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HomeMy WebLinkAbout0375 BAXTERS NECK ROAD - Health 375 BAXTER NECK , MARST.MH LS A-075.007.004 f Commonwealth of Massachusetts O �0O� D0� Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 375 Baxters Neck Road Property Address Arthur Solomon TTEE Owner Owner's Name information is required for every Marstons Mills Y MA 02648 10/06/2020 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. Important:When A. Inspector Information , 9029 filling out forms on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road Co � Company Address Teaticket Ma. 02536 CityTrown State Zip Code ran 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes f 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails /7/2020 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate . regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts a Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form, Not for Voluntary Assessments 375 Baxters Neck Road Property Address y _nS , Arthur Solomon TTEE Owner Owner's Name information is required for every Marstons Mills MA 02648 10/06/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This 5 bedroom home has a 2000 gallon 2 compartment septic tank with a D-Box feeding (7) 500 gallon leaching chambers with stone. At the time of the inspection no visible failure criteria was found. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass r inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form I� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 375 Baxters Neck Road u Property Address Arthur Solomon TTEE Owner Owner's Name information is required for every Marstons Mills MA 02648 10/06/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): . ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 375 Baxters Neck Road Property Address Arthur Solomon TTEE Owner Owner's Name information is required for every Marstons Mills MA 02648 10/06/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts �n _ ►e Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 375 Baxters Neck Road V� Property Address Arthur Solomon TTEE Owner Owner's Name information is required for every Marstons Mills MA 02648 10/06/2020 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence _. of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ,® The system is a cesspool serving a facility with a design flow of 2000 gpd' 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5 Large Systems: To be considered a larg e system the system must serve a facility with a ., design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form lie Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c.� 375 Baxters Neck Road Property Address Arthur Solomon TTEE Owner Owner's Name information is required for every Marstons Mills MA 02648 10/06/2020 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, µ dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site,has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 ^ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments L., 375 Baxters Neck Road Property Address Arthur Solomon TTEE Owner Owner's Name information is required for every Marstons Mills MA 02648 10/06/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 plus GPD Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage Town water 9 ( Y 9 (gpd))� Detail: In 2019-349,000 gallons were used and in 2018-415,000 gallons were used. Sump pump? ❑ Yes ® No Last date of occupancy: seasonal-use Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 375 Baxters Neck Road Property Address Arthur Solomon TTEE Owner Owner's Name information is required for every Marstons Mills MA 02648 10/06/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): • Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form J. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ........... 375 Baxters Neck Road L-- Property Address Arthur Solomon TTEE Owner Owner's Name information is required for every Marstons Mills MA 02648 10/06/2020 page. Cityfrown State Zip Code Date of Inspection D. System, Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 1711 feet Material of construction: - ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line. town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth f o Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 375 Baxters Neck Road Property Address Arthur Solomon TTEE Owner Owner's Name information is required for every Marstons Mills MA 02648 10/06/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 8"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: 2000 gallon Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle 33" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 i Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 375 Baxters Neck Road Property Address Arthur Solomon TTEE Owner Owner's Name information is required for every Marstons Mills MA 02648 10/06/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness ' Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: r„ Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 _,vr° Commonwealth of Massachusetts Title 5 Official Inspection Form fSubsurface Sewage Disposal System Form - Not for Voluntary Assessments 375 Baxters Neck Road Property Address Arthur Solomon TTEE Owner Owner's Name information is required for every Marstons Mills MA 02648 10/06/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" I 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.