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HomeMy WebLinkAbout0163 BAXTERS NECK ROAD - Health Baxter Neck Road, Lot 10 Marstons Mills C>01 - 101 Commonwealth of Massachusetts bbf- Xo . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments rz- y�� 163 Baxters Neck Rd Property Address F.a OHEARN, EDWARD J & DEBORAH A 0 Owner Owner's Name 17;) information is Marstons Mills ✓ Ma 02648 7/31/2018 X:required for every page. City/Town State Zip Code Date of Inspection , EA 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 forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones TitleV Septic Inspection tA rlb Company Name 74 Beldan Ln. Company Address ' Centerville Ma 02632 Cltyrrown State Zip Code ,- 774-248-4850 smonestitle5@gmail.com S14522 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: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 7/31/2018 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 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 Forth:Subsurface Sewage Disposal System•Page 1 of 17 l Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,..°� 163 Baxters Neck Rd Property Address OHEARN, EDWARD J & DEBORAH A Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/31/2018 page. City/Town 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: The dwelling located at 163 Baxters Neck Rd Marstons Mills is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and 6 330 cultec infiltrators. The system was found to be in proper working condition at the time of inspection. 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 F) Commonwealth of Massachusetts _ . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 163 Baxters Neck Rd Property Address OHEARN, EDWARD J & DEBORAH A Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/31/2018 page. Cityrrown State Zip Code 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, 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 163 Baxters Neck Rd Property Address OHEARN, EDWARD J & DEBORAH A Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/31/2018 page. Citylrown State Zip Code Date of Inspection 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 7 100 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 ❑ ® 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 '/day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts = v . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M a 163 Baxters Neck Rd Property Address OHEARN, EDWARD J & DEBORAH A Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/31/2018 page. City/Town State Zip Code Date of Inspection 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. ❑ ® 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 CM 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 16,000 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 ❑ ❑ 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 If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 163 Baxters Neck Rd Property Address OHEARN, EDWARD J & DEBORAH A Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/31/2018 page. City/Town State Zip Code Date of Inspection 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)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ,> 163 Baxters Neck Rd Property Address OHEARN, EDWARD J & DEBORAH A Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/31/2018 page. Cityrrown State Zip Code Date of Inspection 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 years usage(gpd)): Detail: "*property has irrigation system Sump pump? ❑ Yes ® No Last date of occupancy: seasonal use Date 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 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts v W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 163 Baxters Neck Rd Property