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HomeMy WebLinkAbout0162 BAXTERS NECK ROAD - Health E Baxters Neck•.Road ons Mills075 021 I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ..�'` 162 Baxter Neck Road(Pool House) Property Address Linda Coifman Owner Owner's Name information required for every Marston Mills MA 02648 7-9-14 . page. Cityrrown 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 out forms A. General Information ,,t��►tttlrlrrq on filling the computer, (,( ``\ �1N OF Mq �c use only the tab 1. Inspector: I U 2; •.ti key to your JAMES cursor-do not James D.Sears =o e the return Name of Inspector key. Capewide Enterprises,LLC Company Name ras p Y �'F,a�N npE````��p 153 Commercial Street Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 ,..� Telephone Number License Number 0 0 C— � O B. Certification I certify that I have personally inspected the sewage disposal system at this addre s and thaFthe information reported below is true, accurate and complete as of the time..of the ins ection. The insp tion was performed based on my training and experience in the proper function and m intenance f on., sewage disposal systems. I am a DEP approved system inspector pursuant to ection M340 of Title 5(310 CMR 15.000).The system: e- ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 7-9-14 nspector'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�_nder the same or different conditions of use. ; t5ins•3113 Title 5 OjInspon nn:Subsurface Sewage Disposal System•page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,.•''I 162 Baxter Neck Road(Pool House) Property Address Linda Coifman Owner Owners Name information is required for every Marston Mills MA 02648 7-9-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Pool House System B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r— Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 162 Baxter Neck Road(Pool House) Property Address Linda Coifman Owner Owner's Name information is required for every Marston Mills MA 02648 7-9-14 page. Cityrrown 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 Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed i Y q P P 9 Y pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or'a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 162 Baxter Neck Road(Pool House) Property Address Linda Coifman Owner Owner's Name information is required for every Marston Mills MA 02648 7-9-14 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in is less than 6" below invert or available volume is less than %day flow -Z drAel{i�46:� t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 r Commonwealth of Massachusetts v: Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 162 Baxter Neck Road(Pool House) Property Address Linda Coifman Owner owner's Name information is required for every Marston Mills MA 02648 7-9-14- page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Z 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 r Commonwealth of Massachusetts Tithe 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a_ y( 162 Baxter Neck Road(Pool House) Property Address Linda Coifman Owner Owner's Name information is required for every Marston Mills MA 02648 7-9-14 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined? If the were n ® P Y ( y of 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? Z ❑ 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): 0 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 220 t5ins•3/13 Me 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 r Commonwealth of Massachusetts v: Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 162 Baxter Neck Road(Pool House) Property Address Linda Coifman Owner Owner's Name information is required for every Marston Mills MA 02648 7-9-14 page. Citylrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal.Tank D Box and two 500 Gal.Chambers. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) P ) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage water usage g ( y g (gPd)) w/main house Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form Subsurface Sew age wage Disposal System•Page 7 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yy< 162 Baxter Neck Road(Pool House) Property Address Linda Coifman Owner owner's Name information is required for every Marston Mills MA 02648 7-9-14 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): N General Information Pumping Records: Source of information: 2011 P Was system pumped as part of the inspection? ❑ Yes ® No If yes, volue-ne pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 c Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 162 Baxter Neck Road(Pool House) Property Address Linda Coifman Owner Owners Name information is required for every Marston Mills MA 02648 7-9-14 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2002 Permit # 2002-278 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2'feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal.Precast H-10 Sludge depth: 1" t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 f Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 162 Baxter Neck Road(Pool House) Property Address Linda Coifman Owner Owner's Name information is required for every Marston Mills MA 02648 7-9-14 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 29" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions Asbuilt-Tape- Plan determined? Sludge Judge (Past Report) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank and covers at 1' below grade. In and out let Tee's. No sign of leakage or over loading: Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 r Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 162 Baxter Neck Road(Pool House) Property Address Linda Coifman Owner Owner's Name information is required for every Marston Mills MA 02648 7-9-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 162 Baxter Neck Road(Pool House) Property Address Linda Coifman Owner Owner's Name information is required for every Marston Mills MA 02648 7-9-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): , D Box inspected and located w/camera. Box looks clean and solid. No sign of over loading or solid carry over. 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: t5ins•3113 Tide 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 162 Baxter Neck Road(Pool House) Property Address Linda Coifman Owner Owner's Name information is required for every Marston Mills MA 02648 7-9-14 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number. ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is two 500 Gal. dry well chambers. Chambers are 30" below grade. Chambers are clean and dry. No sign of over loading. 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 f Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 162 Baxter Neck Road(Pool House) Property Address Linda Coifman Owner owner's Name information is s Marston Mill MA 02648 7-9-14 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15ins•3/13 Title 5 Official Inspecfigr Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form. o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .�' 162 Baxter Neck Road(Pool House) Property Address Linda Coifman Owner Owner's Name information is required for every Marston Mills MA 02648 7-9-14 page. City/Town 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 fi�F,4R /3 A-/ _ d-6 ° ° t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary.Assessments 162 Baxter Neck Road(Pool House) Property Address Linda Coifman Owner Owner's Name information is required for every Marston Mills MA 02648 7-9-14 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells d N Estimated depth to high ground water: 10'+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record Y 9 If checked, date of design plan reviewed. 7-2-02 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: T.H. on design plan 7-2-02 no G.W. at 10'+. Bottom of chambers at 5' below grade. Bottom of chambers at 5'+above T.H. depth. Before filing this inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 162 Baxter Neck Road(Pool House) Property Address Linda Coifman Owner Owner's Name information is required for every Marston Mills MA 02648 7-9-14 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file j t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 162 Baxter Neck Road 601 ,o rJ S 0 Property Address Linda Coifman Owner Owner's Name information is required for every Marstons Mills MA 02648 7-9-14 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 filling out forms A. General Information 0F lyq on the computer, �� �St1 �iy use only the tab ��y>� '�• 1. Inspector: P �. key move your our a •y a cursor-do not ��:' JAMES James D.Sears =�; ; use the return key. Name of Inspector Capewide Enterprises,LLC ../F1 • I I Company Name �' ??l 153 Commercial Street �i,�F�s'+INSP�G�r���� Company Address Mashpee MA 02649 Cltyrrown State Zip Code 508-477-8877 S1623 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: ® 1 0 ® Passes ZE ❑ Conditionally Passes ❑ Fali fl Needs Further Evaluation by the Local Approving Authority