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HomeMy WebLinkAbout0068 AMELIA WAY - Health 68 AMfLIA WAY,MARSTONS MILLS LA=149-031-003 i TOWN OF BARNSTABLE LOCATION ^ I r SEWAGE# VILLAGE);rn 'SF6,n !^mot a//S ASSES OR'S MAP&PARCEL AV 7-dAJ- A93 INSTALLER'S NAME&PHONE NO.�dQ�®l /fit! �; � �yes/ gt� SEPTIC TANK CAPACITY 10 7 'f/�✓%� ,- LEACHING FACILITY:(type) 7 1rW4e1WS (size);`7'XV. NO.-OF BEDROOMS =OWNER' T� e,y) Lh1+Pr�1<, 4. PERMIT DATE: Z 6 s COMPLIANCE DATE:Z Separation Distance Between the`:1,, 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 6, �O ... s �ARC TOWN OF BARNSTABLE LOCATION _ SEWAGE# V'LLAGF, ��^'// ASSES OR'S MAP&PARCEL� D — G�.3 INSTALLER'S NAME&PHONE NO.�,Q�t�01 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) z'- g NO.OF BEDROOMS OWNERT�DiCrV PERMIT DATE: t Z 6 COMPLIANCE DATE:Z Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet I .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 i y w^4 z))veos I s � I 1 y Fee No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE MASSACHUSETTS es 01ppliLatlon for �I8 0" ' *pstrm Construction J)fftnit Application for Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location.Address or Lot No.6 Q' m� ,l Owner's Name,Address,and Tel.No. v 5Te-p4&0 .T,�v�+4QeSZ Assessor's Map/Parcel ,/1 - MZ W 4 t( ; 6 S h i,1 S Installer's Name,Address,and Tel.d.0� �Y r. Designer's Name,Addres ,and Tel.No.fjtp;eUL L,'qq (/U l5 `� �j�: _ ri ,�,G�, `c.,�i.r� � I•Z G(.� G�p�fS�'ie//� IQ/�• J�6!¢.sTp//�1G2-i Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures �. Design Flow(min.re uired) y gpd Design flow provided gpd Plan Date /S" ! Number of sheets Revision Date Title Size of Septic Tank ggAfJ Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 71—Va,,IG/ lJvC.6__ 14- -Z.6 �7 sTrCi 7t,71;oti ��yC. [,.� S'7-AJ iGt,� 'ram z4a�lo� .��c ed4A Gc ,S 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 En onmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board a h. Signed Date Z Z Application Approved by Date 012 Application Disapproved by Date for the following reasons Permit No. 0 0 Date Issued rt; ' -�" -.r _ _ + YL .. tea..,,,,rt.^••.-.n,;�-.. ^..7"..-t.J �,� ,• .. ��� . .. � p,.�., w No. �� ,L//V/ Fee s THE COMMONWEALTH OF MASSACHUSETT&,- Entered in computer: e� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplicatlon for Misposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No �/11 jre, / Owner's Name,Address,and Tel.No. 1 r s'i�p��1e,� ...1.TOm S 3 Assessor's Map/Parcel !�l '-C7 /-- C3LJ M.A, . � s�9 d A w-, A t4,14 k /� d i'S44,A S P7,I/ Installer's Name,Address,and Tel.� ���� Designer's Name,Address,and Tel.No. n��, q,�,� �t'c 1C 2 (�ia7 7`lit✓ /ZA• t!—kl '/�� 1 /..Z 1( S7 C4�S c 'el,q .x Type of Building: lja�-,.�jg/✓.. Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 5 y gpd Design flow provided 3 7 gpd Plan Date M17-/ / j Number of sheets , Revision Date Title / Size of Septic Tank�(�: � ��/rG�c. Type of S.A.S. fi(,IU 151. - sN'7, a-4, rl /114&z Description of Soil - Nature of Repairs or Alterations(Answer when applicable) Zt Svll/i 0r1,- / S T, sr4, 57L2 7//,1 %d / /fit ' �.{/ `i' ✓rJn �,A,1 c/� [_ / C1,4. ,jL 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 Certificate of ,r Compliance has been issued by this Board ofH h. Signed � Date z h Kht Application Approved by ,1 K cY A /// 7 ,, `1 Date !, Application Disapproved by Date fi Y for the following reasons Permit No.j o a o 0 /�/J Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded Abandoned( )by �� '��✓t./�( l�ar:.C7iC.t. f`il�/l, ---- - -- at 1`7 / .¢ /.f s/r / has been constructed in accordance withdhe provisions of Title 5 and the for Disposal System Construction Permit Na�0W—617 dated :�J at6& a-I Ins.- le Designer 7�,,t�'r/1et.C,n9 l,�t/�Lk -7.fr e #bc; rooms Approved desig�n'flloow f 1 3 0 gpd The issuance of this permit fun (shall not be construed as a guarantee that the system will ction aas designed. Date ; I 10 Inspector No.@ Fee A07 F.- -THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal *pstent Construction Permit Permission is hereby/granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at 1-wJ,4-•/ 1,041e" 111 I s &/f, and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply.with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date /Z 6 J�C Approved by I Town of Barnstable OF't'E T Regulatory.Services a snnxsz.►a[s ' * Richard V.Scali,Interim Director Public Health Division rEO �rL Thomas McKean,Director 200.Main Street,Hyannis,MA 02601 Office: 508-862-4644 Faa: .503-790-6304 r ] Installer&Designer Certification Form Date: Sewage Permit#ZZ'7Z0--0<'6 Assessor's MaplParcel Designer: iElll c ;„tge--ne tlaYlL.c s jhC Installer: ��Ild/��-. u J Address: )2. 