Address OHEARN, EDWARD J & DEBORAH A Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/31/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 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): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 163 Baxters Neck Rd Property Address OHEARN, EDWARD J & DEBORAH A Owner Owners Name information is required for every Marstons Mills Ma 02648 7/31/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1998 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.5 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+feet ' Comments(on condition of joints, venting, evidence of leakage, etc.): Joints ok, no leakage, vented through roof Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Sludge depth: 6" t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 163 Baxters Neck Rd Property Address OHEARN, EDWARD J & DEBORAH A Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/31/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers, took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank should be cleaned soon and again every 2 years for proper maintenance. Water level was even with outlet invert., tank was not leaking and was structurally sound. Outlet tee was intact and in good condition. 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 t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form a Subsurface.Sewage Disposal System Form - Not for Voluntary Assessments 163 Baxters Neck Rd Property Address OHEARN, EDWARD J & DEBORAH A Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/31/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day 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 t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 163 Baxters Neck Rd Property Address OHEARN, EDWARD J & DEBORAH A Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/31/2018 page. City/Town State Zip Code Date of Inspection 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.): D box was video inspected and found to be in good condition. No rot, water level was at bottom of outlet invert, no sign of past hydraulic overloading. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 163 Baxters Neck Rd Property Address OHEARN, EDWAR'D J & DEBORAH A Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/31/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 6 Infiltrators ❑ 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.): soil and stone surrounding s.a.s. was probed in various locations and found to be dry with no sign of past saturation. 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 t5ins•11110 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 163 Baxters Neck Rd Property Address OHEARN, EDWARD J & DEBORAH A Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/31/2018 page. Cityrrown State Zip Code Date of Inspection 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 163 Baxters Neck Rd Property Address OHEARN, EDWARD J & DEBORAH A Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/31/2018 page. Cityrrown State Zip Code Date of Inspection 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 PIC A( qy AZ `44 >;Z I{Zfo n> q�b t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form al Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 163 Baxters Neck Rd Property Address OHEARN, EDWARD J & DEBORAH A Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/31/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater elevation was established by accessing Town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M °a 163 Baxters Neck Rd Property Address OHEARN, EDWARD J & DEBORAH A Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/31/2018 page. City/Town State Zip Code Date of Inspection 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 1 3 TOWN OF BARNSTABLE i LOCATION o P-)4 -f lU (�_SEWAGE VILLAGE t f n1. ASSESSOR'S MAP & LOT 07s'- 001-Y0/ STALLER'S NAME PHONE NO. d d r v r IN SEPTIC TANK CAPACITY U /5J0 ca�C LEACHING FACILITY: (type) o c4 `rwsize) :NO..OF BEDROOMS I I ..BUILDER OR OWNER e l o .