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 f Commonwealth of Massachusetts �n Title 5 Official Inspection Form lip Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 375 Baxters Neck Road u Property Address Arthur Solomon TTEE Owner Owner's Name information is required for every Marstons Mills MA 02648 10/06/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 7 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 L Commonwealth of Massachusetts Ip Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 375 Baxters Neck Road Property Address Arthur Solomon TTEE Owner Owner's Name information is required for every Marstons Mills MA 02648 10/06/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection no visible failure criteria was found. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 i Commonwealth of Massachusetts ,q Title 5 Official Inspection Form k_ �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 375 Baxters Neck Road V� Property Address Arthur Solomon TTEE Owner Owner's Name information is required for every Marstons Mills MA 02648 10/06/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form r_ Ib Subsurface Sewage Disposal System Form -Not for Voluntary Assessments cM 375 Baxters Neck Road u Property Address Arthur Solomon TTEE Owner Owner's Name information is required for every Marstons Mills MA 02648 10/06/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately As btill , t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 r Assessing As-Built Cards https://townofbamstable.us/Departments/Assessing/Property_Valu... TOWN OFBARNSTABLE t l� LOCATION P� [TYv1r(C/i'R D "122S SEWAGE# ? sb VILLAGE ao dTo3. 11.f to //ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE N0. K SEPTIC TANK CAPACITY LEACHING FACILITY:(ripe) Seo qA 19r y (sizej NO.OF BEDROOMS F'J^ BUILDER OR O L� �e tv /�C a 53,40, e�r PERMITDATE: VR2 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 .� r7J'6(iV1 1 13 37 3/ 1 of 1 10/5/2020,3:49 PM r i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c !% 375 Baxters Neck Road u Property Address Arthur Solomon TTEE Owner Owner's Name information is required for every Marstons Mills MA 02648 10/06/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 12 plus feet feet i 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: I augered a hole at a lower elevation and shot it with a transit. i Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 r Commonwealth of Massachusetts Title 5 (Official Inspection Form I, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 375 Baxters Neck Road Property Address Arthur Solomon TTEE Owner Owner's Name information is arstons Mills MA 02648 10/06/2020 required for every M i page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: 'Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 COMMOINMVE4: '_i'H OF _NLASSaCHI Sr ExECtiTIVE OFFICE OF E-N-VZROr T _A >1 DEPART-VIENT OF ENIti'IRON"1IENTAI, RP.O'Tr('M1C WTI' � s TITI-E 5 OFFICIAL INSPECTION FORA—NOT FOR VOLUNTARY ASSESS'AIENTS SUBSURFACE SEWAGE DISPOSAL. SYSTEM FOR-11 41 . PART A / CERTIFICATION Property Address: �A t� /1L-Cli- 9G/ Owner's Name: 41q ALA Owner's Address: 63 G N i✓� /ovi d e lee Date of Inspection:. )/j�Jp /� Name of Inspector: (please print) I' ' rlli — %o/S-e_�11j Company'-Name: — 7TAG// Mailina Address: _o eoX /a 46 Telephone NumberC,s,VF .) �S- �ij' !f(f CERTIFICATION STATEAENT cer ifv That I have personally inspected the sewage disposal system at this address and that the i-fo:-nna cr rere-ed below-is tn:e, accurate and complete as of the time of the inspection. The inspection-,vas ne= o- ed,D asid e-. -. training and experience in the proper function and maintenance of on site sewage disposal s Vsterr s. am a P approved s'°stem inspector pursuant to Section 15.340 of Title 5(310 04R 15.000). y passes Conditionally Passes Needs Further Evaluation by the Local Appro Ongutho Fails s� Inspector's Signature: Date: /V w hhe system inspector shall submit a copy of this inspection report to the approving�tthcr"-:{3c rc of '_e 't^ DEP)within 30 days of completing this inspection.If the system is a shared systcrn or has a deligr_ gpd or greater,the inspector and the system owner shall submit the report to the approp.:ate regional a` ce :,_ _ DEEP. The original should be sent to the system ow,_er and copies sent to the buve-, if � e eD _�3 _�. 