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HomeMy WebLinkAbout0345 BAXTERS NECK ROAD - Health 3=0 t3AX-f Eli MARST�,N MILLS i TOWN OF BARNSTABLE LOCATION SEWAGE# S i. VILLAGE P&PARCEL NAME&PHONE N SEPTIC TANK CAPACITY. LEACHING FACILITY:(type) ( _ I1Ql�� S (size) NO.OF BE OMS 1 OWNE I PERMIT DATE: ¢ #SEE DATE�-A/S J-2 z 11 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Lf kj L+\r\r4 L L \ L L '~f f /•f~f f L L \ \ \ \ L \ L L 4 \ 1 \ 50 ;/ Fuse \ L \ L L \ L J f f J f f f Q f f 1 r r J f 1 L \ 1 \ L \ 4 L L L L \ L \ L 34 f r f r f r f 38 s G/ L �lG r -t O r tone \ r�%cCos u re k \ L L \ :.: all .1c 33 f f ' f 'GU-eSf_HDW"T0" OF BARNSTABLE. LOCATIOBaAA2,s VILLAGE S A SSOR'SMAP&tPARCEL ME&PHONE NO. SEPTIC TANK CAPACITY10610 LEACHING FACILITY:(type) (size) NO.OF BED OOMS to OWNE (' PERMIT DATE: ATE`� -z ' Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY �r f J 4 \ +. \ ♦ 4 4 4 4 1 �p t Kra \ k k .r�r+rkf k f fir f.4 f`j�J'�f�y+�' f•f+f 1 f i f F J f F J f f+.r t + 4 �1.1�f�f�f�f4 •• f r r F r F f+J r f 31 r r f f f r J \ 4 1 \ \ 1 f f J r J f r \ 4 \ 4 l k F J r r f J k \ \ k 1 1 53 Jff,f f 4 1 4 \ + 5 5 1 : 10 102 W t r ®? 00a� No. �� Fe � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS t ZIppYication for ]Biopooal opotem Conotructton Permit Application for a Permit to Construct( )Repair(v1 Upgrade( )Abandon( ) O Complete System 21� dividual Components Location Address or Lot No. �" Owner's Name,Address�s�and Tel.No. Assessor's Map/Parcel /11I, �u� l �v I�T/B Installer's Name,Address,and Tel.No. y. Desi ner's Name,Address and Tel.No. r'� M 5 19 PMM CONS IN = x noyi5 6,wa"04 o -7-7 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank AIPW Type of S.A.S. N Description of Soil Nature of—Repairs or Alterations(Answer when pplicable Is Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5.of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is;VM M j Signed Date �(' Application Approved by Date/a t o � Application Disapproved the foll ing reasons Permit No. 7313-316 Date Issued Ab ro.lzo3 � I? 39,E - ��_ � ,``L` t '. �S �;�0 =� oZ3 _-F� woo No. (-� ,� ,v to _ r Entered in computer: THE C MONWEA TH OF MASSACHUSETTS p Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS _.tiµ 01 p�prication for Zio poiW 4p5temc Con!6truction Permit : Application for a Permit to Construct( )Repair(✓,S Upgrade( )Abandon( ) Elm L�Complete'Syste 'htdividual Components , . Location Address or Lot No. s � /� Owner's Name,Address and Tel.No. 44 Assessor's Map/Parcel vU '" ox t Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. tJ 9 ��. �5 $N T, �� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other+' Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date hs� Number of sheets Revision Date Title Size of Septic Tank Per Type of S.A.S. N� Descriptionrof Soil IZ Nature of Repairs or Alte ations(Answer when applicable �Q 1 i Date last inspected:Y� Agreement The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu d ,y$ is oard,of He the I Signed Date In A 1 Application Approved by Date!a b,° 'Zo 1 3 Application Disapproved TAthe foll wing reasons Permit No. Zo13- 316 Date Issued lb 1 i0/?�i 3 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 _PY)10 PON M t�l'u_, //r 4 at has been constructed in accordance with the pro isions of Title 5 and the for Disposal System Construction Permit No.Z°13 3176 dated Installer _13 s Designer . _ _ The issuance of this�s}; 11�0* nstrued as a guarantee that a syst it ncti�bn as designed. Date �b Inspec r No /J 3 1� Feerw� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Miopogal *p5tem Conotruction Permit Permission is hereby ,anted to Construct( )Reps( )Upgrade( )Abandon( ) System located at a1 / and as described in'the above Apphc ti n for isposal Sy es m construction PerCTheappl* reco nizes 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 t 's p Date: l(���d/ZD13 Approved by Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M a 345 Baxter's Neck Road *Main House* Property Address Stanley & Sandra Berger Owner Owner's Name' information is Marstons Mills MA 02648 . December 12, 2011 required for every page. Cityrrown State Zip Code: Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in anv, way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out I �} forms on the U computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name r� 189 Cammett Road Company Address Marstons Mills MA 02648 Cityrrown State Zip Code 508-428-1779 _ _ S1 12_855 Telephone Number License Number J 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 pefformed based on my training and experience in the proper function and maintenance of on site E n-1 sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 51(310 CMR 15.000). The system: find LL- ®`_Passes ❑ Conditionally Passes ❑ Fails © ' .