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Home My WebLink About1155 SANTUIT-NEWTOWN ROAD - Health 1155-Santuit-Newtown Road Cotuit A = 026` 043 Uv RZ i a tii `' •-•__ �`f r.� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............OF...... !L� .i `� s � . r ...._.. V` Appl ration for Biupuuttl Vorkg Towitrurtiun runfit ®7-� Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ...........L�.. .. 1=1..1 ?- li ......................... ................................................ a Loction Address �� or Lot Noj1�� _41 - Owner •Address w M Installer Address V Type of Building Size Lotl-� 1.G.64 ri .Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type of Building No.. of persons............................ Showers a YP Yg .........:............•----• P ( ) — Cafeteria ( ) a d Other fixtures .......................••-----.._.......--••--•-•--...._.....-•-•----•----........-•----..._.._............._.................................----.... Design Flow..........1i .........................gallons per person per day. Total daily flow........... 4C.D.................gallons. Septic Tank—Liquid capacityl.70.0..._gallons Length.__ Width:�%9 Diameter:--_-.-_ Depth.' x Disposal Trench—No. .......... ........ Width.................... Total Length....................Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter__-_.1 ._..... Depth below inlet.....�d._......... Total leaching area.K�_I_sq. ft. z Other Distribution box ( Dosing tank ( ) �.. Percolation Test Results Performed by._. +..................... i ... ,��............. ` i-�•t'�d.f��i----•-••-•--•....... ........ Date.... ..�4 ,.a Test Pit No. 1�.2__._minutes per inch Depth of Test Pit.....:7.._....... Depth to ground water...::. 1............. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.....................Depth to ground water........................ x ..... t.... -.............-.•--......... oDescription ofSoil_... f26 ��.......................•--..a...._1.V_..1....-•--l•�-•--f--u--••�------..�..s.-._-_,-.�..../....................t.........._......_....................................-.-.-.-.-.-............ W ••--••---•..............••-•----•---...----•----•-•------•--..........._..._.--•--•----•--.......:.------...-------.--..-----•=----•--.._._..-----:_...._............._._...........__.................. VNature of Repairs or Alterations—Answer when applicable............................................................................................... ........................................................=............................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of A ITLZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate,of Compliance has been issued board of Siged .•.......................... ......... Dla Application Approved BY_ �_--Q �< - .. ? .... . ....... Date. Application Disapproved for the following reasons.............................................................................................................».. ..............•-••-•---......._................... ._.................----...............-----......._.._.......---._..__......_. ...._.................................... ............ Date . Permit' Issued.................................................... Date No ...^_AA.. ............. f (J % Fza.f....- ..... .. THE COMMONWEALTH OF MASSACHUSETTS 1 r BOARD OF HEALTH iJr,��tr: L11Y ........ ... ....................OF............. ...................:. S ; ~ Applttn'tion for Utopmal Works Tonstrurtion Permit Application is hereby made for a Permit to Construct O' or Repair ( ) an Individual Sewage Disposal System at: `T Y. Cc -••••� ^ I«.- Location -Address + or Lot No•'^ ---......-«.... CD W ........... - Owner Address .... ..:. .«.«..... M Installer Address Type of Building Size Lot ....,«('(!A:.Sq. feet U ,=- ,.' , ., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) ., Garbage Grinder ( ) Other—Type of Building persons............................ Showers G4 YP g .........:....::........._.. No.. of p ( ) — Cafeteria ( ) p' Other fixtures Design Flow..........11J7.........................gallons per person per day. Total daily flow..........�:'.�CD ............gallons. WSeptic Tank—Liquid capacity!�r5- _._gallons Length._t.2" Width.yl.!2". Diameter:..-•---:-~:... Depthf�A ti x Disposal Trench—No. .................... Width..---_ __-•--•---.. Total Length.#................. Total leaching area....................sq. ft. 3 Seepage Pit No.. Diameter...... ._.___. Depth below inlet.... ........ Total leaching area. �.4sq. ft. Other Distribution box (,A)' Dosing tank ( ) aPercolation Test Res Performed by...� 1 �� r Date..�..................................�� Test Pit No. ...minutes per inch Depth of Test Pit.................._. Depth to ground water...:................. Lj. Test Pit No. 2................minutes per inch Depth of Test Pit._.................. Depth to ground water........................ O Description of Soil......... `2.�_..r? .... ±41.......... /i�.b/LINI................................, ........................................• U .--•---....-•........................•. •----••-• . --. .... .. ............-•---•-------•--•-----•--•------••------•-•-•---............... ........................... UW ........----•-......---•----••--•----------------------------------------•-••--•--••--••-...._..---•-•-••--•---------...................---•--------•........_......------•--•--........................ Nature of Repairs or Alterations—Answer when applicable............................................................................................... ................................................................................................................................................___..--------...._....................._..•••-•............ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of:ITLZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued the board of ea } Sig de( o.:... "-''lz.••• - `°,,�••_•-••••-- .......... ..........« Date A lication A roved B c ....0 __t /i � � -• ? PP PP y-• ... Date _r Application Disapproved for'the following reasons:................ ..........................................................................................---- ...............................•------.....----------.........._..-•-•--•-----...._...--•-----....._..................._..--------........_._._._.............--••--...................................« Date . Permit No............ -- ..... Issued:.............. --..._.._......... ......... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .0F. (Irrtif uttte of Tomplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by......-•- ... ...... �G ...............................................:�_� ................................ . --.........._..................--•---.............- «. ...«� Installer ` has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.,1 ... ........ dated _./_�� / THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE i SYSTEM WILL FUNCTION SATISFACTORY. ---~-' DATE......................... Inspector..r ...._......................... . ... THE COMMONWEALTH OF MASSACHUSETTS BOAR-D.--O.E HEALTH :i�� 'Z (� VoO.:.'�- i a.........oF....... Fes..,? ........... Disposal Works Tonstrurtion Permit Permission is hereby granted............. ... 1�-.-......-•---........................---••--••-•-•----..................................t................ o to Construct ( ),,.,6r Repair ( ) an .Individual Sewage Disposal-System ...... ........ ........_..._......-. ._... ................................................................ Street as shown on the app cation for Disposal Works Construction Permit N�27. P:�_'-� Dated...:.-T( ......................... "...,., "---� lloard of Health DATE... ...................................... TOWN OF BARNSTABLE E Li�CAI ON, a�� i��7C�3� 1 � SEWAGE # ::2M�� VILLAGE y`� ` ASSESSOR'S MAP& LOT 02 0 eI3 INSTALLER'S NAME&PHONE NOS 6�� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) dc7 dS (size) NO.OF BEDROOMS BUILDER OR OWNER S PERMITDATE: 0 COMPLIANCE DATE: �ZI Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �3D >^p5 TOWN OF BARNSTABLE LOCAT,PN 1/1.5'! '.tie% %O/jjy /Q SEWAGE# VILLAGE C D? ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1,606 LEACHING FACEL=:'(type) A-9F, (size) -"4FPt) NO.OF BEDROOMS BUILDER OR OWNER e;!�a PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility / Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and,Leaching Facility(If any wetl ds exist within 300 feet� Yac-i� C' ty)�G� � Feet Furnished by ' f pa,-�-�-T � 7d Tl�`� W7o,rvA.> iu:7' No. �'—,.sue-- Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS /,Yes Zippficatiou for Moozal braem Comaruction 3permit Application for a Permit to Construct( )Repair O Upgrade( )Abandon( ) ❑Complete System XMdividual components Location Address or Lot No. 11 SJ SANTut r { Pck Owner's Name,Address and Tel.No. Co-'J iT, M4 Ro c&1-oo -a s Assessor's Map/Parcel 1 50 WY\1 m til5� PtL,, Installer's Name,Address,and Tel.No. LLLNe)—S31C� Designer's Name,Address and Tel.No. t2 548.0--Fx, F�wbP.cES �iC S-Avic-- �jk-tA'l �U1c7t�taf)tY�sl�C S'VCS 5'Tex�—,UA cr , Ype mass" ,\4h e'�,a Z>ax �� , �. (-_c)M0jkh t MA 0a534 . Type of Building: Dwelling No.of Bedrooms Lot Size 4 !sq.ft. Garbage Grinder(A►%- Other Type of Building M eH1-e No. of Persons _4- Showers( Cafeteria( ✓) Other Fixtures LravAmpp YY 1 k%TcAsn) 'LiNk- 1 LawNv Design Flow �,�)o gallons per day. Calcula ted daily flow 5G S 0 5� gallons. Plan Date I n,�'n4 Number of sheets Revision Date Title Wapo )(,�C4,-Ce 5a .mac -!Di sDO�Fs ,4�r Size of Septic Tank i 5 CCU CkG\Vo-(1 Type of S.A.S. Description of Soils �RS� S�Aoa\ Nature of Repairs or Alterations(Answer when applicable) _ ocgN Date last inspected: Agreement: The undersigned agreitensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provf Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has be b oar4 oLLtcalth. Si ed Date LWOV Application Approved b Date .d Application Disapproved for the following reasons Permit No. noo y �1 Date Issued t No. ..Fee ' J THE COMMONWEALTH OF MASSACHUSETTS `, Entered in computer: ,�'►'. Yes PUBLIC HEALTH DIVISION -TOWN OF•.BARNSTABLE, MASSACHUSETTS 12(pprication for Miopozar 6p5tem Cow5truction Permit Application for a Permit to Construct( )Repair(X Upgrade( )Abandon( ) ❑Complete System >&dividual Components Location Address or Lot No. 1 1 5�` A"_rv(T r-Vtu, Pict Owner's ame,Address and Tel.No. _. v x_. DT,11T, MW K1CelaDo �r A2,R,0WS Assessor's Map/Parcel P o u. Installer's Name,K ress,and Tel. o. U LAb-53,v Designer's Name,Address and Tel.No. � c1:P.:C'�S ��•i C. �N\CR 'Sk t iFl`t! CC.�J��uv i f'��l`G Type ofsBuilding: / Dwelling No.of Bedrooms Lot Size 431 ((04 ft. Garbage Grinder Other Type of Building N pS�2 No. of Persons 4 Showers( l�'-Cafeteria( � Other Fixtures l_ va-�c3c � , k�Tc�� aJ S�r�k , LauGvpc,�� Design Flow g p y y s�S�� gallons per day. Calculated daily flow gallons. Plan Date U\ P 3 I,01A Number of sheets Revision Date Title YCt p me& Sub Luxe CC- 5Z _D i 15 Xx t Size of Septic Tank` C\Ct%\( -<� Type'of S.A.S. ' Description of Soil . Atz, `v7\C,�\ Nature of Repairs or Alterations(Answer when applicable) t'� �`CA 9 Date last inspected: Agreement: The undersigned agrees to ensure.the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has b is Tied b}��'i� o �oee�lth. } 'Sighed Date Application Approved by f Date �eZ Application Drs`approved for the Mowing reasons .i Permit No. /-, Date Issued `3g i THE COMMONWEALTH OF MASSACHUSETTS • BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTI , -that the On-site,-Sewage Disposal System Constructed( )Repaired ( )Upgraded�(Y) Abandoned( b D�eY`-� at C _ 61V/hits ben constructed ip accordance with the provi+ ons f T' e 5 and Disposal System Construction Permit No ; W�`31'7 dated Installer �� Designer The issuanc f thiYs enl t shall not be construed as a guarantee that the s to will n ction a ddi ned. Date �0 y Inspector V. " No. 7 3 T? ---------------- ---------.—Fee r- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwigogal *p$tem Cow5truction Permit Permission is hereby grantce�to Construct, ( . )R pair l�jUp rade(N band ) System located at I ✓.> ft ) Py L M I \ � 1 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Constru ction, ustbee completed within three years of the date of thi pe t. J Ae Date: ./ Approved by ' e TOWN OF BARNSTAB E LC LOCATION 1� JU` t SEWAGE# VILLAGE ` V�` ` ASSESSOR'S MAP & LOT 11A — �3 INSTALLER'S NAME&PHONE N 6n: StPTIC TANK CAPACITY '�to� S��—S„�� /,/ f LEACHING FACII.ITY:'( ) -Tds 7 Y OS (size) X NO.OF BED ROOMS BUILDER OR OWNER �� S ERMITDATE:J COMPLIANCE DATE: 0 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 0 ` llrr 30 >05 b AL V 1 Town of Barnstable tHE Tp� do Regulatory Services Thomas F. Geiler, Director • snxxsenste. ,M�; � Public Health Division �F01Aa�A Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 6/28/04 4_ . Designer: Shay Environmental Services Installer: Roberts Septic Service Address: 34 Thatchers Lane Address: 5 Treriton Street East Falmouth, MA 02536 Yarmouth, MA On 6/21/04 Roberts Septic Service was issued<4:permit to install a (date) (installer) ry, sceptic system at 1155 SANTUIT-NEWTOWN ROAD, COTUIT based on a design drawn Y (address) Shay Environmental Services dated 6/24/04 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. X X I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. `�XAPF�Ms Installer's Signature) ° E: SHAY N N0. 1181. O �cr;st a (Designer's Signature) V (Affix Design e) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form CLI CE - 1 � a- co cc LO O x rd vov C,o } � •_ 'r� — � H e ..� -. ' .. .rt a.. •fit «.. i•pp ct i co CD w N N i = Z JUN-23-2004 WED 04:26 PM Danny Griffin, com FAX NO, 508 362 1437 P. 03 intemetmisMLS.com-Cape Cod Network Page I of 1 Customer One Page View CaPe Cod&Islands Multiple Listing Service-Single Family MLS :2038546m Status:Pending Cat: Single Family Home LP;$495.000 Address: 1155 SANTUIT NEWTOWN RD Unit#: Town;RARNSTABLE,MA ZIP:02648 Village:MAM County: BARNSTABLE Subdivision: Rooms:8 FullBaths;2 SedRooms:3 Half®aths; 1 General Information Zoning: RESIDENTIAL Levels: 1 LivSpc: 1,801to2,200 Yr Bit: 1986/APPROXIMATE Samt Baths:0 Lev1 Baths:2.5 Lev2 Baths:0 Lev3 Baths:0 Fo and;RNain Width:44 Main Depth- 30 Win •30 P� g Width. Wing Depth:26 Irreg.Y Basement; Y/Crawl Space,Full,Gar.Access, Interior Acc, Partial, Walkout Rd Fmtg: 150 Assoc-Fee Includes; Gar/#Cars;Y/2 Lot Depth:216 Sep Liv Qtrs; N/ Association:U Lot Dose: Level,Sloping,View Garage Desc:Attached,poor Opener,Stone/Gravel,Storage Abve . Year Round:Y Services; Waterfront;N/ Waterview: N/ Reach Ckm:Lake/Pond Beach Own: Public Miles to Beach: .3-.5MI Mbrshp Req: U Street: Paced; Public,Town Mntnd' Water Ace:Beach, Lake/Pond, Public Foundation:Concrete Convenient To;Golf Course, Marina,Shopping Acres: 1 Ann Asc Fee:$0/0 SeacIVLakelPond Name: Exterior Information Style:Ranch/ Pool: N/ Dock:N/ Exterior Features:Deck, Scrnd Poach Siding;Clapboard Roof: Asphalt ` Mechanical Information Heating/Cooling;3/*Zone Ht,Hot Water,Natural,Gas Water/Sewer/Util.Cable