HomeMy WebLinkAbout0031 AUDREYS LANE - Health 31 AUDREYS LANE
028 - 055 Marstons Milk
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4
31 AUDREYS IN
u� Property Address
Jason and Molly Croteau
Owner Owner's Name /
information is Marstons Milss V Ma 02648 6/17/20
required for every
page. City/Town Mills 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 A. Inspector Information Sl-r 1 y+CA80%,
filling out forms
on the-computer,
use only the tab Michael DiBuono
key to move your Name of Inspector
cursor-do not DiBuono Sewer And Drain
use the return Company Name
key.
35 Content Lane
Company Address
Cotuit Ma 02635
City/Town State Zip Code
508-364-9587 S113522
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined
that the system:
1. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
6/18/20
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
in the future under the same or different conditions of use.
l5in7p.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
f F'
31 AUDREYS IN
Property Address
Jason and Molly Croteau
Owner Owner's Name
information is required for every Marstons Milss Ma 02648 6/17/20
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
System contains a 1500 Gallon septic tank as well as a concrete distribution box and 6 Lc6
Chambers in stone.
2) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not
�J
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.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18
r
r
Commonwealth of Massachusetts
; Title 5 Official Inspection Form
1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 AUDREYS IN
V
Property Address
Jason and Molly Croteau
Owner Owner's Name
information is required for every Marstons Milss Ma 02648 6/17/20
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
F
' r
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.7/26/201 B Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
u � 31 AUDREYS IN
Property Address
Jason and Molly Croteau
Owner Owner's Name
information is required for every Marstons Milss Ma 02648 6/17/20
page. Cityrrown 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
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
Commonwealth of Massachusetts
,I Title 5 Official Inspection Form
la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
............. 31 AUDREYS IN
Property Address
Jason and Molly Croteau
Owner Owner's Name
information is required for every Marstons Milss Ma 02648 6/17/20
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 %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
Commonwealth of Massachusetts
Title 5 Official Inspection Form ° '
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
4�
31 AUDREYS IN
Property Address
Jason and Molly Groteau
Owner Owner's Name
information is required for every Marstons Milss Ma 02648 6/17/20
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered "yes" to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes" or"no"for each of the following for all inspections:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
�a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
v � 31 AUDREYS IN
Property Address
Jason and Molly Croteau
Owner Owner's Name
information is required for every Marstons Milss Ma 02648 6/17/20
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): 2
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Description:
Number of current residents:
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ® Yes ❑ No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d Well
9 ( Y 9 (gp ))�
Detail:
1,
Sump pump? ❑ Yes ❑ No
Last date of occupancy: Date
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
Commonwealth of Massachusetts
x Title 5 Official Inspection Form --
Flo Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
31 AUDREYS IN
Property Address
Jason and Molly Croteau
Owner Owner's Name
information is required for every Marstons Milss Ma 02648 6/17/20
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ' ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe bellow):
3. Pumping Records:
Source of information: Pumped 2018
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
31 AUDREYS IN
Property Address
Jason and Molly Croteau
Owner Owner's Name
information is Marstons Milss Ma 02648 6/17/20
required for every
page. Cityrrown 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:
Installed 12/13/18
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: 1.5feet
" Material of construction:
cast iron ®40 PVC El other(explain):
' Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
System is ventred at the roof line
t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
ie Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
31 AUDREYS IN
Property Address
Jason and Molly Croteau
Owner Owner's Name
information is required for every Marstons Milss Ma 02648 6/17/20
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
Depth below grade: 1
feet
Material of construction:
® concrete -❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
1500
If tank is metal, list age:
years
Is age confirmed b a Certificate of Compliance? attach a co of certificate ❑ Yes ❑ No
9 Y p ( copy )
Dimensions: 1500
Sludge depth: 3
Distance from top of sludge to bottom of outlet tee or baffle
24"
3"
Scum thickness
Distance from top of scum to top of outlet tee or baffle 411
Distance from bottom of scum to bottom of outlet tee or baffle
30"
How were dimensions determined? Tape Measure
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity;
liquid levels as related to outlet invert, evidence of leakage, etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
r o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
31 AUDREYS IN
Property Address
Jason and Molly Croteau
Owner Owner's Name
information is Marstons Milss Ma 02648 6/17/20
required for every
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 ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
' Depth below grade:
Material of construction:
f ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow:
gallons per day
t5insp.doc•rev.7/26/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18
Commonwealth of Massachusetts
rp Title 5 Official Inspection Form ,
to Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
I;
31 AUDREYS IN
Property Address
Jason and Molly Croteau
Owner Owner's Name
information is required for every Marstons Milss Ma 02648 6/17/20
page. CitylTown State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank (cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert Level and at normal level
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.):
t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18.,
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
31 AUDREYS IN
V
Property Address
Jason and Molly Croteau
Owner Owner's Name
information is required for every Marstons Milss Ma 02648 6/17/20
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
® leaching chambers number: 6 Lc6's
❑ 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
c Commonwealth of Massachusetts
�x 1p Title 5 Official Inspection Form
I. la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
31 AUDREYS IN
Property Address
Jason and Molly Croteau
Owner Owner's Name
information is Marstons Milss Ma 02648 6/17/20
required for every
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.):
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 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
to Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
31 AUDREYS IN
Property Address
Jason and Molly Croteau
Owner Owner's Name
information is required for every Marstons Milss Ma 02648 6/17/20
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
�9 Subsurface Sewage Disposal System Form - Not'for Voluntary Assessments
31 AUDREYS IN
Property Address
Jason and Molly Croteau
Owner Owner's Name
information is Marstons Milss Ma 02648 6/17/20
required for every
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including Fties 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 Vatvwchusetts
• orm
Title 5 Offrcial Inspection k
r
Subsurface Sewage Disposal System Form-Not for Voluntary'Assessments
31 AUDREYS IN
Property Address
Jason and Molly Croteau
Owner Owner's Name Ma 026 6./17/20
information is Marstons M.ilss State Zip Code Date of Inspection
required for evh citylTown
page.
D. System Information (cont.) .
14. Sketch of Sewage,Disposal System: -least I enters
Provide a view of the sewage disposal system, including tidS to at
within 100 feet. Locatewhere public water supp reference enters
landmarks or benchmarks: Locate all wells
the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
Tdis,aofficiai inspection Form:Subsurface Sewage.Disposel System•Page 16 of 18
t5insp.doc•rev.7/26/2018
cam, Commonwealth of Massachusetts
I
Title 5 Official Inspection Form
FIQ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 AUDREYS IN
Property Address
Jason and Molly Croteau
Owner Owner's Name
information is Marstons Milss Ma 02648 6/17/20
required for every
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: 15+
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: 12/01/18
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Test hoole data on plan
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
Commonwealth of Massachusetts
,z Title 5 Official Inspection form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 AUDREYS IN
Property Address
Jason and Molly Croteau
Owner Owner's Name
information is required for every Marstons Milss Ma 02648 6/17/20
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
❑ A. Inspector Information: Complete all fields in this section.