� ❑"'Needs Further Evaluation by the Local Approving Authority _. December 12, 2011 Job# 11-216 I pector's tignature Date The system inspector shall submit a copy of this'inspection report.to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system-or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same,or different conditions of use. t5ins•11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 1 of 17 �0 5 Commonwealth of Massachusetts - Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 345 Baxter's Neck Road Property Address Stanley & Sandra Berger Owner Owner's Name information is required for Marstons Mills MA 02648 December 12, 2011 every page. Cityrrown 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: Tank was not in need of pumping at time of inspection, leaching system showed no signs of saturation or surcharge. Pump and alarm were functioning properly. B System Conditional) Passes: Y Y ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 345 Baxter's Neck Road Property Address Stanley & Sandra Berger Owner Owner's Name information is required for Marstons Mills MA 02648 December 12, 2011 ______________ _____ every page. Citylrown 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 l Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments µM 345 Baxter's Neck Road Property Address Stanley & Sandra Berger Owner Owner's Name information is required for Marstons Mills MA 02648 December 12, 2011 every page. City/Town 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 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 L Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 345 Baxter's Neck Road Property Address Stanley & Sandra Berger Owner Owners Name information is required for m Marstons Mills MA 02648 Deceber 12, 2011 every page. CitylTown 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 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ 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. (Sins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M a,.•y''p 345 Baxter's Neck Road Property Address Stanley& Sandra Berger Owner Owner's Name information is required for Marstons Mills MA 02648 December 12, 2011 every page. Cityfrown 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): 11 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 f Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 345 Baxter's Neck Road Property Address Stanley & Sandra Berger Owner Owner's Name information is required for Marstons Mills MA 02648 December 12, 2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: House has two systems, one is designed for 5 bedrooms and the other is designed for 6 bedrooms. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d N/A one meter g ( y g (gp )) for 2 systems. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: CurrentlyOccupied. 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: 15ins•11/10 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface S _- ewa a Disposal System Form Not for Voluntary 9 p Y o tar Assessments Y M 345 Baxter's Neck Road Property Address Stanley& Sandra Berger Owner Owners Name information is required for Marstons Mills MA 02648 December 12, 2011 every page. Cityrrown 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: Tanks pumped every three years. 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): 15ins•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 345 Baxter's Neck Road Property Address Stanley& Sandra Berger _ Owner Owner's Name information is required for Marstons Mills MA 02648 December 12, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Compliance date 12/9/97 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 4' Depth below grade: feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.).- Septic Tank (locate on site plan): Depth below grade: 30" (cover 2" below grade) 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: 12' long x 'wide-2000 gal. 0 Sludge depth: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 345 Baxter's Neck Road Property Address Stanley & Sandra Berger Owner Owner's Name information is required for Marstons Mills MA 02648 December 12, 2011 every page. CitylTown 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 Scum thickness 0" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Measured. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank had liquid only, no solids. Liquid level was found at bottom of outlet invert and tees were intact and clear. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 345 Baxter's Neck Road _ Property Address Stanley& Sandra Berger Owner Owner's Name information is required for Marstons Mills MA 02648 December 12, 2011 _ every 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•11/10 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 345 Baxter's Neck Road Property Address Stanley & Sandra Berger Owner Owner's Name information is required for Marstons Mills MA 02648 December 12, 2011 every page. Cityrrown 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.): No solids or high stains present. 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.): Floats were properly positioned. Pump and alarm were functioning at time of inspection. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11110 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 w. 345 Baxter's Neck Road Property Address Stanley & Sandra Berger Owner Owner's Name information is required for Marstons Mills MA 02648 December 12, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 8 Flowdifussors. ❑ 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.): Leaching system showed no signs of saturation or surcharge. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 13 of 17 Commonwealth of Massachusetts 4 r Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 345 Baxter's Neck Road Property Address Stanley & Sandra Berger Owner Owner's Name information is required for Marstons Mills MA 02648 December 12, 2011 every page. Cityfrown 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 345 Baxter's Neck Road Property Address Stanley & Sandra Berger Owner Owner's Name information is Marstons Mills MA 02648 December 12, 2011 required for ---- -----. _ — ----- —— ----- every page. CityFrown State_ Zip Code Dale 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 50kt4us'e 58 34 i 38 A 2 to r tone - nc[osure 33 all i Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,..'' 345 Baxter's Neck Road Property Address Stanley & Sandra Berger Owner Owner's Name information is Marstons Mills MA 02648 December 12, 2011 required for every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells 15+ Estimated depth to high ground water: 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: Water elevation at rear of property is more than 15 feet lower than bottom of SAS. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 16 of 17 `i I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 345 Baxter's Neck Road Property Address Stanley & Sandra Berger Owner Owner's Name information is Marstons Mills MA 02648 December 12, 2011 required for every 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 Y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 345 Baxter's Neck Road *Guest House* Property Address _ ------ Stanley & Sandra Berger Owner Owner's Name information is required for Marstons Mills MA 02648 December 12, 2011 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. nf: Whhenen filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not use the return Name of Inspector key. Septic Inspection Services Co. Company Name r� 189 Cammett Road Company Address Marstons Mills MA 02648 City/Town State Zip Code 508-428-1779 SI 12855 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 6 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Al December 12, 2011 Job# 11-217 Inspector's Signa 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. 15ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Lz z,, �3 � v Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 345 Baxter's Neck Road *Guest House* Property Address Stanley & Sandra Berger Owner Owner's Name information is required for Marstons Mills _ MA 02648 December 12, 2011 every page. Cltyrrown State Zip Code Date of Inspection R. 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: Tank was not in need of pumping at time of inspection, leaching system showed no signs of saturation or surcharge. 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): l5ins-11110 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 2 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 345 Baxter's Neck Road `Guest House" Property Address Stanley & Sandra Berger Owner Owners Name information is required for Marstons Mills MA 02648 December 12, 2011 every page. CltylTown 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 15ins-11/10 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 3 of 17 P% Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 345 Baxter's Neck Road *Guest House* Property Address Stanley& Sandra Berger Owner Owners Name information is Marstons Mills required for MA 02648 December 12, 2011 every page. Cityrrown 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 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 Commonw ealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 345 Baxter's Neck Road "Guest House* Property Address Stanley& Sandra Berger Owner Owners Name information is required for Marstons Mills MA 02648 December 12, 2011 every 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 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ 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. 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 'Commonwe alth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 345 Baxter's Neck Road *Guest House' Property Address Stanley & Sandra Berger Owner Owners Name information is required for Marstons Mills MA 02648 December 12, 2011 every 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): 6 — Number of bedrooms (actual): 11 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 345 Baxter's Neck Road *Guest House* Property Address Stanley& Sandra Berger Owner Owners Name information is required for Marstons Mills MA 02648 December 12, 2011 every page. Cltylrown State Zip Code Date of Inspection D. System Information Description: House has two systems one is designed for 5 bedrooms and the other is designed for 6 bedrooms Number of current residents: 0 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)): N/A one meter Detail: for 2 systems. Sump pump? ❑ Yes ® No Last date of occupancy: Unknown 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 345 Baxter's Neck Road `Guest House" Property Address Stanley & Sandra Berger Owner Owners Name information is Marstons Mills required for MA 02648 December 12, 2011 every page. Cttylrown 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: Tanks pumped every three years. 