TV, Electric,Gas, Priv Sewer,Telephone,Town Water Hot Water:Tank Remarks MAGNIFICENT BOG VIEWS ALL YEAR LONG.THIS WELL CONSTRUCTED HOME HAS A WONDERFUL OPEN FLOOR PLAN,GREAT FOR ENTERTAINING,THE KITCHEN OPENS TO THE EXTRA LARGE FAMILY ROOM(27X14FT)W/ CATHEDRAL CEILING,FIREPLACE,WOOD FLOORS, DECK.THE DINING ROOM HAS BUILT IN CORNER HUTCH AND HUGE FORMAL LIVING ROOM W/FIREPLACEI BOTH HAVE WOOD FLOORS. MUST SEE TO APPRECIATE. LegaVTax Information Imprmts Asmt; 210900 Annual Taxes: $2,447,68/2005 Title Reference; 12470/042/0 Land Assessment: 159400 Annual Betterment: 0 Plan: Total Asmt: 370300 Unpd Bettrm: 0 To Be Assessed: N Spec Assessment; U Mass Use. 101 Assessors Map: 026 Asse ssors essore Parcel: 043 Undgmd Fuel, lJ - Asbestos: U Lead Paint; U ICertlfreat: Flood Zone: Unknown Documents: No Documents _ Directions to Property: RTE 28 TO NORTH ON SANTUIT NEWTOWN LOOK FOR SIGN#1155 Printed by REALTY EXECUTIVES on 2004.06-23 03:59:02 PM ®Identified agent may not bo the fisting agent.Informatian herein deemed reliable but not guaranteed. ' i http://app4c.capecodmis.net/capecod/mis 6/23/2004 JUN-23-2004 WED 03:58PM ID: PACE:3 0a DATE: .2/2.3•/.99 PROPERTY ADDRESS: 4155--Newtown Road Cotuit , Mass . '02635 On the above date, I Inspected the "ptic system QA a a o ddre, Thl5 system consists of the following: 1y �` 1 . 1-1500 gallon septic tank . 'Q 2 . 1—Distri•but•ion box . 3 . 1-1000 gallon precast leaching pit . ' �'99,9 Beeed 'on my InPc-actlon, I certify the following con 4 . This is a title five 'septic system. ( ••7,8% Ec4de 5 . The septic system is in p•r•oper working order ' 9 at the' present time . 81GNATURr; I" Name: J P . N_acomber Company..__J � P.Hacoigber & onl'Inc , ___ -•_---- -__- • • • ' . . , . . ' . address• _-8-sac-66_____.'a___..__ Phone; -- 548. -Z7.S�338_..____.. -- THIS. CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY XSEPH P, MACOMBER '& SON; INC. Tanks-Ctupoo4-L/&chfllldi . PUmp+d G In;UII d ' Town Siwor Connictiont P.O. Box 60 ' Centervllle, MA 02632.0066 77.'-33M 775-b412 I COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address:115 5 Newtown Road Nerve of owner John H. Mason Cotuit ,Mass . 2/23/99 Address of Owner: Date of 4upectkm: Name of Inspector:(Please Print) J o s e p h P.M a c o m b e r J r . IarnaDEPa oved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Comparry Name: J .M a c o m b e r & Son Inc . Mar&VAddress: Box 66 Centerville Mass _ 02632 Telephone Number: S n S2_7-7 5—2 231 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience In the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails 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 thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the Inspector and the system owner shall submit the report to the appropriate regional office of the Department ofrEnvironmeMal Protection. The original should,be sent toVX system owner and copies sent to the buyer, if applicable, and the approving authority. . NOTES AND COMMENTS revised 9/2/98 Pagel orll ��} Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1155 Newtown Road C o t u i t ,Mass . Owner: John H. Mason Date of k-P--don:2/2 3/9 9 INSPECTION SUMMARY: check A, B, C, or A A. SYSTEM PASSES: I have not found any Information which Indicates that any of the failure conditions described in 310 CMR 16.303 exist. Any failure -'criteria not evaluated are Indicated below.. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health, will pass. Indicate yes, no,or not determined(Y,N,or NO). Describe basis of determination In all Instances. If "not determined", explain why not. The septic tank is metal,unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was Installed within twenty(20) years prior to the date of the Inspection; or the septic tank, whether or not metal,is cracked,structurally unsound, shows substantial Infiltration or exfiltration, or tank failure is imminent. The system will pass inspection If the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction Is removed distribution box Is levelled or replaced Yi! - The system requked pumphig•more than four-times a year due to broken or obstructed pipe(s). The vystem wilt1raw— inspection if(with approval of the Board of Health): - broken pipe(s) are replaced obstruction is removed 'r. revised 9/2/98 Page 2ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTiON FORM PART A CERTIFICATION (continued) Property Address: 1155 Newtown Road C o t u i t ,Mass . Ownea John H. Mason Date of hspec6=2/2 3/9 9 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: AlJ Conditions exist which require further evaluation by the Board of Health in order to determine if the system Is failing to protect the public health,safety and the environment. 1) SYSTEM WiLL PASS UNLESS BOARD OF HEALTH DETERMINES W ACCORDANCE WiTH 310 CUR 15.303(1)(b)THAT THE SYSTEM I'I IS NOT FUNCTIONING W A MANNER WHICH.W".PRQTFCT THE PUBLIC HEALTH.AND SAFETY AND THE Ek' BONMENT: Cesspool or privy Is within 60 fest of surface water Cesspool or privy Is within 60 feet of a bordering vegetated wetland or a self marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING W A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: &0 The system has a septic tank and soll 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and loll absorption system and the SAS Is within 60 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS Is less than 100 feet but 60 fset or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well Is free from pollution from that facility and the presence of immonla nitrogen and nitrate nitrogen is equal to or less than 6 ppm. Method used to determine distance •,6/4 (approximation not valid).- 3) OTHER �1T ' revised 9/2/98 P&ge3or11 SUBSURFACE SEWAGE DISPOSAL gYSTEM INSPECTION FORM PART A CERTIFICATION(continued) • �,pyAeu; 1155 Newtown Road Cotuit ,Mass . Owner: John H. Mason Date of lnspectioo: 2/2 3/9 9 D. SYSTEM FAILS: You must Indicate either "Yes" or"No" to each of the following: —4 1 have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is Identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No No Backup of•aewage in 4aci6tjr.or••elatemcomponentdue-to an overloaded or•--legged•SAS-ot-ceaspool. �-- Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or dogged SAS or cesspool. Static liquid level in the distn ution box•above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in-zoeepord is less than 6" below invert or available volume is less than 1/2 day flow. i e Required pumping more than 4 times in the last year NOT due to clogged or obstructed p p (s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy Is below the high groundwater elevation. - Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is-wlth(n a Zone I of a public well.. • _ Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy Is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for ••coliform bacteria,volatile organio-compounds, ammonia nitrogen•and nitrate nitrogen. - E. LARGE SYSTEM FAILS: You must Indicate either "Yes" or"No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system•ia-wit in 200 4et*f-*4FR utar"o•asurfaoa dfk4aA9-watw.-*uWr.