2�` rt ` Notes and Comrnents 1`*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. Title 5 Inspection Form 6.115i2000 , page , Page 2 of I 1 OFFICIAL INSPECTION FOR I—NOT FOR VOLL--NTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM n-SPECTION FORA P 31�Z'a CERTIFICATION (continued) Property Address. AX Owner: Bate of Inspection: O // O 6 Inspection Summary: Check A,B,C.D or E%AL«VAYS complete all of Section D A. System Passes: y I ha,e not found any information«-hich cares that anv of the failure criteria de_c 1 .303 or in 310 CMR 1f.304 exist. Any failure criteria not evaluated are indicated be;ow. Comments: B. Svstem Corditionallv Passes: One or more system components as described in the"Condi Llonal Pass"section need-o e ren a_,d or repaired. T'he system upon completion of the replacement or repair,as approved by t'r_e Board of eaith will pass. Answer ves. no or not determined(Y,-N`. \TD)in the for the following statements. If"not deterr—n-ine "niease explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or Wool is .:auc0jra i_ :unsound, exhibits substantial infiitraron or exfiitraron or tank failure is imminent. S-,s`e r {illy _: srec=�n if e existing tank is replaced with a complying septic tank as approved by the Board of Heatti'_. "A metal septic tank will pass inspection ift is structurally sound,not leaking and if a Ce-t 'sate of Co _lance indicating that the tank is less than 20-,ears old is available. \-D- explain: Observation of sewage backup or break out or high static water level in the disbution box`ue to obstructed pipe(s) or due to a broken;settled or uneven distribution box. Systeri <li pas_ insnec e-:if approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced `.D exniain: The system required pumping more than 4 times a year due to broken or obsructed n •_!_'; -_ _-=___ -__ pass inspection if(with approval of the Board of Health): v broken pipes)are replaced obstruction is removed D explain: II cPlnnn 7 raq _ of 1 1 OFFICIAL INSPECTION FORM-'_VOT FOR VOLLT-NZARY ASSESSlIE1TS SUBSURFACE SEWAGE DISPOSAL SYSTEI'I INSPECTION FOR-£ YAl?,T A CERTIFICATION(contilnued) Property Address: /S 12, -kv /'ec - /?c—J �►�5 Owner: So/O Oil Date of Inspection: C. Further Evaluation is Required by the Board of Health: conditions exist which require further evaluation by the Board of Health in order-o de-L:—=e if e s s-2r~ is failing to protect public health, safety-or the environment. 1. Systemdill pass unless Board of Health determines in accordance with 310 CMR 1^.303(1)(.b) that the system is not functioning in a manner which will protect public health, safety and the enxirontnent: Cesspool or pricy is-,;•ithin 0 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a sal-:_ears~ 2. Svstem vs ill fail unless the Board of Health(and Public Water Supplier.if any) determines that the system is functionira in a manner that protects the public health. safety and environment: _ The system has a septic tariK and soil absorption system(SAS)and the SAS is '00 tee.e=a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is :thin a Zone 1 of pubic iva.er sip"l_r. The system has a septic tank and SAS and the SAS is within 50 feet of a private %-,atln s__=___ _l. The system has aseptic tank and SAS and the SAS is less than 100 f et but f e'o--ore=om,a private water supply well". Method used to determine distance "This system passes if the well water analyss,performed at a DEP certified iaborato_ _o-celi b.-- bacteria and volatile organic compounds indicates that the well is free front pollution=on ,ha. acilirn-- the presence of arnmoma nitrogen and nitrate nitrogen is equal to or less than- pp-n^-e _ t_ar 3 c-21et failure criteria are triggered.A copy of the analysis must be attached to this'=orris. 3. Other: T;ti- C �.�,o r; L 111 r inn Page 4 of 1 I OFFICIAL INSPECTION'FORM—NOT FOR VOLU TA_RY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SXSTEINI INSPFCTTON FORzr Pa,Rr CERTIFICATION(continued) Property Address: 3/S 4-eC� �G/ Owner: Date of Inspection: D. System Failure Criteria applicable to all systems: I'ou must indicate "yes" or`'no"to each of the following for all inspections: Yes ��o ` _�ackun _ .;;- c 'f . Of�e awe Into iaCilIt� or system component due t0 overloaded Q CiCg`,�,d S?C 0=.'es5_�OOL Discharge or pondina of effluent to the surface of the ground or s a - eue t• _ - dogged SAS or cesspool r _ an Static '_iquid level in the distribution box above outlet invert due to an o;,erloaded cr clog-ed c_�S n- �esspool 1//L iquid depth in cesspool is less.than 6"belo;;-invert or available volume is less t_ da _0- // Required pnmpin2 more than 4 times In the last year NOT due to clogged or ebs?r :-ed_ �`times pumped -� -.. ny portion of the SAS. cesspool or privy is belo n-high ground water eIe i'aron. Any pertion of cesspool_or pri;fir is within 100 feet of a surface water su�piv er bu w_ -o a surface ater supply. y .portion of a cesspool or privy is within a Zone 1 of a public Well. _ Aliv portion of a cesspool or pniy is withLi 50 feet of a private water sunniv .any portion of a cesspool or privy is less than 100 feet brut p—eater than 50 f et fro-n a or t ,-at,-7 supply well with no acceptable water quality analysis. [This system passes if the well rater analysis. performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen. and nitrate nitrogen is equal to or less than 5 ppm.prodded that no other failure criteria are triggered.A copy of the analysis must be attached to this form.) ;Yes._N o) The.system fails.1 have determined that one or more of the above fail e C `e~a e_2st as described in 310 C-'vM 15.3303.therefore the system fails. The system ov.