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 th of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 345 Baxter's Neck Road "Guest House' Property Address Stanley & Sandra Berger _ Owner Owner's Name information is required for Marstons Mills MA 02648 December 12, 2011 every page. Cltylfown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Compliance date 9/30/99 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2' feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 8" feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene El 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: 12' long x 6'wide-2000 gal. Sludge depth: 0" t5ins-11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 9 of 17 i 'Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 345 Baxter's Neck Road "Guest House* Property Address Stanley & Sandra Berger Owner Owners Name information is Marstons Mills required for MA 02648 December 12, 2011 every page. CitylTown 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 Scum thickness 0 11 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Measured. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank had liquid only, no solids. Liquid level was found at bottom of outlet invert and tees were intact and clear. 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 !Sins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 r -Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 345 Baxter°s Neck Road `Guest House* Property Address Stanley & Sandra Berger Owner Owners Name information is required for Marstons Mills MA 02648 December 12, 2011 every page. City/Town 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•11/10 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 345 Baxter's Neck Road `Guest House" Property Address Stanley &Sandra Berger Owner Owners Name information is Marstons Mills required aired for MA 02648 December 12, 2011 every page. Cityrrown 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 1. 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.): No solids or high stains present. 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: 15ins-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 345 Baxter's Neck Road *Guest House* Property Address Stanley & Sandra Berger Owner Owner's Name information is required for Marstons Mills _ MA 02648 December 12, 2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: Eight 500 gal® leaching chambers number: drywells. ❑ 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.): Leaching system showed no signs of saturation or surcharge 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 15ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 ' Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 345 Baxter's Neck Road *Guest House` Property Address Stanley& Sandra Berger Owner Owners Name information is required for Marstons Mills MA 02648 December 12, 2011 every page. City/Town 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.): l5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 345 Baxter's Neck Road 'Guest House' Property Add ess Stanley & Sandra Ber.er. Owner _. _._... — ---.._ -- -- — — — Owner's Name information is required for Marstons Mills MA 02648 December 12, 2011 — every 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 / / / / / / / / / / / / / r i / / i / / /•/ 1 / /Gue 13 l \!\/\ ♦ ♦ ♦ \ ♦`\ \ ♦ \ \ \ \f\/\/\/ f . 31 \ \ \ \ \ \ 53 / r 5 5 .f 10 a 102 Ei^„ VYtif 71:MV �a K V ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 345 Baxter's Neck Road `Guest House* Property Address Stanley & Sandra Berger Owner Owner's Name information is required for Marstons Mills MA 02648 December 12, 2011 every page. Cityrrown 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: 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: 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: Water elevation at rear of property is more than 15 feet lower than bottom of SAS. 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 1 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 345 Baxter's Neck Road `Guest House" Property Address Stanley & Sandra Berger Owner Owner's Name information is required for Marstons Mills MA 02648 December 12, 2011 every page. Cityrrown 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 l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION'S Q c �{;— �/o /� �I SEWAGE # S— VILLAGE ASSESSOR'S MAP & LOT LNI STALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 0 U a O 00 LEACHING FACILITY: (type) _ - Sao qc./lop �,,,--//f(size) t 2 �c 7 Z' NO.OF BEDROOMS BUILDER OR OWNER CC) PERMITDATE: 9 7Z2A — I ? COMPLIANCE DATE: —2/32H: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist L on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of aching facility) Feet Furnished by t �01 /Zp ! is 1 c f$2 f TOWN OF BARNSTABLE LOCATION I S ZAxT�2 1� SEWAGE # 9�- 'VILLAGE '��-��t175 1 V , rl--`�S ASSESSOR'S MAP &LOT -75 -7-06I .INSTALLER'S NAME&PHONE NO. CTt�-��=Y CO tVS�IZ tZOYI� '41 SEPTIC TANK CAPACITY 2CCC G&161LLlID LEACHING FACILITY: (type) v�p0 5 'A? X Z. #'`sqz I OF Sops NO. OF BEDROOMS BUILDER OR OWNERXFvOw t PERMITDATE: 11,� I ��� COMPLIANCE DATE: Separation Distance Between the: �. Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet I Private Water Supply Well and Leaching Facility (If any wells exist4 �- on site or within 200 feet of leaching facility) d Edge of Wedand and Leaching Facility (If any wetlands exist I-7D ( , Feet within 300i� eac faci t Furnished by I ----------- ro t� "9 3 M P � - Li o v ® Il (ll w rirry,"altos 3 T . TOWN OF BARNSTABLE LOCATION ��S C�Ss�c�— �/�e/L n� SEWAGE # 9g'63S— EU AGE ASSESSOR'S MAP& LOT —oa ,INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 2, d U 0 0 LEACHING FACILITY: (type) �'- 5DO dt., (size) !2 Y¢7 Z' NO.OF BEDROOMS BUILDER OR OWNER ©'Z) PERMIT DATE: 9'2,k — i I COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist L on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of aching facility) Feet Furnished by 0., _ 3 r - T7 z X TOWN`OF BARNSTABLE LOCATION S 3AX1Q?- M D SEWAGE # 51 - "0 V`II.LLAGE ��Ta►L75 1 V, tl--`t-S ASSESSOR'S MAP & LOT 12/-2--06 1 ,INSTALLER'S NAME&PHONE NO. CTit-I��Y CO t�S�TLtxItZO tl� I -4125 SEPTIC TANK CAPACITY. 2ab0 G54,t.-L,o0 2 ►sac���,�P C 6� LEACHING FACILITY: (type) `r'wo 9XQZ.X Z (size T7u usso�S NO.'OF BEDROOMS BUILDER OR OWNER PERMUDATE: 1 1 l 4 Z(17 COMPLIANCE DATE: 1 Z I 912 2 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 �10 k) on site or within 200 feet of leaching facility) C Edge of Wetland and Leaching Facility(If any wetlands exist 1-IQ ' Feet within 300 eac faci O Furnished by CzEH• Q ` Eu A Ise s q 3 15Do ® O S Etc-Ti;al�c. k 2 3 A_ 34 36 q7 d'3m 2Z 2G I a. sip, SS61 _ of: ,�uLKN�► - k15 , t .L, No. v_ `1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[pprication for 30igpo.5a16potem Conotructfon Permit Application for a Permit to Construct( )Repair( )Upgrade(K )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 345 ZAy e MIL FJ® Owners Name,Address and Tel No. _ Assessor's Map/Parcel m 7� �a r -1 No rwo d bao(o Installer's Name,Address,and Tel.N . Designer's Name,Address and Tel.No. • G{Z$- 203Q14 ?G-1 Z:-e. SUI-L.�vAJj ff- &1FA2Y_' c—e_ eb&-O Type of Building: Dwelling No.of Bedrooms� Lot Size �� =Eft- Garbage Grinder(pt) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 6610 gallons per day. Calculated daily flow gallons. Plan Date E V r ZO 4 1939 Number of sheets t Revision Date 00 1.A E Title'SITE 1't.AA.A S E9T1C Sq5amm V`98einst?s (0 34S :F26X-%r-_a.S UffL4 Cois-D Size of Septic Tank `ZM G'Ac-t_oL4 'Z COY%&PAe , Type of S.A.S. 1 X7 1-CAc."ii-AG G�SAyl-k6G?S- Description of Soil 3 Lo 1�vtA -6`�_4 L B f' CC,Aia5 1�'- d2r CDAe- - 6&"D lP"iV. G/� 42'= 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 Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b s Board Health. Signed Cl— Date Application Approved by Date �92T Application Disapproved for Me fol owing reasons Permit No. &k3,5- Date Issued r ` V • ., No. 3 3 r fee y. THE COMMONWEALTH OF MASSACHU ETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 21pprication for Digogal *pgtem Congtruction i3errnit Application for a Permit to Construct( )Repair( )Upgrade(ac )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 345�AX S'ECZ IaGC.�G �D Owner's Name,Address-` Td14No MAW-6T6 s V\ LL_6 6x4)ri Assessor's Map/Parcel �, l)1� �" (urd�C r7 / W S C�an4+�, t.� .� I No w Installer's Name,Address,and Tel.N . Designer's Name,Address and Tel.No. 4{Z,!a- 3*34L� �C - P�ire. sU t-t_,vA.�, � X "VA2)LC--C Qb&0 0S VT_::r2V I U_ Type of Building: ` Dwelling No.of Bedrooms 6:, Lot Size -A Garbage Grinder( �() Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 6(10 gallons per day. Calculated daily flow �� gallons.. Plan Date 5 EPT' ZO l9 Number of sheets, l Revision Date Q01..1 E Title SITE R-4,&A SEPOC SYSM wM VP,60.60 5 e. 347 5Y-\-r-_(_S(4ELy-, oArO Size of Septic Tank ZCCO GAU-064 2 LpnA eAQT, Type of S.A.S. 1 X7 r2 L`Ac "icj G 6.t—IgEQS' Description of-Soil 0-3 O Pr vt/\ 3"`^l $�• Co AdSS� n-i C1 7 �`!t2 S/(� 19'- ,4V COA2sC 15ArJ 1ay2. !o /(� 42= 12b SAk n 10-te-(/4 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 Environmental Code and not to place the system in operation until a Certifi- ="`'f cate of Compliance has been issued b s Board.LHealth. ,E Signed Date - Application Approved by Date Q k,. Application Disapproved for Me follYwing reasons J Permit No. Date Issued ——————————— -—————— -----------�' °---�--- f THE COMMONWEALTH'OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS F Certificate of Com plianc 'y THIS IS TO CE ate n- ite a e `� t C' ted( )Repaired Upgraded Abandoned( )by at 4 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. - dated Installer W I I., Designer The issuance of e .'t h be construed as a guarantee that the st wi /fueti n a esig�e, Date Ins ector G �. / P f -----------------------------------� f -- No. !y - �D.��J Feel THE COMMONWEALTH OF MASSACHUSETTS �• PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS oigpogaf bpotentm n�truction permit Permission is hereby ranted to Construct Re air U rade Abandon Yg ( ) P (�()�Pg ,( ) ( ) System located at ?�-4� t�A K.1'"?='� 1���►[ � ' i 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:Constructi n must a om leted within three years of the date of s p rmit.��� Date: Approved by r _ 10-08-1997 03:16FM CENT DST FIREDEPT 5087-302385 P.02 . Make application to local t-tre ueparxmenL D e 0 O �y . Fire Department retains original application and issues duplicate as Permit. /u " _........