-�••- - -— — A)A the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area ;IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further inforptation. revised 9/2/98 Pseeaofll I t i SUBSURFACE SEWAGE DISPOSAI,SYSTEM INSPECTiON FORM PART B CHECKLIST PropertyAddre"J155 Newtown Road Cotuit ,Mass . Owrw: John H . Mason Data of Inspection:2/2 3/9 9 Check if the following have been done:You must Indicate either'Yes" or"No' as to each of the following: Yes No / Pumping Information was provided by the owner, occupant,or Board of Health. -None of the systemcompowants.iwwa:bean PrxnPad+bopat.j"sitwo. weakasadthe-system hasbaeoaacaiaiwywsol flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this Inspection. As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or Industrial waste flow. The site was Inspected for signs of breakout. _ All system components,-4Imciuding the Soil Absorption System,have been located on the site. _ The septic tank manholes were uncovered, opened, and the Interior of the septic tank was Inspected for condition of baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge, depth of scum. The size and location of the Soil Absorption System orrthe sit*has been determined based on:- 1! Existing Informs F U g lion. or example, Plan at B.O.H. _ Detarmined In the field(if any of the failure criteria related to Part C Is at Issue,approximation of distance is unacceptable) [15.302(3)(b)) The facility owner.(and.O 1—pants-If ditlaraW lrootoarcnar),3ware prnuIded wIih infauaasioaan rho prcpor,,,ninian f SubSurface Disposal Systems. I i� revised 9/2/98 Pseesorii SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropartyAddretts: 1.155 Newtown Road Cotuit ,Mass . owner: John Mason Date of Inspection: 2/2 3/9 9 FLOW CONDITIONS RESIDENTIAL: Design flow:' lb g.p.d./bedr M. Number of bedrooms( esig 1 Number of bedrooms(actual): Total DESIGN flow Number of current residents: Garbage grinder(yes or no): LaundryIse arate system) (yes or ):�C); If yes,separate.Inspection•required P Laundry system inspected,(' as or no Seasonal use(yes or no):� , Water meter readings,if avaj ble(last two year's usage(gpd): Sump Pump(yes or no) Last date of occupancy COM M ERCIALAN DUSTRIAL: Type of establishment: A Design flow: d ( Based on 15.203) Basis of design flow Grease trap present:(yes or no) Industrial Waste Holding Tank present: (yes or no)� Non-sanitary waste discharged to the Title 5 systerrk (yes or no)/V/7 Water meter readings,if available: — Last date of occupancy: A _ OTHER:(Describe) A), Last date of occupancy: GENERAL INFORMATION PUMPING REC9RDS and spyrce of informati �-. P-0 I L je, System pumped as liart of inspection-. (yes or no)_ If yes, volume pumped: gall s Reason for pumping: ON 1 f-T ,ill _ TYPE SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool 7 Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) 1/A Technology a Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other .44 APPROXIMATE AGE of all components, date instaNed{if known)-and source of4aformation: - — - Sewage odor detected when arriving at the site: (yes or no) revised 9/2/98 Page 6of11 Macomber Customer History Screen 2125199 Customernumber 4165 —.-® Companyid me Create New Invoice Cwtomertdmne JAn.Ma—sm.........................._.. ............._.._._...._.._..._......_.._._. Find Invoice JobAddress J.1.5`..L eYA-DY n..Rfla1_..._................._..._.......__.............._....... Find Custorner JobState MA..............._........_...................................................... ........................... Add Billing Address Jobzip .026-35. ---- Tel 42Q:. Q4.8._................._,_.__........_.........._......................__.........._....... Print History Fax _.__..._...._..._.............__.__...._.._....._._...__............._.�.._..._......_....._...... Custorrter List Billing Address .1_ � t1..F� ............................................................... ----�— Print BillingCity _.._........ BilfingStatef&........................_........._..._.................................._.._....._...__.._._....... Billingip ._ . _._...... _......___r......__......_...__.___.__..__._.__.. MotesT..D.O.O.w&o.up..... �1� 4_._....._....._.._..._.__...__..:...._..__....... ...._.. ...._ ... .............. ...._..........._........................__. ...... I ..._..� _ ..... .. _.... _�_.._._ ..��e.._.�....... ...._ ._......._.................. ......._ .._:_..._.....�. ,r I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1155 Newtown Road Cotuit,Mass . Owner: John H. Mason Date of Inspection:2/2 3/9 9 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction:_cast iron Z40 PVC—other(explain) Distance from Rrivate water supply well or suction line Ze Diameter Comments: (condition of joints, venting,evidence of leakage,-etc.) Joints appear tiht No evidence. of leakage - System ig VPntpd through SEPTIC TANK: 600 YA4AOV.9 j (locate on site plan) � rl Depth below grade tr Material of consuction:Zconcrete_metal_Fiberglass _Polyethylene_other(explain) i If tank is(petal,list age, Js.age-confirmed by Certificate of Compliance_(Yes/No) Dimensions: if +C-d A"> f, 15> Sludge depth. �L Distance from top o�Judge to bottom of outlet teevrtaffle-.-TL41 Scum thickness:' tiL,G— --- Distance from top of scum to top of outlet tee or baffle:/�dt-,�1 Distance from bottom of scum to bottom of outlet tee pr baffle:./,�.i, , How dimensions.were determined: Comments: (recommendation for pumping,condition,of inlet and outlet tees or-baffles,depth of liquid level in relation to outlet invert, structural4ntegrity, evidence of leakage,etc.) Puma tank annually _ GarhagP di anneal ; c nracnnt Liquid 1PVP1 air'—n f j-ft;y Q P A 4P _6 structurally sound . Shows nn PvidenrP_ nf1PakagP GREASE TRAP: e, (locate on site plan) Depth below grade: Material of construction:A//IZoncrete,L�Ametal fiberglass,#APolyethylen&aother(explain) / . Dimensions: 4 Scum thickness: Distance from top of scum to top of outlet tee or baffle: 2.6 Distance from bottom o�f�cum to bottom of outlet tee or baffle:/d Date of last pumping:�!L Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) Greasp trap is not nrPSPnt revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL;SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddrss: 1155 Newtown Road Cotuit ,Mass . Owrw: John H. Mason Data of hupectioo:2/2 3/9 9 TIGHT OR HOLDING TANK-ALg-(Tank must be pumped prior to, or at time of, Inspection) (locate on site plan) Depth below grade: 4J� Material of construction�oncrete /'metal4�2Rberglassi�polyethylene.,l;lother(expiain) Dimensions• Capacity: gallons Design flow: 14gallons/day Alarm present Alarm level: Alarm,'I working order:Yes Al,� Now/t Date of previous pumping: N� Comments: (condition of inlet tee,condition of alarm and float switches,etc.) i1grit or fioldin2 tanks arP not prpqent DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet Invert: A)& Comments: (note•if level and distribution is equal, evidenoe of solids carryover, evidence of leakage into or out of box, etc.) — — Distribution box has onP latpral Tern o..; depse—p€ 881idq earry a No Pvi dpnrp of l oakage �R 8 or out o PUMP CHAMBER-,tAve (locate on site plan) Pumps in working order:(Yes or No) Alarms In working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) Pump Chamber iq not nreS6rlt revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART 6 SYSTEM INFORMATION(continued) PropenyAddress:1155 Newtown Road Cotuit ,Mass . owner: John Mason Date of Irtsp"tion: 2/2 3/9 9 SOIL ABSORPTION SYSTEM(SAS)-_ZVd 41//� (locate on site plan,if possible:excavation not required,location may be approximated by non4ntruslve methods) If not located,explain: Type: leaching pits,number: leaching chambers,number: leaching galleries,number:_ leaching trenches,number,length: leaching fields,number,dime lon7r77- overflow cesspool,number: Alternative system:_77 Name of Technology: Y act L � Comments: Lnote condition of soil, signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.) Loamy