1A), Crbss -._1d 9a Address: Z Grc,r hda Ie.MA 6 Z64jlq U/_/, On �' rAXD1;"C d"Is was as issued a permit to install a (d te) (installer) septic system at (0 �j 411M e It OX W� !vt` s_ based on a design drawn by (address) nzer,'179 NG;,—Iksl Jk( dated (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. Strip out (if required) was inspected and the soils were found satisfactory. 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. Strip out(if required)was inspected and the soils were found satisfactory. certify that the system referenced above was constructed in with the teens f the I\A approval Ietters(if applicable) po;.Trr m (Install es Signature) M CIVIL No. cos C� 0 g�RfOtSZ��� (Designer's Signature) (Affix Designe 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:`.Septi;.Designer Certification Form Rev 8-14-13.doe Engineers note:This certification is limited to an as-built inspection of system components as installed prior to backfill.The engineer did not supervise construction of the system.The installer assumes responsibility for all materials,workmanship,backfilling to specified grades with proper compaction and setting riserstcovers as shown on the design plan. COMPLETE • COMPLETE THIS'SECTION ON DELIVERY ■ Complete items 1,2,and 3. A. Signature ■ Print your name and address on the reverse ❑Agent so that we can return the card to you. ❑Addressee ■ Attach this card to,the back of the mailpiece, eive` by( Md C; at of Delivery or on the front,if space permits. - D. Is delivery address different fro item 1. ❑Yes .__ If YES,enter delivery address below: ❑No DUMARESQ, STEPHEN J&CHRISTINE A f 68 AMELIA WAY MARSTONS MILLS,MA 026" II I IIIIII IIII III I ILIII)III I I III I I I I II I I I II III 3. Service Type ❑Priority Mail Expresso ❑Adult Signature ❑Registered MaiITM ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted) Wh 9590 9402 4798 8344 8569 36 Certified Mail® _/'Q.-livery ertified Mail Restricted Delivery �Return Receipt for ❑Collect on Delivery erchandise 2. Article Number(transfer from service_label) 0 Collect on Delivery Restricted Delivery ❑Signature ConfirmationTM ail El Signature Confirmation 7 015 17 3 0. 0 0 01 4 9 8 7 9651 ail Restricted Delivery Restricted Delivery Ps Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt USPS TRACKING# First-Class Mail Postage&Fees Paid USPS Permit No.G-10 9590 9409"14740-8344 8569 36 United States •Sender:Please print your name,address,and ZIP+4®in this box* Postal Service Town of Barnstable I r0: Health Division ° 200 Main Street Hyannis,MA 02601 I � I I itrrrlillrl.l�i�llijt' ► 'iitif,)I}i'��f Whir I Lrl Ir _ cD Certified Mail Fee Pp�r Extra Services&Fees(check box,add fee as.approprlete) ❑Raturn Receipt(hardcopy) $. ` ❑,Return Receipt(electronic) $ AA Postmark Ct 0- ❑Certified Mall Restricted Delivery $ Here O ❑Adult Signature Required ❑AdultSlgnature Restricted Delivery$ I O Postage - - - N $ �sAs rj Total Postage a $ DUMARESQ, STEPHEN J&CHRISTINE`A , � Sent to 68AMELIAWAY Stieefanil,4jit.j MARSTONS MILLS,MA 02648 Ciry-Staae,ZIPS i Certified Mail service provides the following benefits: •A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique Identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this _ delivery. USPS®-postmarked Certified Mail receipt to the j ■A record of delivery(including the recipient's retail associate. C, signature)that Is retained by the Postal Service- Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent 1 Important Reminders: Adult signature service,which requires the •You may purchase Certified Mail service with signee to be at least 21 years of age(not 'C First-Class Mail®,First-Class Package Service®, available at retail). t or Priority Mail®service. Adult signature restricted delivery service,which •Certified Mail service is notavailable for requires the signee to be at least 21 years of age International mail. and provides delivery to the addressee specified-■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). _ of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is Insurance coverage automatically included with accepted as legal proof of mailing,it should bear a` certain Priority Mail items. USPS postmark.If you would like a postmark on •For an additional fee,and with a.proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarkirig.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded porbon) of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply f-y You can request a hardcopy return receipt or an appropriate postage,and deposit the mailplece. >—? electronic version.Fora hardcopy return receipt, n complete PS Form 3811,Domestic Return Receipt,attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records. Ps Form 3800,April 2015(Reverse)PSN 7530.02-000-9047 r Town of Barnstable Barnstable Inspectional Services Al-fteicaC'igr BAEtNf3TABL& 69 Public Health Division Argo M40�s 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO r FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 9651 April 23, 2019 DUMARESQ, STEPHEN J & CHRISTINE A 68 AMELIA WAY MARSTONS MILLS, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 68 Amelia Way, Marstons Mills, MA was inspected on 04/08/2019 by Shawn McElroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20h). You are ordered to repair of replace the septic system within two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Vtik Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\68 Amelia Way Marstons Mills.doc cF T"e roy, Town of Barnstable • anxn,sraer.e. MASa 1639. ,��°' Regulatory Services Department - rfa µno Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or 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) Keaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc f cam,` Commonwealth of Massachusetts Title 5 Official Inspection Form ws t nl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Amelia Way Property Address ••" Christine Dumaresq Owner Owner's Name information is ; required for every Marstons Mills MA 02648 4-8-19 page. City/Town State Zip Code Date of Inspection _P 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. A. Inspector Information Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CMR 15.000);1 have personally inspected the sewage disposal system at theproperty 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 4-8-19 Inspec or's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form `�•%► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Amelia Way Property Address Christine Dumaresq Owner Owner's Name information is required for every Marstons Mills MA 02648 4-8-19 ' page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary:Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: I• 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 s Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /rf 68 Amelia Way R Property Address Christine Dumaresq Owner Owner's Name information is required for every Marstons Mills MA 02648 4-8-19 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 system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑Y ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑Y ❑N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i.1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Amelia Way `.r Property Address Christine Dumaresq Owner Owner's Name information is required for every Marstons Mills MA 02648 4-8-19 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: i 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or ® El 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 f Commonwealth of Massachusetts 4.1 ,w Title 5 Official Inspection Form 1�1, bl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Amelia Way Property Address Christine Dumaresq Owner Owner's Name information is required for every Marstons Mills MA 02648 4-8-19 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 Y 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 II 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 s ` Commonwealth of Massachusetts + 03 Title 5 Official Inspection Form i�I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,fc 68 Amelia Way Property Address Christine Dumaresq Owner Owner's Name information is required for every Marstons Mills MA 02648 4-8-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade.the system in accordance with 310 CMR 15.304. The system owner ' should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the.following for all inspections: Yes No Z, ❑ Pumping information was provided by the owner, occupant, or Board of Health ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has`the system received normal flows in the previous two week period? ❑ ® ; Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ -Was the site inspected for signs of break out? ® 0 Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, M 'dimensions, depth of liquid, depth of sludge and depth of scum? Wasthe facility owner(and occupants if different from owner) provided