_.._- APPLICATION and PERMIT Fee: ,n nn for storage tank remcvsl and transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 14Z.Section 38A, 527 CMR 9.00, application is hereby made by: • Tank Owner Name(please print) High Point Property X o.gn61un3 Map yrorponnM Address 345 Baxter Neck Road Marstons Mills Suavr MYsue,. A; Removal Contractor KMI Env!ro-Safe Corp. Enviro-Safe Corp. Company Name Print Co. or Individual Pnnr Address P.O. Box 304, Sagamore..Beach, MA Address Pnnr �t Signatu pptyino: r=er Signature(if applying ur=ermit) IFCI Certine= Other I XIFCI Certified = h?# Other,.., Tank _ . ^J Tank Location 345 8axrer Neck Road. ]Ma ctons M i c. A 02648 4,000 SfAa ddd=s Tank Capacity(gallcns: Substance Last Storer #2 Fuel,b.il Tank Dimensions( '--ter x length) -r Remarks: Is 4C Firm transporting wale Enviro-Safe Corp. State Lic.# A-329 r-. Han dous waste marri�T E.P.A. # Approved tank dsposai yz d Turner Salvage Tank yard# 002 Type of inert gas Tank yard address Lynn, MA Our City or Town Centerville FDID# 01920 Permit# Date of issue October- 8, 1997 Date of expiration October 22, 1997 r Dig safe approval numioa<- 973503188 Dig Safe Toll-: Tel. Number-800-322-4844 Signature/Title of Officar panting permit " After removal(s)send Fccm =?-290R signed by Local Fire Dept.to UST Regulatory Compliasx--Unit,One Ashburton Place. Room 1310, Boston,MA CZ-:0&1618. TOTAL P.02 10-09-1997 04:20PM CENT DST FIREDEPT 5087902385 P.04 . ••••.mac arrua.a..v. w owum ruc NC{�drLnlenT_ Fre]Department retains original application and issues duplicate as Permit �P a�� •�ivae� �0��1� APPLICATION and PERMIT Fee: for storage tank remt vsl and transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 148, Section 38A, 527 CM 9.00, application is hereby made by: � 07 • 0-o ? Tank Owner Name(per print) High Point: Property X - ,,, Yy7rIerU7e � QB?AA Address 345 Baxter Neck Road Marstons Mills weer Ary Sure Zo Removal COMMetar oil Company Na me Co.or Ind ividual Enviro-Safe Corp. Enviro-Safe Corp. Pnnr Peru Address P.O. Box 304, Sagamore.Beach, M.A . Address P*t • nnr Signatur pyina:ter rmit) Signature(if applying mr:ermit) IFC!CartmE= Other V IFCI Certified Other Tank Location 345 Mxter Nee c ir'A Q2(,GR Sreor aobress n Tank Capacity(gaticrs: n27 I?—"- Substance Last Store^ #2 Fuel Oil Tank Dimensions(diar��x length) c�^ Remarks: lFirm transporting waste Enviro-Safe Corp. p State Lic. # MA-32 � I Hazardous waste man. E.P.A. # Approved tank disposai vartr Turner Salvage Tank yard# 002 -Type of inert gas Tank yard address Lvnn. MA Icily or Town Centerville 01920 FDID# Permit# Date of issue October• 8, 1997 Date of expiration October 22, 1997 Dig safe approval numcEt 973503188 ly Safe Tclt a844 Tel.Number-800-322- Signature/Title of Office panting permit After removal(s)send Fors?-290R signed by Local Fire Dept.to UST Regulatory Compliier=Jnit, One Ashburton Place, Room 1310,Boston. MA D2-08.1618. FP-292(revised 9/96) TOTAL P.04 _ 10-09-199? 04:19PM CENT DST F I REDEPT 6 vd o 0'7 508?902385 P.03 ..qnc arNua.a•mvi+ w IUU41 r-Ire LJepar•[rnefm Fire Department retains original application and issues duPOMte as permit. a /`�Z�kt � UX9�JP/k?LCIJCCb— ✓U0 Q�C-�7'GT!� ��yg�rZ r APPLICATION and PERMIT Fee:_,n nn for storage tank remcwd and transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 148,Section 38A, 527 CMR 9.00, application is hereby made by: oil • Tank Owner Name(please print) High Point Property X taro-Foolpmp•rmy Address 345 Baxter Neck Road, Marstons Mills Sfreat COY Stara Tip Enviro-Safe Corp. Enviro-Safe Corp. Company Name Co. or Individual Pgrtt Address P..O. Box 304, Sagamore.Beach, 'MA Pmf Address Pant Si atur P�,r gn Signature(if applying-.cr:ermit) IFCI Cartiflea Other !; IFCI Certified r E;? Other Tarn _ 14% Baxter Neck Roa wr.,,-,.�...j Mil 1 S MA O2h4 500 srear�cc�: Tank Capacity(gallcns: Substance Last Store- #2 Fuel Oil Tank Dimensions(dia.. .=r x length) ter Remarks: C' Firm transporting wwe Enviro-Safe Corn State Lic.#_)u!A-329 �==' Hazardous waste mzn&--_m* E.P.A. # Approved tank disposal va d Turner Salvage Tank yard# 002 Type of inert gas Tank yard address Lynn, MA • • City or Town Centerville F 01920 DID# Permit# Date of issue October• 8, 1997 Date of expiration October 22, 1997 Dig safe approval number.. 973503188 fe Toll=-e Tel. Number-800-322-48 44 Signature/Title of Offi :Er--ranting permit ,,Lig After removal(s) send For a=?-290R signed by Local Fire Dept.to UST Regulatory Complies Unit, One Ashburton Place, Room 1310, Boston, MA -M 08-1618. FP•292(revised 9M6) L $ 4S'16 32' E 191.84' Finish Grade 314.00' EXIST. 56GT%C SY5TEM 1% / Filter �— Compacted Fill TN I S AREA TO RS"AIN" + Fabric SEE veRM%T 97-G60 !_:++ _ N I/8'=Ile Pea Stone i� • Leaching ............ I 3/4"-11/2a.a Chamber - Double Washed Stone 1 4'-10' (� 13'-0" CROSS SECTION OF CHAMBER irr I 1 >k ri _ NOT TO SCALE. d r y I " Vent leach field if depth of cover exceeds 3 feet. Qr x�` cP K ""►, Z �i4 ... Exist.Outlet Pipe � FG.47.0 F.G.46 5 : R r ... . .........: \ — — — \ pLc sT 45,0 42.7 �►--- . 44.8 2000 Gallon 44.6 Top E1.43.7 Septic Tank 43 8 Sot.E1.40.7 8S / �gc N` y , o.00x F p 43.6 CK 1'i 20 S s bedding as Per Title 5 ���[++� a6F'LUM13 WES�,'w\NG OF 1i2 10. 