❑ B. Certification: Signed & Dated and 1, 2, 3, or checked
❑ C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria) and 6 (Checklist) completed
❑ D. System Information:
For 8: Tight/Holding Tank— Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
Y
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18
I
TOWN OF BARNSTABLE
LOCATION D Aal e yf Lam✓ SEWAGE# c-�a/*6' I
VILLAGE /&44 1 Al -e ASSESSOR'S MAP&PARCEL 67 �S
INSTALLER'S NAME&PHONE NO. J);
SEPTIC TANK CAPACITY /S�✓a
r �
.LEACHING FACILITY:(type) a4 4"14'0 (size)/C
NO.OF BEDROOMS 2 D��S
OWNER .fie 60.n r-O ea-
PERMIT DATE: xlph / COMPLIANCE DATE: /
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility f� �_ 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 el
2 6 y'
414- i
0
2
3
. ® I
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ftpf Cation for Misposal *pstem Construction permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 3 r �S Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel Z g
Installer's Name,Address,and Tel.No. 3 6l� 9 '1� Designer's Name,Address,and Tel.No.
A
� 0 5;"V O f A�a. /q j "'n G w /L u�
Type of Building:
Dwelling No.of Bedrooms Z Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) pd Design flow provided 3 c/3 gpd
Plan Date --2 Number of sheets 2 Revision Date
Title / �[
Size of Septic Tank 11.50 Type of S.A.S. L L6
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) F, t, l k"01, 1J j�a,C
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
Compliance has been issued by this Board of Health.
Sig�e 7Date /2 ` �1
Application Approved by Date �—r /
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
p.
po� 2g j
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
2ppfitation for Disposal.;*pstrm Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( `) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 3 I 7,Z,4,.A. .1-4 Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel Q<` 0 is S(iK /U
Installer's Name,Address,and Tel.No. � Designer's Name,Address,and Tel.No.
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.r/equired) ( d Design flow provided -� ' gpd
Plan Date / ? —�$ Number of sheets "2- Revision Date
Title / �/
Size of Septic Tank /'.1 60 Type of S.A.S. <<6 /? ZQ C /� 7�0l9 2
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) F yt 01 o
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
Compliance has been issued by this Board of Health -�'-
" .�
Signe Date 12
Application Approved by �) /�� , Date
Application Disapproved by Date
for the following reasons
Permit No. 4& 01 �� 1C Date Issued--------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTI Y,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned( )by r, 1A.10 h o i LZ. ®t C. �•�
at / � lle!t !( Liel. has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.c, ��1 dated
r O � "� // r
Installer �,�1ri p vl /G.� �!!.�, Designer - _ ...,.,�•.,.
#bedrooms Z- Approved design flow ® gpd
The issuance of this permit shall not b`e``construed as a guarantee that the system will Earle' n a designed
Date / t Inspector
. . .---------------- ------------------- ---------------------- -----------------------------------------------Fee----- ,.-� .11
No.
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
39isposar *pstem Construction Vermit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( )
System located at � r
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. f
Date 1; - Approved by
t
Town of Barnstable
irte r
Regulatory Services
Richard V. Scali,,InterintDirector
BARNSTAB[,E, • - - -
9<b s6r+tAss. �e
Public-IIealth Division
Ma+' Thomas McKean,Director
2100 Main Street,Hyannis,NIA 0260.1 gg'
4
Office: 508-862-4644
Fax: 508-790-6304
Installer&Designer Certification Form
Date: i� �� Sewage Permit# s t, Assessors Map\Parcel
c c-Designer: _.���r-;�tjj t.O �� S lt-t� Installer: 12� \�J.14-j AC, -Rw r ??
Address: )Z wi Cr-z15sA,JC/ R- address: 3 C11n4-e.vt
On tJc%vLe� „�,r was issued a peirmit to install a
(date} _(installer) ,
septic system.at f uel
i
C S L ` N� (
7 based on a design drawn by
(address)
Ag i''t een`rt , <'Ua✓� l dated 1� Z'Z l
(designer)
414 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.
I certify that the system referenced above was constructed iu with the tenns
of the I';A approva.{.letters(if applicable) .
P
(Installer's Signature) . vit E
0,35109
(Designer's Signature) (Affix Design e ..ere)
PLEASE RETURIN 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:`15e1)601)e5igtter Cmificelion Eon..Rev 8-14-13.doc
Engineers note:This certification is limited to an as-budt inspection.of system componenls as installed prior to backfill.The
engineer did not supervise construction of the system.The installer assumes responsibility for ail materials,workrnanship,backRing
to specified grades with proper compaction and selling risers£covers as shorn on the design plan.
I
Town of Barns blve P# 840
Department of Regulatory Services ___q 2
stAas.
Public Health Division Date
200 Main Street,Hyannis MA 02601
tfA�.t a
-
Date Scheduled Time / r a p
Fee.Pd. 1
Soil Suitability Assessment fog° Se e Disposal
Performed"liy:_Few�� /��"'"�-'" 5�'l ��itnessed By:
LOCATION&t GENERAL INFORMATION
Location Address 31 A o d rm-.,f S Owner's Name e J Z q-6kA
MCI r. 'CCAS �e �I s Address 3 2 7�" � Pe-c-1�CQ r- �- blte. D/'
Assessor's Map/,Parcel: C— ` 64� C(C- y � < �� (j
!� "l c J Engineer's Name �.
NEW CONSTRUCTION REPAIR -- - Telephone# - 7"7
Land Use .... gus JE''l>L/lx f! Slopes(%) Surface Stones
Distances from: Open Water Body A01/_4� ft Possible Wet Area /J�j/0-- ft Drinking Water Weil J_Y1 ft
Drainage Way A&trA_ ft Property Line ft Other ft
SKETCH.:(Street name,dimensions of Jot,exact locations of test holes&pere tests,locate wetlands in proximity-to holes)
i
r S2
1
-
A ,
.tcA r +S
Parent matedal.(geologic)- L Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: 4L\ LL- 7� Weeping from Pit Nce
Estimated Seasonal High Groundwater .
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: —_-_-- in, Depth to soil mottles:
Depth to weeping from side of obs:hole: in, Groundwater Adjustment ft.
Index Well# Reading.Date:_ Index Welt level �_ Adi,factor Adj.Owundwnter Level,
PERCOLATION TEST Date Thne
Observation
Hole# Time at(Y
Depth of Perc. , Time at 6"
2A Gea,l(4,"_S
Start Pre-soak Time @ d Titne(9"-6")
End Pre G• 1 S (� a~
Rate Min;/Inch Z
Site Suitability Assessment: Site Passed,_�� Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole.Data To Be Completed on Back-----------
***If percolation test is to.be conducted within.1016 of wetland,you must first notify the,
Barnstable Conservation Division-it least one(1)week prior to beginning.
QAS EPTIC\PERCFORM.DO.0
i
DEEP OBSERVATION HOLE LOG Hole# t .._.
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Stnface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders..
Consistency.% ravel
r
DEE'P'OBSERVATION HOLE LOG Dole# 'Z
Depth from Soil Hoorizon Soil Texture Soil Color Soil Other
Surface,(in.) (USDA) (Munsell) Mottling (Structure;Stones,Boulders.
Consistency,% ravel
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture. Soil Color "Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones„Boulders:
Consistency. Gravel!
ti
t
DEEP OBSERVATION BOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) .(Munsell Mottling (Structure,Stones,Boulders.