with ® information on the proper maintenance of subsurface sewage disposal systems? p p 9 p y 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 Commonwealth of Massachusetts M. Title 5 Official Inspection Form M Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Amelia Way Ty�! �J u. Property Address Christine Dumaresq Owner Owner's Name information is required for every Marstons Mills MA 02648 4-8-19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 5 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 2019Date t5insp.doc-rev.7/26=18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts 3 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Amelia Way Property Address Christine Dumaresq Owner Owner's Name information is required for every Marstons Mills MA 02648 4-8-19 page. City/Town 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 i 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: Owner----pumped 2016 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts 3 Title 5 Official Inspection Form -1 hl w'' ri Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Amelia Way Property Address Christine Dumaresq Owner Owner's Name information is required for every Marstons Mills MA 02648 4-8-19 - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1996 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below-grade: 18"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.): Good condition. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form I�r i� o" ib�i Subsurface Sewage Disposal System Form -Not-for Voluntary Assessments ,,_,.•T,;,,, 68 Amelia Way J. Property Address Christine Dumaresq Owner Owner's Name information is required for every Marstons Mills MA 02648 4-8-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade:— 12°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: 1000 gal - 611 i Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle Err Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts f� Title 5 Official Inspection Form r,.I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Amelia Way Property Address Christine Dumaresq Owner Owner's Name information is required for every Marstons Mills MA 02648 4-8-19 page. City/Town 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 El metal El fiberglass El polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of i nspectio n)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form Ir Yi,01 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �i;' 68 Amelia Way Property Address Christine Dumaresq Owner Owner's Name information is required for every Marstons Mills MA 02648 4-8-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm resent: p ❑ Yes ' ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box had water at working level with stain lines above inlet invert. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts r� 3, Title 5 Official Inspection Form 1;111 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Amelia Way Property Address Christine Dumaresq Owner Owner's Name information is required for every Marstons Mills MA 02648 4-8-19 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.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1-1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 4e°, Commonwealth of Massachusetts r� 3 Title 5 Official Inspection Form lr' wa ill Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Amelia Way Property Address Christine Dumaresq Owner Owner's Name information is required for every Marstons Mills MA 02648 4-8-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit had water level at inlet invert with stain lines above invert. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts f Title 5 Official Inspection Form Vill i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Amelia Way Property Address Christine Dumaresq Owner Owner's Name information is Marstons Mills MA 02648 4-8-19 required for every - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i i t5insp.doc-rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts -f Title 5 Official Inspection Form w_ hI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Amelia Way Property Address Christine Dumaresq Owner Owner's Name information is required for every Marstons Mills MA 02648 4-8-19 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts , Title 5 Official Inspection Form �i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Amelia Way Property Address Christine Dumaresq Owner Owner's Name information is required for every Marstons Mills MA 02648 4-8-19 page. City/Town 