-ter should con tact t_e Bcard ;,± health to determine what will be necessan,to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility,with a de.sian#;ow of iC,C00 �pd to i5.CC0 gpd. ` You must indicate either";-es"or"no"to each of the foflow-Ig: (The following criteria apply to large systems in addition to the crteria above) Xsystem is;��ithin 400feet of a surface drin'kirg water supply system.is within 200 feet of a tributan,to a surface dr_nking water supply system is located in a nitrogen sensitive area(interim�t'elihead Protect on a ea_i..7ne II of a public water supply well - -_ if you have any;yered"yes"to any question in Section E the system is considered a sib ; -,- =-=-- -es"in Section D above the large system has failed. The o;;per or operator of auv large s;s>er cc,-significant threat under Section E or failed under Section D shall ang:ade the system Ln a� v 1 04. The system owner should contact the appropr;ate regional Office e_thn+ De 2�_en L ri-„ � Tncnartinn i.n.-w. L : •.n.... Pace 5 of:1 OFFICIAL n- SPECTIO\ FORM—NOT FOR VOLUNT' AIRY ASSESS:iJT TS SUDStiRFACE SEN AGE DISPOSAL SYSTEM I\SPEMON FORM PART B //�� CHECKLIST PropertyAddress: �/S 19,J.x 74,- /4/2e4-- s ct✓S rr Owner: SO�0 v`7a-7 Date of Inspection: Check if the following have been done.You must indicate"yes'or`-no"as to each of he Pumping information was pro-vided by the owner,occupant, or Board of ea_=_ �V-,e any of the system components pumped out in the previou M o lV ell s ✓Has the system received normal flows in the precious r-o,reek period Have large volumes of water been introduced to the system recently or as part of thins sec=cn were as buil-plans of the system obtained and examined?(If they mere not available pore as\_ ', 1L Was the facility or 6veiling inspected for suns of se-wace back up? Was the site=respected for signs of break out? N-'ere all system components,excluding the SAS,located on site Were the septic tank manholes uncovered,opened,and the interior of the tan_'t in pected.for of the baffles or tees, ma_erial of construction,dimensions,depth ofliquid, depth of sludg_an dep-�of 4;1-U eb — Was the facili -oNmer(and occupants if different from ou-ner)provided ; t iJ ra=ion on _maintenance of subsurface sev-age disposal systems The size and location of the Soil Absorption System(SAS)on the site has bee- deter me, "act- _ Existing information. For example;a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part Cis at r a is unacceptable) 1310 CMR 15302(3)(b T;rl.o Page (of 11 OFFICL=LL Ii SPECTION FORM--OT FOR VOLU-N-TARY ASS ESS-AIE N T S . SUBSURFACE SEtiNAGE DISPOSAL SYSTEM nSPECTION FORM P.--vRT C SYSTEN•I INFORMATIO Property Address: O«ner: SO �PLl:o fs hs •//S� ��� a2 6�f� Date of Inspection: V // p(� O`V CONDITIONS RE SIDEN TL A-L Number of bedrooms(design): J INu_mber of bedrooms(actual): DESIGN flow based on 310 CN R 15.203(for example: 110 gpd x of bedroom): J Number of current residents: Does residence have a garbage grinder lees or no): Is laundry on a separate sewage system(yes or no):W[if yes separate inst-) inn.eq i-ed Laundry wstem inspected(yes or no): Seasonal use: (yes or no): eS 'Water meter readings. if available(Iasi 2 years usage(gpd)): Sump pump(yes or no): T ast date of occupancy: CO-L\IERCIAL.,N-DL,STRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats personsisgft.etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(ys or no):_ �,V,ater meter readil-ags. if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATIO'ti Pumping Records Source of information: V-as system pumped as part of the inspec 'on(yes or no): If ves,'volume pumped: gallons--Hova«-as quantity pumped dete=,ined'?_ Reason for pumping: TYP SYSTEM Septic tank, distribution box. soil_absomtion system _Single cesspool O erfio-a cesspool P 1v Shared system(yes oI no) (if yes. attach previous inspection records.of any) —InnovariyeLA.,Itemative technology. Attach a copy of the current operation and maL-tena-c- obtained from system owner,) _Tight tank Attach a copy of the DEP approval _Other(describe): Approximate age of all components. date installed(if Lno«n)and so-rce of mfo-Laren: ��. —Soo l ere seivaoe odors detected when arriving at the site(_-es or no). Pave 7 of i I OFFICIAL INSPECTION FORM—NOT FOR VOI g IN'_�RY ASSES SA.ENTS SUBSURFACE SEN'VAGE DISPOSAL SYSTEM INSPECTION FORM PART C n SYSTEM I\1 OR-�MATIO\ (continued) Property Address: /� /J,-X�e, ,l c 4, A,/ fls•ner: JO� -7� Date oflrspection: BUILDING SENVE.R(locate on site plan) Depth belowgrade: Materials of construction:_cast iron _^_other(explain): Distance from private water supply well or suction line: Comments (on condition of;oints; Denting,evidence of leakage;etc.): SEPTIC TANK: _('�on site plan) Depth below grade: Material of construction:_..o��ncrete_metal_fiberglass Dolvethvlene —other(explain) y If tank is metal list age:_ Is age.conf=ed by a Certificate of Co=- Nance(ves or no): a-aCh a cop-of certificate) y Dimensions: d OO o Sludge depth: 02 -, Distance from top o/�sludge to bottom of outlet tee or bade: o7 7 Scum thickness: 25Sr /!