sand to medium fine sand . No signs og hydraulic fni l lire r)-r ponding Qni l a nrri jgy 34Qgetnt-j QQ i c nr)rmn1 CESSPOOLS: (locate on site plan) Number and configuration:_ n Depth-top of liquid to Inlet Invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: Inflow(cesspool must be pumped as part of Inspection) PPCSgnnlc are not irpepnt Comments: (note condition of soil, signs of hydraulic failure,.level of ponding,condition of-vegetation, etc.) Cesspools are not present . (locate on site plan) Materjals of construction: /`%l Dimensions: Depth of solids: %'IrW Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.) Privy is not present . i revised 9/2/98 Page 9or11 I ' SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECT10N FORM PART C SYSTEM INFORMATION(cwWrxred) PropedyAddresa: 1155 Newtown Road Cotuit ,Mass . Ownw: John Mason Drte of Inspection: 2/2 3/9 9 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes Into house) yo o° r 00 T A,A; Au;y i revised 9/2/98 Page 10of11 I SUBSURFACE SE1. '.GE DISPOSAL SYSTEM INSPECTION FORM PART C SYS M INFORMATION(continued) Property Address: 1155 Newtown Road C o t u i t ,Mass . Owner: John Mason Date of Inspection: 2/2 3/9 9 NRCS Report name _ Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow f.. —rate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater dL Feet Please indicate all the methods used to determine High Gt. -dwater Elevation: Obtained from Design Plans on record �bserved.Site(Abutting property„bbservation hole, .:sameot sump etc.) i.6etermined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Ele% n. (Must be completed) Used water contours map . Gahrety & Miller Model 12/16/94 revised 9/2/98 Page 11of11 ` TZl'T+'�RI'}T�TT\T1r�J1'!t'R\TRJ4TRi'STT.ITtT:•.ITT•\RT:T.ITRRT TfT�lY 11>Y�STLT.IYl1 .TR•TTT�T.�..T••...�. r..,F 1 TOWN OF Barnstable BOARD OF HEALTHSUIISUIIFACF SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION �� •••T••t•T••.••.'.-T.IIT.�.TTT,fST.TII•R.'T.IITTICl1TTr'7R1'T':'I^ilRTt11'RM-•nRRR��flTSIR.Ti'TR'ILTi iTfl IITR>-\1TiiQ�TTrTI�T.•.�t'I•T'T!•1. .�..� -TYPE OR PRINT CI.EARL1'- PROPERTY INSPECTED STREET ADDRESS 1155 Newtown Road Cotuit , Mass . ' ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME John Mason- . PART D - CERTIFICATION 1 NAME OF INSPECTOR Joseph P.Macomber JR. i COMPANY NAME J• P.Macomber� & Soqi�' Inc . COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Street Town or C1ty State LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 - 1578 q CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time of :inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , n i Illi{I I, Check one , System PASSED ,' The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or, the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which I have con acted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection Form . Inspector Signature 1, r1t r Date One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF 1tEALZ'11, * If the inspection FAILED, the owner or"'.operator shall u p pgrade ' the system within one year of the date of the inspection , unless allowed or required otherwise as provided in 3.10 CMR 16 , 305 , i partd .doc L FAILED INSPECTION COMMONWEALTH OF MASSACHUSETTS RECEIVE® EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAI S DEPARTMENT OF ENVIRONMENTAL PROTECT 01'-UUN 2 12004 a TOWN OF BARNSTABLE MAP ,� �.�..- HEALTH DEPT. c, PARCEL LOB' TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1155 SANTUIT-NEWTOWN ROADMA4LST03LS MIL!S,MA 02648 o o3'4 g f Owner's Name: C/O RICH MARVIN cumk" Owner's Address: 26 CHERRYWOOD ROAD MARSTONS MILLS,MA 02648 Date of Inspection: 5/24/04 Name of Inspector: (please print) JOHN GRACI,INC in co Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 - Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the'information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _ Passes _,Conditional P sses _ Needs Furt r valuation by the Local Approving Authority r X Fails Inspector's Signature: Date: 5/24/04 The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing.this inspecti n. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Conunents SYSTEM FAILED TITLE V INSPECTION. LIQUID LEVEL IN LEACH PIT IS FULL UP TO PIPE.D-BOX IS STRUCTURALLY UNSOUND. ****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. Titles 5 lncnPntinn Fnrm 6/1 V Mfl 1 4 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1155 SANTUIT-NEWTOWN ROAD MARSTONS MILLS,MA 02648 Owner: C/O RICH MARVIN Date of Inspection: 5/24/04 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM FAILED TITLE V INSPECTION.LIQUID LEVEL IN LEACH PIT IS FULL UP TO PIPE. D-BOX IS STRUCTURALLY UNSOUND. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass.'- Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. n/a 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. ND explain: n/a n/a 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 obstruction is removed distribution box is leveled or replaced ND explain: n/a n/a 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 _obstruction is removed ND explain: n/a Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1155 SANTUIT-NEWTOWN ROAD MARSTONS MILLS,MA 02648 Owner: C/O RICH MARVIN Date of Inspection: 5/24/04 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is r not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance n/a' "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1155 SANTUIT-NEWTOWN ROAD MARSTONS MILLS,MA 02648 Owner: C/O RICH MARVIN Date of Inspection: 5/24/04 D. System Failure Criteria applicable to.all systems: You must indicate"yes"or"no"to each of the following for alLinspections: Yes No 1 X _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or pond ing of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than'/2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nLa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ X Any portion of a cesspool.or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. ' X 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 co6form bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen 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.] YES (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd'to 15,000 gpd. You must indicate either `yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no ` X the system is within 400 feet of a surface drinking water supply ' X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located m`a nitrogen sensitive area(Interim Wellhead Protection-Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15'.304.The system owner should contact the appropriate regional office of the Department. 1 , Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1155 SANTUIT-NEWTOWN ROAD MARSTONS MILLS,MA 02648 Owner: C/O RICH MARVIN ' Date of Inspection: 5/24/04 Check if the following have been done.You must indicate"yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health _ X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period') a X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out X _ Were all system components,excluding the SAS,'located on site'? X _ 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 ? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems S . The size and location of the.Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information. For example,a plan at the Board of Health. X _ 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(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1155 SANTUIT-NEWTOWN ROAD MARSTONS MILLS,MA 02648 Owner: C/O RICH MARVIN Date of Inspection:"5/24/04 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents: 3 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)):vA* Q 3 OC 0 Sump pump(yes or no): NO Last date of occupancy: n/a C3 vU'�) " COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings,if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy ) _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1986 PER PERMIT Were sewage odors detected when arriving at the site(yes or no): NO Page 7 of 11 t OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) t Property Address: 1155 SANTUIT-NEWTOWN ROAD MARSTONS MILLS,MA 02648 Owner: C/O RICH MARVIN Date of Inspection: 5/24/04 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction:_cast iron =40 PVC Xother(explain): 20 PVC Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 12" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no):NO(attach a copy of certificate) Dimensions: L 9' 6" H 5' 7" W 4' 10111' Sludge depth: 4"- Distance from top of sludge to bottom of outlet tee or baffle:30" Scum thickness: 5" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 13 How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass jolyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a i t r r 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1155 SANTUIT-NEWTOWN ROAD MARSTONS MILLS,MA 02648 Owner: C/O RICH MARVIN Date of Inspection: 5/24/04 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level:N/A Alarm in working order(yes or no):NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence,of leakage into or out of box,etc.): D-BOX IS STRUCTURALLY UNSOUND. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a { R t Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property.Address: 1155 SANTUIT-NEWTOWN ROAD MARSTONS MILLS,MA 02648 Owner: C/O RICH MARVIN Date of Inspection: 5/24/04 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a . n/a leaching trenches, number, length:" n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a � i Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): LIQUID LEVEL IN LEACH PIT IS FULL UP TO PIPE.THE LEACHiPIfIS PAST THE EFFECTIVE DEPTH OF . LEACHING AND IN HYDRAULIC FAILURE. BOTTOM IS AT 9 FT. 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:_n/a y Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a A Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) , Property Address: 1155 SANTUIT-NEWTOWN ROAD MARSTONS MILLS,MA 02648 Owner: C/O RICH MARVIN Date of Inspection: 5/24/04 _ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. j 6 A 30 r ZL4 N :G la `° ix) q 0 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1155 SANTUIT-NEWTOWN ROAD MARSTONS MILLS,MA 02648 Owner: C/O RICH MARVIN Date of Inspection: 5/24/04 SITE EXAM _Slope _Surface water _Check cellar _Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-,If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 12+FT. y. ff 1 I 11 : i . 33 I i I j , ff ( i Iff ivy T I _ 11, , .."1 77- ITT ,a —+'� T-t I'.•' IQ + I I i �) J �. �.� � � � � � � � L�J, �_' _��—�-__'s-1': ___—___ __L—.—..�_�_ •sj,l it P.._ APPROVED VED BY:" .. .. '. SCAL..... �..... .•.. 'DRAWN BY:... ., _ .. q REVISED - +� - _ AWING NUMBER • aw dOl C� Ll �d D o 1 — - --- — _ f �k .... . . �I .......... ---------- r IIt t C. Jg t 1 ....._- { -�- " . . - - - �. ��E:-z:-:_:.. 111 �— '—t i--_ I � .. ___ -1 ri A._t�'1 .-•. �i-� 3rt:.!tl�?7 J,+;. - t i IF - ,j yy i. : T I ff i�3 � -fir - _— _ -ii ;_,k= — H''I h i1-it I — _ h \ i f5t I ! +rl } - 4 k t u k } I ✓s ^ I ' i k 77. — I scALE,-!' ?,�,11;0�!" -APPROVEDBVDRAWNB,_ DATE s "!G/ ;Q� pEV18ED • - .. ORAWIND NUMBER. - SECTION .SEWAGE - �1 70 X 1 ac= l-V7' - 13 —SEPTIC TANK — — "D"BOX. l —LEACH— 4� f TOP OF FDN I /�L L67 Is ? idQ (MSL)• ..2..OFtiaTO'h" _ WASHED STONE (iz� \ TF N• OUT• IN• ^ 2 I Z_5OG OUT• IN• , SEPTIC r 20� > ELEV. , TANK �_ 7v, ELEV. 0� ELEV. 1 t , { �� 70, ELEV: ELEV. �� I FT`� I g,D WASHED STONE 1 � o --------------- TEST HOLE LOG 5-tEC):�Za TEST BY f�'.'F::m r54LK* K tso Y I� !7•I I 1, Y� �. cs. '1 '� / / I ` �i/ 1 - q � WITNESS TEST DATE t7I�I 24,1S� BEDROOM HOUSE' G DESI N N T.H 1 T.H. A 4 l C E V � -� LESqO ELEV. . NO �. 1 A. PERC RATE G� MIN/IN. DISPOSER. DISPOSER M I!S I FLOW RATE. I I (GAL./DAY) \ `�. - }•L SEPTIC TANK � �.�l0.5 . � �. Tq \ ,. 3 . : �SLS RE SEPTIC TANK SIZE Z5 0'. ' / ( k d 6Z.p LEACH FACILITY V.IATErs SIDE_WAL I01T�c — IS3. . �2,5�`:. 7I1 0 G/D. TTQM' ,LIT) G/U. \ 1. . 1 f EIO r TOTAL , km f - x t ' USE:S >w : �. - b P1 ' WAT N �- ER E COUNTERED .1.• I _ . " `... ra. UNLESS E '. S ^.,„. NOTES- ( OTHERWISE NOTED) r ,. ' :>,v,,:.• 5�'�C .Nr��'7�� 1. itA4 t I.DATUM(MSL)_TAKEN FRO C-- . .CfUADRANGLE MAP 2.MUNICIPAL ��---- @�t WATER 1��...----_'AVAILABLE 3.PIPE PITCH.%"PER FOOT v:' - LS 4.DESIGN.LOADING FOR ALL PRE-CAST UNITS:AASHO- 0 •44 y:'Q ;. M ..S.MIN. ROUND COVER OVER ALL SEWAGE FACILITIES: F L ES: T. _1 6.PIPE JOINTS SHALL BE MADE WATER TIGHT 7..CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS: s A STATE ENVIRONMENTAL CODE TITLE 5 I I - s I a t - SITE PLA 8 fi�l5 Pt.Anl �R PROFI�S�D I.IoRK 0►.1��r p1:1D�-IOIJ I r I�mpp Locus: l.�oT�t3 •i-�Ekl-��I�. �I7►: Klo'r � USSR FOR LI►.lE.lE1AAKl ere_ - yeC REG.PR R:. x� �{ c t ., /��P�`_ CoTu I't'; l�•3i�t:1.��1�,F31,��,11. I y ( REF: —'"• • 11 t ` _ down -, ca e. en i eetin aFOR , a:c. PREPARED K : CIVIL ENGINEERS _ t e. SURVEYORS^a _.. . ._ — ,.. HEALTH k _ - .:.. u„....BOARD. • , .. _,... . . ..-.:� lw'r�. ,_.. (EXISTING) �,......� j� _ .. r,a� - - OR U . . CONTOURS. ... _ _ � ,.�.: . ,.,__.. _ h .. ., >.� . .._ �- AIR E:. Y 1��, f, SCAL ... . .. ... . . ... ...:'. PROPQSED —O—O—O—O— APPROVED, DATE ,.••,: � 'T MA r ,r{ F . , ::... YaIwM� `' r ':_._ ,...:�: ...::.,,.. . .:•: __: � ..,_:a, _. ..�':�, �.,- .� k r ;:'�•�'S ',. sr fin•. ,,. �:, ., .. ..DATE, � i,r� 7 7 w L e� -A VENT PIPE (0 Least 24 Inches tall) A Schedule 40 PVC w/Charcoal Odor Filter liN 3-24* D4AM. ACCESS MANHOLES 10' min. from 10' -61 71,. Existing Foundation �hc.se to septic tank Septic tank covers must be "NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. 71�. T.O.F. slay. 100.00 within 6 in. of finished grade 77= sent Or s .4 Grade over Septic Tank 9a.50 Grade over D-Box over SAS ELEV. 98.50 N A -A SECTI It 4 - 0A PROFILE VIEW Oil LEACHING SYSTEM Not�to Scale S 0.02 3 HOLE Top Load - Elev. -96.00 INLET (H-10) DIST. BOX 3' Maxim 14'il"" 10. -0 sr A Top of SAS-Etev.-95.50 3, of 1/0* f/s INLET OUT ET S .01 or t PIPE V) NEW 1.500 GAL S- 0.010' per foot or reacter THE ACCESS COVERS FOR THE SEPTIC TANK, 5;� 23' 1 t/2 I iritemd&.0h.14 DISTRIBUTION BOX AND LEACHING COMPONENT FROM FOUNDATION SEPTIC TANK r It r- 27* SHALL BE RAISED TO WITHIN 6" OF H-10 Effeeive Depth PVC (CAPPED,INrcnON 7" II 4 PORT To 11 INSTALLED AND To mTHIN OF Cii\\ • FINISHED GRADE. CONCRETE FULL FOUNDA1 0) a, STEEL REINFORCED PRECAST CONCRETE INSTALL TLIF-TITS GAS BAFFLES OR EQUALS Wri 8 a, 3 3' ON ALL OUTLET TEE ENDS ft > 4 PLAN VIEW 60 2004 RmW#*Ni*r A Convapy W 29M h1aiiiwhon TocOwmiisVov SYSTEM PROFILE -0 T 11. 