• onsi ten ra
Flood Insurance Rate Map:.,
Above 500 year flood boundary No— Yes
Within 500 year boundary No� Yes .. P
Within 100year flood`boundary No Yes •�
Depth of Naturally Occurring Pervious M;jterial
Does at least four feet of naturally occurring pervious material.exist in,all areas observed throughout the
area proposed for the;soil absorption system? __YZ
If not,what is the depth of naturally occurring pervious material'?------
Certification
I certify that on 1 0 (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and-that the above analysis was:performed by me consistent with
the required training,expertise and experience described in 10 CMR 15.017. I
Signature
t
C V"� Da I {�
Q:\SE"lCTERCFORM.DOC
__....._......._..---.._._
31
No. C �1 Fee 1��
THE COMMONWEALTH OF MASSACHUSETTS
Entered in computer: __A0 7`
Yes
�03c, PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE. MASSACHUSETTS
ZIPPItcatiott for Xhgpoal *pgtem Com5tructlon J)ermtt
Application for a Permit to Construct(--)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. y. aE,/ Z 7
f �QN� Owner's Name,Address and Tel.No.4ZD-4•Z
Assessor's Map/Parcel 6'7.1 ��' • '����K�h/S
6?S 7•
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Z Lot Size 2004.to sq.ft. Garbage Grinder(tJ O)
Other Type of Building Woi! No.of Persons R4m.,Ly Showers( ) Cafeteria( )
Other Fixtures
Design Flow Z'Zv gallons per day. Calculated daily flow "Z">"S gallons.
Plan Date 5-2-9 S Number of sheets Revision Date
Title
Size of Septic Tank /_45'ov Type of S.A.S.
Description of Soil Q -f!.-A- I3 G _G
Nature of Repairs or Alterations(Answer when applicable)
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 Tij#5 of the nvironmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued b o f Healt
Signed Date
Application Approved by e . , Date C/
Application Disapproved for the lowing reasons
Permit No. 72 ; Date Issued — �7
I
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
at v � J �^ has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 19 dated
Installer Designer
The issuance/of his a shall no be c ed as a guarantee that th w' 1 c 'on esig
Date Inspector`
q Dig
No. r r r Fee_/ Ir e' S
fi 4BLIC
Entered in computer:OF MASSACHUSETTS Yes HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Application for )Di�pogal *'p! tem �Cottgtruction erntit
Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.AV 7 rLc S („•AA/, Iq Owner's Name,Address and Tel.No.¢,Zp-4-Zz 7
Nt�t�� � � , r3e.� f�n�4 K��✓s
Assessor's Map/Parcel 611-19�L:� �•
�
Installer's Name,Address-j�nd Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling�. No. of Bedrooms Z. � Lot Size Z DOG v s .ft. Garbage Grinder c)
9 g � )
Other Type of Building 16 No. of Persons (_ Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow Z-'>-S gallons.
Plan,,Date '9-9c -c! S Number of,,sheets Revision Date
Title I
Size of Septic Tank / S un Type of S.A.S.
iF
µ Description of Soil. - A - R
- r
Nature of Repairs or Alterations(Answer when applicable)
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 Ti 5 of the Environmental Code and not to place the system in•operation until a Certifi-
cate of Compliance has been issued b is o"Healt
A
Signed _ Date
Application Approved by - Date
th Application Disapproved for e lowing reasons
Permit No. r Date Issued �S 9
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(�Reepaired ( )Upgraded( )
Abandoned( by
at 3 1 h-e f4wj r~ 1 has been constructed in accordance ~
with the provisions of Title 5 and the for Disposal System Construction Permit No. ' dated
Installer Designer
The issuanc of ermit shall not be ed as a guarantee that th willtuction esignfAl
Date t,1 i Inspector A
-
u
— J / ---------------------------------
No.
Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Mopo$al tem Congtruction Permit
Permission is hereby granted to Construct( Repair( )Upgrade( )Abandon
System located at 3/ Yl La ko
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
ik:,
Provided:Construction must be completed within three years of the date of this permit.
Date: �2_/ ?/` ' Approved by
SEP-14-98 MON 13 :30 ENVIROTECH LABS 508 888 6446 P. 01
ENVIRO I ECH ILAEORATORIES, INC.
449 Rte. 130 • Sandwich,MA 02663
(608)888-6460 - 1-800.339-6460
FAX(608)888-64 6
F A X M E S S A G E S
TO: op � f/t�f?!f FAX#:
ja •
FROM:
DATE:
NUMBER OF PACES INCLUDING COVER PACE:
ADDITIONAL COMMENTS:
ANY QUESTIONS PLEASE CALL: (508) 888--6460
L
r
SEP-14-98 MON 13 :31 ENVIROTECH LASS 508 888 6446 P. 02
e
PN0ROTL'CBiwORA7tOs s,mc.
= NEE CBBT.,NO.:N-ZA 06S
449 RTZ 130
SANO*?Cff, .A 0R$o,F
Sod(888-6460) 1400-3.19-6460
FAX(50tl)6W-0446
CLIENT: Atlantic Wells LOCATION: Lot 3
ADDRESS: PO Box 339 Audree's Lane
No.Eastham MA 02651 Marston Mills MA
COLLECTED BY. R. Peterson SAMPLE DATE: 9-1-98
SAMPLE TIME: 4:30
WATER SAMPLE TYPE: New Well DATE RECEIVED: 9-2-98
LAB LD,1#: 989078
WELL SPECS.: 61'Deep/40'Static
RESULTS OF ANALYSIS:
Parameters Units Recommended Results Method Date Analyzed
Limits
Colifor,n bacteria A 00ml 0 0 92228 912198
PH pH units 6.5-8.5 6.24 4500 H+ 9/2198
Conductance umhos/cm 500 139 120.1 9/2198
Nitrate-N1Nitrite-N mg/L 10.0 3A0 4500-NO3 E 9/2/98
Sodium mg/L 28.0 16.7 200.7 9/3/98
Iron mg/L 0.3 <0.02 200.7 9/3/98
Manganese mg/L 0.05 <0.002 200.7 9/3/98
Volatile Organics ug/L See Report ND EPA 524.2 9/10/98
COMMENTS: pH is below recommended limit and may have corrosive characteristics.
WATER MEETS EPA STANDARDS AND 1S SUITABLE FOR DRINKING PURPOSES
FOR PARAMETERS TESTED.