/ '! Distance from top of scum to top of outlet tee or baffle: . 6 Distance from bottom of scum to bottom f�o}itiet tee or baffle: . How were dimensions determined: Comments on purnping recommendations,inlet and outle tee or baffle conditi = as fated to outlet invert, evidence of leaka ge, etc.)): ,/ / Oo �"► /OH O 2G�i GREASE TRAP: . locate on site plan) Depth below grade: \lateriai of Construction:_concrete. metal `fiberglass olY" �je`e C(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: Comments (on pumping recommendations, inlet and outlet tee or baffle condition as related to outlet invert, evidence of leakage, etc.): - P?Ge S of i l OFFICL4,L INSPECTIO\FOR-NI—NOT FOR VOLI.NT RY ASSESS-NITLNTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION t ORMI PART C n C SYSTEM INFORMATION(contir_ued) Property Address: Owner: So/V 1A710 N oe Date of Inspection: TIGHT or HOLDIN G T \'Ii:A��(tani:must be pumped at time of inspec ion)(ioca-e on Depth below Grade: Material of construction: concrete metal nberalass polve*Whylene oche-i ex, a ): Dimensions: Capacity: Gallons Design Flow: Gallons/day Alarm present(yes or no): y Alarm level: Alarm in workinG order(yes or r Date of last pumping: Comments (condition of alarm and float switches,etc.): DISTRIBUTION'BOX: (ice fpresent must be opened)(locate on site plan) Depth of liquid level above outlet invert: kjf91V4-j G L_ Comments(note if box is level and distribution to outlets equal,any evidence of solids ca 7,-cv=- a .: , c_— of _eakaae into 0 o�}t of box, etc.): PUMP CHAAMBER: zeclocate on site plan) Pumps in wo-kinc7 order(-,-es or no): Alarms in working order(yes or no): Comments (note condition of pump chamber.condition of pumps and anlurrenances. z`c.is Titles incnAr+in» t=nr.,.� 4,1{/;nun C . f Page 9ofiI OFFICIAL E SPECTION FORN7-NOT FOR VOL U TARY_ASSESS�TE�T S SUBSURFACE SEWAGE DISPOSAL SYSTEI.7I'_VSPECTION FORM YA RT C 'j SYSTETNI INFORMATIO'!(coat' —4', Property Address: J ��>C�Ps� It ee-1 Owrer: �ol0ti"Jor► Date of inspection: SOIL ABSORPTION SY"STE1S(SAS): (locate on site plan, excavation not required) If SAS not located explain whv: Ti pe leaching pits; number: leaching chambers,number: leaching aalleries;number: leaching trenches, number,length: I C✓- leachirig 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 so-=, condition of ege," etc.): Q / °� cJi� �n Sj�a�rn Li ✓1-e, CESSPOOLS: /✓ cess ool must be Dumped as art o_`inspection locate on site plar_` ( P mP pa-it )( _ Number and comiguration: Dept:':—top of liquid to inlet invert: Depth of solids layer: Depth of scum laver: Dimensions of cesspool: Materials of construction: indication of groundwater inflow(yes or no): Comments (note condition of soil; signs of hydraulic failure,level of pondirq. condi or of e—za`on. :'c.t: PRIVY (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs ofhydraulic failure;level ofponding, conci=o- Title G Page 10 of 1 l OFFICIAL INS PE CTIO\FORIM-NOT FOR tiOLL1TA_RY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ­ORM PA_ZT C SYSTEM INFOR L-I&TION(con '—d"; Property Address: J ApX4,-✓ �Crf Owner Sa/o Vi o-7 Date of Inspection: O ///�� SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sew a2e disposal system including ties to at least two pernanent rere=ence Ian`-z rk 5 ar benc -narks. Locate all v.-e.ls within 100 feet. Locate there public water supply enters the Fro, O u l.� l � t T:;Il G T,c...finn r 41 Pate 11 of i 1 A OFFICIAL. INSPECTION FORM—NOT FOR Z OLL-NT ARY ASSES S'�fE N TS SUBSURFACE SENVAOE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFOR-A NTION(continued), Property Address: ✓ �� ���C �`�i/ /ji��i� �� 0-.vner• SO r0 d`70�rf Date of Inspection: SITE E7_aAi Slope Surface water �� Q Check cellar Shallow.yells Estimated depth to ground water /(X O feet Please indicate (check) all methods used to detertr ne the high ground eater eleva Cn: Obtained fr system design plans on record-1f checked,date of design elan rev-e"Ved: Ob -ed site (abutting properyiobservation hole 7 it r0 feet of SAS) Checked with local Board of Health-explain: �<� Checked--ith local excavators, installers-(attach documentation) Accessed uSGS database-explain: You must des olb ow you established lie�,u grou d water ele-ation- , � / �e/O k/ ✓I T"?� � Tncno..rinn F'nrm fii;!�nnn t; . i' TOWN OF BARNSTABLE 'G' LOCATION �` ���T�� t("�i {U i�7 S� SEWAGE # VILLAGE �,�t� to1 Mr r�ra ASSESSOR'S MAP &LOT '- -lip--INSTALLER'S NAME&PHONE N0. f 4_r 5 SEPTIC TANK CAPACITY 2 O R LEACHING FACILTTy: (type) _ , S o o C1�+ 1 y (size) NO.OF BEDROOMS- BUILDER OR OWNS L7 PERMI 'DATE: 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 3 TOWN OF BARNSTABLE LOCATION �" �aX�`ev �e C`i 7 6— SEWAGE # g Sb G VILLAGE g �� T�C fw (ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. v jr K- 77 / 1 2.