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:: 20 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 wish local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS antown maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspector Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts ,w, Title 5 Official Inspection Form ! rl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Amelia Way Property Address Christine Dumaresq Owner Owner's Name information is required for every Marstons Mills MA 02648 4-8-19 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D.System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 " '€per OF;gAIt$ISTABLE L4CITIQN ��� SEWAGE e # tLSSESSQR'S brw ETA.LEA'S NA IEA FRONE No WD SBPh T. VK' QFI'X 3,BAC1IINC FACILI' { ) NQ QFBED�QOhRS � - '. BUILDER CAR t3W'riER PlE1Al1ITDATE CLfANCE DATE.'. Segarsuon Dcstance rcen' e Feet Maacumum Adustect Grout water Table to the Bottom ofLeachng Fa fy F an �reUs exist Su 1 : dell3014+"O ac luy ( Y Feet. stater . Y_ Private PF .. - on seta ur ti�un�fact y€3eact�n$ - F.dge:o£wl and and I.eaciu g£�aa ty(It'ariy widands exist Feet vsnttuat gil4 feet teaching to guriusbed by, ..�-� �k I a D� � � 83 a , TOWN OF BARNSTABLE `t: CATION W�c SEWAGE # `•,'MLAGE Mal U ASSESSOR'S MAP & O b�3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY, j LEACHING FACILITY: (type) (size) I NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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 wetlands exist within 300 feet of leaching facility) Feet Furnished by } Dec � g A � A g1S'-7 AD tip:�1;, �.- TOWN OF BARNSTAiLE -c LOCATION b 8 AV R-L1 V1- SEWAGE # ' 1"ILLAGE L ASSESSOR'S MA'r&LOT •0 1-D63 INSTALLER'S NAME&PHONE NO.�,Cd SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �_. (size) t� NO.OF BEDROOMS y BUILDER OR OWNER ps Q,PERMTTDATE: �� - _COMPLIANCE DATE: © Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist .on site or within 200 feet of leaching facility) y Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of lea g f�ty� � , , � Feet Furnished by 0 2 Gt D it Z J ' 3 3g r 2 S" a � w N....... V/F.R i ......... .THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Divi-poottl Worko Tantitrnrtion ratnit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at -- rzs / "Cii. d ri s --•---------------or Lot No..-••------..............-...^.--••--•--- -------- ------- ---• . A"_� Installer Address d Type of Building Size Lot.. ...., __.._ Sq. feet V Dwelling—No. of Bedrooms... ........... ..........._.._ Expansion Attic ( ) Gar1lage rinder ( ) ��o. of ersons____________________________ Showers — Cafeteria Other—Type of Building ________________ __ p ( ) ( ) a' Other fixtures ------------------------------- - - W Design Flow____-__---575........................gallons per person per day. Total daily flow--------- .................gallons. R P: Septic Tank—Liquid capacity� ®tigallons Length --------- Width-----51 ...... Diameter---------------- Depth f ---.- Disposal Trench—No. .................... Width.................... Total Length...._.....__..... Total leaching area....................sq. ft. Seepage Pit No.--/.............. Diameter.....Zo...... Depth below inlet_<............. Total leaching area5y. %-,Z.sc-€ — Z Other Distribution box ( ) Dosing tank ( ) �� '-' Percolation Test Results Performed by._ .C- - - ... �5 -'.. Date___9. ... -... __✓. .......... Test Pit No. 1--m-Z -minutes per inch Depth of Test Pit -__.__- Depth to ground water.. ............ G Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------------------------------------•--•••-----------------.....-•--... O Description of Soil.......am -•--••--------......................................................... x V ----------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------•------------ --- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Co p nR s bee issueddby the board of health. A/ Signed -------- • . ...... -------- -- ----- -- ------ ---e! ,,-- :. ........................ Date Application.Approved By ------6 ... - - .........._..._------...._...._ ------._........ .......................... Date Application Disapproved for the following reasons: ------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------- ------------ - - ---------------- Permit No. ............p5_-4,V-3 � 9S Date ......... ... ..... Issued Date pj — L THE COMMONWEALTH OF MASSACHUSETTSVIE z. BOARD OF HEALTH TOWN OF BARNSTABLE Apphration for Di-nVoottl Mork.6 onotrnr#inn ramit Application is hereby made for a Permit to Construct ( v) or Repair ( ) an Individual Sewage Disposal System at: LocaI -Ad css or Lot No. - -� . /`c... --�-/--- --/ ------------------------------- 6wlier W � 'r e /� [/ t v' e Ad re/G- `� Installer Address d Type of Building Size Lot-./4/ 2'��`_-!