<=less than Date
Date491V�
>=greater than R aid J.S i
TNTC=too numerous to count Laboratory Nrector
SEP-14-98 MON 13 :31 ENVIROTECH LABS 508 888 6446 P. 03
Page 2 of 3
R.1,Analytical Laboratories. inc,
CERTIFICATE OF ANALYM
Envirotech Laboratories, im,
Date Received: 9/04/98 Approved by:
Work Order# 9809-07065 R.I,
1
5alnpIa#: 001
SAMPLE bESCMMON: #989029 AUDREY LANE 9/1/98
SAMPLE VET. ANALYZED
PARAA?CTEk RESMTS LIMIT UPIITS METHOD DATE/TIl14E ANALYST
' s
Valanle Orgatlo Comwuody
Bromoaichloromraorte <0.3 0.5 Usti EPA$24.2 9/10198 14:39 JAH
Bromoform <03 0,5 UgA EPA 524.2 9/10/98 14:39 JAH
Dibromoohlorotoethaee <0.5 0.5 tlpfl EPA 524.2 9/10191 14.39 JAIL
Chlorafom <0.5 0.5 u n EPA 5U.2 9/10/98 14:39 JAR
1,2-DibrozwAa,e <0.5 O.S U94 EPA 524,2 9110198 14:39 JAH
Sctaone <0.5 0.3 u8f1 EPA S24.2 9/10/98 14:39 JAH
Carbon TotmWotide <0.5 0.5 U811 EPA 524.3 9110/98 14:39 JAH
1.2-Diebioroerhane <0.5 0.5 ug/l EPA$24.2 9/10/98 14:39 JAH
T.4-15kt loro a <0.5 0.5 U911 EPA 524.2 9/10198 14:39 JAR
l,4-t1;c#ilorobonzeae <O.S 0.5 ugll EPA 524.2 9110/98 14:39 JAH
l,l-Dichlorocthane <0.5 0.$ ug/l EPA 524.2 9/10/93 14:39 JAH
1,1.1.TrichlatvcthM <0.5 0.5 ugn EPA 524,2 9/10/98 14:39 JAR
Vinyl Chloride <0.5 0.5 ug/l EPA 524.2 9/10/99 14:39 JAH
Dromobepmn4 <0.5 a's Ug/l EPA 524,2 9/10/98 14:39 JAH
Eromomcthanc <10 10 ug/I EPA 524.2 9/10/98 14:39 JAH
Chlorobeum <0.5 0.5 ug/1 EPA 524.2 9/10/98 14:39 JAH
C1110roatm <5 5 ugll EPA 524.2 9110/91 14:39 JAR
Cbloroftdum <5 5 USA EPA SM.2 9/10/98 14:39 /AH
247hlorolohlene <0,5 0.3 USA 8PA S24.2 9110198 14:39 JAH
441loto0olttene <0,5 0.5 ug11 EPA 524.2 9/10/98 I4.39 JAH
nibromOmathene <2 2 ugll EPA 524.2 9110/98 14,39 JAN
1,3-Diohlombenzono <0.5 0.5 ugti EPA 524.2 9110t98 14:39 JAH
1,2-Did dorabenzeno <03 0.5 ugll EPA 5U.2 9110198 14:39 JAH
ututs-1,2-Dichloroeftm <0.5 0,5 Ugll EPA S24.2 9/10199 14:39 JAM
cis-1,2-Dichlotoed%Tt <0.5 0.5 us/l EPA 524.2 9110198 14.39 JAR
Mcdtyko CNodde <0.5 O.S u&A EPA 524.2 9110198 14:39 JAR.
1,1-D;ctdojucch= <0.5 0.5 t1e11 EPA 524.2 9/10198 14:39 JAR
<0.5 0.5 44 EPA 524.2 9110198 14:39 JAM
1,2-Dchlompfopane <0.5 0.5 ug/l EPA 524.2 9110199 14:39 JAH
1.3-DlehlaroprMum <O.S 0.5 rgrl EPA 524.2 0110MI 14:39 JAH
1.3-Dichlompropene <0.5 0.5 ug/1 EPA 524.2 9110/99 14:39 JAH
2.2-Dic Nomptopaac <0.5 0.5 ugli EPA 524.2 0/10194 14:39 JAR
taltylbcnzm <0.5 0.$ ugll TPA 524.2 9/10199 14:39 JAR
Styrene <0.5 0.3 U111 EPA 5242 9/10/98 14:39 JAR
1,1,2-Triw0f0Cft to <0.5 0.5 ttg/l EPA S24.2 9/10/99 14:29 JAM
1.1.1,2-Tev"OtoctAw <0,5 O,S ug0 EPA 524.2 9/10198 14:39 JAR
t,t.2.2-Tevadilefaetbam <0.5 0.5 ugn EPA 524.2 9/10/90 14:39 FAH
TttracNoroetbece eo_s_- 0.5 tr0 EPA 524,2 9110198 14:3 - JAR
SEP-14-98 MON 13 :32 ENVIROTECH LABS 508 888 6446 P. 04
Page 3 of 3 -
R.[. Aoalytic�l.Laboratoriess, be,
CERTIFICATE OF ANALYSIS
Envirotea Laboratories, Inc.
Dare Received: 9/04198 Approved by:
Work Order# 9809-09065
Sample#: 001
#989028 AUDREY LANE 9/1/98
SAMPLE DET. ANALYZED
PAItAnILT� RESULTS LwT uN1TS MMOD DATEffM ANALYST
11,3$Vk#doropropatte <0.5 0.5 Ye/I EPA 524.2 9/10/98 1439 JAR
7olueno <0.5 0.5 u811 EPA S24.2 9/10/98 14:39 IAFI
xyl ua <0.5 0.5 ug/1 EPA 524.2 9/10/% 14:39 IAH
1,2-Dbrome3-Chloropmpane <10 10 ag/l EPA S24.2 9/10/98 14:39 JAH
Bromochloromcdmm <1 1 ug/1 EPA 524,2 9/10198 14:39 JAR
n-�' 6020De <0•$ 0.5 USA EPA 524.2 9/10/98 14:39 IAH
bicbl°rodiRvorornedtene <0.5 0.5 u9n EPA S24.2 9110198 14:39 JAH
i}icbiOroiJuoro►oo9taae <0.5 0.5 ugn EPA$24.2 9/10/98 14:39 JAH
Hetactflprobutadiplle 0.5 0.5 ug/I DA 52d.2 9/10/99 14:39 IAH
IsopropylbwW4 <03 0.5 ugA EPA 524,2 9/10/98 14:39 ]AN
"Opropyltoblem <03 0.5 u01 EPA 524.2 9/10/98 14:39 JAH
Naph"Inc <03 0.3 ug/l EPA 524.2 9110M 14:39 JAR
n-Propylbenaene 0.5 0.5 u01 EPA 524.2 9/10198 14:39 JAH
sec-Buryunzene <0,5 M ug/f EPA 524.2 9110/98 14:39 JAR
>brt•Butylbenzene <0.5 0.5 u8/1 EPA 524.2 9/10198 14:39 JAH
1,2,3-Trichlorobenum <0,; 0.3 ug4 EPA 524.2 9/10199 14:39 JAR
1,24-Trichlorobenreft <0.5 0.5 44 EPA 524.2 9110/98 14:39 JAR
1.2,4-'I'HnwAy%eeteae <0.5 0.3 ugh EPA 524,2 9110199 14:39 JAH
1.3.5-Ttirmtbylbeum <0.5 0.S ugA EPA 524.2 9/10198 14:39 JAR
Melbyi Ternary Barbyl 9OXT <1 1 ug/t EPA S24,2 9/10198 14:39 JAH
a-He:im <;10 10 u8A EPA$24,2 9110198 14:30 IAH
SURROGATES RANGE EPA 524.2 9110198 14:39 JAR
4-Br mcftoMb=cm 92 80-120% BPA 524.2 9/10/% 14:39 JAH
1,2 Gichlombe nartoda 85 80.120% EPA 324.2 9/10/98 14:19 JAR
nw ww •sn�. ,P. •,f R,v ,-- --- ,^`n._____-__w-=-___..w_____________. -"-^ -----------------------
-------------------
Search'for Map/Parcel 028055 �E , t � � gown ofsBarnstablr'""�� t� a�
For Parcel�Number6 028055 ent
/ Business Name � ��o tuton N IV
000 0000000 �f�el Storage TankPermit PllOp t / w� C,ardpn Flie N1 ,
Perc'Test construction
1Ne111 Permit � 5�
W98 35 £ 98 599
f
"' 09/15/1998
Issuance�Dated v'
�Fy1 �#x �MOWN
��
��Go�iii pietion"Date
^�T, elSieof.SAS . 2 25 X 2 X 2 LEACHINGm \+S¢eofnSeptrc� y ( )
Com ` � /� P/ments
i 1
2 BEDROOM HOUSE(233 GPD)
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TOWN OF BAr i.,;T:22 :
-� BUILDING PERMIT
{'�RC:EL TD 028 055 GEOBASE ID 1644
ADDRESS 31 AUDREYS LANE
MARSTONS MILLS
BLOCK LOT
?A DEVELOPMENTA�
L
PERMIT33317 DESCRIPTION 2BR/1BA CAPE/&CAR Nfq-'; . flkii , .1
`> IPE BUILD TITLE NEW RESIDENTIAL BLDG P^1T
4 R,kG'rORS: PROPERTY OWNER Department of Health, Safet;
'u'."-iITECTS= and Environmental'Services
E$S: $323.27 THE
r'.•i �10 $.00
L1".Tr, t�TIOPd COSTS $104,280.00
la 1 -S I NGL•E FAM HOME DETACHED .1 V P. :sARrtsrABM .