o 0% _ 7-9-14 w spector's Signature Date € r'n The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. """"This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Title 5 Official Ins pec6tF. Surface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 162 Baxter Neck Road Property Address Linda Coifman Owner owner's Name information is required for every Marstons Mills MA 02648 7-9-14 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: Main House System B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form law- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 162 Baxter Neck Road Property Address Linda Coifman Owner Owner's Name information is required for every Marstons Mills MA 02648 7-9-14 page. Cityrrown 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 Conditionally Passes(cunt.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced .❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or:a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 162 Baxter Neck Road Property Address Linda Coifman Owner Owners Name information is required for every Marstons Mills MA 02648 7-9-14 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ g 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 ❑ z Liquid depth in his less than 6" below invert or available volume is less than Y2 day flow /°/T.S° t5ins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,•'' 162 Baxter Neck Road Property Address Linda Coifman Owner Owner's Name information is required for every Marstons Mills MA 02648 7-9-14 page. Cityrrown 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. ❑ Z 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 15.3.04. The system owner should contact the appropriate regional office of the Department. t5ins•3/73 Title 5 Official Inspection Form:Subsurface spe Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 162 Baxter Neck Road Property Address Linda Coifman Owner Owner's Name information is required for every Marstons Mills MA 02648 7-9-14 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 162 Baxter Neck Road Property Address Linda Coifman Owner Owner's Name information is required for every Marstons Mills MA 02648 7-9-14 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal.Tank D Box and two pits. Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No Water meter readings, if available last 2 ears usage d 2012-355,000Gal g ( y g (gP ))' 2013-347,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts . Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'y 162 Baxter Neck Road Property Address Linda Coifman Owner Owner's Name information is required for every Marstons Mills MA 02648 7-9-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 2011 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Jy< 162 Baxter Neck Road Property Address Linda Coifman Owner Owner's Name information is required for every Marstons Mills MA 02648 7-9-14 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: 1986 Permit#86-285 2011 Permit#2011 -402 D box and line change Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 6' feet Material of construction: ❑ cast iron ®40 PVC ❑ other ) (ex lain : P Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): Depth below grade: 51.10" feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal.Precast Sludge depth: 211 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 162 Baxter Neck Road Property Address Linda Coifman Owner Owner's Name information is required for every Marstons Mills MA 02648 7-9-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top 9 of sludge to bottom of outlet tee or baffle 28" Scum thickness 1" 81' Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 17" ill How were dimensions determined? Asbuilt-Tape Past Report 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.): Tank at working level. Tank at 6-10 below grade w/cover at 1'. In and outlet Tees. No sign of leakage or over loading. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 162 Baxter Neck Road Property Address Linda Coifman Owner owner's Name information is required for every Marstons Mills MA 02648 7-9-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-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 M 162 Baxter Neck Road Property Address Linda Coifman Owner Owner's Name information is required for every Marstons Mills MA 02648 7-9-14 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"-6' below grade w/cover at 14". Box is clean and solid w/2 line's out. No sign of over loading or solid carry over. 