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Home My WebLink About0079 AMELIA WAY - Health 79 Amelia Way Marstons Mills _ _ _ A= 148-161 �► I�`� tluv � ��t � J� �' �� ' �� c5 �� _ � C °' I Commonwealth of Massachusetts Title 5 Official Inspection Form .� p m I i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Amelia Way Property Address -- Owner Jane Mclnness information is required for �- every page. Owner's Name --" - a" -- ---- - -- Marstons Mills i �. MA__.__ 7/20/12 City/Town State ~ Zip Code— Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: When filling out A. General Information } forms on the computer,use 1. Inspector: �� i✓t� only the tab key to move your Wayne Ar_chambeault _ cursor-do not use the return Name of Inspector key. Company Name ,Q Box 914 Company Address _Hyannis MA 02601 rerum City/Town State ------- - Zip Code _775-1362 355 Telephone Number License Number -+ --- B. Certification _ 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: t. N-Passes ❑ Conditionally Passes ❑ Fails >rr" CZ>_ ❑ Needs Further Evaluation by the Local Approving Authority C: 7/20/12 ,ks�&I°s at-6re- 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 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. ****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. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 f < � Commonwealth of Massachusetts Title 5 Official Inspection Form f, 'I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Amelia Way Property Address Owner Jane Mclnness information is required for every page. Owner's Name ------ M_arstons-Mills _ MA _ 7/20/12 City/Town Y State Zip Code Date of Inspection B. Certification (cont.) 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: 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. 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): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ' ,I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Amelia Way Property Address — — Owner Jane Mclnness information is required for every page. Owner's Name -- --- -- —- —... Ma_rstons Mills _ MA _ 7/20/12 City/Town _ �� State Zip Coder Date of Inspection B. .Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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): 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 not functioning in a manner which will protect public health, t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 f � Commonwealth of Massachusetts Title 5 Official Inspection Form I.� 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Amelia Way Property Address - — - --- — — Owner Jane Mclnness information is required for every page. Owner's Name — - M_arstons Mills _MA_ 7/20/12 City/Town __ State Zip Code Date of Inspection_ 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 B. Certification (Cont.) 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: *` 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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 commonwealth of Massachusetts Title 5 Official Inspection Form 1- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Amelia Way Property Address Y — — Owner Jane Mclnness information is required for -------- _ -. _ every page. Owner's Name ��--- -------- M_ars_t_ons_Mills _MA ___ _ 7/20/12 City/Town State Zip Code — Date of Inspec_tion — ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® 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 'h day flow B. Certification (cont.) Yes No ❑ ® 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. ❑ 0 Any portion of a cesspool or privy is within a Zone 1 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. [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 2000gpd- 10,000gpd. ❑ ® 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. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No I ❑ ❑ the system is within 400 feet of a surface drinking water supply t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts A Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Amelia Way Property Address Owner Jane Mclnness information is required for every page. Owner's Name _Marstons Mills MA_ _ 7/20/12 _ City/Town �� State Y Zip Code Date o f Inspection _ _ — ❑ ❑ 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 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 CM 15.304. The system owner should contact the appropriate regional office of the Department. C. Checklist Check if the following have been done. You must indicate 'yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 f r � Commonwealth of Massachusetts Title 5 Official Inspection Fora, _ - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Amelia Way Property Address ----- Owner Jane Mclnness information is required for every page. Owner's Name - M_arstons Mills __�u MA__ _ _ 7/20/12 Cityrrown State _ Zip Code Date of Inspection "J D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 -- DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 _ _ _ D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d na ` 9 ( Y 9 (gP ))� ------- Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 7/20/12 Date Commercial/Industrial Flow Conditions: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts u� r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Amelia Way Property Address Owner Jane Mclnness information is required for every page. Owner's Name _Marstons Mills _✓ MA 7/20/12 City[Town State Zip Code Date of Inspection ~ 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 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: D. System Information (cont.) Last date of occupancy/use: Date -- Other(describe below): General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons — �- How was quantity pumped determined? site gauge on truck _ Reason for pumping: maintainance� Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool l5ins•11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 8 of 17 i Commonwealth of Massachusetts aNl ~rjb Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,_- ' 79 Amelia Way Property Address Owner Jane Mclnness information is required for every page. Owner's Name Marstons Mills _ '� MA _ _7/20/12 _ City/Town �� State Zip Code Date of Inspect_ ion ❑ 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): D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: installed 2/27/96 permit#95-436 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 __ 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.): Septic Tank(locate on site plan): Depth below grade: 1 _ feet ---� t5ins•11110 Title 5 Official Inspection Form;Subsurface Sewage Disposal System.Page 9 of 17 wa� Commonwealth of Massachusetts Title 5 Official ~~ ~~~p~=~=t"omm Form Subsurface Sewage Disposal System Form ' Not for Voluntary Assessments 73 Amelia Way Property Address Owner JaneK8c|nneae information is required for every page. Owner's Name �-----'------------' xxarstonuMills _ MA 7/20/12 ,..,'.,_. State Zip Code Date of Inspection - - - -- Material ofconstruction: 0oononate 0meto| El fiberglass El polyethylene El other(exp|ain) tank in goodcondition tees at proper hai!ahts |f tank is metal, list age: ------- years |o age confirmed bya Certificate nf Compliance? (attach a-oopynfcertificate) El Yes El No Dimensions: 105'x5'x5' Sludge depth: 3^ D. System Information (cont.) Septic Tank (c/nL) � � Distance from top of sludge to bottom of outlet tee mbaffle 37" Scum thickness o" Distance from top of Scum to top of outlet tee orbaffle 4^ � Distance from bottom of Scum tn bottom ofoutlet tee orbaffle 13" � How were dimensions determined? -measuring rod Comments (on pumping reuommondationn, inlet and outlet tee or baffle oundihon structural inhegr''�y, � |iquid |eve|aaano|atedtoouUetinve�. evidonoeof|aakage. e�1 ' ' � / t5ins'nno Title s Official Inspection Form:Subsurface Sewage Disposal System'Page mm`r | Commonwealth of Massachusetts T°��N�� x��°��N N��~�� U�N1K� -- _ -- ~~ ~ ~ ~==°~=� �� m��m��mm Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments � 79 Amelia Way uwner Jnney@dnneoa ~ information is required for every page. Owner's Name �---------------------------__- Marstons Mills __— MA 7�012 City/Town S��-- Date of Inspection ---'-- -- Grease Trap (locate on site p|an): Depth below grade: feet Material of ofounotruction: � El concrete El metal El fiberglass El polyethylene El other (exp|ain): Dimensions: Scum thickness Distance from top Of scum totop of outlet tee mbaffle Distance from bottom of scum tn bottom of outlet tee orbaffle � Date of last pumping: Date D. System Information (cont.) ' Comments (on pumping recommendations, inlet and outlet tee nr baffle oondidon o�u�una| inb*g�y liquid levels as related toouUetinve� j invert, ' ' Tight mr Holding Tank (tank must bo pumped sk time ' inspection) (locate or! site p|an): Depth below grade: � Material ofconstruction: E] oonnrete mabe| El fiberglass El polyethylene El other (yxo|ain): Dimensions: Capaoby� t5ins'nno Title s Official Inspection Form:Subsurface Sewage Disposal System'Page omn Commonwealth of Massachusetts -- _ ea Title 5 Official Inspection Form - ` Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Amelia Way Property Address -` Owner Jane Mclnness information is required for _._._ every page. Owner's Name M_arst_ons Mills MA 7/20/12 City/Town r State W Zip Code Date of Inspection _ Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: -- -- — ----_- Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date - '�---1-- - -- Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No D. System Information (cont.) 