03
,,�� ED MI`►1
°Nj BUILDING DIVISION ;
{ BYf. .
DATE ISSUED 09/15/1998 EXPIRATION DATE
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,_ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN-
CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR W ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS
PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF FOUR CALL INSPECTIONS REQUIRED
FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE
1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED
2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU FOR
- ELECTRICAL,PLUMBING AND M FOR
(READY TO LATH). PANCY IS REQUIRED,SUCH.BUILDING SHALL Npf BE ANICAL INSTALLATIONS.
CH-
3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE.
4.FINAL INSPECTION BEFORE OCCUPANCY.
i
BUILDING.INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
awl
2--is;..4I `A -
1 _AEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT --
2 Au _ � c,91 BOARD F HEALTH
-'"fib-l►e.+� 9" g ' Q5' Z
OTHER:Fin- bcp l SITE PLAN REVIEW APPROVAL
WORK SHALL NOT PROLE UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS.
THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY
VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA-
TION. . NOTED ABOVE. TION.
31
No. �� �+ � Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Application for �Dizpoq;al *potent Construction Permit
Application for a Permit to Construct(--)Repair( )Upgrade( )Abandon( ) ❑Complete System D Individual Components
Location Address or Lot No. y. 2t,/f N 4►ZU 4-ZZ]/, �.+A � Owner's Name,Address and Tel.No.
Assessor's Map/Parcel di- � ��� �K�vs Q
S;.—
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No. of Bedrooms Z Lot Size ?_00Gv sq.ft. Garbage Grinder(iJA)
Other Type of Building W/�No.of Persons 7- mw Lv Showers( ) Cafeteria( )
Other Fixtures
Design Flow Z'Zv gallons per day. Calculated daily flow 7-">-S gallons.
Plan Date .ej-8-9 S Number of sheets Revision Date
Tine
Size of Septic Tank /_oo Type of S.A.S.
Description of Soil _O -M-A - M - G'-G a
Nature of Repairs or Alterations(Answer when applicable)
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 Thig 5 of the nvironmental Code anZnt place the system in operation until a Certifi-
cate of Compliance has been issued b Bo Health. l/r
Signed Date
Application Approved by " Date /S
Application Disapproved for the o lowing reasons
Permit No. Date Issued - lS 9
t ( .
at 7Z I 4,P7 e- J t-has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. / ��� / dated
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date Inspector
No.'`/�'�� ----------------�----------Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
�Ig�lO�aY teat Conotruction Permit
Permission is hereby granted to Construct( Repair( )Upgrade( )Abandon( )
System located at
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.
Date: Approved by
C �
u '
r
1 ,u ,
�'� =�
� „ � / � ,
�� II `� ry � � � � e��
��� �� JI � ''�� �
�I
No. -- -
-- - ---- -------- Fee-------
OF HEALTH
TOWN OF BARNSTABLE
Zippfitation-forlVell Con5truttionpermit.
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at:
Location 7— Address Assessors Map and Parcel
Owner Address
d
-- 4'tt.__l,l�l,L _!!_.21 Z1�t — 5. — — ,f�, '� _ ,s o��i �!'t�I ®2�S1
Installer — Driller Address
Type of Building
Dwelling
Other - Type of Building------ -- ---- No. of Persons--------------------------------------------------
Type of Well_ � � ' t� ---------- - - Capacity---------- --
Purpose of Well-C� ?��-LLI��'� ---— ---
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Certificate of Compliance has been issued by the Board of Health.
a
4
Sign-4a----------
Apphcahon Approved By- - --- -- -------- --- - ---- ✓`-� ---/dat -�
Application Disapproved for the following reas --------------------- -- --------
- ---------
date
Permit No. - - --- Issued --- -- ----- -----------------
BOARD OF HEALTH
" TOWN OF BARNSTABLE
Certificate Of compliance
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( )
by----------------- ----------------------------------------------------------------—---- — --
----- ----------
Installer
has been installed in accordance with the provisions of the Town of Barnstable Board Heal vate Well Protection
Regulation as described in the application for Well Construction Permit No. - r-~ - ated---------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE--------------------------------------------— - ----- - - — Inspector— --—---- -- — ---— ---- ------
-056
No.-- Fee-------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
x:, ���ricatiori,�or�eYr �on�truction�erntit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at:
--hulR£y'_s 1�46_,_MR510�4 M us---
Location — Address Assessors Map and Parcel -- -
-- b "!?--5�,-�'-K- _a - ---- ---— F'�-C. Wit?t c)xi2 f�jl CA_.� ST21/l�..t_
Owner Address
- t f �3`"t C. L.t t l �Q i u►�� k . _ �f�, . _ilk._4 m-t4 M, �_I_,_� o___2(.Sl
Installer — Driller Address --- --
Type of Building J
Dwelling------------------ - ---------- ----------
Other - Type of Building --------- No. of Persons-------- --------
Type of Well-- 1�. 1/['_..------------------------------— Capacity-----------L 4A64----- —
Purpose of Well-�` - p T��?�,--------------
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The-
Town of'Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Certificate of Compliance has been issued by the Board of Health.`
Signed=st��_a"�c pc.
irr
--1G L G Idate1 Ui6J�o
11q
Application Approved BY
date/
Application Disapproved for the following reasons—__
1
/� l I date
Permit No.------------- - -` , -- -----+ Issued5r
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( )
y-----------
------------
- - -------------------
Installer
at-------------------------------------------------------------------------— --------has been installed in accordance with the provisions of the Town of Barnstable Board� o Health. vate Well Protection
z Regulation as described in the application for Well Construction Permit No./ - ?- Dated-------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
rDATE------------------------------------------------------------------------------------ Inspector—- ______— - - —_
BOAO{D OF HEALTH '
,TOWN OF,� BARNS'xTABLE.