4 Not to Scale > 10, EffeeRve 3-24' REMOVABLE COVERS Eff*ctivir Width Sidewall > I i 7 Units @ 7' 49' GENERAL NOTES 4' A 6 In.of 3/4'-1 1/2" .5' 3" min. d 1. Contractor is responsible for Digsafe notification compacted stone 0 0 L NOTE; EXISTING 1,000 GALLON TANK TO BE REPLACED WITH 1500 GAL TANK. ET r.4 JTli'm7k M -_�._a� rnin. Wet to outlet 111'min. _f"XT and protection of all underground utilities and pipes. : "4 asi OUTLET 5-2' IN nlo'min, 2. The septic tank ap� distribution box shall be set Effective Length 5, r 5' -7* level on 6" of 3/4"-1 1/2" stone. SOIL ABSORPTION' SYSTEM (SAS) 4'-0* min, 3. Backfill should be clean sand or gravel with no � b Liquid depth stones over 3" in size. INFILTRATOR MODEL 3050 (H-JO LOADING)/ SUMNER DUNBAR 4. This system is subject to inspection during installation by Carmen E. Shay - Environmental Services, Inc. IVALENT) N' 5. The contractor shall install this system in accordance NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE NOTE: OVERALL HEIGHT OF I'NFILTR IS 30- /EFFECTIVE HEIGHT IS 24- 1O'_0" with Title V of the Massachusetts state code, the approved plan ff CROSS SECTION END-SECTION and Local Regulations. 6. If, during installation the contractor encounters any soil conditions or site conditions that are different from those shown on the soil log or in our design TYPICAL 1500 GALLON SEPTIC TANK installation must halt & immediate notification be NOT TO SCALE made to Carmen E. Shay - Environmental Services, Inc. 7. No vehicle or heavy machinery shall drive over the (H- 10 LOADING) septic system unless noted as H-20 septic components. 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. 9. All Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes. V 10. All solid piping, tees & fittings shall be 4" diameter PERCOLATION TEST Schedule 40 NSF PVC pipes with water tight joints. Date of Percolation Test: JUNE 21, 2004 11. SITE and Surrounding Properties are Connected to Municipal Water. Test Performed By: CARMEN E. SHAY- R.S., C.S.E. Results Witnessed By. WAIVER - Per Barnstable BOH Excavator: SHAY ENVIRONMENTAL SERVICES, INC. ro Percolation Rote: Less Than 2 min./inch 0 30" BELOW GRADE. lei, NIF WILJOLE J NOTF7 00 Test Hole THE PROPERTY LINES ARE APPROXIMATE AND No. 1 COMPILED FROM THE SURVEY PLAN GENERATED BY CID DEPTH SOILS ELEV. BAXTER & NYE, INC. OF OSTERVILLE, MA, DATED 1/17/84 CD :7t: 0 98.50 ENTITLED " PLAN OF LAND FOR WILJOLES LANDS C43 N 05d 40' 42 E BARNSTABLE, MA" AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN Co ------------- Sandy Loom IT SHOULD BE USED FOR NO PURPOSE OTHER THAN 1 OYR 3/2 THE SEPTIC SYSTEM INSTALLATION. 0.-8. Ap 97.75 Sandy Loom LOT #$ 10YR 5/6 43,664 Square Feet 8-- 30- 1 B, 96.001 WETLANDS LOCATED WITHIN A 200' RADIUS OF THE SITE ARE AS SHOWN. Mod-Coarse Sand 2.5 Y 6/3 0 01? IrAy 30'-132" C1 87.50 NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE FROM THE EXISTING SEPTIC SYSTEM TO BE DISPOSED J).E'VDF1l ft GO OF AS PER BOARD OF HEALTH SPECIFICATIONS. ------------- 0,tD- 4,J ESS 'Accc EXISTING LEACH PIT TO BE PUMPED DRY & FILLED IN PLACE OR REMOVED TO FACILITATE NEW SEPTIC SYSTEM INSTALLATION. O COD Cb ZONING RESIDENTIAL FLOOD ZONE C • Pe #1 0 Test. Hole #1 4.4j _ ivOr I Depth to Perc: 30" to 48" Perc Rate=<2 min./inch _WETLAND&`L� Ri -0 FTHE7_SITF_,kRE`-k5_'S-N-6-t--Ob- e-rie-d- TED_-WTTHINW ZOO AOTUS H70WN. CC) BOTTOM OF TEST HOLE Elev. 132" ADJUSTED H20 Elev. No Adjustment Req uir�d. X ------ ALL OUTLET PIPES FROM THE DISTRIBUTION BOX SMALL BE 12" ----------------- SET LEVEL FOR AT LEAST 2 FT. CONCRETE COVER LEGEND 4>� ;L 5* OUTLET 2 6 E KNOCKOUTS k - --- DENOTES PROPOSED F88X01 12 OUTLET IN SPOT GRADE DENOTES EXISTING I`0 X 104.46 15.5' SPOT GRADE 1.7 PLAN-SECTION CROSS SECTION LAN PL PROPERTY LINE - 10 DISTRIBUTION BOX 3 HOLE H PROPOSED CONTOUR NOT TO SCALE t NIF WILJOLE LOT #4 97- - - - - -97 EXISTING CONTOUR Design Calculations 1<1 Number of Bedrooms: 3 Equivalent to 330 Gal./Day DEEP TEST HOLE & PERCOLATION TEST LOCATION Garbage Grinder: No EXISTING Leaching Capacity Proposed: 550 Gal. Da Minimum At Owners Request) GARAGE Septic Tank 2 x 550 Gal./Day = 1100 USE Exist. 1,500 GAL. Septic Tank. FENCE SOIL ABSORPTION AREA: Using percolation rate of <2 min, inch 3. Bottom Area: 0.74 gal/sq. ft. x 520 sq. ft. = 384.8 gallons Sidewall Area: 0.74 gal./sq. ft. x 248 sq. ft. 183.52 gallons PRIVATE DRINKING WATER WELL Providing: 568.32 gallons EXISTING 3 BEDROOM Use: (7) 3050 INFILTRATOR CHAMBERS, HAVING A 2' EFFECTIVE DEPTH, HOUSE 1(4' W x 7' L) TO BE USED WITH 3' OF WASHED STONE ON THE SIDES AND 1.5' OF WASHED STONE ON THE ENDS. 1155 84 C.4 86� ASPHALT NEW 1500 gal. 0 11 PREPARED EO R : 88, Septic Tank IN PROPOSED DRIVEWAY 2 90 9 0.5 9r CID RICCARDO MARTHA BARROS SUBSURFACE SEWAGE DISPOSAL SYSTEM OF 96- PROJECT BENCH;' MARK #50 WILLMINGTON AVENUE # 1155 SANTUIT NEWTOWN ROAD TOP OF FOUNDATION 2' ELEV. 160.01]d (Assumed) / \ 1 12. MARSTONS MILLS , MA 02648 COTUIT, MA L 150.00 TEST HOLE #1 Failed Leach Pit I ii, PREPARED BY: NOTE: EXISTING 11,000 GALLON TANK TO BE REPLACED WITH 1500 GAL TANK. ELEV.= 98.50 C F 4%. 388.98 REVISIONS M /' C1.",4RffEjV E. , 5H.AY NO. DATE: DEFINITION 0 �4 ENVIRONMENTAL SERVICES, INC. 34 THATCHERS LANE EAST FALMOUTH, MA 02536 • N 'R\ 7-- S7A 2V �2"C-.,Tr J" 2V_JE7 TIV 9"0 TIV-ZV OAT TEL/FAX 508-548-0796 (60 FOOT RIGHT OF WAY) SCALE: 1 "=20' DRAWN BY: CES DATE: DUNE 23, 2004 PROJECT#SD-593 FILENAME: SD593PP.DWG SHEET 1 OF 1 -3 HOLE- 230-D' or so'., (H-10) DIST 0 14- IN V ,+r m ,.w: _...:r .x a '+ ' �,,�,,,�,-,,�,,,,'�,��""-�-�"",�",��,,,,,�,'�,��,-,� �.. , r ..n , �1 .,,� I'�";, ." , - , , " , " -, " __� , ,,," ,�!, , ,'I , , , - 1� ,, ,,, � ....- ,,.,. - , r. ,-, ,.,. , �, Y ^ , � I -, , , �, I .y.: t a: ... , ,. ,. , '.i ,: s r .,., , :. .. 1. t '1°.` .. • ,.-r ..., , �� :A s.,....... ,. .� ., .e...,. .�: �... .. ,. ,a , , .: e.�. , , n n v..... ,. , r ", } r ' .q�k ,. .. : r t. _. .r ,. .y: ,�., 1, I1 .. n , , ,' . ,. > r .. , r - % .:r. .e v. r -' _ = a - , , , .: , .. I .. r_. .:. _ - n: x , -h - _ ,.. 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' 6 tc tank a ... .mutt _, ; ".. #s.- . . ,:: _, a.F. el.v Stp 7 A T. x 00 00 ' . �.�-,�..�a�L-II'1_ u -I,I I�"1I. ILI �-Ir, wit i tit. fini�h.d rod. s . r 9 : a tic 7 k _ . uY •�. �.,._ ..,r S "r Crud.o+�r on pE SO Grodr evr D-Box {I8 30 •ewK S 6 _ _ Ir. a...._. . Ii II9 I D $A ELEV p SO E Ne . V _ , S GTION `.4 A `" a _. _ ,' . :...... ,,..,.... »v,,x..,.. ,. ,. _ .. w..d .... , .o ._. .,. _ �i .. a. PROFI E V 1P �_,,. L IE dF, LEACHING SYSTEM � � ,,:_� _ , ... � , Not to cola T Lead ET Y6 00 � ,op a Ta T BOX INL ET �,: :_ r � , S 0. r Mo im , . . .... 01 a ar � " r§F- t r x v ...,.. A n. a .. INLET. � � � __ �,. .r.. PIPE ' XiS . 1 000 G � �1�.., D I �. _ ,.r O. T O K /OOl OI' . - _$..tK , , A � ems. ,43' THE CC � ��, „ -.�I��III�I aaN r DAT ESS COVERS R TH _ 1 L 1.I,II L�I 1I,�'Ii-�;�I�I�I IIII. ,�-I IlI II I IIII II-,II IILI I I1.1,"I 1: ,I:I�1I�lIII I1.I I�-,I 'I�I1'I,1�.I�,.��I-I II.�I�L.:III�11 I��1,II1 I-II1iI��I- l�I1 J'1�I I�I LI�1,�I�iI I��I�I�I"II' �I�I I�I,I�I�I L I,�-I '"-1 I'IIII .�,1 I,,1,1 1�� I,,I��1,1�1,11.I.1 �I I�I'1��I:fL.,- -�II 11 I.I.I I',1,�."�_�_��I1 I1-v1,, 1,11I IIIIII -,I,, 1",I,1 I.,11 j-',"I��,I�I�1,,I;1-I. � "I,.I I,1'IZ�.�I�� II iL II 11 I��' II 11 II l�I lI f OUN ION R' ;, s".to I,! s _i►.rAr+tlCL"e�.Mat � , F'D E SEPTIC TANK �. . - ... ,",,.n.,. ,. / sew. SEP TA K J ii 4J ,.., +..: ... ,.,.. DISTRIB Ti U N OX AN A ,� . . 0 B D HiN, _ 2T .; <._ . LE C G COMPONENT r �..� � ;,'.�, �rr:� Ett.etiw D. h' �` , *,.T Pt .: .c_ : , N 4 PYC C ._. - a�s .:,i,_.._.11 +o..t.w. CAPPED)MIS�CTION Ppt?TO BE .._ SHALL BERAISED TO 1 ,. " . .� - _., _ r---. -r-'...r. WITH N 6 OF . . �x ax_ I ...ax ,.. ,r ... /J/ �r .v �:: n�sTAuLro AND TO BE NtTFNN a M � � _.�,.� v .__,�- CONCRETE Fuu. Fou"DAnorr--� tx"'cawE FINISHED GRADE. � ,, .....,, v STEEL REINFORCED PRECAST ONCR _ � :_ p p 0 , C ETE INSTALL TUF-TITS GAS BAFFLES OR EQUALS teaea �� , _ s: 4 ON ALL OUTLET TEE ENDS S06 SYSTEM P OFILE > °' 4 4 "' PLAN VIEW . a 6 --t p °' M� rezaat6l.nawtM st. anym39Nax�p #tag b. f Not to $cola za . 