/ -Sq. feet Dwelling—No. of Bedrooms---------------�"a----------------------- ----Expansion Attic ( ) Garbage Grinder ( ) p.1 Other—Type of Building _ly_'�No. of persons--------_---------------- .. Showers ( ) — Cafeteria ( ) QI Other fixtures ------------------------------- -- W Design Flow-----------5-:5.........................gallons per person per day. Total daily flow-........ 4�-...._.__...._._gal WSeptic Tank—Liquid capa6ty./j2�b 'gallons Length-�....... Width----- ._._. Diameter................ Depth..4!........ x Disposal Trench—No. .................... Width.................... Total Length-----------�....... Total leaching area....................sq. ft. Seepage Pit No.--I.............. Diameter.....r. _-_- Depth below inlet_ ............. Total leaching areaSr �lr ..sq-f•.% - Z Other Distribution box ( ) Dosing tank Percolation Test Results Per by-. !. .CG- _c� _•-? .5 .... Date_ ..........Z/S 5�....... a i / f 1 Test Pit No. 1--r.�_-minutes per inch Depth of Test Pit S` Depth to ground water..s . _ Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W •---••-•-•-•----------------••-•-•••---•---•----•---------••---•••......-•---• •...= 0 Description of Soil......Z5 .. ?'L►9-G -,� '?- •� L - x W x •-•-••-•--------------------•-----.....--•-•._._._... .................................................................................................................................................. U 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance s beentissued�by the board of health. `� 9Signed J ..- ---, �` -a--- /----f�l--------c' �......... Date Application.Approved BY � .... '� <,ci ✓ - --..a ---'�'r"_ r r'---------------------- Date Application Disapproved for the following reasons- ---------------- ---------------------------------------------------------------------------------------------------------- -------- .......... ... ........................................ . .........................__........ ... .......... . --. ....... .... . ........................................ Permit No. p5_-1''�- Issued _5_/ � Date ... ----------------------------------- - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE V,Qrtifirate of Tomplianre THIS IS TO CERT , .ghat theLlndividual Sewage Disposal System constructed ( ) or Repaired ( ) by _....... / - -----------------------------------------------_.------------------------------------- ------- at ..................................................... ....1,�-� /.�At.aie ' ---._-------------------------------------------------.......------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ........_............._....._..._._------- dated .---------------------..--------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. j DATE..._......_.........._...... l- =~1 .. ....'...t-/t`' Inspector . :' =.'..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No..... TOWN OF BARNSTABLE FEE.....�.DU ....... ��..... -.'..... .......... UWposal- orkii To ntr inn Vrr�4 Permission `hereby granted.. - ✓ = ..... to Construct ( ) or Repair ( an Individual Sewage Disposal System atNo.....! .••••-t�....-C��1' • U-1la-f_...1 ;-4 - 7 - ----------------------------------------------------------------••-•---------- IStreet �� as shown on the application for Disposal Works Construction Permit No._%�__..____.r�_.__lr- Dated_-_. __��.�•�...J.-S......... - Board -- Health DATE......................................---------------�.......--- FORM 36508 HOBBS&WARREN,INC..PUBLISHERS APPL1CA` iON I"OR PERCOLATION TEST AND OBSERVATION PITS LOCATION " VILLAGE___ ��4�y�stf �.�, ��APPLICANT � '�� �- DATE FEE •0 , 70�, 4r ADDRESS. ra ` `�f�,'sI;EPHO NO. (Non-refundable ENGINEER ��Avx � TELEPHONE NO 1 DATE SCHEDULED p icant's signature AS So LOT NO. o. . . . . . . . o . . . . . . . . o . . . . . . . . . . . . . . . . . . . . . . . o . . . . . . , . . . . . . . . SOIL LOG SUB-DIVISION NAME : r �� ��'`l��J���DATE � �� TIME EXPANSION AREA: YES NO s,e_ ENGINEER � _. �._ TOWN WATER.,�PRIVATE WELL S BOARD OF HEALTH EXCAVATOR SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes) NOTES: Cyr N PERCOLATION RATE: TEST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: 1 4C>'4_ e- r 2 ZYv 2 3 3 4 ®des 5�.�e.