=.• -
VeYY Con!5truct ion Permit 1
No. - Fee--------- --
1
Permission is hereby granted---- U— - - -- -- ----- --- - -— !�`'"----------------------
to Constrri
uct ( lter ( ), or R-pair . ) n n%dividual W 11 at:
�__ �
Street
as shown Vt
p icati!__7
f r a Well Construction Permit
No.------- �a — Dated -- —- -----—- —— /1�1-
J� Board of Health \\
DATE---------------s- ---:---- (�-----------
via
r
---_ _�
IA
G.
ti
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4 7— 159
rill
gIl/C Li
lip
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LqVj"MCff LAMWA 700M MC— v
zA mar.#a:&&A W-1
� a 44P tic ISO
ooM , " DIMS
JrAX(M)SAW-68
CLIENT. Atlantic Wells LOCATION: Lot 3 "s Lane
ADDRESS: PO Box 339 AudrMarstons MillsMA
MA 02551
COLLECTED BY. R. Peterson SAMPLE DATE: 9-1-98
SAMPLE TIME: 410
WATER SAMPLE TYPE: New Well DATE RECEIVED, 9-2-98
LA8 I.D. 9. 989078
WELL SPECS.: 81°Deep/40' Static
RESULTS OF ANALYSis:
Parameters units Recommended Results Method Date Analyzed
Um/ts
Coliform bactarla /100ml 0 0 9222E 9/2/98
PH PH units 8.5-8.5 5.24 4500 H+ 9/2/98
Conductancs umhos/cm 500 139 120.1 9/2198
Nitrate-N*Wfte-N mg/L 10.0 3.10 4500-NO3 E 9/2/98
Sodum ftv/L 28.0 18.7 200.7 9/3/98
Iron nV& 0.3 <0.02 200.7 9/3/98
Vaese nxyt 0.05 < 0.002 200.7 9/3/98
l Organic@ u91L See Report ND EPA 524.2 9/10198
COMMENTS: pH is below recommended limit and may have corrosive characteristics.
WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES
FOR PARAALFMS TESTED
Date
<sless than
»greater than R ald.I.
TNTCatoo numerous to count Laboratory grscW
Pap 2 of 3
i
R.I. Andy"Llabo , 1w.
CnTMCATZ OF ANALYM
P�vi:Otecl�L�blaralllsi�a lac.
Dean Rad"d: 9MM Appmved by:
Work Order f OMM7065 R.I.
SJlg6 0: 001
Wou uaw- r-Hu 1: #999QM8 AUDREY LANE 9/1J98
SAMM DZT. ANALYZED
PARAWIM DFMTS LAW UNITS METHOD DATL/TM ANALYST
i ,•
Vaho ow*Ceyalm
<0.9 0.S v8/l EPA S24,2 9/1010 14:39 JAM
Dfumohm <0.9 0.3 v9A EPA S24,2 9/1W% 14:39 JAH
Dilltew <0.5 as v8/1 SPA 524.2 9/10/98 14:39 JAR
Cbioteteem <03 0.3 44 IWA 324.2 9/10M 14:39 ;Am
1,2,Diflotl00�11b <0.9 0.3 Og/1 SPA 924.2 9110/96 14:39 JAH
Heataee <as 0.3 "n SPA S24.2 9J10M 14:39 JAR
Gem Toommem <0.3 0.3 tall RPA$24.2 9/10198 14:39 JAH
1,24)clalotoodaft 0.5 0.5 IV EPA 924.2 9/10/98 14:39 ]AN
Tticatiae mom <as 0.5 44 EPA S24.2 9/10/98 14:39 1AH
1,4- <0,3 0.S un EPA 924.2 9/10/9e 14:39 JAH
1114)wdcto dtl <0.3 O.S us/l WA S24.2 9110/98 14:39 JAH
1,1,1-Tfi*jcfeedm <0.5 0.5 44 EPA S24.2 9/10/98 14:39 JAR
Vinyl Chwwo 0.5 0.3 tlf/l SPA 324.2 9/10/98 14.39 1AH
a <0.5 0.5 uyl EPA 5U.2 9/101N 14:39 JAH
® <10 10 U01 EPA 524.2 9110M 14:39 JAH
<0.3 0.5 44 BPA 524.2 9/10/96 14-39 JAH
<3 9 v8/1 IPA S24.2 9/101% 14:39 JAR
Mlioa <5 S call SPA S24.2 9/10198 14:39 JAH
2' 40.3 0.3 tall 11PA$24.2 9/10M 14:39 JAH
<0.5 0.5 v&4 EPA 324.2 9/10/98 14:39 JAH
D%CQ e° mhm c2 2 will EPA$24.2 9/10/98 14:39 JAH
l,3- <0.3 0.3 "A EPA $24.2 9/10/9/ 14:39 JAH
1.2-DiMarolaltme <0.3 0.5 Ian BPA SU.2 9/10/98 14:39 1AH
a'It*1,2-Dl WW0@ftft 0.3 0.5 tall EPA S24.2 VIM 14:29 JAH
cia1.24)k11oms&m e0.3 0.5 W4 SPA 524.2 9/10198 14.39 JAH
metyk 9 Cie <0.5 0.5 v&4 IWA 534.2 9/10M 14:39 1AR
1.1-1'j*kg=&m <0.1 0.3 "A IWA 324.2 WI0/91 14:30 IAN
I•I-Die31etepmpm 40.3 0.3 w EPA 924.2 WON 14:29 JAM
t.2401dimpmpm <0J 0.5 "A EPA 524.2 9/10198 14:39 JAH
1.3'DisidWalimpm 40.3 0.3 v9A EPA 324.2 9110M 14:39 JAH
1.3 qpwm <0.9 O•S NO EPA S24.2 9110M 14:39 JAH
21-Dleile/epeepir 40.3 0.5 %A SPA 524.2 MOM 14:39 JAR
<0.3 0.5 v011 SPA 924.2 9/10198 14:39 JAH
SO' <0.3 6.3 v8/1 EPA SU.2 9/10198 14:399 JAH
60.3 0.9 USA ZPA 324.2 9/100 14:39 JAH
<0.5 0.3 vS/1 EPA M.2 9/101" 14:39 JAR
1.1.2,2�T <O.S 0.3 69A SPA S24.2 91101" 14:39 JAH
T 'N' allow 'Call 0.5 44 EPA 524.2 9/10/98 18:3� JAR
Page 3 of 3
R.I. Amb" , I=.
C9JlTIIIiCA'!'E OF ANALYSE
Eo��roasA 1.�toriet, Inc.
Dime ftelved: 9/04/9$ Approved by.