42' _ 45' 12� \t.IT<D 1VEW R SepT\c- 5y5-rG Bottom of Test Hole El.36.5 FM 1 , No Ground Water "e c�Ass T•�� DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM PLAN VIEW ��� �_ � M4j�R qJ�4z/ q� Not to Scale Scale: I =50' / ` Engineer to verify at time of construction ci that 5 feet of dry suitable material is present; elow the system. NQTES DESIGN DATA b 1 L Water Supply ForThis Lot is Municipal Water Single Family-6.Bedroom \ J 2 Location of Utilities Shown on This Plan Are A With Garbage Grinder Approx. Daily Flow=I10 x6=660 GPD At Least 72 Hours Prior to Any Excavation For This Septic Tank:660 GPD x 200%=1320 Gal. .Project The Contractor Shall Make The Required Use 2000 Gallon Septic Tank Notification to Dig Safe(1-800-322-4844) LEACHING AREA 3 The Contractor is Required to Secure Appropriate Permits From Town Agencies For Construction ' 660 GPD/0.74=892 SFt 50%=1338 SF Defined by This Plan. SidewalI=2(13'r76')2=356 S.F. � ; ¢ Bottom Area=13'x76'= 988 'SF 4 InstallFinished d Risers as Required to Within 12 of 1344 SF.Total Provided Finished Grade. LEACHING CHAMBER DESIGN ; SI LLlVf+N 5.All Structures Buried Four Feet or More orSub•ect `r&•S """oa 1 All Pipes to be Schedule40,Use O •7HST HOLE CL. � �)n ����,� to Vehicular Traffic to be H-20 Loading. 8 -500 Gal.leaching Chamber Its b fir Septic System to be Installed in Accordance With. lSx76'WashedStoneFeldosShown. LOAM y 310 CMR 15.00 Latest Revision And The Town of 3p SITE PLAN���.�+:���,;` q�. .'�• Barnstable Board of Health Regulations , ��, r .. 7. All Piping tobeSch.40PVC. STRONG BRN COARSE "'` __�'�`"°� � 0 SEPTIC SYSTEM UPGRADE SAN O 7.5 Y R 5/L ¢ ,,. S.Septic Tank Shall be a 2000 Gal.,2 Compartments. " 16 The First Compartment Shall Have a Volume of Not 5AINID H Y'=L. COARSt 345 BAXTERS .NECK ROAD Less Than 1320 Gal.And The Second of Not Less SA N o 1 O'�R (o/i. Than 660 Gal. 42.' MARSTONS MILLS , MASS. =COARSE 11 91a DRV SA AO \OYR &/W FOR 120" tvo Gczour►a wA�ER OXBOW REALTY TRUST There are not wetlands within 100 feet of.the proposed leaching facility. Tc sT N o LE c3y SAE._, 9/20/9 9 SCALE AS SHOWN DATE SEPT.20, 19 99. There are no private wells within 150 feet of the proposed septic system. SULLIVAN ENGINEERING INC.. There are no variances requested or needed. OSTERVILLE,MA . ._ _ 7, g ; .� ...- BAXTER NYE W •` — , o }ram' } -T ,, i AO GENE V{L ����/�■T(\►�;�, - - ��..;;� •-� :,, ,Q • t�•f .� ENGINEERING & Q�, ODO •• �'`� ') ,`v ,. r . • 1.) 11E NIEM OF THIS PUN 6 10 SIM P11oPasED GARAGE a LOQIS C K or b ,tip :�`. tt • ,', ";+� _ �` ••.tiC'7 .'� ,',p•'°"';F. LOGRS AREA IS COMPRISED OF. S U R VE YI N G BAXTER ir 'S wP 75 PARCEL 7-14 < � lC44 SSESSOR private r RM BOOK sal PAGE 27 Registered Professional Engineers cam, — _ •�• a ! - ;^ '' �'� on REFS 2s928/�s and Land Surveyors 7 , /' •s+.ui�`�1' 1 _'•.• `• , .� APPLDMQ. MR QMRIfS Me JIL Ui ML /� I - =, L' �, r..� fir. r ✓!i_ .-s ►. t., � �•'r.�, , �-'-�-...•• -L`-' -,1 vf��.'�•,•� -�, '� ':' ,,,��:�._ -�.•t.�, +.'.t ,�"�F UG GAS 78 North S treet — 3rd Floor Hyannis Massachusetts 1 02601 . - - AS SIM ON INS FLAN CIE, -- �� . ,o\ ,' •,r,' r� �'' ,� ,., /:- w.t '�` 1) FROM RN'Np9MRL• r r _ a 4v;, \ ,v.. - : ° 4 . ►Q''. F�:4 ' "'� 1" l5 4) Doi W NFaRw M Phone — (508) 771—7502 M D6necr RF Fax — (508) 771—7622 _,,,,,�..: 14 T T \ \\\ �� •..- ; Q 4► ""';• `J.>--,ii '�'r' �� '.,. t'• V` .s. M Lf A��MA�Ia7zOM/Is R�u�16115 www.boxter—nye.com x'• „ WI. UP FROND = i5O' � \ O \\ t �, ���. �'-•�:;' N '�"+• •• 1 _ l��y�+ �;, 't�•' FROW YARD = 30' SIDE t REAR YAW \ \ fl , . e.k% - !-, -: ,.•�" M%X BLUR HEI6HRf - 30' OR 2 1 SFORES STAMP STAMP T3V ® STAKE •i : •i .. a 1 ".aria;..•� � /c �� E'_ = 3 4.71' N G VD I rr •S ;` '_% I .' , ` , :.+, .-•r ? ('�'� i`+' ti.ti Mew DIS7R9.'15. APO D (R®OIR,'E PLEIB.'IMIN okmff DWR� Jim p f M `0� ', - \.ti - - ^� .y--; s- , ,/ 1 c.. ;•• , _�i �-' - n'.- -' AFM (40M FF4n iM'�L OMAN D6LI�n tc.PJ' '9`S'S \ ,�,�..�' `' ^ .t- •` ----- ---:%• `j?;+�" ��r. �� TEP EN cyG \ - a.'' ♦ ••,::F!s '_ti 5.) A 1111.E SEJ" i11S NOT BEEN PERFUMED FOR THIS SIZE F DEIEIWO A, TO BE IECFSSARi'. A LIRE Z4RCNi SHRILL BE PERFUMED BY MERS. N �.- - • ✓ �; w•_ e.(/.�•'i.• �""t[>t .�'' :K+r.:... ':wee.. ! ' ,• —f \ -..1•" - r• ��\•1 - JJ aM •1�'•:• k =.'�.-l}ti i. .♦ .•'W ,i,�a' Lam. ij- \ \, ir•A, t.. t. T^ 7�ar,� r' •,ti ;:: :� •y c. \�n�.: i. +' AwABIF R NO.30`216 -59 r- �=`'i , '• .• �� �`•` E)NUaY11pN OQ�NG IDB�IS� UI q�Ellf pt •.. :��"�" `w`+�..+... �' a• _.` L••I qS;•. ; •` �:T'ls`� �. ilE DOM FEi11UES MM MMM �MW® FROM M ON DE QID N D S/DIRT E G FIELD SURVEY PERFUMED BY SLYIER WE 901MV t SUMEI'NG N 2MO AND LOCUS = r _ MAP $Ci11Q' i' = 1000' UPDIIED N.IAY, 2011 - a L 7.) COMMNOY PANEL MAMWR 250001 0016 D CONSULTANT !s' SCH 10 PVC OR iFE FLOOD N6INMYEE 817E wP DE1M TW AREA AS ZUE C ! V17. SDR-35 PVC PPE \ _ /JOSS --� --i. � � -__ --- ---__ ,vac 075 PARiM 007-002 �) RISER M,901irE - - �` )r \ \ S' T ,A FISH GRADE __ - -- - �;2`1 _ - `' _ - ____ C. b USA n. 9cV£RMA.v T `' SITE IS NOT MTI W M AGED (OTTER OF OEM 9MLQA6IDE CON E30Q AV1FA OF ESrNplm IMBIfAT OF RARE MIAiE PM7t ` 'v - - MFSP wP WIDSERR 1. 2010 1<STM M WEDIII3 OF RARE RDLFF ----------- --- - -- -�- ` - ir � � _ FOR USE IIIH TFE w MILIi/MMAS PROIEI.'TIONR ACT"• IIx. ______ --- \ — I�AA7O15 (310 CIIR CONSULTANT .. --- ,I l _ a.Ass c ooNCiw�E --- -_ �, � - _ . 2DIO 10 W S � � _ _____ SITE A COMMC VDNIL POOL PER NNESP MM1P OCIULBR _ -- - - \ - -� 191E 6 NOT wiF/1 PfM PO LS.' FLOOR BOX FRAME AND LID - }_. 1 YAP-75-PARC�l�7_-L---------- `` -- -- • FIR MOP DIP OMBE R 1. 