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HomeMy WebLinkAbout0040 BAXTERS NECK ROAD - Health 40 Neck Road 1 '` + Marstons"Mills ,�, � . s ; A,= 056 ;055]`{"tier , 7 - I I I I i II Town of Barnstable Barnstable kzftld �BMW9fABMRegulatory Services Department p Public Health Division m 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7014 1200 0001 0358 7535 August 26, 2015 Katherine F. Conroy 5 John Poulter Road Lexington, MA 02173 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 40 Baxters Neck Road, Marstons Mills MA was last inspected on July 13,2015,by Michael DiBuono, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • The Distribution Box has rotted out, it needs to be replaced. You are ordered to repair or replace the septic system components within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH rcKean,R.S., CHO Agent of the Board of Health Q:\SEPTIC\Conditionally Passes Ltr\40 Basters Neck Rd MM Aug 2015.doc 1 -8/25/2015 Parcel Detail --- L ?�cF T H+y�E I�y\ w � 1■ � �y`H `[" "'' 'Of'�' i is ..�� -• _ � .--- •,•d f ,.dA .y 6lii1a5YABLE +rl p i j' �a / r � yg lk Logged In As: Parcel Detail Tuesday, August 25 2015 Parcel Lookup Pa rce I Info Parcel ID 056-055 I Developer Lot ,LOT 9 , Location 40 BAXTERS NECK RoA Pri Frontage '152 - I Sec Road CEDAR TREE NECK ROJ sec Frontage 197 ' village MARSTONS MILLS I Fire District C-O-MM ' Town sewer exists at this address No I Road Index 0083 zz Asbuilt Septic Scan: n Interactive Map0560551 Owner Info owner Owner CONROY, KATHERINE FI co I 1 I streetl 5 JOHN POULTER RD street2 City LEXINGTON ' State MA I zip '02173 country Land Info Acres 1.73 l use Single Fam MDL-01 ( zoning RF I Nghbd '0107 Topography Above Street Road t Paved Utilities Public Water,Gas,Septic Location -� Construction Info Building 1 of 1 Year.1983 Roof W Gable/Hi J Fxt`Cla board Built Struct p all ' p Livin Area 1980 Ro cover'Wood Shingle AC Central/Half Type Style Colonial wall'Plastered^ Roomy 2 Bedrooms Int Pine/Soft Wood RoBoa„s 2 Full-1 Half Model Residential Floor Grade tAverage Plus Type,Hot Air Rooms Total 17 Rooms J Heat, _ Found- Stories t2.3 I Fuel •Gas ation Poured Conc. Gross f4436__j A rea Permit History Issue Date Purpose Permit# Amount Insp Date Comments 5/6/2004 Addition 76429 $37,632 .11/30/2004 12:00:00 AM 5/1/1983 Dwelling B25066 $0 1/15/1984 12:00:00 AM MM 1112 S I http:/fssq Illntranet/propdata/ParcelDetail.asp)OlD=3663 1/3 Com.m,onwe61th of Massachusetts D�U' " v�or Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Baxters Neck rd FL Property Address �P Fred Conroy Owner Owner's Name wmm information is rho required for every Marstons_Mills_ Ma 02648 7/30/15 �r 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 IXI way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, J��,ft i Iv use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return --- -- --- _ -- - - - - key. Name of Inspector Di Buono Sewer and Drain C I Company Name 8 Johns path Company Address return S Yarmouth MA 02664 City/Town State Zip Code 508-364-9587 S113522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the al Approving Authority 7/3 0/15 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP') within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t.,cins•.,/ 3^i Title 5 Official Inspection Form Subsurface Sewage Dispose-m e 1 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments o °tea,• ' 40 Baxters Neck rd Property Address Fred Conroy Owner _.._._ Owner's Name information is required for every Marstons Mills Ma G2648 7130/15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/ always complete all of Section D A) System Passes:- - ❑ 1 have not found any information which indicates that any of the failure criteria described ,. "in'310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The system contains a 1000 gallon tank as well as a concrete Distribution box. All tees and baffles are in place. The Distribution box rotted and needs to be replaced. the level in the pit does not seem to have evef been more than within 20",of invert pipe: System will pass with-new-D-•Bex-- B) System Conditionally Passes: ® One or more system components as described in the "Conditional Pass" section need to be replaces: 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): (Sins•3/13 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form 9R� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Baxters Neck rd Property Address Fred Conroy____ Owner -._._....--- --------__.-.._..