Work Order 0 98094W 2
7--� -
Sample dP: 001
09a9M AUDEEY LANE 91 U98
V-
MMM DST. ANALYZRD
PARAMM YtzKx7S IJMI ' UN17S MVMOD DATM ME ANALYST
1.2. 4c0.3 0.$ W/l SPA M.2 9 lWM 14:39 JAR
ToWOM <0.5 0.3 uJA EPA 524.2 9/10/9i 14:39 JAN
xylm 4C0.3 0.5 vsA EPA 924.2 9110/24 14.39 JAH
114 nMO-3Cloto MP= <10 10 %A EPA S24.2 9/10M 14:39 1AH
Iiroluocalordlud o <1 1 qll SPA 324.2 9/1019tt 14.39 JAR
Noq bl <O.s 0.5 ue/l SPA 524.2 91100 14:39 JAN
<0.5 0.5 USA EPA s24.2 OWN 14:39 JAH
<0.3 0.5 w EPA 524.2 9110M 14:" JAH
<M O.s uj/I EPA SU.2 9/10/911 14:39 JAH
boPo' obmam <0.3 0.5 No EPA 524.2 9/10/9e 14:39 JAH
al>Io OPY11oltM <0.3 0.3 VVI VA 324.2 9110t93 14:39 JAR
Na iqu <0.3 0.3 "n EPA 324.2 9/10/% 14:39 JAH
o•Propyll4asemc <0.5 0.3 uoil EPA 524.2 9/10M 14.39 JAH
rlee�te!► <0.5 0.5 cell BPA 524.2 9/101% 14:39 JAH
tat�Bu4dbaaeeoo <0.3 0.3 us/1 EPA 524.2 91100 14:39 JAH
1.2,3-Tdot�evb�soae <0.3 0.3 u n EPA 524.2 9110M 14:39 JAH
t,2,4•� <0.5 0.5 twl EPA 524.2 9110/98 14:39 JAR
1,2,4-T t
weer 0.3 0.3 uill l3PA 324,2 9/1019! 14:39 INN
1,S,S 1'tiwiJrl <0.3 O.s u#A BPA 324.2 91101" 14:39 JAH
MOW Tat W ww Or <1 I "n EPA 524.2 9/DO19e 14:39 JAH
u°11e� <10 10 w SPA s24.2 9/10/" 14.30 JAH
1<LfiEltO�AT� IAMB 'EPA 524.2 9110M 14:39 JAH
92 OOd20R EPA 524.2 SI/10/91< 14:39 JAH
1.24ialtloea6wsw&dt is 10.1M EPA 924.2 9110fo 14:39 JAH
wn n ....a• .w In ...- .A. - .pH •n- n---.-..-n--:--. -- ----_-___• -_ ------------ - - --
f-
f
--100 -- EXISTING CONTOUR
x 100.98 EXISTING SPOT GRADE N
♦ EXISTING WELL Wokeby Road
W EXISTING WATER SERVICE
G EXISTING GAS SERVICE LOCUS o
-�1GV1� UNDERGROUND WIRES o
of
TEST PIT \o r 3
BENCHMARK �° ch/pp�9Sto
LEGEND p� 92 Q ne z
P6 Z�2_
Q yes
LOCUS MAP
NOT TO SCALE
S 25'45'10" W
11 U.00'
a .+ . . . . . 106.84
107.34 +
to
E--- --- �TP-2-
107.9l --- 37'. .. . - _
_____ [' ,. ,.PROPOSED
S 21�
_____ Tf ;..: . .A.S..'::':
EXISTING S.A.S. ��,:,:. O O 1 O' O O .•i::' VENT
TO BE ABANDONED LOT 3 1L_ =� =�'� + 106.65
20,060±S.F.
x 107.06
EXISTING SEPTIC TANK 107.00 +
(TO REMAIN) x 106,96
TOP OF TANK, EL.=104.63E
INV.(OUT)=103.30E
106.90
x
rn
BENCHMARK
BULKHEAD CORNER 106,73
EL. 106.77 O 106.71
W 106.58 +
+ 106.84
in
ct
MSHED x:..-:.. 0BM 6 x 106. 4 cn
106.41, : ;: 106.54 1 J7 DECK
c� 106.26 BH 0o N
x 106.74 rinse + Co v_
.: N
106.73 v
\ A m
:..�: .: EXISTING
HOUSE#45 �..: ;: x HOUSE#19
HAS TOW!✓ WATER SVC. . ., 106,30 106.80 HOUSE(#37)
T.O.F.=108.Of G�
HAS TOWN WATER SVC.
:., PORCH /
105.02 :' '�:. DECK l
GARAGE /
106.36/
5.32
103,45 ` 10 .39 ::E-
x --
106,24 M6207 /
102.84
104.37
103.12 x DRIVEWAY
101.01
x 125.00�` 102,33 WELL
23'46'38" E:...
CATCH BASIN CATCH BASIN 99.52 99.72 100,32 100.65 101.19
99.25 99.30 A UDRE YS LANE
of 414ss9� PARCEL ID: 028-055
o PETER T. yG� PROPOSED SEPTIC SYSTEM UPGRADE PLAN
M CIVILEE y 31 AUDREY'S LANE, MARSTONS MILLS, MA
No. 35109 Prepared for: DiBuono Sewer & Drain, 35 Content Lane, Cotuit, MA 02635
£GIStER� �
f sI OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO.
G CROTEAU, JASON & MOLLY Engineering Works, Inc. 1"=20' P.T.M. 269-18
31 AUDREY'S LANE 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO.
v�\ MARSTONS MILLS, MA 02648 (508) 477-5313 11/27/18 P.T.M. 1 Of 2
I
NOTE: TO PREVENT BREAKOUT, FINAL GRADE
SHALL NOT BE AT, OR BELOW, EL.=102.5
FOR A DISTANCE OF 15' FROM THE EDGE
SEPTIC TANK PROPOSED D-BOX OF THE PROPOSED S.A.S.
INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT PROPOSED S.A.S.
OUTLET AND SET TO 6" OF FINISH GRADE COVER SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER (MIN.)
AND SET TO WITHIN 3" OF FINISH GRADE TO SERVE
T.O.F.=108.0t AS AN INSPECTION MANHOLE.
F.G. EL.=106.8t F.G. EL.=107.0tt
F.G. EL.=106.7t F.G. EL.=106.6t
CHARCOAL VENT
L = 44' L = 23'(MAX.)
® S=1% (MIN.) ® S=1% (MIN.)