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: t5ins•3113 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 12 of 17 f Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 162 Baxter Neck Road Property Address Linda Coifman Owner Owner's Name information is required for every Marstons Mills MA 02648 7-9-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: El innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is two 1000 Gal. Precast Pits. Pit#4)on Plan at 7' below grade w/cover at 1'.6"water in pit.Pit#5) On plan at 5'-6" below grade w/cover at 6". 4"water in pit. Both pits are clean wall's, No sign of over loading solid carry over or high stain line. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 162 Baxter Neck Road Property Address Linda Coifman Owner Owner's Name information is required for every Marstons Mills MA 02648 7-9-14 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 f - • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 162 Baxter Neck Road Property Address Linda Coifman Owner Owner's Name information is Marstons Mills MA 02648 7-9-14. required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cons.) 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 Aq A 13-/ I o r� 13-,2 R - 3`� 13_3 /�- � - 31 13 47 - 6 I Iwa5 &VAPKUW ft"M amv�-otmpme&" !%�a15fg17 Mms•3/13 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 162 Baxter Neck Road Property Address Linda Coifman Owner Owner's Name information is required for every Marstons Mills MA 02648 7-9-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N® Estimated tthhi feet de gh ground water: feet p 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: Past report 20'+ no G.W. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 r � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 162 Baxter Neck Road Property Address Linda Coifman Owner Owner's Name information is required for every Marstons Mills MA 02648 7-9-14 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Rage 17 of 17 Town of Barnstable Barnstable ��p THE T�y it A®-Amr�iCa 1.1 City Regulatory Services Department 1 i• IIARNSCABLE, MASS. r Public Health Division �A i63q �0 A 007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7011 0470 0001 4525 5416 October 26, 2011 Mr. &Mrs. Daniel Coifimn Olympic Tower#601 1 Rodriquez Serra Street San Juan, Puerto Rico 00907 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 162 Baxters Neck,Marstons Mills, MA was last inspected on 9/20/2011/2008, by Sean M. Jones, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Fails"under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • D-box was found to be overfull with sewage effluent. D-box and piping need to be repaired or replaced to allow for even flow to the leach pits. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system with the deadline period will result in future enforcement action. �-6 F THE BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures\Town of Barnstable.doc .t TOWN OF BAR®NSTABLE LOCATION J 6 BA X fe r ►ler,� R U SEWAGE# 610 J 4.01 VILLAG&604-I� °9 SSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHA NO. r.ct P eAAJit Cyrfemdjw Lx 501'477-ff 77 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) Z ffACk Pi f S (size) g NO.OF BEDROOMS OWNER L y/i�1 f�'c'I`�i+vva+��✓l PERMIT DATE: 23 l COMPLIANCE DATE: /ol 7j Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY IA - I= il j3-1 -53 A -3=95 8-347 q Q_y=s8, No. 1IDZ, Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN'OF BARNSTABLE, MASSACHUSETTS ftpfiration for Misposal *pstem Construction i3ermit Application for a Permit to Construct( ) Repair d Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Addre and Tel.No. Assessor's Map/Parcel U75 Installer's NameWA�ddress,a d Tel.No. 6,ag~ 77— -77 Designer's Name,Address,and Tel.No. C-a �14u.. 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) Li✓LQ. —� , 'r bN._V -- Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Hea _ Sig Sig=l C Date� � —o - �� Application Approved by Date �p dI Application Disapproved b 1ZDate for the following reaso s Permit No. �� ®� Date Issued No. 0` 1W, j Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipplitation for Misposa.Y *pstem Construction Permit Application for a Permit to Construct( ) Repair(� Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ((p Owner's Name,Addre and Tel.No. Assessor's Map/Parcel 44-a— U75 a♦I L_" a �L Installer's Name,W Ad ress,a d Tel.No. 5,08- 77- -77 Designer's Name,Address,and Tel.No. Ca ,d`�, �Y; 'Ctis�3 t_l� 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(Answ-er whenlapplicable) (9- 'e- orw�— S;T., -}-z._ Date last inspected: Agreement: The undersigned agrees to the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has,been issued by this Board of Hea f Signe fl Date Application Approved by Date �'G?l f Application Disapproved b Date J for the following reasoffs Permit No.7 m u 2 Date Is"sued Z, ------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired V Upgraded( ) Abandoned( )by C."