------------------------------------- Owner's Name information is required for every Marstons Mills Ma 02648' 7130/15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conclitionatly 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): D Box is rotted ❑ The system required pumping more than 4 times a year due to broken or obstructedpipe(s). The q p 9 Y 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. 11. 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•3113 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 3 of 17 r Commonwealth of Massachusetts �u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for.Voluntary Assessments �¢ 40 Baxters Neck rd Property Address Fred Conroy Owner - — — ---------------------- -------._...------ Owner's Name information is required for every Marstons Mills Ma 02648 7/30/15 -- --.-- -----------------...._._._------____— 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 1/2 day flow 151ns•3/13 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form im Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Baxters Neck rd Property Address Fred Conroy_ Owner Owner's Name —-- ----- -- ------ ---- -- --- --------- information is required for every Marstons Mills Ma 02648' 7/30/15 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•Ti 3 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 e 40 Baxters Neck rd Property Address Fred Conro�r - Owner Owner's Name information is required for every Marstons Mills _ _ - — Ma 02648' 713OT1`5` ------— ------ page. CitylTown 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? ❑ 0 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?v(If`th'ey were not available note as N/A) E ❑ 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): 2__ - - -- Number of bedrooms (actual): �- -- - -- -- DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 -- ---- t5ins•3/13 Title 5 Official Inspection form.Subsurface Sewage Disposal System•Page 6 of 17 . Commonwealth of Massachusetts Title 5 Official Inspection Form Im 8 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Baxters Neck rd Property Address Fred Conroy Owner -- -----------------..._----__------- ----- —--------- -------------------------- Owner's Name information is Marstons MiTTs Ma' 02648 71a0'115� required for every -.._-_-- ---____— --___-- _ _ _ page. City/Town State Zip Code Date of Inspection D. System Information Description. The system contains a 1000 gallon tank as well as a concrete Distribution box. All tees and baffles are in place. The Distribution box rotted and needs to be replaced. the level in the pit does not seem to have ever been more than within 20" of invert pie. System will pass with new D Box Number of current residents: — ----------- Does residence have a garbage grinder? ❑ Yes ® No Is laurTdry can ar-separata sewage-system? (Ynclude`iaundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage d 163 GPD- - 9 ( Y 9 (gp ))� Detail Sump pump? ❑ Yes ® No Last date of occupancy: date Commercial/industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): ----Gallons per day 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•3113 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 7 of 17 COnlrMonVvo8)th of Massachusetts ~0�^~�U �� Official H Inspection �� ` � U ���� �� �"�� � U����� � ������������U���� �-o0~m Subsurface Sewage Disposal System Form Not for Voluntary Assessments 40 Baxbers Neck nd Property Audeoo ------------------------'- Fred Co�o_y__ Owner Owner's Name infonnahonis required for every Manskohe Mills ' ' ' KY 026487' 7730 1'5 page. City/Town State Zip Code Date ufInspection D. System Information (cont.) 000u i d Last date nfocuupanoyuae� -����-------- � Date Other (describe behrw) General Information Pumping Records: Bortn|otti2OO141O1214 Sourcnofinfonnation� -------���� �"-=�-��----'------------------ ' Was system pumped aa part of the inspection? El Yea N No If yes, volume ---------- ' gallons How was quantity pumped determined? -'---------- ---- -- � ' Reason for pumping: -----------------------------------�-�-----'-- Type of System: 0 Septic tank, distribution box, soil absorption system El Single cesspool 0 Overflow cesspool 7 privy � | | | | | Shared system (yes or no) (if yes, attach previous inspection records. if any) | �1 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 |/4 system by system operator under contract Tight tank. Attach a copy nf the OEPapproval. Other (describe): .5i"".3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-p"eeumn Commonwealth of Massachusetts W Title 5 Official Inspection Fora' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 40 Baxters Neck rd Property Address FredConroy----- ----- - ----- -----------__._.