� SEPTIC TANK CAPACITY o G / LEACHING FACILITY: (type) :2 oUd I ��y (size) NO.OF BEDROOMS BUILDER OR OWNE 17-• 6- W [dC c`c ,2 mot' PERMTTDATE: . COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet I Furnished by i �,�1 � 1� '�"-?0'G v(n 1 37 - 3� �� � �� No. " f Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: N�X Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for �N.5ponl *pztem Con6truction Permit �� Application for a Permit to Construct(�)Repair( )Upgrade( )Abandon( ) El Complete System El Individual Components X Location Address or Lot No. 375:j3AXTEP_ EL-ir—eD Owner's Name,Address an Tel.No. I_?&"-I C9 ^2ZZ2 Lz>i'4 M+rasTO"S 1\kkL_L_S V_0ALr-(\pus i Assessor's Map/Parcel ST K�9 Z L.5 faecc 6oZ_� `I2 v_A+—�T Klo �Ccxb f-\ 2 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. .42g^ 3SA4 3 J-, fl�x`'' / ts`'� '7 ���E2 'eoA-<-:) 06Ta-P—Q t L-L G • s•_�s 711 -4 12 Type of Building: Dwelling No.of Bedrooms S Lot Size+l3 63D sq.ft. Garbage Grinder( (55 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow :5 SO-� 50 gallons per day. Calculated daily flow P\ZA gallons. Plan Date J u L 4 291 M b Number of sheets Z Revision Date Kkb K E Title S t TC- PLPA►,-, V ��P l C_ [ -_@_ 3T� G Xie2 K OLLE Size of Septic Tank 2CCCKAZz01-A Z CORM OWP-T. Type of S.A.S. 12 X(.'7 L C-A-1_vk k" C tAkA Description of Soil O_ZA" /\$6 - LO)kM $ 25 u 656% L. 24"— Q,0" C, M 6Af l0 - hlo \Aj /AT t=._-►2_ F---+-kco a taT'cae—e(p 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 is ed b 't oard of ealth. p Signed Date Application Approved by Date Application Disapproved for th ollo g reasons Permit No. sm Date Issued .w y - No. (/� .� ,.«,k. _ . . . ,. � "*�t+" .Fee THE COMMONWEALTH OF MASSACHUSETTS Entered i n1puter: I' Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 01porication for Miopooar:*p!6tem Con.5truction Vermit '0 Application for a Permit to Construct(k )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components ` Location Address or Lot No. �- 7 j ,t7A X Tr—Z Rt—i("IZO Owner's Name,Address Tel.No. OT A MAnZ->Tbt..1.S M 1 ULS 4 1C,kA POI ti��i_A L:N 1 e_u5 T Assessor'sMap/Parcel VkA, -�,�,,!7AQCCI. ��y -725 CAS �O►.1 � 'C C NC>CN coo W�A. - C)ZOG- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -4Z12>^ SSA/4 . ., 3 tLsa•,� c�....� 7 �P.t2t'EZ eoA.!D 06 Type of Building: ` - Dwelling No.of Bedrooms S Lot Size-73 6 D sq.ft. Garbage Grinder qt=-)5 a Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures i Design Flow 5 SO-1 SU°,G gallons per day. Calculated daily flow 8Z P) gallons. �. Plan Date J U L..,-( 2-9� lb Number of sheets 2 Revision Date NO NA E ~ Title S 1 TC X?' P.yy 'P{LC.�f3 O �✓E PTl C_�`lST= (�_ - 1 AxVL2.l\j Size of Septic Tank ZCC�3G)ALL0►._A ZCC^i7A2_7• Type of S.A.S. \ZXfo7 lLA(_tA1,\)6 C.(AA,u,&C,P, Description of Soil O"Z g�� A\$ S LOAM * S u t3SC51 L_.. 24'`— 1Z0" C, N1 zo \/,j A'T LOU�,A'T i j2-F—D Ftl 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 is ued by thiaBoard of Health. Signed Date _ Application Approved by Date Application Disapproved for th ollow ng reasons 'R Permit No. SQ0 Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS y BARNSTABLE, MASSACHUSETTS Certificate of (Compliance 4 THIS IS TO CE T that t e •n-s' - Se age-Di, �sayl ste . Constructed (�C )Repaired( )Upgraded( ) Abandoned( )b � : W71 ��%/ / �19 �J at 675 CJ Aef�>Tb US t.S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No - QO dated Installer Designer The issuance of this pe, j't shall not be construed as a guarantee that the sy to 11 function as d/ens?, ed. G iC Date r9 // "� j Inspector � .� --------------------------------------� No. no Fee 4 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS tgatar *p! tem Conotruction Permit Permission is hereby granted to Construct()C)Repair( )Upgrade( )Abandon( ) System located at '3757 66�JC"1 M-r— CLK,. 1?_b F 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:Cons ction must be completed within three years of the date of t Date: 1 Z� r Approved by ® tit r ELEv. 32.0 PERCOLATION TC—ST 0' CLASS I M ATE R►A L A/8 am_ LOAM DEPTH -q6.. Q P� SUBSOIL LESS THAN 2.MIN/INCH 0 24. NO WATER ENCOUN-TED GK 48# PERK TEST DATE - 03/24/88 CCR NE No. P- 6879 c_, MeD. SAND WITNC5S:3.0UWNINC- Bp I.ZD_ TEST WY P. SULLIVAN / No tNATBR gticouklTeO it % oQ4 Al �• P t .1 o a eg Q� J M41 z pill 0 bp 'Z9Ju ` 010 C. , 1%0 OF PE1ER o• SULLIVAN W.29733 y f � �a CIVIL :m cP pi �No `ti" SITE PLAN � PROPOSED SEPTIC SYSTEM o. 1- o AT CLOT 4}375 BAXTER NECK ROAD N ,,• 11�ARSTONS MILLS, MA F O R ;a HIGHPOINT REALTY TRUST ru. ARSTONS y'Oe{0 R. J. BURKE TRUSTEE M S R/ NS PLAN V I E W SCALE: 1"d0' DATE: JULY 29, 1 M/ 998 Scale: 1 = 60' SULLIVAN ENGINEERING INC. SHEET IOf 2. OSTERVILLE, MA 02655 y . NOTES DESIGN DATA ' L Water Supply ForThis Lot isMunicipal Water Single Family=5 Bedroom With .Garbage Grinder 2.Location of Utilities Shown onThis Plan Are Approx. Daily Flow=110 x5.=550 GPD At Least 72 Hours Prior to Any Excavation ForThis SepticTank.550 x 200%=1100 Gal Project The ConlroctorShall Make The Required Use 2000Galion Septic Tank With 2Compartments. Not ificationtoDigSafe(1-800-322-48 4) LEACHING AREA 3 The Contractor is Required to Secure Appropriates 825 GPD/0.74?1115'SF Required Permits From Town Agencies For Construction Sidewall=2(12.67.)2 a 316 S.F. Defined by7hisPlan. BoltomAreazdx67.'