`PERMTTDATE: �07 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist 'Within 300 feet of leaching facility) Feet Furnished by -:r g 3� � v 1 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA DARTER NECK RC>AD lo g D R 00 fLi iNDER - . I 5S0,GP0 70= 1100 GPD >TIC TANK .�► �- �_.. —. +� 1.031 ACRES' � h R DKSIGN s cr TUC7E-'%TC)-T-NVC- 'PED.END5 . ` J LINE IN � � TR=20' Q 4S SHOWN \ e 0v REQUIRED D B SF TII-I • e�< / --- \ PERK > O v' i P 5 - qo' 00 y 40 9y J - .PLAN VIEW I h SCALEi. I."=14O'. MM I BRING INC '�'TAA' 14BAtRINSTABLE r �, c LOCATION ^ D D ozaf SEWAGE# g I S VILLAGE ASSESSOR'S MAP & LOT —Jf Ool yo/' INSTALLER'S NAME&PHONE NO. O (r,,,U,0,vd a 4J I.ax,- SEPTIC TANK CAPACITY fy -10 5 JO� LEACHING FACILITY: (type) 1-9 J/ y C4/kC 'T"" ;A A,; size) NO.OF BEDROOMS J BUILDER OR'OWNER uel PERMPT DATE: - _ I O -7 S COMPLIANCE DATE: -�G Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by A r J7 f= a 137 i-- �' - 01 Gy q No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 90 ?0 Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Mizpogar *pOtem Con5truction Verutit Application for a Permit to Construct(X)Repair( )Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No. L.0-r /G 3A X ter NG'c lc 12D Owner's Name,Address and Tel.No. JM I�rSfO/✓t jvl I t-!.s A4 A ;' d-L Pe VELri P,416rA/7" Assessor's Map/Parcel P_O. 13 0)( 2 0 5- 76' I• XOi 1-4A/V111_t /v /r))9 01431, 1429-3341_1 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. RQMCI� vN�aJ SLiL L i v,41v /YG i�vs�rli7/G 11V 4. •7 p,Qr le-E2 R D Osrcr//1LLE A14. 2S- 33e4e-1 Type of Building: Dwelling No.of Bedrooms Lot Size �iei� /® sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 41,410 gallons per day. Calculated daily flow 14/1. Z gallons. Plan Date aA W. 27 0 1 9'q 9- Number of sheets I Revision Date Title S I fiE PL PIV Size of Septic Tank 1 ,5'00 Gf1 L— Type of S.A.S. 12 X 3 `LGAcPmr % L'hAINSE2 Description of Soil 0—2 it P1 NE /VEEDLEs OR&A/Y1 e M-4t, 2"— 9 0� arowAl C©Art6 9'-' 3 2.2 co P rse sAivD 3 2:'° 12.2." N A &yA ter �IVGv u�TEO 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 Title 5 of the Environrn 1 Code and not to place the system in operation until a Certifi- cate of Compliance has been iss y is f It , Signed Date Application Approved by Date / ; Application Disapproved for th follow' g reasons Permit No. 9 b� Date Issued ,. TOWN OF BARNSTABLE ,.:LOCATION , yt& ��_ SEWAGE# c r A,, ASSESSOR'S MAP & LOT Q2Y- 001-Y01 VILLAGE h `INtVC STALLER'S NAME&PHONE NO. o d nnr SEPTIC TANK CAPACITY 0 /S JO aX 'LEACHING FACILITY: (type) .f.;d c4 size) J -VO OF BEDROOMS I .:BUILDER OR OWNER e L De ve 10 PEITTDATE: �-- - 10 �zT B COMPLIANCE DATE: ;:;.Separation Distance Between the: aiumum Adjusted Groundwater Table and Bottom of Leaching Facility Feet . Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet -:-'-Edge of Wetland and Leaching Facility(If any wetlands exist ` - within 300 feet of leaching facility) Feet :Fiirrushed by - -- ('f "47 7 i -_ -.._ No. _ THE COMMONWEALTH OF MASSACHUSETTS Enie�in-computer: U �p V 70 ?oPUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS ' Yes ZIpprication for Miopogar *ps tem Congtruc oit Ver�m'ii', Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. `.,0 7' 10 (3A x ter A/Ec K RD Owner's Name,Address and Tel.No. to A rstoNs r►i c s M A 3 a- 1, P c-vELa P/HZ tip- Assessor's Map/Parcel PO. BOX a O S' "7S" 1. )(01 NAMte.te /rl,� 01g34, �/28�33N�f Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ^QMdy