2• p 24 Effective 3-24"REMOVABLE COVERS c > 8 EPPtctNe Width c i _ Sidewall / I t 01 d Units e ?' 42' - ai Si ,, �' r:. GENERAL NOTES B In.of 3/4"-1 1/2 1.0' �/ C)' 3 min. of e f • C ompacted .tone a o , „• 1. Contractor is responsible for Digsafe notification NOTE: EXISTING 1,000 GALLON TANK TO BE REPLACED 1MTH 1500 GAL TANK. m INLEf 8 mT 2"mb, Mlet to ouN.t ouTLET P g pipes. 4, 1---- e"+^t, :' and rotection of all Under round utilities and w '" to•mIn- �""i '; C 2. The septic"tank and distri ution box shall be set Effective Length 5' -r 'A s• _r level on 6 of:3/4 -1 _1�, stone. b a-� ,V- depth 3• Btonesl overui3"bin sizen Bond or ravel with no 11 #. I I L%',.I 4�I.I".1 I .:,�;---�LAI._ 1I.1�10--Iri,,.,.�,d SOIL ABSORPTION SYSTEM (SAS) l 4-0•min. 9 INFILTRATOR MODEL 3050 (H-I0 LOADING)!' SUMNER & DUNBAR ., 1s 4. This s em is sub'ect,to inspection during installation y J p I'rII_.:--II,,I I OR EQUIVALENT :• by Carmen E. Sha Environmental Services, Inc. NOTE: ALL COMPONENTS MUST HAVE_RISERS TO WITHIN 6" BELOW GRADE ( " ) " :••ti• • ' ' .1•• .,; : », "• • �"' • •••"'''t 5. The contractor shall install this system in accordance NOTE: OVERALL HEIGHT OF NFiLTRATOR iS 30 /EFFECTIVE HEIGHT 15 24 101_01 5' -6" with Title V of the Massachusetts state code, the approved plan CROSS SECTION END-SECTIQN and Local Regulations. 6. if, during installation the contractor encounters any soil conditions or site conditions that are different TYPICAL 1 C�00 GALLON SEPTIC TANK from those shown on the soil log or in our design installation must halt & immediate notification be NOT TO SCALE made to Carmen E. Shay - Environmental Services, Inc. (H-70 LOADING) 7. No vehicle or heavy machinery shall drive over the septic system unless noted as H-20 septic components. 8. Install Tuf'ite gas baffles or equals on all outlet tee ends. 9. All Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes. 10. All solid piping, tees & fittings shall be 4" diameter P E R C O L.ATi O N TEST Schedule 40 NSF PVC pipes with water tight joints. , Date of Percolation Test: JUNE 21, 2004 11. SITE and Surrounding Properties are Connected _�•- Test Performed By: CARMEN E. SHAY- R.S., C.S.E. to Municipal Water. Results Witnessed By. WAIVER - Per Barnstable BOH ltN Excavator: SHAY ENVIRONMENTAL SERVICES, INC. ; .-- ///,`/A6 N/F WILJOLE / Percolation Rate: Less Than 2 min./inch ® 30" BELOW GRADE. 1---' oho / Test Hole NOTE• ---__'/ /'y/ ,I / -' No. 1 COMPILED FROMLTHE SURVEYPPLANMGENERATED BY R N I--� DEPTH SOILS ELEV. BAXTER & NYE, INC. OF OSTERVILLE, MA, DATED 1/17/84 O w _y // N 05d 40' ¢Z�° r __ 1-1 0 98.50 ENTITLED " PLAN OF LAND FOR WILJOLES LANDS , W O 2z E ,---_-�-_ r _ i r/ Sandy Loam BARNSTABLE, .MA AND IS NOT INTENDED TO f�E A SURVEY PLOT PLAN IT SHOULD BE USED FOR NO PURPOSE OTHER THAN 1I"),_..1.�1.I_I.I..II'.I1"..,1.I��.I1.I,I 1I,I"�.__,._-7-'1.I__\_.I�_,I-1_.,11,,_,I��_I_._-,�_/,�.I\�I'"I_,.,�,1_I,��_I,�� ,_,.I4.,III II�,1_r�1_I1,_.I,,�I I_"_�,-C, I__II/.-_.I-I.\...I�.I�-WI 1�I I-�1 II.1 II I..-I 0I I�1 III I 1�I��"_r.,.I��II-I-�I,I-��I1.:I,.�,.,I I I 1;�.I-II I II-1 II�.\1I p 7.75' 1oYR aye THE SEPTIC SYSTEM INSTALLATION. " r' ' r 0"-8" A 97.75 / /'�' LOT #Jr I I ..- ! '� � / Sandy Loom ,I�-_-.-I-_-��I I�I I.�. ,-I1I_I I-II%-_�-1-.I I'I--.I-r1I_L,-_-_�_1,_'�_I,,_I -�I-_I_I II/J-�I I_1_.I.I .__I_I"I.._1 1__J�_�I__�I.I.II I,I��I II�_��I/��-_�N�I"I�.I I�.�1I-I I,�.I.V-'�I I z/,-I:III I I',I_I_.1, 1 11�,I I_,-I�I)_..,/1"_II,I�I.,�I"�.\�I I._/\1I-_I1,,I.-_II-.I,.I,I_-_I I'1.I,..r_II I III._I" -� \\_�-1-11__1I--_I-.�I,I I_I I�.C..I 1\IZ / 1 / 101R 5/6 / / 43,664 Square Feet t/- \ -''" r, WETLANDS LOCATED WiTHIN A 200' RADIUS OF THE SITE ARE AS SHOWN. / \ - / _ - •� Med-Coarse �! / -- \ ..--• - Sand '- / - 30 -132 C, 87.50 NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE F WAY `' --'' . . _ pjGgT 0 ` - - -- r,r--' FROM THE EXISTING SEPTIC SYSTEM 'TO BE DISPOSED QZ __----_____ D- DEEDED _ OF AS PER BOARD OF HEALTH SPECIFICATIONS. _ `,- " CESS g0A 11/r Z _- II ACC ___- /11 ____ BA EXISTING LEACH PIT TO BE PUMPED DRY & FILLED IN PLACE ,// /' IT .1" / _ /'' _____ OR REMOVED TO FACILITATE NEW SEPTIC SYSTEM INSTALLATION. W Irr '-ter„ ✓' // �r''� __- >' ZONING - RESIDENTIAL __ O J FL OOD OD N,- ZO E r C Per 1 r � Te H 1 i 6 c st o e 1 r _ " i S .. .. 0ethtoPr e c. 30 to 48 / / r _ p , j r r O r r_ _,___.._r- arc_ o e_ __ _._ P Rote <2 ch_ _ n,/ / r G n w r ou d ote N Observed of s ed W ETLANbS LOCAT fi ED Wi IN `H A 200- D!U RA S OF THE;SIT... ARE , / GT E E AS SHOWN. r B0 M F 7 H TTO 0 TES I r / -_ r .. w OLE E ev 132 AD U H STED 20 lev. N_ o Ad u�. E stmen R y _ t e uIr ed t __ ___ �� I- / 1 i I i - -' : A 1 1 1 '_ V ALL OUTLET PIPES FROM THE 1 tr I ______--_ _ , DISTRIBUTION BOX SHALL BE {/�� '/ i 1 - �� _Y,_:-..,_r - / SET LEVEL FOR AT LEAST 2 FT. 12 LEG E N D / / I P SA I /ter -. / CONCRETE COVER rr _.. I/ \ __� ,. / _& C I / `� // KNOCKOUTS / � .. 6 - S OUTLET '„'e.v, .,a.a, y .: „,, . I / \ . ;, ; / \\ I C I / yam. ,r i '��'' _ - _�_ `N ,. 88X0 DENOTES PROPOSED i�-1 I��I�1".,1..1-1III ,., , -�\."I,r I_-I_8I_L-1 �, I / / r / 1 �► j /' /// `.r^'� '' --"' ♦ 1S 5 OUTLET r t✓ t. 12 -INLET SPOT GRADE \ 1 -' .�lr r-' `\ ;, =. �.;. R. , 2 DENOTES EXISTING / / ,.' i +i /`I/ /, ",- \ 1s.5• 1.rs• X 104.46 SPOT GRADE --_ / PLAN SECTION / 1, /I/ .'/ ._''� -�'� _ .-Jrr ,/' ,/' \ \ CROSS SECTION /'// / i /I/ - _`__ 11 Jr/ it \\ \\ \\ \\\\ `,\ PL PROPERTY LINE r _ 3 HOLE H- 10 DISTRIBUTION BOX / � !/ ` 1 \ PROPOSED CONTOUR // " N/F WILJOLE i it �' I r _--- i I/ /, �\ \\ \\ \ o NOT TO SCALE I r / _ 1 I r \ \ \ \ 9 7�-- / i r / / , �� „r.. I r v v LOT 4 r / ,-�,..-' , v yv y `v # 97- - - - ----97 EXISTING CONTOUR // 1 1 i /r /` / // //' _ I /,, -,"\ \\ \\ \ �1 Design Calculations / r i % r/ // // // /le ' .,,1`_ // \\ \\ \ \\ N Number of Bedrooms: 3 Equivalent to 330 Gal./Day DEEP TEST HOLE & .^ / / I / / / / / / / / \ \ \ \ I I / it r/ / / / `\ \\ \\ \\ Garbage Grinder. No PERCOLATION TEST LOCATION / I I I I I I I r EXISTING \\ \ I \\ Leaching Capacity Proposed: 550 Gal./Day Minimum (At Owners Request) fI I I I I i I 1 r GARAGE \ `\ \ Septic Tank - 2 x 330 Gal./Day = 660 USE Exist. 1,000'GAL. Septic Tank, _ ' FENCE i t I i r I \\ `\ \\ SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch .. Bottom Area: 0.74 al s ft. x 528 s ft. = 390.72 gallons 1 1 / CO I { I i i i I \ \ 9 f q q• ,� i� \ I i i j1 \\\ t\ \�\\\ SidewaN Area: 0.74 gal./sqx ft. x 224 sq. ft. 165.78 gallons PRIVATE DRINKING WATER WELL \ 1 556.50 allons I Providin = I \ 1 I I EXISTING \ \ \ \ 9 9 .. . i �� \I i i 1 3 BEDROOM B \\ \\\ 11 I' Use: (6) 3050 INFILTRATOR CHAMBERS, HAVING A 2' EFFECTIVE DEPTH, '" I 2 8.5' 0�, ' i i i SOUSE \\ \,\ (4 W x T L) TO BE USED WiTH 4' OF WASHED STONE ON THE SIDES AND 1 i t i j #1�f55 A ` 1 Cy 1.0` OF WASHED STONE ON THE ENDS. .< i I \\ \ c , , 1 V 1 I i I i .\ ,•,. i I 1 1 \ ;.-, • I I 1 \ r \ l I i 1 I 1 I I 1 1 \ \ �. I I I i . / i ,,, \ 861 I f PREPARED F OR *88 / /' D-Box �I " 44 I �\ \\ A S,�, ' BUILT I, 9�,/ �. \ o \ `i / v v © v ' 9 ,,. r' / v� \ GRAVEL \\ 6 to SUBSURFACE SEWAGE DISP A\ R CCARDO & MARTHA BARROS OS L SYSTEM / Exist. 100 gal. . 94' , ,,._ , `� � Septic To \ DRIVEWAY '" \ I ,: 6- - �� TEST HOLE #1 `N -', ,_-.; \\ \\ / ELEV.- 98.50 _, \ I OF 9 / _ �; , I \ \ "PROJECT BENCH ,MARK /I _ I\"__/ \\ ` c50 WI LLM I NGTON AVEN U E 1 155 SANTU IT NEWTOWN ROAD TOP OF FOUNDATION . ,. �\ f � ' ELEV., = 100.00 (Assumed) // \ ` ` . MARSTONS MILLS , MA 02 �48 COTUIT, MA r/ , , / 150.0 ailed SWING TIE SCHEDULE •, r/ $• r L L ach Pit \\ 11 PREPARED BY: , 388.9 , } j*_ f,A REVISIONS R \\ � `Hr C . 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