� 4 5 eJ��raz�dg�'c. 5 6 6 7 yi 7 8 8 9 C.0t"_-c9 9 10 10 11 11 12 /Y y y 12 13 13 14 14 15 �v=����a 15 16 16 SUITABLE_FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING P ITS LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P. E..,-AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT TEST HOLE LOG DATE: TEST BY: WELLER&ASSOC. WITNESS.: o:4�--c . PERC RATE:..— Z.rfi�,��J Zy s' Z ! ayy 17 Z r3 �� _-Gam /o P:'z c.3 Tan ��yTi� �S N DESIGN DATA � i X_5 6 5 5 DAILY FLOW: SEPTIC TANK: 33o x 150%= `17s" USE: C� LEACHING FACILITY: USE:-_ C CAPACITY: SIDEWALL: /��SX z,5 y7/.z BOTTOM: TOTAL: S 5i y� c7h2� PIPE TO $E LAID 2"LAYER OF 3/8"PEASTONE LEVEL FOR 2' OUT OF OVER 3/4"-1 1/2" WASHED DISTRIBUTION BOX STONE ALL AROUND TOP OF FOUND. @EL. 58.00. 10„ 14 — : ;sl 7- 53, � 3 5 Z J b 1 O O ALL PIPE TO BE 4"DIA.SCH 40 PVC Z RAISE ALL APPLICABLE MANHOLE \! COVERS TO WITHIN 6" OF FINISH GRADE THIS SYSTEM IS NOT DESIGNED FOR THE USE OF A GARBAGE DISPOSAL SEWAGE SYSTEM PROFILE SCALE: 1"=10' GENERAL NOTES 1. CONTRACTOR TO BE RESPONSIBLE FOR THE SITE-SEWAGE TAN LOCATION OF ALL UTILITIES,ABOVE AND ;�' UNDER GROUND,PRIOR TO ANY CONSTRUCTION FORQ ��s� o i��: OR EXCAVATION. 2. INSTALLATION OF SEPTIC SYSTEM TO BE IN' COMPLIANCE WITH 310 CMR 15.00:TITLE V. PREPARED FOR 3 THIS PLAN IS NOT TO BE USED FOR PROPERTY c-- piN OF hk . ✓ ��� - �q r LINE DETERMINATION. Y Q SCALE:_f�5 /KaT�,o. DATE: �lA,� / 9�-� R3 v7 T Pd0 - 7 WELLER & ASSOCIATES , VV day.,, P. O. BOX 119 YARMOUTHPORT, MA. 02675 (508) 362-8131 APPROVED BY: TEST HOLE LOG . DATE SST zZ,��9y 8Z85/ TEST BY:WELLER&ASSOC. WITNESS:-_lzf_o_ PERC RATE:- Z.�7itil/��h� 1.9 8y~ yy z - � . Q E.N / DESIGN DATA DAILY FLOW:C3)&c9i��s-� 3` o yes SG y d_ i SEPTIC TANK: 33o x 150%= USE:. /co o 4-4L. LEACHING FACILITY: USE: �S'` 3 SZ ' CAPACITY: SIDEWALL: ys3' BOTTOM: TOTAL: S y9 7 '77 f ; PIPE TO BE LAID 2"LAYER OF3/8"PEASTONE LEVEL FOR 2' OUT OF OVER 3/4"-1 1/2" WASHED DISTRIBUTION BOX STONE ALL AROUND TOP OF FOUND. @ EL. - 10" 14" -3.27 e ' 53.5 Z ALL PIPE TO BE 4"DIA.SCH 40 PVC RAISE ALL APPLICABLE MANHOLE COVERS TO WITHIN 6" OF FINISH GRADE THIS SYSTEM IS NOT DESIGNED FOR THE USE OF A GARBAGE DISPOSAL SEWAGE SYSTEM PROFILE SCALE: 1"=10' GENERAL NOTES 1. CONTRACTOR TO BE RESPONSIBLE FOR THE r r{' LOCATION OF ALL UTILITIES,ABOVE AND SITE-SEWAGE CLAN - . 5,. UNDER GROUND,PRIOR TO ANY CONSTRUCTION '' FOR (,f OR EXCAVATION. G.o T// C 1)07',gl,4y S7�6C 2. INSTALLATION OF SEPTIC SYSTEM TO BE IN COMPLIANCE WITH 310 CMR 15.00:TITLE V. PREPARED FOR - -- 3 i�' `' TO USED F �H of THIS PLAN IS NOT O B OR PROPERTY LINE DETERMINATION. SCALE:f�5i�o DATE: �A-� G- / � .5 'V , r - WELLER & ASSOCIATES "Vy�� �, d"1'{ P. O. BOX 119 YARMOUTHPORT, MA. 02675 (508) 362-8131 APPROVED BY: r -- 97- -EXISTING CONTOUR x 100.98 EXISTING SPOT GRADE vo"T ohs LCP 15666 e 97 PROPOSED CONTOUR Val EXISTING. WATER SERVICE o`a �• 9 BENCHMARK G EXISTING GAS SERVICE F - +99.6a INSIDE COR./ BULKHEAD •�JGW-- UNDERGROUND WIRES EXISTING LEACH PIT 68 Amelia way t'•..... ..•• EL.=103.89 TEST PIT -CONTRACTOR SHALL PUMP, +,101.05' >' FILL WITH SAND & ABANDON 1 BENCHMARK ;: f `� LEGEND 206' SWING SET 100,01 EXISTING SEPTIC TANK �\ TOP OF TANK, EL.=101.54 INV.(OUT)=900.21E :x 101.71 .;' " ""' LOCUS MAP 'z NOT TO SCALE 1.9.............. .....1'O6'a Of �yqs \ 0 o PETER T. s x 1o1.a �' McENTEE GENERAL NOTES: 101.7a } 1 CIVIL N 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL No.. 35109 BOARD OF HEALTH AND THE DESIGN ENGINEER. x 101.66 '/1f 2� '017'% �'� ` REG/$TES �t� 2• ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS _ OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 6�) :100.1 / T LOCAL RULES AND REGULATIONS. 102.66 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR ` x 102.22 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE x 102.87 1J.r' ( � 1� DESIGN ENGINEER. _ \ �l x 102.47 ! PATIO +1oo:D3. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN x 10315 103.89 DECK ENGINEER BEFORE CONSTRUCTION CONTINUES. bh BM 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. 20' i / 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF t ,EXISTING ` GARAGE x 102sa THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 0 0 TP-2 HOUSE(#68) / \ HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. I 102.94 xv,ll'';. / 0 7. WATER SUPPLIED BY TOWN WATER SERVICE. (0` ? TP-1 T.O.F.=104�f 103.87 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. x 101.30 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 103 53 -;. ; - AGREED _ _ AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 30 12.8' +103. 3 DIRECTED BY THE APPROVING AUTHORITIES. WA K OF THE CONTRACTOR TO VERIFY' 10. IT SHALL BE THE RESPONSIBILITY `�S°2.17 / 103.02 x THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING PA,VED;.