-pa- W�Ag.-r at 1(-1�Z &At-a _ K s� —' e%'� - has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No, ,A/1- 407- dated 17-0 1 Installer`c•veQ w `p�a- [ titAV<f 64j 5 Designer #bedrooms Approved design flow gpd The issuance of this permi sh711 not be construed as a guarantee that the system wffl'funblion de ' ned. Date /} Inspect o --------------------------------------------------------------------------------------------------------------------------------------- No.(�I y Fee ��� ' y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pSte;Y[ Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized hi - duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date ` ( �Z J J Approved by of SHE Tp� Town of Barnstable Barnstable � AS-AmericaCiry Regulatory Services Department BARNSTABLE, ` m \9 Nam. Public Health Division QED M"`6.1 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED.MAIL # 7006 0810 0000 3524 5393 October 26, 2011 r ifm Mr. &Mrs. Daniel an et Co an Olympic Tower, #601 1 Rodriguez Serra Street San Juan, Puerto Rico 00907 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 162v Baxters Neck Road, Marstons Mills, MA was last inspected on 9/2011/2011, by Sean M. Jones, 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 the 1995 TITLE 5 (310 CMR 15.00) due to the following: • D-box was found to be overfull because of settling of the pipes, D-box and piping need to be replaced to allow for even flow to the leach pits. As of today, we have not received any notice that the construction work of replacing the Title 5 septic system has been done. You are ordered to repair or replace the septic system within two (2) years from the date you receive this notification. Failure to repair/replace the septic system with the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas Mc Kean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures\Town of Bamstable.doc f, TO��WflN OF BARNSTABLE LOCATION e I- K /SEWAGE # 077�l V'1LLAGE �f�1'.S/a&,7 1W,,11SASSESSOR'S MAP & LOT S Z INSTALLER'S NAME& PHONE NO. i SEPTIC TANK CAPACITY LEACHING FACILITY: (type) —SOS (size) NO. OF BEDROOMS /-�N/423f BUILDER 0W� ��l � PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet • Private Water Supply Well and Leaching Facility (If any wells exist 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 Furtushed by gag A Poo I i 6 O, tR a. No. Qd 7(� FeeTHE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BAR�NSTABLE., MASSACHUSETTS 01ppYication for Miopooar *p5tem Construction 3permit Application for a Permit to Construct(t/)Repair( )Upgrade( )Abandon( ) B'Complete System ❑Individual Components Location Address or Lot No.1`0?- ZUCNERS NECA\b. Owner's Name,Address and Tel.No. 1ARSToms Ptlol loS, tY1A DA1J1EL i-L1alk C %jrMAN Assessor's Map/Parcel OLYMPIL TI OW Pr ORT (90\— 1 lR0t)R%r0EZ �E Atk S 075—6Z oN. o 107 Installer's Name,Address,and Tel.No. Designer's Name,Address and9��o Tel.No. &JiL.\V�AD EN64A�6�P�i II 7 PAW,cR tZOk-� �0.3QX toy Type of Building Dwelling No.of Bedrooms G Lot Size e�, Garbage Grinder(!li(s) Other Type of Building P001"Reuse No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ZS gallons per day. Calculated daily flow ® gallons. Plan Date (o ZS ®?'_ Number of sheets t Revision Date "— Title S( �,- 'PAIJ VMkQuR :l SS? '\C SyST n Size of Septic Tank-56® (oAf. Type of S.A.S. �xct r-eaCA W1 Z-so® oo- Ct1W&R,S c. Description of Soil ®-Z� MOCkjt\ Z-1Z 10V9 :Uln meb SA > IL�I Soria . (LZT' B IhK y)6 m -b 5�r Nature of Repairs or Alterations(Answer when applicable) r �L_Tt 0 14 - Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued this Bo d of lth. Signed Date I Z3 0 Z_ Application Approved by Date Application Disapproved for the following reasons Permit No. a uv2-.27 i' Date Issued 7 U� 788, No. FeeTHE C1111MOA�WEALTH OF'MASSACHUSETTS Entered in computer: `' Yes rr PUBLIC HEALTH DIVISION-TOWN OF BARN'STA$LE., MASSACHUSETTS 01p,plication for, !6 o.gaY_*zp0tem Co;ngtruction'Vermit Application for a Permit to Construct('Repair(, )Upgrade( � )`Abandon(! ), : Complete System O Individual Components Location Address or Lot No. i v. BAwm?.5 tJ ecK P,D. Owner's Name,Address and Tel.No.' n'IAR�ZoaJ� Mtc�, +�' ,�,, : 4: AA�/IEL,t Gir*►Dtl� c.UtF'Mav Assessor's Map/Parcel OwYmpic.Tawek A+ZT ( ot- 1 ROAitwop-z 5Er m►h s 075 Installer's Name,Address,and Tel.No. Y ti ` Designer's NamejAddress and Tel.No. �t1 4 1 C c � n ,`_ MA O&S-1 Sa$- 2 3 Type of Building! Dwelling No.of Bedrooms 4 Lot Sizes..