= 804 S.F. 4 Install Risers as Required to Within 12!�of 1120 SF Total Provided Finished Grade. LEACHING CHAMBER DESIGN 5.All Structures Buried Foiir Feet or More or Subject' All Pipes to be Schedule 40.PVC to Vehicular Traffic Lobe H-20 Loading. 7-50OGol Leaching Chambers in 66 Septic System to be Installed in Accordance With 12!x 67'Washed Stone Field as 310 CMR 15.00 Latest Revision And The Townef Shown, Barnstable Board of Health Regulations. 7. All Piping to be Sch.40 PVC B. Septic Tank Shall be a 2000Gal., 2 Compartment. The First Compartment Shall Have a Volume of Not Less Thon 11 OOGol.And The Second of Not Less . Than550 Gal. FG. 36.0 'F.G.35.0 34.0 31.8 33.3 Top EI. 32.8 SEE NOTE 33.1 i No.8 32•2 sot.E1 29.8 32.0 Bedding as , Per Title 5 7.8 35' 10.5, 45 10 12' Bottom of Test Hole Elev.22.0,No Water DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Not to Scale Finish Grade NOF PEER Filter Fabric �— Compacted Fill Sl)1. 3 - M0.99739733 N 1/8'=1/2" civil Pea Stone Leaching 3/4"-1 1/2"Double 4 Chamber Washed r 4!-ld I 12'-0" LOT 1375 BAXTER NECK ROAD ARSTONS MILLS, MA FOR CROSS SECTION OF CHAMBER HIGHPOINT REALTY TRUST NOT TO SCALE R. J. BURKE TRUSTEE SCALE: 1"m60' DATE: JULY 29, 1998 SULLIVAN ENGINEERING INC. SHEET 2 of 2 OSTERVILLE. MA 02655 ha`� M p or SOL LOGS DATE:December 18, 2003 a n 1 erg+ a \, ,° P#'=P-1o62s _ h- EP- xa� LEGEND a o ,� TBM: MAG NAI `� }o - - EXISTING _- x 71.6 _.. . PROPOSED U. - 38.ss �'+o • _ o • P SOIIEVALUATOR: BOARD OF HEALTH AGENT: -�° A k:4 0 u c► ., ° ' %- D.E.P. File SE 3■ Ep�CCE EP RO A� ` - _ OHEP.4W--1-7�� 4' 34 JohrR.Ellis,RPLS Dave Straton RS - ��• 3 9 T - P V�� ` OHW--- OwWr-_ OH - 0 Stake & Tac Set/Found w : �37 CC g O L �S UP 33 8T05"30" E ^� - ao• ° Ma Nail Set Found ' F EPA. 35,0 J ao. . 9 / ,. TEST PIT 1 TEST PIT 2 �. �+0.6 40 0 �;° � ° G.S.E. = 38.5f G.S.E. = 38.4t Conservation Notes. s2.o,3 o Concrete aBaund • �`Pa�tfi f x 7 5 _ Go 77 � + O 0 1) ALL ROOF LEADERS SHALL DISCHARGE TO DRY WELLS o� '� --- ® Electric Meter • 'j b - O 0 uP !E 32 w ❑ Catch Basin 37.2 r� c� 04 • © t° e { ° 8" SOREST DEBRIS 8" FOREST DEBRIS 2) LIMIT OF WORK/EROSION CONTROL BARRIER SHAI1 BE �' •96. I ,/ f a Water Gate {t7 , . y.. 343 l ® Water Meter • _ MAINTAINED IN GOOD REPAIR FOR THE DURATION OF THE PROJECT. •► 36 5 -� 1:.TI s " `� / ' r ® Telephone Riser no. C � A' A 3 ALL EXCESS EXCAVATED MATERIAL TO BE REMOVED OFF SITE I I / p •• Mowers/ Mandv i <, 620 LOAN COARSE SAND LOAMY COARSE SAND , WOODED • No ) ` x / r ,�/' -o- Utility Pole TION COMMI 24" 10 YR 4/3 24" 10 YR 4/3 4) ANY REVISIONS TO THIS PLAN REQUIRE CONSERIVASSION Contours I ! 0 • . Nosy,r�s .. 8�ts p WOODED200x00 a Spot Grade ::• `�.� P ° '. 6 B APPROVAL I •= �, 'a 3£3.0 � 5,3 ,� Test Pit o ° r LO,4Y COARSE SAND LOAMY COARSE SAND 5) CONSTUC71ON OF STAIRS SHALL CONFORM TO COMMISSION GUIDELINES S `. f Y • 10 YR 6 8 " 10 YR 6 8 x 38,1 \ l o Conc. Concrete swims o• 43 / 43 / \ . \ I t m EP Edge of Pavement J ' ' x 37'2 BCC Bottom of Concrete Curb C C `I !_ __ _ F.F.E. Finish Floor Elevation LOCUS MAP ' OARSE SAND COARSE SAND r �_ a I ".. � i F.F.E. IP Iron Pipe 1" = 2000' 1207110 YR 6/6 120" 10 YR 6/6 I J - RESERVE �a2 r PERC 0 48" LOT 3D ZONING DISTRICT: RF RATE= <2 MIN/IN NO WATER ENCOUNTERED N/F PEIPER }: 1 7 _I�. 2~~ - ------ ' i N/F BERGSTROM GENERAL NOTES UN ME TO SOAR aI). OVERLAY DISTRICTS: AP (AQUIFER PROTECTION) '`37'2 ' x; ,A ,' LOT 3E AREA PROJECT BENCHMARK: DATUM NGVD (RM-41) RPOD (RESOURCE PROTECTION OVERLAY DISTRICT) 3 ,5-- x 3 8.6 _- MINIMUM LOT AREA: 2 ACRES �, ---- PER PLAN BOOK 552 PAGE 88 i �37,• _ �' IBM = MAG NAIL SET IN PAVEMENT ® ELEV.= 38.66' i MINIMUM FRONTAGE: 150' x 36,3'~ --- 20,470t S.F. UPLAND ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE WITH FRONT YARD = 30' SIDE YARD = 15' REAR YARD = 15' --- ` -- - - -- _ _- - _ ,35- 82,367t S.F. WETLAND TITLE V OF THE STATE SANITARY CODE DATED MARCH 31,1995 I Leaching Area Requirements -'� e - - _ ~�- - 8Z367± S.F. ANY LOCAL RULES APPLICABLE. I Z x35. - _ _ -� �' 1.89t ACRES TOTAL LOCUS PROPERTY IS SHOWN AS: 6 BlDROOMS AT 110 GPD/BEDROOM = 660 GPD x 36,9 _ , MENEM x'4, y x ASSESSORS MAP 54 - PARCEL 11-004 ^' ___ A ul- -�' ANY CHANGE TO THIS PLAN MUST BE APPROVED IN WRITING x b'` BY DESIGNING ENGINEER ` ° d _ NO GARBAGE GRINDER - - x ._� _ r _, '. N -- - RETAININ�'G 'WALL- LOCUS DEED: / c'�' 30•0 _ =PUMP CHAMIBER d s �x�5.5 DEED BOOK 10,757 PAGE 291 --_- f,.. RATE = 2 /1 MIN. / INCH (CLASS 1 ) / `_�. X-- - -' ,30 _ , PRIOR TO BACKf1LUNG, WHEN CONSTRUCTION IS COMPLETED PERK ING CB ` -- .max 5.8 -,,, NOTIFY THE ENGINEER & BOARD OF HEALTH AGENT x32, - R_IM 29.5'" TOP OF�- 10.0 FOR INSPECTION. PLAN REFERENCE: LTAf = 0.74 GPD/S.F. / - N: FoyNDATIION PLAN BOOK 552 PAGE 88 /� i ,'WOODED T ' 'X 32.6MIN.`LEACHING AREA OF S.A.S. : / _ -tf -`: 25�3 5 � �- � THESE ELEVATIONS MUST NOT BE CHANGED WITHOUT WRITTEN x;3`3,3 r ; x a - R�[TAINING wAu. - APPROVAL BY DESIGNING ENGINEER COMMUNITY PANEL NUMBER 250001 0018 D ; THE FLOOD INSURANCE RATE MAP DEFINES THIS AREA AS ZONES 660'GPD/ 0.74 GPD/S.F. = 892 S.F. MIN. i� ,' ,'f --z� / 1OO!'OFFSET FRO TOP C, VI (EL 9.0') - A13 (EL 12.0) = BASE FLOOD ELEVATION (B.F.E.) !