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 level and water Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 f r: Commonwealth of Massachusetts v , aL Title 5 Official Inspection Form �3\ 111 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Amelia Way Property Address --- -- Owner Jane Mclnness information is required for ---• __�_ —__ every page. Owner's Name --�—�-- Marstons_Mills�__` MA 7/20/12 State Zip Code Date of Inspection Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: D. System Information (cont.) Type: 1 ® leaching pits number: — — ❑ leaching chambers number: --- -- — ❑ leaching galleries number: -- — ❑ leaching trenches number, length: ------- ❑ leaching fields number, dimensions: --------- ❑ overflow cesspool number: ------- --- - ❑ innovative/alternative system Type/name of technology: -- -- Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Amelia Way Property Address -- - Owner Jane Mclnness information is required for every page. Owner's Name Marstons Mills _ _MA 7/20/12 City/Town State Zip Code Date of Inspection�� no standing water in it no stain line 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 D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: — -- ---- ----- Dimensions Depth of solids --- _-._-_ t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts _ V ; Title 5 Official Inspection Form J Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Amelia Way Property Address `-- -- owner Jane Mclnness information is required for every page. Owner's Name �— Marstons Mills _ MA _ 7/20/12 City/Town State Zip.Code Date of Inspection _ Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): D. System Information (cont.) 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 i5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Amelia Way Property Address �a Owner Jane Mclnness information is required for every page. Owner's Name — Marstons Mills_ MA_ 7/20/12 CityFrown State Zip Code Date of Inspection___ u D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 10, feet Please indicate all methods used to determine the high ground water elevation: l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Assessing As-Built Cards 7/24/12 6:26 AM 79 TOWN OF BARNSTABLE LOCATION ""�` 99 SEWAGE# 3!y36 VILLAGE ASSESSOR'S MAP&�OT INSTALLER'S NAME dt PHONE NO. SEPTIC TANK CAPACITY Spa LEACHING FACILITY: (type) ODO / (size) tO . /� L NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: .3 J2 9 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) IG CL14TQZ Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 1 Q 3 - 2 3 - qZ pq 27 S-Yf 60 5 s http://www.town.barnstable.ma.us/Assessing/IHMdisplay.asp?mappar=148161&seq=1 Page i of 2 Commonwealth of Massachusetts Title 5 Official Inspection Form I'll Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Amelia Way Property Address Owner Jane Mclnness information is required for every page. Owner's Name -- --- Marsto_ns Mills — __ MA _ _ _7/20/12 _ CitylTown State Zip Code Date of Inspection ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date -- - --- ---- --_-- ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ground water maps ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground.water elevation: town ground water maps show water table at 18' bottom of leaching pit at 8' sepration 10' Before filing this Inspection Report, please see Report Completeness Checklist on next page. E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 L Existing concrete walls 14' 0" BASEMENT RENOVATION 79 Amelia Way Existing concrete walls to be sheet rocked Marstons Mills, MA 02648 New walls Hot Water Map: 148 Block/Parcel: 161 � New door Heater OVERALL PLAN ® support column UNFINISHED Bookshelf built-in (4' wide) STORAGE AREA 1 Total finished Square footage: 805 25'0„ 71611 91011 7 UNFINISHED STORAGE AREA 2 bo 31011 Materials List HALL AREA 14'X 5' + 7.5'X 8' Drywall: Blueboard = 130 SQ FT Ln / `. 16' 611 o Studs: 2 X 4 X 8 KD o �— Insulation: Rolled z N fiberglass R-13 faced n m LL o Z a Ceilings: Drop type 2' G) T o X 4' tiles BILLIARDS AREA LOUNGE AREA Zn M z . 21'x16.5' =347SQFT 15'X 16'=240 SQ FT z = in D v m Flooring: Moisture 81311 r Bloc underlayment, and indoor/outdoor Do 'oo carpet EXERCISE AREA 11'X 8'=88 SQ FT 15'0" 411- I o abl7jtc�73 I ,I 261011 20'0" 2' 0„ 91 0„ '79 TOWN OF BARNSTABLE LOCATION �� g SEWAGE# S--`13� VILLAGE c.L ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. L 72 _ 3®Z SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 00 0 / (size) X NO.OF BEDROOMS BUILDER OR OWNER 2T f/� a a.21t.j�tr�S PERMITDATE: J 2' 2 _COMPLIANCE DATE: -7- ?,6' Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist o� within 300 feet of leaching facility) Feet Furnished by �' s 0 2.� , �- �d75- -�. 4 F> .:............