-------- ------ — ---- ------------------------ Owner Owners Name information is Marstons-Mil-Is Ma 02648` 7`t37115" required for 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: 33 Years Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: reel 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.): System is vented throught the roof. Septic Tank (locate on site plan): Depth below grade: 1 ftfeet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 gallon If tank is metal, list age: ________--_----------_--- _-_-----_-------___-- years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: --------1000 Gallon------------------- -- Sludge depth: 3"-- -- --- --- ---- --- 151ns•3113 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Baxters Neck rd Property Address F _ - . - -- -- -- - ---- --- Owner Owner's Name information is required for every Marstons Mil'rs_ - _Ma_ 02648 ''"" 7130/15' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from-top of,sludge to bottom of outlet tee or baffle 2-4 - — Scum thickness 3 Distance from top of scum to top of outlet tee or baffle 42 Distance from bottom of scum to bottom of outlet tee or baffle 1" Sludge stick_ How were dimensions determined? Tape Measure _ Comments-,(on-pumping-,recommendations, inlet and outlet,tee or baffre condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): No evidence of Ieaking,Tees and or baffles in place at time of inspection. Grease Trap (locate on site plan): Depth below grade: NA 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: pate t5ins•3113 - Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Baxters Neck: rd Property Address- --_---- ---- -- - Fred Conroy Owner -- ------------------- - -------------------- Owner's Name information is required for every Marstons Mills Ma 02648` 7/30%15' _ 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.): Tees are in Glace and levels are normal. .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): Di mension sc -----—--------- — Capacity: -- ----- -- -- gallons Design Flow: --- -- ---- — -------- gallons per day Alarm present: ❑ Yes ❑ No Alarm level: ---- Alarm in working order: ❑ Yes E. 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 15ins•3/13 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 �p 40 Baxters Neck rd Property Address Fred Conr� ____ Owner — - -------------------- ---- --------------------------_------------ ----------------------- Owner's Name information is Marstons Mills Ma 02648 7/30/15- required for every _ _ ------.------------------.___-- page. City/Town . State Zip Code Date of Inspection D. System Information (cost.) Distribution Box (if present must be opened) (locate on site plan): Depth-of Itiquid"Ievel above outlet invert" Needs replacement 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.): Distribution Box is rotted 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. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t51ns•3/13 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 40 Baxters Neck rd Property Address FredC o n r> _--------------- -- ------- ------- --- ------------------ --------- Owner Owner's Name information is required for every Marstons Mills Ma ' 02648' 7/3011`5 _ page. CityFrown State Zip Code Date of Inspection D. System Information (cont.) Type: 1 leaching-pits number: - --- -- -- - ❑ leaching chambers number: ❑ leaching galleries number: - ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ----- --- --- ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No sins of carry, over and no signs of hydraulic failure_ 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•3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � /. 40 Baxters Neck rd - - - - ...- ----- - - ---- Property Address Fred Conroy -- ----—------ Owner ---------------- ---__...