/' �' �� - i coAsra. eANK MOWN DEF. " PROPOSED SYSTEM ,, f ,' i - - GAttIuC�E SL/1Q-- -- _ _ /2`' /� ALL SANITARY DISPOSAL SYSTEM PIPING TO BE 4 PVC., SCH 40 PROPERTY OWNER: SIDEWALL (12 +56)(2)(2) = 272 S.F. ., / �, EL. )' __ _ EXCAVATE AND REPLACE ALL UNSUITABLE MATERIAL SURROUNDING THE OLD POST ROAD REALTY TRUST BOTTOM 12' X 56 = 672 S.F. i � ,/ / ,- --- - :..:.r-- __�}�'- r ,' / r 9. ' O -- _ - -'' SURROUNDING THE LEACHING FIELD FOR A DISTANCE OF 5', PER P.O. BOX 277 FFERY W. STOOKEY, TRUSTEES TOTAL = 944 S.F. ,'` �'/r / /i` �i /,�r 2 , - �, x_ .!-- ��2 ^_RE7wNINN j1 l' -�-�r� -�`21 310 CMR 15.255. DUXBURY, MA 02332 ,' / ,' / - T.0 F-•300 ----- " r / , / / c U.'d _-__ , I- -- OMIT OF WORK r I, _ _ - - - - - - LOCATION OF UNDERGROUND UTILITIES ARE APPROXIMATE AND 5'6 x.4f / SHOULD BE VERIFIED IN THE FIELD BY THE APPROPRIATE � SLAB ---- RETAINING'WALL ___.--_ - A UTIU COMP PR TO ANY CONSTRUCTION. TY ANY TOR 48' N01'ES FOR PUMP SYSTLI[ i , x 1 _ - _ r f , , � RETAINING , �'- `- -.�_ x / r r -PORCH x 16II jf- - -- - THIS PLAN IS BASED ON AVAILABLE RECORD INFORMATION, EXISTING WDOD, , ,,-- �� PLANS AND AN ON THE GROUND FIELD SURVEY BY THIS FIRM 4' 1. PUMP TO BE SIZED BY PUMP SUPPLIER. BUILDING To BE RELO / ,J ___ ' may OvTslp f '.�}dFFER ' j / �. _ ON 12/05/03 �..:. . 2. PUI TO MEET GENERAL SPEGFlCATIONS OF 310 CMR 15.23E r ; /' / i6. �• / '^ .�= _ OMIT OF ORK i6 i �J 4 , 3. MAINTAIN CONSTANT PITCH FROM DISTRIBUTION BOX BACK TO PUMP CHAMBER TO /� 2 x 13 // 00 . ' • . ALLOW FORCE MAIN TO DRAIN BETWEEN PUMPING. i 1� ` ING FA TO BE VENTED _• :-� _ 4 141 o13, . CL 56 a- 5 VISUAL ALARM TO BE MOUNTED ON THE EXTERIOR OF THE \ " •x \� , , •' r �EFlNm HOUSE FACING THE STREET. xCS\\ ' \ \_ .moo `, ' = x 11,3o� PLAN OF PRECAST LEACHING CHAMBERS r 3 ` `` ce I>Fi FND S NO SCALE \ \ �� \ `� \\ 1*2 1�., /V �TE'FfEN -,i PROPOSED 4 , _ s Pdo. WIDE, PATH / / ''i;l ,,, '�' 4 MANHOLE FRAME AND 5 I �. COVER TO GRADE " ,�2 a 1 \;, I I /l : i 1.5 (IF UNDER PAVEMENT) /4 - 1 " �` 3 REMOVEABLE COVER 6,1 '3 , `\x i I i l ` WASHED STONE �� ; ��' /•' // � O DESIGN SCHEDULE ELEVATION 1 .23.0 5, ,/, 2 I O I - ' G� / / �//, , PROVIDE INLET TEE i 0. 118i. ,\ 2"PEASTON FOR PUMP SYSTEM OUTLET PIPES TOP OF FOUNDATION 30.8 �\ ` n. x) 116 x/1st' ;:::;: Kr\- •v .-Y.•..Y-•' - '�_:< ••�; ��E--f_•��y. .-y- • ',• (AS REQD.) .SEWER INVERT AT. FOUNDATION 27.8 :$. •i•_:� "T -•:4 _ ��r,�i- �•: •`c l 1 �.C. I . ;Y;�.�t ;;�: SEWER INVERT INTO SEPTIC TANK 27.6 r. b s , rx M " yn yy., 24 12 «.:=:�'_ =;r . ,::: o C=1 ?k -ram •"'}:,�s�i i p�F1NmON t///i / Oo EFFECTIVEr•.»:�-P; •r':�,-•:..._�-•i...y:..�.,:-�,�:.'.tx�z:•:F.,3r.�-� ��yy,,;,5.,-�-tifi::,•,�-,3,'{..•_s-�ty.;.-+.'y;�.l ' y I . OSEWER INVERT OUT OF SEP11C TANK 27.3 DEPTH �` t 'x -c"jj3Ol 1 5.1 r INVERT INTO PUMP CHAMBER 27.0 �' '�` 4 4► 4 INVERT OUT OF PUMP' CHAMBER 27.9 / ao 17'_ �`r/ h� , l 743 Old Post Road / /, �.1 i 12 INLEr PIPE SEWER INVERT INTO DISTRIBUTION BOX 35.9 'f `4p, ; r, , ?? , /' / SEWER INVERT OUT OF DISTRIBUTION BOX 35.7 l l / Cotuit, Massachusetts T L g SEWER INVERT INTO LEACHING SYSTEM 35.5 16 j CONCRETE LEACHING CHAMBER DE AI DISTRIBUTION Box , rn, ,y , / / , PREPARED FOR (H 20 No SCALE LOADING) No SCALE BOTTOM OF LEACHING' SYSTEM 33.5 ;/;, /1�{�'�KoQ O .,�//,/�/ PROPOSED N r. , -; • a STAIM WATER TABLE: NONE !OBSERVED AT EL 28.4 I r3�[ � d ,�r^ o . „' / � ;I ,I� -,�'�;� - ,,,� . • N � The Old Post Realty Trust , NOTE IF AREA OVER SEPTIC SYSTEM IS UNPAVED, MANHOLE COVER & / / i FRAMES ARE NOT NEEDED. ADJUST CONCRETE COVERS TO 9 PROPOSED SYSTEM WAS REVIEWED BY BOARD OF HEALTH / 3 BELOW FINISHED GRADE AND APPROVED ON: TITLE wry', 1.9 Wetlands Permit Plan - House, Stairs & Path I T.O.F. = 30.8 / C.I. COVER COVER ADJUSTED To 4 PVC VENT %�!: / �� . ;:�• i/WITHIN 9 OF F.G. 1.7COVERS LOCATED To GRADE ADJUSTED To , / / .• , INC. ''�" �'' ' •`' BAXTER NYE & HOLMGREN I C PAVEMENT F.G. F.G.= 39.Of 4' MIN /'� '' -. END of PAVEMENT F.G.= 38.5t \ Registered Professional V-1 s m� > % ' En eers and Land Surve ors /N/ ( n) Cover y PROPOSED 4 y'INV. = 27.8 3' COVE 4" DIA. PVC 36" (max) Cover CONNECTION / r.� 6 , = - WIDE PATH 812 Main Street, Osterville, Massachusetts 02655 " 2 IAMETER " FORCE MAIN 1 3/4'-1 1/2" Phone - (508)42$-9131 Fax - (508)42$-3750 > 7 INV. = 2000 GAL. :;•- o 0 0 C 0 o WASHED STONE 27.6 SEPTIC TANK INV. = INV. = INV= 35.7 .= = INV. =27.9 INV= 35.9 r 12 ,...:: : �. •. :, , 27.3 27.0 � : :::: � _.-- :.� =•�:z-> �' 30 0 30 60 EL 33.5 , 1.9 l s PUMP CHAMBER .��, � i 1,7 DIST. BOX EDGE H f/ SEE PUMP NOTES (SEE DETAIL) 5 ,MIN / w OF MARSH ........::::::::�::::::: m - ;f 2,3 SCALE IN FEET INV= 35.5 No Groundwater Observed ® Elev. 28.4 _ 6" CRUSHED STONE BASE -- - ' SCALE: 1" = 30' DATE: 03/26/04 2,000 GALLON SEPTIC TANK DISTRIBUTION BOX CONCRETE LEACHING CHAMBERS -- -._--_._ ; Mt,� HIGH wq R �'' z. - CB DK-FNO REV. DATE: REMARKS H-20 H-20 H-20 - _ _ _- -� 0.0 /� 0.7 x L3 _ - -�' Co x 1 ---- r • • , • • DRAWING NUMBER TYPICAL SYSTEM PROFILE MEgN _ iam NOT TO SCALE �/ • LO. •w WATER • . . . . .C 0 TUFT BAY 0: 03-083 surve - wrksht 03-083w b.dw • • 2003-083