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applirativit for Bi-n.Vini al Workg Tnntrnrthin Prrmit Application is b ma ermit o Construct or Repair ( ) an Individual Sewage Disposal System t: �� f CA ( :o� /. ...........................................( Location-Address or Lot No. ......................_-.__..........................••... ---•-- ------------------------ ----------------------..------- Owner �� Address - ----....... -•-•• --------•--- ••-•-...... .... ' Installer Address Q Type of Building Size Lot--- 2 . Sq. feet U Dwelling No. of Bedrooms _____________________________ _ _ _Ex ansion Attic Gzrba e Grinder a g— ' P" ( ) g ( ) Other—Type e of Buildin �/ _p� yp g •�J��-No. of persons____________________________ Showers ( ) — Cafeteria ( ) p" Other fixture ..__.. Q -------------- ------------------------------------ ------------ -------------- ------------------_--r� Design Flow................�........__.._______._gallons per person per day. Total daily flow.............3.?-d..............gallons. � r W Septic Tank—Liquid capacity _U�gallons Length.--c�-_..... Width...... ......... D>ameter._._._...__.--- Depth...Y_.`..._ x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. ---.- Diameter.... -Q..-...... Depth below inlet..__.? :. � Seepage Pit No._..__�_._.. � � I __..�_.__._ Total leaching area..... z Other Distribution box (� Dosing tank '-' Percolation Test Results Performed ...... Date..... ..___.. Pit No. 1�--�_2-minutes per inch Depth of Test Pit� . `f__ Depth to ground water- Test Test Pit No. 2................minutes per inch Depth of Test Pit_----------------- Depth to ground water........................ -- ------------------------------------------------------------------------•••. ¢-------------•-._._.._... -----•--------------- 0 Description of Soil.........�.F-�—"' '.. .. ................ � .__ Z.�/ ----------------•------------•---•-•-•••-•-••••---•----••••--•-•--•••••._....-•--.•---- 1.4 W ----•-•--•-•----------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------•-- UNature 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 un ersigned further agrees not to place the system in operation until a Certificate of C ; nce has n issued by/he board of health. Signe - ---- ---- . --- -...... Date " - Application.Approved By ------- --.---- -- -_� ... ........_... ----3--- 42.."_n..1` �-----------------------------------'----..-..—�------------- Dace Application Disapproved for the following rearonr- ------------------------------------- -------------------------------- -----------------------------------------------_....__'----------------------------------------------------------------------------- -------------------------------.-._..._....... .. ---------------------------------------- Da,,� Dace PermitNo. Y .... ....................................... Dace No.._. S.x, %3 ,- - Fps�. d n�.. �- ? THE COMMONWEALTH OF MASSACHUSETTS r X - BOARD OF HEALTH TOWN OF BARNSTABLE Allpliratiou for Divi-p ial Works Tomitrurtion ramit Application is herebyr made._fo a Permit to Construct ( . or Repair ( ) an Individual Sewage Disposal l� System at: t /1 �- i 1 Location-Address or Lot No. ......................_...........................................--- ---••- /� -•-•-•-• -•••••••••-•-2 -G------------------....-•--•---------- -•------...--•-•-------.............. O� sr--- l��/ .Fil Address dd L-� W Installer Address Q Type of Building Size Lot___ -`8--- q. feet Dwelling—No. of Bedrooms................ ............`-_---__-__---.__-_------.-Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building `/1T -No. of a yp g�..._____.___�__ persons____________________________ Showers ( ) — Cafeteria ( ) a' Other fixtu e d -------------------------------- ------------------------- -----------------•---- �--................................. DesigDesign - n Flow................:...........................gallons per person per day.,Total daily rflow....-.--_____3-�_�_�.!........._....gallons. WSeptic Tank—Liquid capacityUdgalIons Length--- ��idth-----y/_.... Diameter---------------- Depth_._rf_ _ .-. x Disposal Trench—No. .......... ......... Width.......i------------ Total Length.............. Total leaching area....................sq. ft. Seepage Pit No.................... 1- Depth below inlet-_-- _-___� � . Diameter____ _._._-_ p ____. Total leaching area_._.. z Other Distribution box ( Dosing tank ( ) ��'� `-' Percolation Test Results Performed --------- -_........ `r�''_ _ Date--- ��-�y--_ _-.. a Test Pit No. I........�minutes per inch Depth of Test Pit/a��y Depth to round water._�QA_AJ.�F. � -- P P - �--------- P g �T4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ a -------------------------------------------------------- --------------------_..._--••- Description of Soil......... � 7-mac�f ....