---- ------------- Owner's Name information is required for every Marstons_Mills _ Ma 02648 7/30/15 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.): No signs ofponding or hydraulic failure._ — _....... — Privy (locate on Site plan): Materials of construction: ------- -- --- Dimensions - --- -- _ ----- ---- - -- ----- Depth of soids -------- --- - - Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5,ns•3113 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 14 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form 1= Subsurface.Sewage Disposal System Form - Not for.Voluntary Assessments 40 Baxters Neck rd Property Address Fred Conroy Owner — ----------------------------------_------------------- Owner's Name information is required for every- Marstons Mil'Is Ma 02648" 7/30/1`5 page. CityFrown 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form I — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Baxters Neck ec rd Property Address Fred Conro Owner -- -----y---- ---------------------------__-------- ------------------------ -- Owner's Name information is Marstons Mills Ma 02648 7/30/15 required for every - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells 20+ ft 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: pate ❑ 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: Property_sits apprmimately_20 ft above_nearest water venue Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 16 of 17 r �-U j Jo �7 j BARNSTABLE Location: 40 Baxter Neck Road Yilla ee_ Marstons Mills Septic _ 1000 Gallon Septic Tank Otener Fredrick Conroy PUMPING III STORY 8/1 /01- 1000 Gallons Commonwealth of Massachusetts -� Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Baxters Neck rd Property Address ------------- ---- — - Fred Owner Owner's Name information is Marstons Mills Ma 02648 7/30/15 required for every ----- __ _----___. -------_ ___- - --------------------------- page. CityFrown State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D'(Syst'em'Failure Criteria Appli'cabl6to-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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 r No. Fee ooO THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftPlitotion for Disposal *pstrm Construction i3Prmit Application for a Permit to Construct( ) Repair Vupgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. V6 6u4A4.`� Owner's Name,Address,and Tel.No. � o8-</ol0-3 3/9 Assessor'sMap/Parcel OJS�v/oss- /t(ccrsi�v�s/Ki1�5 � �' C°hr1O a�a5-3b% �HCA` Installer's Name,Ad ress,and Tel.No. 0b9-77/-�39 Designer's I a ,Address,and Tel.No. " Gorda con,64ruc.:k'aa Inc- gN ®. Q0x 7aL1 �'►�la�s+o fls o </ TI pe of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 6 Nature of Repairs or Alterations(Answer when applicable) f S 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 Enviro al Code d not to place the system in operation until a Certificate of Compliance has been issued by this Board of He Sign d Date (� Application Approved by Date 6MVIIJ Application Disapproved by Date for the following reasons Permit No. �� `,) "-' Date Issued No.a"`� Fee d THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for MispoBal *pstem Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System k ndividual Components Location Address or Lot No. 4/U > ,C�� R Owner's Name,Address,and Tel.No. ,08-.ua0- 3 3/9 rt Assessor's Ma /Parcel US'(o/ MarSr,SMiI�S ��� � s.?v{,n Fbt-!cam f?� p 05 L�c�ns-Mn. va�/a/ Installer's Name,Address,and Tel.No. ,�'r>$ '�7/- 93�9 Designer's Dame,Address,and•;Tel.No.—VMMIME 3�r Eo l cV,�, ConS4 r Ue, (-ion inc-• /�. •0. G,,c �o(( Tarsivr�s � 115- M 14 U-L•V$ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) CUC i S / Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore descxibe" don-site sewage disposal system in accordance with the provisions of Title 5 of the Enviroamen al Code d not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healthon Signed Date Application Approved by ` Date 19)AIIJ ,,. Application Disapproved by Date. for the following reasons Permit No. C7;�o Date Issued 1 -- ---------------------------------------------------------------------- (1 A, 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 ar+U 1 o� l.c,n s�fL,(— -,C1m ,1h c at qo Gw(4 rs ,NeLk P�� ���nrs�ai�s�i�r� has been constructed in accordance with the provisions of Title 5 and thefor Disposal System Construction Permit No—' l 5 dated r3 I Installer ��>��� _ .( F�nS�Yt�r He�r� Inc " 'Designer AT i #bedrooms r I Approved design flow gpd The issuance of thi permit sAl not be construed as a guarantee that the system w"fd t t n as design . i Date �� �p _ Inspector Y� No. -:� D g Fee 0 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstr Construction permit Permission is hereby granted toConstruct( ) Repair ) Upgrade( ) Abandon( ) System located at Y19 J'�/ Xt M 5 A)o(k h-� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction ust be)completed within three years of the date of this p(erfiit. Date) / Approved`by Assessing As-Built Cards Page 1 of 2 r L>U c�—w,� Name Lxatlon �-dh -c cj_t, gUSFIELD SANITARY SERVICE. tnatdiec'a'Name and Addreu SA? BWI6i1,OAA 6253F --- BuUd&--a Name and Address Date Permit tuned Date Compilaaee I meds fl/D-83 ✓� g' B o � Y i http://www.town.barnstable.ma.us/Assessing/HMdisplay.asp?mappar=056055&seq=1 7/24/2 4 L vlr ✓ �t 9 ,ems Swer Permit No. 93- o? Name '' y - 6 Location t.L`z. e BOUSHEL5 SANITARY SERVICE Installer's Name and Address Mot 6HOF —Builder's Name and Address Date Permit Issued: Date Compliance Issued: !!) 