4"SCH40 PVC 4"SCH40 PVC
6" 2" LAYER OF 1/8"
" ER 0®*�13.5' 1
TO 1/2 DOUBLE
14" L
12" WASHED STONE
EXISTING 48" LIQUID PROVED FILTER FABRIC)
LEVEL ADD
GAS BAFFLE INV.=102.40 PROPOSED INV.=102.23 3.5' 33/4"-1 1/2"
INV.=103.30t D-BO� INV.=102.00 EFFECTIVE WIDTH = 10' DOUBLE WASHED i
EXISTING STONE
EXISTING SEPTIC TANK USE 5 LC-6 LEACHING CHAMBERS IN SERIES
WITH 3.5' OF DOUBLE WASHED STONE-ALL AROUND
NOTES: H-20 RATED
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE TOP CONC. ELEV.=102.83
INVERTS, PRIOR TO INSTALLATION. -- -- -BREAKOUT
2) D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.=102.00 ®®®0®®® ELEV.=102.50
GRADE ON A MECHANICALLY COMPACTED SIX MMI 13 E3 E3 E3 E3 E3 E3
INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.=101.00
310 CMR 15.221(2). 1 3.5' 5 x 6' = 30' 3.5'
3) INSTALL INLET & OUTLET TEES AS REQUIRED. 4' OF NATURALLY OCCURRING
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE PERVIOUS MATERIAL EFFECTIVE LENGTH = 37'
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. 5' (MIN.) ABOVE G.W.
BOTTOM OF TP„ EL=95.6 = BEACHING SYSTEM SECTION
SEPTIC SYSTEM PROFILE
N.T.S.
GENERAL NOTES:
1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL LOG
BOARD OF HEALTH AND THE DESIGN ENGINEER. DATE: NOVEMBER 26, 2018 (REF#15,836)
2. ALL WORK .AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SOIL EVALUATOR: PETER McENTEE PE(SE#1542)
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE WITNESS: DONALD DESMARAIS R.S.HEALTH AGENT
LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW:
-310 CMR 15.405(1)(b): ELEV. TP- 1 DEPTH ELEV. TP-2 DEPTH
1) A 2' variance to the 3' maximum cover requirement, for up to 107.0 A 0 106.8 A 0
5' of max. cover. S.A.S. shall be H-20 and vented.
-LOCAL REG. Chapter 397-8. E (f): WELL SETBACKS, S.A.S. TO WELL SANDY LOAM SANDY LOAM
2) A 10' variance, S.A.S. to private well, for a 140' setback. 106.5 6" 106.3 6"
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR B 10YR 4/2 B 10YR 4/2
_ TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE SANDY LOAM SANDY LOAM
DESIGN ENGINEER. 10YR 5/6 10YR 5/6 -- -
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 105.0 C 24" 105.0 C 22"
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
I' ENGINEER BEFORE CONSTRUCTION CONTINUES. n PERC
5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. M-C SAND 36"/54"
M-C SAND 2.5Y 6/6
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 2.5Y 6/6
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S.
9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 96.0 132" 95.6 135"
AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE PERC RATE <2 MIN/IN. "C" HORIZON
DIRECTED BY THE APPROVING AUTHORITIES. NO GROUNDWATER ENCOUNTERED
10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
CONSTRUCTION.
11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS --4. J----
IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 20.Ina COVER
REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). I I
12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE I _
INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. to
14'KNOCKOUT 4"KNOCKOUT M
13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
NOT CONSIDERED TO BE A PROPERTY LINE SURVEY.
14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC
L------ 4*KNOCKOUT --�
SYSTEM COMPONENTS NOT SHOWN ON THE PLAN I J
r- 72" 1
DESIGN CRITERIA PLAN VIEW
NUMBER OF BEDROOMS: 2 BEDROOMS ---- ----
SOIL TEXTURAL CLASS: CLASS I ® ® ® ® ® ® ® 2" E3
12
DESIGN PERCOLATION RATE: <2 MIN/IN INVERT I ® ® ® ® ® ® ® I I I
DAILY FLOW: 220 G.P.D. I- 72" 36°
DESIGN FLOW: 330 G.P.D.
GARBAGE GRINDER: NO-not allowed with design SIDE VIEW END VIEW
LEACHING ,AREA REQUIRED: (330 GPD) = 445.9 SF WIGGIN LC-6, OR EQUAL, H-20 LOADING
.74 GPD/SF LEACHING CHAMBER
EXISTING SEPTIC TANK: 1500 GALLON CAPACITY
PROPOSED D-BOX: 1 INLET, 3 OUTLETS, H-10 RATED
USE 5 LC-6 LEACHING CHAMBERS IN SERIES WITH PROPOSED SEPTIC SYSTEM UPGRADE PLAN
3.5' OF DOUBLE WASHED STONE-ALL AROUND 31 AUDREY'S LANE, MARSTONS MILLS, MA
SIDEWALL AREA: (10.0' + 37.0') x 2 x 1' = 94.0 SF Prepared for: DiBuono Sewer & Drain, 35 Content Lane, Cotuit, MA 02635
BOTTOM AREA: 10.0' x 37.0' = 370.0 SF Engineering by: SCALE DRAWN JOB. NO.
'
TOTAL AREA:........................................................... 464.0 SF Engineering Works, Inc. N.T.S. P.T.M. 269-18
12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
DESIGN FLOW PROVIDED: 0.74 GPD/SF(464.0 SF) = 343.4 GPD (508) 477-5313 11/27/18 P.T.M. 2 of 2
metal pink
metal p i n . : .
c2
limit 5 removal
unsuitable material b
tom-
existing ,g Z03 0Iz existing
pit - 4a, pit ;.
9z pit Lot 3
Lot 4 / Lot 2
C,5 T
Septic de sign
2 bedrooms
fNo disposal
( I CL-'' Septic tank . req. 1500
- 2 brx110=220 qpd -
' s, Leaching prim:-- & res.
_.
�./ 25x2+2
x.74gal . / (ft2/day)
=233 gpd
metal in `
p' �>.o metal pin ..
,
4.0 s Audre ' s Lane
Itop;of S 9
found: "` 40 ' wide Pk
R y; j�-
to D—B �2of=LisS A;o .�aLI= M.►C.
v-_.
Liu x.c: �w�----
r— i=L
/4']]
15ao C-,S-,- �_ .� � t�; e4„'pvc pE,
,
� • j 1 YI �.�
_
6' stone ____. - ��.. t_ _ _.
for level a I z I z I V I .L Gx ,
I �gpT Tag"%-/el ELL
.
Test pi't data
Made- 8-=20-98
`Wit. J. Dunning
,gvalu'ator D. Coughanowr
r _
'hest pit 1 _
:Depth Texture color
:0-3" 0 loamy sand 7 .5yr2.5/2 j
13 5 : E loamy sand 10 " 4/2
5 1*1 - A . loamy sand 10 " 5/6
j 11-43' B loamy sand 10 " 6/4 �- - - — ----- --- z s'
43-84- Cl Coarse 10 5/6 : a
j 8.4-'132C2 Med. " 10 " 6/4
� Test pit 2
j •0-4" O loamy sand 7 .5yr2.5/3
! 4-6 E loamy sand 10 " 5/2
j6-11 A loamy sand 10 " 5/6 Site Plan of Land in Marston Mills, MA:
11- 40 B loamy sand 10 " 5/4 For Ben Hodgkins
140-80 Cl coarse 10 " 5/6 Being lot 3 as shown in book 272 page 92
80-156C2 med. sand 10 " 6/4 NGVD
Elevations are on
No -water encountered
Date Agent Barnstable board of Health -
Date 9-8-98 Q�--
All Cape Engineering
i 49 Harbor Road
. . , Hyannis, MA 02601 �,\`.�' •
(M OF SASS
Vic, BERNAI 9CyG
1
o tOHN YOUNG n
• � ARCH