4 Minton Lane Property Address Richard Bonavita Owner Owner's Name information is required for every West Barnstable MA 02668 8/25/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 16"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. H-20 Sludge depth: 2 Distance from top of sludge to bottom of outlet tee or baffle 23 Scum thickness 3 Distance from top of scum to top of outlet tee or baffle 5 Distance from bottom of scum to bottom of outlet tee or baffle 13 How were dimensions determined? measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tees were present. There was no sign of leakage. The inlet steel cover was in the driveway. The outlet cover was unaccessable under driveway/cobble stone coping. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 r Commonwealth of Massachusetts - Title 5 Official Inspection Form I.- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �!% 4 Minton Lane Property Address Richard Bonavita Owner Owner's Name information is required for every West Barnstable MA 02668 8/25/2019 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): N/a 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): N/a 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 Minton Lane V� Property Address Richard Bonavita Owner Owner's Name information is required for every West Barnstable MA 02668 8/25/2019 page. Cityrrown 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.): N/a *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 even Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The D-box was broken down and needs replacing t5insp.doc•rev.7,,426/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 i Commonwealth of Massachusetts !. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 Minton Lane Property Address Richard Bonavita Owner Owners Name information is required for every West Barnstable MA 02668 8/25/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a *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: ® leaching chambers number: infiltrators 46'x9' ❑ 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 i Commonwealth of Massachusetts - Title 5 Official Inspection Form (- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 Minton Lane Property Address Richard Bonavita Owner Owner's Name information is required for every West Barnstable MA 02668 8/25/2019 page. Cityrrown 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.): The infiltrators were dry and clean. They are under the driveway. A camera was used. ***NOTE no way to confirm if they were H-20. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration n/a 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 Minton Lane Property Address Richard Bonavita Owner Owner's Name information is required for every West Barnstable MA 02668 8/25/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: N/a Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form i< Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 Minton Lane Property Address Richard Bonavita Owner Owner's Name information is every West Barnstable required for eve MA 02668 8/25/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately I � ` l�C tvek,�� GArAS� I 13 proNT a A L3 ' 1-7 a9 � I a ay 4 3 3$ y$ t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 I' Commonwealth of Massachusetts (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 Minton Lane Property Address Richard Bonavita Owner Owner's Name information is required for every West Barnstable MA 02668 8/25/2019 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: 50'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: Topo and water contours map. ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: see above 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 v Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Lv 4 Minton Lane Property Address Richard Bonavita Owner Owner's Name information is required for every West Barnstable MA 02668 8/25/2019 page. Cityrrown 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 �o cJ lot d-�� GMaI (allyLA vi M T OF BA�RNSTABLE £ �� L��>� �e^ten. !� LOCATIONr - ' SEWAGE # c/ 7 VILLAGE 43. ASSESSOR'S MAP & LO � Ga�� INSTALLER'S NAME&PHONE NO. a6rible hl: Cbnsf 4,08.8904 SEPTIC TANK CAPACITY Aroo 9nJ 1407b LEACHING FACILITY: (type) XMC)fr L4*r5 (size) G X 9 NO.OF BEDROOMS Lf BUILDER OR OWNER Pres 4 i ai a Po acr ft c 5 PERMITDATE: COMPLIANCE DATE: j 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 GJ- G� Q 3 � A Fron-) o�' NovSG O D A� ° /7 a i •-a9 " a q2 = aY' ` A3 A ss" 34 ' �s' T.O. . AT E. Io SEPTIC PROFM TES` HOLE LOGS _. _ . _ ._ ACCESS COVER TO WMM d' OF FIN GRADE (►1(r To WA4 ACCESS C (wkTERTJ%M TO f ,` WIN" .7S' Of' WOOER OVER PRECAST f WrWN C OF FW. GRADE 2X SLOPE REQUIRED OW.R SYSTEM RUN 1 "'E LM ? DOUBLE ASKD O - _,.______� _ 9 w PEAsT N€; DATE:_ .___�___......� _..�__.�.__ �.�_.�_ `- �=` FOR FWW 2' T PROPOSED IS" �. . - 3' MAX. 9 �- �'� SF�'tTCJ; AS MASSSOILSTOW (H_ _ � I �. ti --� _. ___ __ ___ -p- ,Ml �o.'�r 3 Li a COMPACT' N (15,221 (2 2 w f EP ELEV. T' ^t Ii TEE SIZES_ 3/4' TO 1 11, 2" DOUBLE WASHE: STONE INLETNTH - (40, ` "- LOCATION MAP SCALE 1" FOUNDATION_.__ Z SEPTIC TANK - D BOX _ r A.C=.-ITY j _� ! ASSESSORS AP I't PARCEL "T- �o i�.. ' vQb�+-t '�.'- I ,� �`,• `r `"�, " `' ZONING DISTRICT: {2 YARD KS: , FRONT tF...ad SIDE = PLAN RAF. - ` �,z ��G._ ��u. f •��+o '". FLOOD ZONE: C.. f 6 A. ,..._.. -- ""'' - -•-p'"'" -�,�-� Sc P,I�., DESIGN: (cARtwcE oi,PQsER sus "--T ,�,..-�,� �_ S 1. DATUM :S Wti` � � l s; � � _ _ A c� a�ttSNICII:'A WATER IS . __._... USE A GPD DESIGN FLOW ;�. MINIMUM PIPE PITCH TO BE I/lr PER FOOT. �_ 4. DESIGN LOADING FOR A PRECAST UNITS TO 9 H H E PTIt; TAtK: .�. ,►_ GPD OAt� 0 ALL £ £ AhAS t� J� � �. ' .-. ______.., - ..✓. ..,__ .- ._ q USE A� � -- -_--- - �. PIPE JOINTS TO �E MADE WATERTIGHT. � `— -•- , �O- GALLON SEPTIC TANK 6. CONS.RUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. £IN RONMENT'AL CODE TITLE V. y"i.`�..5{:ff,$�,2_�- _.';..-�- ..} _�' •_4.ta+�-.:5 7, THIS FLAN IS E't?R PROPOSED WORK ONLY AND NOT TO 8E SIDES: —_ USED FOR LOT LINE STAKING. z'9 8. PIP FOR SEPTIC T H, 4;.. t3U1�"OM: --.___... `�_� *._.�y1?y_. �,. __ - --- E 0 SEP C 5YS't£!bi O SC (=._4" PVC: TOTAL.. �!41 S.F. ASS GPD 5. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED OTHOUT INSPECTION €3Y BOARD OF HEALTH .AND PERMISSION OBTAINED " "` ►. I.► '^1�FA ztt : f ..m_,1 4 4 1 ' ! ti+�,�t FROM BOARD OF HEALTH, l oo.ty M _ f A 'V` ^a { J /+[ L S17E AND SEWAGE PLAN � - '� � ; r--too.o PROPOSED SPOT ELEVATION OFFox T .. igdxC) EXISTING SPOT ELEVATION IN THE TOWN OF., ( O p - :R Al � � _ . _� _�._.._ R0-'�3SED CONTOUR I P►i�'f��a'�r�`.P��-$�• kk 100 — -- EXISTING CONTOUR PREPARED FOR: I, © It. BOARD OF HEALTH , - MA SCALE Ic c s .,... tw 50-30-4541 at down ,cape engineering, I'll C' CIVIL FhiGIN :ER ,» q 7 q'. aimtrrrfni�th rr= tl;i'R'77i �- — ---