E vnG,f SULL14,'M/ cNc1N6'Er/IvG '7 P4r'IGE'1Z R D OSYG �t/rt.GE MA. N2 9- 3 341q Type of Building: Dwelling No.of Bedrooms Lot Size /D sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow Y y o gallons per day. Calculated daily flow 4(4, 2. gallons. Plan Date /4 W. 27 4 19 9 lr Number of sheets i Revision Date Title S 1 tE PL AA/ Size of Septic Tank 1 5C>O GA Type of S.A.S. 12`X 36`LC-gcNiw e*A41MBE/L Description of Soil O-2.t' Pt NC /Vt,60c.6-S ORGA/yI c MA>', Z'- 9 QrOUIXI CoA/'sE si &Dl q 3 Z`t co P rsE SAiyD 3 Z:'- 112, CaprSE 5A IV Po r yAtEl" L�I?/Go uiY>EO �• 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 Title 5 of the Environmen 1 Code and not to place the system in operation until a Certifi- cate of Compliance has been is e ' y t is 'o �f th (� Signed Date />) !�i i Application Approved by Date Application.Di�approved forth--fo lowhig reasons -r F . i Pe1init No. ' - 9 S� Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed (X)Repaired ( )Upgraded( ) Abandoned( )by at 10 6AXfGM NEc►C R0A0 , M rsAm—,s MIL Is 0 MA- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �( �:-dated v Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector C\ d ------------------------------- — ------ N.. _ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 'Wigpool *pgtem Construction Permit Permission is hereby granted to Construct(X)Repair( )Upgrade( )Abandon( ) t System located at L Q-r /✓�' 84g-rE2 &6e IG Q-av n r fYIAI'S�r//1/S M/LL s 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 p t Date: 2- 17 Approved by 1 u�wn 01 Barnstable - - Department of Health,Safety,and Environmental Services / 9 a� Public Health Division Date i 367 Main Street,Hyannis MA 02601 , UNWAKA fin SIL i6 Date Scheduled o / / / Time Fee Pd. � `f Soil uitability Assessment for Sewage Disposal Witnessed By: �U Performed By: ��Q ��t't LOCATION &'GENERAL~IIVI`+iSRMAI(��N � velapm�rrl Location Address Owner's Name J o8 Lot lO 66u4c, Neee lek. p•0 ,66X a '&t06es`"w ) Address f/�.h�I/fan; m� �i93G yl off owl /V��t !-a&L V -// orh?)n ou-f° ' XO/Engineer'sName /oe it SvlI fv&r» PE'Assessor's Map/Parcel: 7.J-1,1L /� , NEW CONSTRUC71ON _V REPAIR Telephones dad 3 3 y Land Use �I��ooO�-Vkipava-Lo Slopes l - �p Surface Stones Distances from: open Water Body to X7 ft Possible We Area �o ft Drinking Water Well @�o ft - Drainage Way KLA ft Property Line Icl+ ft other ft i SKETCH:(Street name,dimensions of lot,exact locations of test holes dt Rerc tests,locate wetlands In proximity to holes) '�q, 9LosF !.. � z vga- wo t G j3 CAez * 1ti0-�Y ; tl F ~ - •-. a -.. _.S. 'i GCa Aclfi SA,,V r VJ Gti,S f , Vl LA(-It A,l., Parent material(geologic) b�"r��� Pi..a`rV Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater Et•• 57 fA6VQ DETERMINATION VOR SEA ONE G AMER T BLE Method Used: low fto �ir,Ir n93NV"W-z in. Depth to soil mottles: in. Depth Observed standing in obs.hole: ! In. Groundwater Adjustment Imo, ft• Depth to weeping from side of obs.hole: Index Well N__•,_._ -Reading Date:_ Index Well level.____ Adj.factor Adj.Groundwater Level PERCOLATIOI'�i ,p 'TEST `��v�aan►tv���� �,,�, � t � • 'tiaiai{tu;4,v%}Qti.Ei,`#`y A.4'{I�Y.t,tr�{ Observation Time at 9" Hole fl 1 Depth of Perc Time at 6" Start Pre-soak Time @ 25�:AL�.o•laS LEbS T3}ArV tS v� Time(9"-61 ­ ' End Pre-soak gy. `'?:'77t'' •! rot Rate Min./Inch LESS ib}-,K.) 2.wlttn� ,GM t,�rvGeq' Site Suitab7PublicHealth ent: Site P d �� Site Failed: Additional Testing Needed(Y/N) 60 Original: Division Observation Hole Data To Be Completed on BackCopy: App , 1 r Hole# � bI;EP 0135E1ZVA'i'lUN 1[dLE LOG soil osier Soil'texture Soil Coinr Mottling (Slruclurc,Stones,noulderts. I)cpllt from Soil I Iorizon (USDA) (Munsell) • Surface(in.) Opt, 6d4� y1. 