8� ? a�g g. - �i �' o �- - { - o5z- No.. .:.��.. F$s_.. v. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T� ( jn�................OF.....%.ATZ. -Cat`,.LZ..................................... Applutttion for Kisposal Works Tontrwtion Prrinit Application is hereby made for Per it to Construct (L_)�Or Repair ( ) an Individual Sewage Disposal System at: ................_�,��: ...�? ... ---I�•----:�(1.�.. .....�1....:...-- .C. -r-»-• ---------__........_».... ................»..»Location0.72A. .... s •-•........... ..........0.................... o ........... ... ye ` Ownler' y� Address a ........................ 1.�d4d ��r6 ................................... .....---............------............---................................. ................. Installer Address Type of Building Size Lot.___ `.../.............:-S T.-feet U Dwelling—No. of Bedrooms..................._..... .....Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria pr Other fixtures ...................•........._... . . .... .. W Design Flow.................J ... .....gallons per person per day. Total daily flow........................... .........gallons. WSeptic Tank—Liquid capacity? .gallons Length................ Width................ Diameter................ Depth................. x Disposal Trench—No..................... Width..........-......... Total Length..------- r... Total leaching area..__... ...........sq. ft. 3 Seepage Pit No..........I--------- iameter......... ..... Depth below inlet....... ....... Total leaching area... ....sq. ft. Z Other Distribution box ( Dosig tank ( ) '" Percolation Test Result Performed by -7.A ......A-Aw -it- Date.....id� ��- 04 Test Pit .No. 1.... ......minutes per inch Depth of Test Pit........1' ..... Depth to ground water.....:'—......... (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........-............... pr ................... ----•.....-•-••---•-....•----•-------------------------------------•--•--•••••-------------------------------------------- -......... Descriptionof Soil...........................•--•----------•...:.---••-......... --• -•-•---•----.........-.....----.....-•----------------...............•-•-•.....------....... w --------------------•-----....---•.......----------.._...•-•---........................------------------------....---------....-----...---........-----........----..............------......---•------ U Nature of Repairs or Alterations—Answer when applicable........................................................................................0...... .. .. .............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i edjb � rf health., z Signed..Y..^...-- ••. ........ ..........�.'`......------•---••---•--. ..�..................._•••. Date Application Approved By----..... !��.:..: _ .....--•-••!- =....................... Date Application Disapproved for the f ollounng reasons:..........................................................................................................»»» ............................................................................................-......................................................................0....................... Date - -- PermitNo. ...............................................»_» Issued-..................................................... _ Date _.4_ _ + � w THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH CLljj,.1...............OF......%4 lJ -- ................................... Appliratton for Disposal Works Tono#rur#ion Prrmit .s ,;.Application is hereby made for a Permit to Construct (&00�or Repair ( ) an Individual Sewage Disposal System at •e Location-Address •• �• •��-� o Lot No _.... .........._ __t-E:: :�L$JL2.?Z_r.... .....501�.--•--..._... ......---•------•-- ..._�..".......S 6..JtaJ�� -- ...._._ ... Owner - .Address a ....... 1 .`".. .� �- .. ........................ .......................................................................... ................. Installer Address Type of Building Size Lot....C` ..._..:.