201 w"j sHs w LID EQUAL Q aoB1IRE I I ' . ' 197AU SF --------------------- o -------`--- - - I AC7OR �S - TRIORiiY iMBiW OF RW SPECIES FOR SPECIES U= THE o __----- __ -- "--- IIASSACIAS S E?DMIDERED SPECIES ICi. REFUAOUiS (321 CMR10j Z �s• PVC (SDR35) BEND \ I-----.1 -- -- -- rwwf Mel _ A SD'JE*PACKED ZONE R 6RO M MR RIDIAFEE 4T WYE PVC o i^ ., . - - -- __,-- 6 IKTf MT1FiR ` --___-� I ----------WOODS - - ---- ---- SITE 66 WIH N A ZONE OF OON111110 N 70 A SUMMER ESIRMNRY PREPARED FOR : '---- MIIANSWE B.O.R REC. 3W-45X ) TO SEWER FROM RDc -�A 9 Mr. and Jii I�tcheA __ ; - 1 ` • IE CO VIRA 0R SWILL CONTACT DIG SAFE(AT I-SM-0IG AND USM COMPANIES 10 LOCAiE 6• PVC (s0R3s� 1X Awl SLOPE i I I �;.� _- -- \,\ -- ALL DDSTNG UWWT AT LEAST 72 HOURS PAM 10 THE START OF CONSiRUC1101L THE LOOM OF 3�45 Baxter Neck Road PK SET DOSING INEFRMU I)/ERISTRlIC1INE; UIWIES� CONDUTS AND LNIS ARE SIM N MI*"K MMITE J� EL A 46.55' MY ONLY. wY NOT BE LUTED 10 Ti,i�SE SHOWN HELM AND i C WN REWARQED BLED ON THE AAWA BLE UTILITY RECORDS NOTED HEFEONL THE CONiRM1r90R MES 70 BE FULLY RE"CARE FOR Marstons Aft MA oL" •NOILL PMI HIM BE OCCI ALL ANY AND B111AGES INCHI M ID BY THE CONMRIC7UCS E 10 LOCATE SAD NF CONCRETE COMER AND FRAME ONLY ;I, -- ,� ;:y✓: eg C-- ',1b�' �, ibISiRUCRNE NO URITES DGIALY. IF FIELD 00lOFM'�NfS OFFERS FROM UN THE REQUIRED MIEN CL.E/WOUT IS INSTALLED / OCF CONTRACTOR SIM N01FY THE ENiEHt YEDOELY FORPOtS38E R RL IN Bln)MINOUS CONCRETE. CONCRETE. OR ANY ND ` � SOURCE/fORMUM FR011 RANG HKS BEEN COIeED M M OMW ENOM OF UIIDFS 10 EP7 S HARDSCAPE SURFACE `� 1 OJ 1 \ EP71C OO� MRI�TS O ON EVELOP 1 _ . ARE APPROXIMATE PER D A VIEW OF TIM U DEII=RN D UIIIIFS HpMEAX LACOG DKIN UM THE OW LDOA7DH INlDER(=N0 FT91111TIE5 CAMlOf BE ADIXNMIIELY. COMPLETELY AND REIJIUY 003MM M7lEJE C- 9'P T17LE V INSPECTION REPORT ADDITIONAL OR HONE DMLED WO MMiHUI 6 REOU RA THE CI.W 6 ADMSED THQ DEMIIIHON wY `� DATED 12/12/11 P. O'CONNELL BE NECIESSIW. 5-3 �; lC,y DOSTNG SEPTIC SMTEII N4iOR1169ION OB'DINED FROM SEPFIC SYSTEM NSPEC!" REPUir S BY P. O'CON)ELL DATE) 12/12/11 ON FiLE AT BOARD OF HEAL.7H- FOR 70 ARCH RECTIMAL FLANS FOR `�, =' OtAnM DETAILS CONCRETE ` IOTA M1ER SERVICE 9R&0 0 I MB PUN FTOR C-O`W M1ER DB'MRTMEIf SOW AND PAD � ZONE C DIG-SAFE 11WAS Gs was BY ON THE Gum SINRAEI' PERFUMED BY BOXIER N1E � Oi6NE�a A SiEN. L . "9�VIE �B A R K 1500 GAL FUP QIAi�R GIS 99W SIM ON IIMI PER 01G-Sim YMM101RS LOCATED BY ON THE QUM C>MFraL h�� �,` ;F.:r ;- t M U L C H 2I10D GAL HF-20 97M TAM( SURVEY BY THIS OFFICE 0 aNE 2011 �•' _ i , --� ELE'CIRIIC LKS SHDMM ON THIS PLAN 5 A OM M 70N OF FIELD LOWED DIG-SAFE MA MWGS o Fsj, AND PRIOR FIELD LOG1IM STRUCTURM a / TOP BANK - `�•>42 V 1 m� LAWN ZONE V17 StDNRY (EL 13) SEINER STONE �^ ig.'t' MAMASONRY CHIMNEY �`��- MASONRY S� — \ LA �t WALL T3M Ca F 11L i' EL = a6.�g NGVD 10• �' �.,, PATIO / .� /' CM 125 \LF. AT 2% � � ?\ � z•,-c _ � � PIPE4-+'4 ENTTRE HEIGHT WHERE LAWN\\ \ � P• S 11,R UL B S �� � / �l (NORTH SIDE OF iM M PERT f/97-M J Y-BRANCH 1-1119(W EXCEEDS 6'-0'. , 6 ' PATIO 2000 6iLIM SERE 1AW INN PIAP OWMwR (9 BED1110011 CWAC" ~_ L A it1 N �� SHRUBS / / LFi1CIM SYSTEIR - iM SETS OF CH AME RS 11'x42'x2' M. Fcome - ` �•�- ' Q`P Q�� 'NAIL 9 TOP RET WALL BOYIOI IIRFA 9'x42• = 378 SF H ♦ tdEE1N CONNECTION ' - S NG C K �� y \ ' N�' : � EL = 10.63' NGVD w (9'+42'}c 2� 204 SF= M SF W INV. 43.76 G �� ��� ��0 PO'c�� x 2 2 MIN. / Q GS 0�'p`� / 1164 SF x 0.74 GPD/7= 861 PGD 0 CON4CRIETE m 2' MINI. 100' BUFFER ZONE `r �'� LNG ( / �� Mi 6PD s 110 GPO/EMI - 7A BEDROW a TOP OF BANK � �� ��6 / 5 BEUi0M LISTED ON AS—T CARD PUW 92 (5 = SIDE OF 6O M FOW 199-•6.I6 z INVERT TO BE SUCH THAT \ STONE / SAND BEACH o HOUSE CONNECTION WILL HAVE / PAT10 2000 GKI.OII SEPTIC TAMc 0 BEDR00Y offer Y) A MIN. 2 x SLOPE LEACl/MG SYSIEII - 6-500 11'AC1/RG CIWMWRS BOARDWALKS BRICK WALL / J� WrIUM NFA 12'x72' = 864 S.F. 45 DEGREE BENDS / /� ��,0� SDEMLL (1Y+72)rIQ = 3� S • v• LAWN Jp 1201D SF w AB 6• MIN. a \�� ,� O�c W O�OAF � 1200 S.F,t o.74 GPD/5F- MD POD OVR DECK BW GPDr110 GmAm - 8 sonoomS CONCRETE s \� \ 6 BEDROOMS USM ON OE316H1 HMI t w - OF BANK. / 4-OW CARD z Q FIRST TO SETSTO TONH E QAY N / BEFORE RESUMINGTON POUR. D8�18q�E EL VA" CB/DH 6• N. 48 DEGREE PROPOSED GARAGE SLAB 50.00 FND MI � ALLOMBLE WWOMN WADM(&0A SALTMIER E'SRIARY) m 6• MIN. .:�.� 48.00 ZONE C ,/ 6• INN. g--BRANCH OR Ap01cTHON1. PROPOSED INVERT AT TOP AT SEWER CHIMNEY 47.70 SAND 3d4 Ac x 440 MD/hERC= tMe9 sPD+ i10 MD/EMI = is B®NIOOMNS Z o BEACH p ALLOM MILE FL0116 15 SB1<ROW SHEET TITLE PROPOSED INVERT AT BOTTOM OF SEWER CHIMNEY 46.26EARTH \ ���P CUIRIVITLY 11 BEDRRoa6 PEAwTTED SVM p = 5 BEDWIMIS(CAPACITY 7 BEDROGW — D SEWER INVERT AT DaSSTiNG SEPTIC TANK 43.76 0�� .� SMEII /2 = 6 BEDROOMS (WKITY 8 =ROC S) Proposed Garage Plan N SECTION rn C, CI•MfrNNEY DETAIL N I BEACH o +g���� GRASS SHEET NO Vf EY KLS. �•�� C10 CD 220 DETA �OELE20)1 I ZONE(EL 13)7 ■ IL 9 / V ' OBSERVED MEAN HIGH WATER DATE : 08 19 13 (OBSERVATION DATE 10/26/10) 40 0 40 80 -j FLOOD LINES DIGITIZED USING ROAD LINES. BUILDING LOCATION 91 , ANC WATER LINE FROM TOWN OF BARNSTABLE GIS SHEET #75 ORIENTED WiTH ROAD AND WATER LINES FROM FIRM COMMUNITY PANEL No. SCALE IN FEET 9 ' 250001 0018D (MAP REVISED: JULY 2. 1992). SCALE : 1"= 40' DRAWN/DESIGN BY: UN CHECKED BY: SW o / JOB NO: 2013-018 CADD FILE: 2013-OlaDMAng 0 0 0—