____.._��L'9 V ..................................... ............................................................... •-•••••-••--•-••••••••-------••---••••-•--•-•-----------------------•---............-••-••---•••.. Rs -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••-•-• V 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 Cornr4axice has been issued by tfie board of health. Signed - . . ------j/----- ...................................... ............. T Date Application.Approved B ---------------------------------------- Date--3 ` - PP PP Y - - - Application Disapproved for the following reason r- ----------------------------------------------------------------------------------------------------------------------------------- ... ..... .................. - ..........------------------------------------------------------------- ----------------------------------------- ------------------------- 9S- y 3 0 _. Date Permit No. ......... ................. Issued _" Dare -------.ter v-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C_erttfi ate of Tomplianee THIS, TO CERTIFY,, Tha'tt e Individual Sewage Disposal System constructed ( (� ) or Repaired ( ) bye..._......... ------------------------------------------ ----..._------ ----.......------_-------------------...-------------------------------------- ----------lrtsrnue.. at . . .. - - _-------- ------------------------ --_-- -------------------------------------- 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. ...S'S" ---- dated .... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL UNCTION SATISFACTORY. r , -.........._ Inspector 4, , 't ' "' 3r .� 1, a.�x.- -------- DATE - .................__..... ..._... a -� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH qq S- y3 1- TOWN OF BARNSTABLE ��v No.....1..... FEE........................ n�tt1 - rk,� Permissionis-hereby grante --. ---._---- ------ -----------------------------------•---•-------- .............................................. to Constr ct (�) or Repair ( ) an)Individual Sewage Disposals System / ..._. ! ........................... ---------------------------------------------------------------------------- at No---------------------------•-••••. Street as shown on the application for Disposal Works Construction Permit NoN ..._y"S�Dated------------------------ ------...-•••-•......••..--••- l—----------------------------••-••••......---•-••---•--- - DATE............� �.............................. Board of Health ---�-�-----••---�----- FORM 36508 HOBBS rl<WARREN.INC.,PUBLISHERS TEST HOLE LOG DATE: TEST BY:WELLER&ASSOC. WITNESS: PERC RATE: z �T = v , o SS,a �i�•� S3,-s 1 r !-ZG S a- <ss�co a'j7Lrz %`"NN _ \ : r r DESIGN DATA 1 DAILY FLOW:_ SEPTIC TANK: 33 S x 150%= Yes' N USE:-/oc> l O t LEACHING FACILITY: , USE: C CAPACITY: j SIDEWALL:- S X 0-5 `�24 Z- . S.w.dE il 'n BOTTOM:_ :`28,:5 Y 1W TOTAL• .-: :>y-5� 4 / PIPE TO BE LAID 2"LAYER OF 3/8"PEASTONE LEVEL FOR 2' OUT OF OVER 3/4"-1 1/2" WASHED DISTRIBUTION BOJ� STONE ALL AROUND TOP OF FOUND. .'. @ EL. 10-- / 14" / \ 00 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' "� ivil GENERAL NOTES 1. CONTRACTOR TO BE RESPONSIBLE FOR THE SITE-SEWAGE PLAN �" c LOCATION OF ALL UTILITIES,ABOVE AND � , \ T FOR �" � r)i; ,'A UNDER GROUND,PRIOR TO ANY CONSTRUCTION pt. OR EXCAVATION. 2. INSTALLATION OF SEPTIC SYSTEM[TO BE IN PREPARED FOR _ COMPLIANCE WITH 310 CMR 15.00:TITLE V. 3. THIS PLAN IS NOT TO BE USED FOR PR OPERTY LINE DETERMINATION. n " $FEi ��u3. _ ID SCALE.:.�.5.'��7_E� DATE: u rEqq r WELLER & ASSOCIATES P. O. BOX 119 YARMOUTHPORT, MA. 02675 -`15 (508) 362-8131 APPROVED BY: �.` TEST BOLE LOG DATE:7,5 TEST BY: WELLER&ASSOC. WITNESSi y PERC RATE:= o y SS, a od- y.� � Gw�CoB�CF•S w q - 'Y; 0, DESIGN DATA \j:. DAILY FLOW: --c3) p SEPTIC TANK 33 0 --x 150%= 1y s > USE /rjob" �� ,O _ `}5 c- ic:_;��/C N c _ r_5. LEACHING FACILITY / USE: CAPACITY: SIDEWALL:" 1/7/, Z BOTTOM:_ TOTAL: • .sy 7. �° 77 _..-- mac'.q c PIPE TO BE LAID 2"LAYER OF 3/8"PEASTONE LEVEL FOR 2' OUT OF OVER 3/4"-1 1/2" WASHED DISTRIBU "ON BOX STONE ALL AROUND ;+ TOP OF FOUND. / 10" or G .rl oo ALL PIPE TO BE 4"DIA.SCH 40 PVC RAISE 'ALL APPLICABL E 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' it"r R , GENTERAL NOTES 1. CONTRACTOR TO BE RESPONSIBLE FOR THE SITE-SEWAGE PLAT LOCATION OF ALL UTILITIES,ABOVE AND FOR r �;' UNDER GROUND,PRIOR TO ANY CONSTRUCTION E ,��• OR EXCAVATION. Lw 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 . LINE DETERMINATION. SCALE:-9J 076,o.DATE: zW/+,4f• RJ�3�A J ^ � NO.351, y WELLER & ASSOCIATES .14 P. O.BOX 119 YARMOUTRPORT, MA..02675 '45 (508) 362-8131 APPROVED BY: -� , x. t. { it I I 1 - t, , r t ' a a is Al OD ip 41. tK SY l{^ q ID AL • gg pp , � i h S, o . < i 4t 3. In- 61 . k . — . .. . --. , • r r-�- -•�- { Cj- Aj ' .....3 ;.,:. _:=:: t..: .• a.. - ..�,«t�:-;. - ...:ice�?'_�.� �"'.�.: .?.� � �.1. - K :. w , i z r. M1 s 1