0=7 'wJ 7 ar Nnl # '? Soil other pEEI' (j[;SEI2 SAfilxr��l IIULCIL�� mottling (Structure,Stones,Douldercs. SoilIlorizon (Munsell) M g • Depth from (USDA) s Surface(in.) gr ------------ I Urrl' (�I35EItVATION HOLE L son other Soil Texture Soil Color $truclure,Stones,Doulderes. Soflllorizon (Munsell) mottling ( • Depth from (USDA) Surface(in.) stole# llEEP OBSERVATION HOLE LUG Soil other 'r Soitexlure Soil Color l,from Soil I loriron (Munsell) Mottling (Structure,Stories,noul eves. Dept (USDA) Surface(in.) r MoodFrance Rate Matte year flood boundary No Yes ' • Above 300 y , )( - Within 500 year boundary No Yes_ ' Within 100 year flood boundary No Yes i e i -� �„ ;' ccurrin Pervious A N1ttl�gl Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? if not,what is the depth of naturally occurring pervious material?. -- �ertili�n '" v 1 certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above aUaCMR as pert e b me v siste t thO -_., a and exr Hence described in 3 __ the required trot� _g,expertls t C3AXTER NECiG ROAD \NAT6R SuPPL.y FOR TNI$ LOT 15 MuNICIPAI. WATER , ws lrf .N O rx AR t3 A G E G R I N D E SZ LOCATION OFUTIIATISS SHOW ON T415 I>LAN ARE APROX, T5.41ZY';')"LC7W-= LIA.`X3 - SSO.,GPO " ,r AT LEAST 72 ►+OURS PRIOR TO AN't EXCAVATION PoR'TN15 SEP_Tft:7`A4W.TSo KZ00'!o.= I100 GPD PROJECT THE CONTRAC-TOR 50ALL MAKE TNE' REQUIRED _CISEE,' .540 - GALL ON SEPTICTAN-K."_ NOT1F' r_A-t"ION TO DIG SAFE(I-8O0- 32z-yByy) AND "IN.AT>PR(>PRIAT"E WA-rER DIS'rRIC.T FOR LOCAT(O N DATA, f _.1-O� l ACR'ES`_ CEAt.N tNG C1aAMF3Et� 6�51"GI`l-:_ o. � � � 7`1 E:":C.0N—rRAC.T0R IS RE0141 RED TO SECURE APPROPRIATE ,.,%` 'a PERM►T5 FROM TOWN AGENCIES -oP CON5TRL1GTI4tr1 D�FIREp_.BY.-TM15.:PLAN JI:R 'CSRAI'ED__V�l1frH".CAPPED.ENAS._; ' �- 'I INS-raLL R1sCn5 r�As Eau►RltD "r0wITN �s.e r-�:-�"i�(s'Y`Rl$"LITICST\I .L.INE .IN.. _. � ,C � �R=�E�.. IN t2� L.EA.C1-1:I.RlG ::_GF{AMC3125 FINISH GRADE. Of WASHr=D .EYONEMEL.D AS SHOWN �t_i::ySrl i]c`r I1RE i3V t�'iED FOLD R..FLm.T ovkMORE:bR - L ACN k Jr::AREA:: 6 `r, I SU 3JEC-r TO VEHICULAR -rRAFFIC'7O pE H= O L0AbII�IG.._._. .^___..__-_ �'/ 6' . , OFi�:ALL .PR �PGRTY SSE-v1iALL " Z � :=t+/Y)Z '=:Z:2�! w SF �• f T,= ° O, i TO:'.LAND COURT .._PLAW. 15573G. TiS�T 7`Ci1vi AP, A C i2XY`/ _ 328 SF ET'"1iC_. .SyS'T" N1 "T.b pl= IN5TXLLEp IN ACCOPIDANCED W ITFF ' �--- -� PERK �52.,=.SF:-T.�TAL__`F�RC�VIDEO:_:"_ 310_GMIZ 15..00_.:LAT65T_.REVISLC?N-.J41.1U:: THE TOWN pF" : f i, p _ . BARNSTAL3Ll= t30ARD. .OF 14EALT1-1 REGULATIONS , _2'CJf.11NCr: D(S`i'RICT.....RF .. _ ��"�,,. �,- i�, 15'O' FRONTAGE 4 .r /� / 5-IDELINE M11%EVNA�4 . OWL-NEST, LANE _ 3G�' • � a 04, PINE r t;8Dt..ES l ', ORGAN c MAT. i SROWII C.OA1z313m SAND- __PLA_N VIEYV,., rn i Ci C0AR.•6 SAND / 32— SO° E.RI< TEST. C� -C<AP!i E:..SAND _KU WATER ENCOUNITED \ ' T2� — C.TATE= 0l/15/98 .No. P-4090 €KCriT�ErEti, 5ILLIVAN ENGINEr=RI"MG- INC J:DUNN.ING,I,SARN$TAl3L E: D.0,4 TEST `C L.A S S S M N-rF_RI A L. DmPTH_.OF - ERI + 48�� LESS 7 NONN CJ4 _ - rftt FIN►S14 t. G-35 C7" !_ _ _ __--- F G___3 4.s- G COMPACTED PILL 3�MAXIMUM - � .150O GAL 3) 8 IL6 I30T, ELL,. _- _1__ — .Ci 0D i N G A$ PEA STONE IPEFZ TITLE 5 ,, (O' 10' 1 , N, Lt=ACHING _-BOTTOM __. 1vA5NEA � .O CNANI�ER - :OF:T�5T.NOl.IE E L.2_75:8=NQ.Vt/ATE R c7 C1o�. ------�- - ___ `'�� _ ._ DEI✓E'L dP t :PRq 1 L :QF.PROP 5ED SePT C. . � Sit' Nor "I"C> .SGAL.E� c CRO55 5E'CTION OF CHW5E'P, 1 NC)T41 1 a nUL dgq°p,n SITE PLAN 9.2tl _ AT il " l LOT lb- BAXTER NECK ROAD MARS TONS MILLS , MA FOR J & L DEVELOPMENT SCALE:ASNOTED DATE:JAN. 27, 1998 14C.PROPOSI:D STRUCTURtia SNpwN WtBt<MON COMPLIES -NNITH THE TOWN OF 13AIzN5TAI3P E IZEGGL►LATION S _;=0R ,5ET,BACKS AND 15 NO-r L..0C.ATEI15 WITHIN SULLIVAN ENGINEERING INC. Teas O_yEAR 'FLOOD PLA1N _ _ . 7 PARKER ROAD s JA$4. ZZ, 199$ OSTERVILLE , MA 02655 ' p AT E (508) 428— 3344