___: meet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures w Design Flow.................. 2...................gallons per person per day. Total daily flow.......................•'_ �.�............gallons. WSeptic Tank—Liquid capacitylq�Q.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .......... ........ Width................. Total Length................f--- Total leaching area...... .........sq. ft. Seepage Pit No.._........ iameter..........3 pag 1�--.-..... Depth below inlet.._.....?....... Total leaching area_.- -...sq. ft. Z Other Distribution box ( Dosing tank 1 Percolation Test Result Performed b L{ y. 2C{ :f.�"` l?• .9! ..1�N?. Date.-•--1--�-�--0--..-��' ......... ,.a Test Pit No. I...... .......minutes per inch Depth of Test Pit........2....... Depth to ground water........ ........... Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ .................................... --••--------- ------------••...............-•....... .............. •....•..• .........................-•••---•--•-•----------•-----................... Descriptionof Soil............................................................... •.... ....--••._...---...........................-•-••-•...-••••-••--••.........._........... w ............................................................M.. "------.....� .p :� ;_�........---------------.....----........----.................---............------.. UNature of Repairs or Alterations—Answer when applicable............................................................................................... ......----•...............................•-••---................................----•--•--..........................._.........................---.........---..................--•-•-••---......----•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.L 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i s ed b t r f health. Signed............. ' 4 J?.b t� Date ApplicationApproved By............'-°_..z'�....:.......................•-----......-----....................--•------ ..........................= ;' ._7 V.._. Date Application Disapproved for the following reasons:...................................•---•----•--•---..................----......---...-----.............-------_ ------•-----•--•-••--•--•-----••-•.................•----....---•--...----....-•-•-------....-•--•---........---•-•--------•-------•------•---•-------.....------•--•-----••-----•...-----.....-••----•-- Date Permit No....! . .....11 S- '........................... Issued..................................................... Date THE COMMONWEA wlH OF-M,A SA,IGHUSETTS ra — ........... , .y BOARD OF HEALTH ! w IQW.0..........:.......OF........_ ................................... (Erriff iratr of Tomplianu THIS IS TO CERTIFY, That the Indi 'dual Sew a Di osal S-stem constructed /) Or R airedP �' ( Repaired ( ) • by-.... -.. ..:.... .. ......-� �L-••--- 'W cr /"`/ 't '�-•• ........ ---------------- taller at....................................•-•----••--••--•--........----•-•---------•---•-----------...----_................--•---....................--•--...........•••..--•-•••--••.........•••-•-...... has been installed in accordance with the provisions of TITIF 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No....... �, .'.+ � `t!......... dated..... -_.'-� ............ THE ISSUA CE F THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GUARANTEE THAT THE SYSTEM WIL U TION SATISFACTORY. DATE.` . . © . ........................................ --.... Inspector. i K „ y ...... ..............•................. fi THE COMMONWEALTH OF MASSACHUSETTS y BOARD F°,,;HEALTH _ n t v3 ' c` .ir7 ............1(� .."'..........OF........... .J^...1:�`.:�1.......`1 ......_ .......................... No............... FEE........................ Disposal Works Tons#rur#ion rrrmi# Permission �10r ereby granted.......... ........:f;A l.�`!_z u�._ . to Construct ( Repair ( ) an Individual Sewage Disposal System �= at No.....- t r .-[:.. ............... --- ` s r r......................................................... Street .mj _ '; , as shown on the application for Disposal Works Construction Permit No..'.................. Dated.......' ".�_'�:�.'�............ i Fi:. ^` 'k ♦ ........................................ ...... .. ..............................................._ Board of Health DATE.................................................... FORM C-1255 CITY& TOWN FORMS, INC. 369-9708 I 33 i 1p03. 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