^� ._ ,/ CONSTRUCTION. ORlV�WAY:;:: 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE S01LS h ✓ :':::'.;:.;:.; .:' IN THE AREA BENEATH AND FOR 5' ON ALL 'SIDES OF THE S.A.S. AND 101.43 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). LOT 11 12. AREAS REQUIRING LICENSED UT OF UNSUITABLE MATERIALS SHALL BE N INSPECTED BY A LICENSED SOIL EVALUATOR PRIOR TO BACKFILL. Q` 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND �303.02 43,854 fSF IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. Cx`102.68DRAINAGE rj*� ," EASEMENT j -- ---- 100597_/ `� A_8 _5�'-��"- - PARCEL ID: 149-031-003 1 136.00' 37� _ � PROPOSED SEPTIC SYSTEM UPGRADE PLAN 102.39 98.62 101.33 _____ _ ;: --- - ae 68 AM ELIA WAY, MARSTO N S MILLS, MA 98.98 100.67 100.36 edge of pavement 99.64 99.43 Prepared for: Christine Dumaresq, 68 Am is Way, Marstons Mills, MA 02648 OWNR OF RECORD Engineering by: SCALE DRAWN JOB. NO. A MELI A WAY DUMARESQ, STEPHEN J. 1"=30' P.T.M. 208-19 & cFiRISTINE A. Engineering Works, Inc. 68 AMELIA WAY 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. MARSTONS MILLS, MA 02648 (508) 477-5313 7/15/19 P.T.M. 1 of , 2 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:99.7 SEPTIC TANK FOR A DISTANCE OF 15' AROUND THE INSTALL RISERS & COVERS OVER INLET PERIMETER OF THE S.A.S. AND SET TO 6" OF FINISH GRADE. PROPOSED D-BOX PROPOSED S.A.S. INSTALL WATERTIGHT RISER & PROVIDE TWO ACCESS MANHOLES TO WITHIN 3" T.O.F.=104.6E COVER SET TO 6" T GRADE OF FINISH GRADE FOR INSPECTION PURPOSES F.G. EL.=103.2t F.G. EL.=102.7t F.G. EL.=102.8t F.G. EL.=102.9E MAINTAIN 2% GRADE (MIN.) OVER S.A.S. r---�20,-"1 / 1 I EXIST/NG GARAGE ' L = 50' L = 5' y.� `� N� $ �y %\ HOUSEe# ® S=1% (MIN.) ® S=1% (MIN.) �y $A �' ^�� T.O.F.=104.6E 4'SCH40 PVC 4"SCH40 PVC — ; as as 10•I • 1TINV.=100.21 B 'a' a- 21.0� EXISTING 48" LIQUID aaaaaaa rl .8 LEVEL ADDINV.=99.47 PROPOSED INV.=99.30 4' 4.8' 4' 33.6' GAS BAFFL D-BOX EFFECTIVE WIDTH = 12.8' INV.=99.20 ED EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H-10 RATED TOP BREAKOUT EELEV.199.070 SEPTIC LAYOUT NOTES: INV. ELEV.=99.20`7 ease ease aaaaa eases 1 CONTRACTOR SHALL VERIFY ALL EXISTING PIPE aaaa aaaaa ) BOTTOM ELEV.=97.20 INVERTS, PRIOR TO INSTALLATION. 4' 2 X 8.5'=17.0' 4' 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 4' MIN. OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0' ON A MECHANICALLY COMPACTED SIX INCH CRUSHED PERVIOUS MATERIAL STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5' MIN. ABOVE GROUNDWATER LEACHING SYSTEM SECTION ®®®® 0 Ea OZA Ea Ell 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTT. OF TEST HOLES, EL.=90.9 - ®®®®®® Ea ® ®Ea Ea33" 4) CONTRACTOR SHALL INSTALL A GAS BAFFLE ON 3/4" TO 1-1/2" DOUBLE w ®Ea THE OUTLET TEE. WASHED STONE cv z ®LO-Ea 3" LAYER OF 1/8" TO 1/2" SEPTIC SYSTEM PROFILE DOUBLE WASHED STONE 02„ (OR APPROVED FILTER FABRIC) DESIGN CRITERIA SOIL LOG 4" KNOCKOUT DATE: JULY 2, 2019 (REF#TPT-19-64) 20" DIA. COVER NUMBER OF BEDROOMS: 3 SOIL EVALUATOR: PETER McENTEE PE(SE#1542) SOIL TEXTURAL CLASS: CLASS I WITNESS: DAVID STANTON R.S. HEALTH AGENT 4" KNOCKOUT 4" KNOCKOUT 58" DESIGN PERCOLATION RATE: <2 MIN/IN ELEV. TP-1 DEPTH ELEV. TP-2 DEPTH (0.74 GPD/SF LOADING RATE) 102.9 A 0" 102,9 A 0" DAILY FLOW: 330 GPD LOAMY SAND LOAMY SAND 4" KNOCKOUT DESIGN FLOW: 330 GPD 102.1 10YR 4/2 10„ 101.9 10YR 4/2 12" GARBAGE GRINDER: NO B e 330 GPD = 445.9 SF LOAMY SAND LOAMY SAND 500 GALLON CAPACITY, H-10 LOADING LEACHING AREA REQUIRED: ( ) 10YR 5/8 10YR 5/8 .74 GPD/SF 100.4 C1 C1 100.2 32" CHAMBERS EXISTING SEPTIC TANK: 1000 GALLON CAPACITY M-C SAND PERC M-C SAND N.T.S. PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLETS 2.5Y 6/4 2.5Y 6/4 USE 2-500 GALLON LEACHING CHAMBERS IN SERIES 20% GRAVEL 20% GRAVEL PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 93 9 C2 108 93 7 C2 110" M-C SAND 68 AMELIA WAY MARSTONS MILLS MA SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. M-C SAND 2.5Y 6/6 Prepared for: Christine Dumaresq, 68 Amea Way, Morstons Mills, MA 02648 BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. 2.5Y 6/6 SCALE DRAWN JOB. NO. Engineering by: - TOTAL AREA:..............................................................471.2 S.F. q 9 144" 90.9 144'✓ Engineering Works, Inc. NTS P.T.M. 208-19 DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD 39.9 NO GROUNDWATER, PERC RATE: <2 MIN./IN. 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. REFERENCE PERC P#8284, 9/13/94, (IN SAND) (508) 477-5313 7/15/19 P.T.M. 2 Of 2