& Garbage Grinder(N(j) Other Type of Building No.of Persons Showers( ) Cafeteria( ) �` Other Fixtures Design Flow Z.Z B i ` ' gallons per day. Calculated daily flow 0 gallons. Plan Date QZ81 DZ, Number of sheets 1 Revision Date Title SITG 'PtW ?%JU tom'DStb =<E5 -tC. SYSAI;�M Size of Septic Tank JSO© bk4 Type of S.A.S. qXC, FICA u! Z'Soo (66< ( AM80Z5 Description of Soil 0"Z" t1r1tkC" Z.'IZ' At Dig 311e m&D SAX)b .)1500SC SILTS.. I Z Z9" � IdyP� 41� A1�D s�1D ZI--12r (_ Z:5Y 6I(a A10 4t0VAr- W1\-%� '+ i Nature of Repairs or Alterations(Answer when applicable) kvs /)r a 1 I A, Lr_ a^L i Date last inspected- w 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 issue this Board of Health.Signed �-4- Date Z-11 a Application Approved by 4'• Date Application Disapproved for the following reasons j Permit No. �Z UO2 -.27 F "Date Issued 7 U2 , --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by at 402. &NWU,RS A G(c K 15>.. (AAS-D05 )AILS � MPA has been constructs i accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. .2(x.;- 7 e" dated 3 0 2 Installer Designer ilI The issuance of t 's e t shall not be construed as a guarantee that the s ste . will function as des* "ned. Date � .7 (!Z Inspector_ / No. QG02` -2 7 r Fee U� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migaal *pztem Construction Vermit Permission is hereby granted to Construct Repair( )Upgrade( )Abandon System located at KOZ ZA'('�P_K,S mxl fw:swx�� nt,IsS , M� and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this p rt. Date: 3 U%Z Approved by *A �V`� TOWN OF-BARNSTABLE LOCATION Z� xf4- /Z� eeee ISEWAGE # 4 -a VILLAGE 1gb'57011.5' ����.SASSESSOR'S MAP & LOT Z( INSTALLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY _ /r4!' LEACHING FACILITY: (type) (size) NO. OF BEDROOMS Awl4Oglf' BUILDER 0 WNE PERMITDATE: COMPLIANCE DATE: v� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i POO) house J r LOCATION LOT -7 SEWAGE PERMIT NO. C VI L•L,AG E ' I N S T A LLE 'S NAME A ADDRESS i o • ER CIL DATE PERMIT ISSUED DATE COMPLIANCE ISSUED IA? zs& K-l� •mot ,' ,S n 4 �� qo �� oa � FE THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........T.w-^r..I........ .......��.,9"r�rs r ApplirFation for Dhipog al Works Tonstxnrtiun Famit Application is hereby made for a Perm' to Construct (v) or Repair ( ) an Individual Sewage Disposal System at: =� I (®`�... &n. „1,..)1� . oz zs.... .e /?p f. --C ---------•------•----•• -•--------------•--•--------..----�' -� -7...........................----•-........... Location-Address or Lot No. � G 1^l Dr9 Co.l.. >/- �..... b .T. �T. Tl e'7 ,,.Cc��.T6�lii G L .......- -•----......•-••--•. -•••----- Ownez Address --- ----------•................................ Address dType of Building Instauer Size Lot._7f�l.c,9._._.._____Sq. feet ----- -II Dwelling—No. of Bedrooms...........�...........................Expansion Attic ( ) Garbage Grinder (L--� Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria. ( ) Q' Other fixtures .................................. W Design Flow...........6`.�..........................gallons per person per day. Total daily flow...........;L40.....................gallons. 9 Septic Tank—Liquid capacity Zsoa..gallons Length_ G."... Width..¢_6-_..._ Diameter_.-_ -..-----. Depths q._... W Disposal Trench—No. .................... Width............... .. Total Length.._....__�. ..... Total leachingarea................ ..s . ft. x 3 Seepage Pit No..................... Diameter...../............ Depth below inlet................... Total leaching area......_.____1...sq. ft. Other Distribution box ( ) Dosing tank ( ) _ z Percolation Test Results Performed by.. �`_....s"'"� �.1?e,-,s.................... Date.-�'� - ��BJ . .................. aTest Pit No. 1..L_ ......minutes per inch Depth of Test Pit.. Depth to ground water....... ......._... Lz, Test Pit No. 2._L__Z....minutes per inch Depth of Test Pit.................... Depth to ground water....._............... . •. ----•---------------•-----•--•-• --• ---•--•-•-•••-•-• •-••••••---- ......................................................... 0 Description of Soil....... '-.G•• W®oD- i "_/B" k/w S%411C V SoiG x _ ...................L/G/f. F/.'2......Gtn/G ..�`� � .........i�`' _.. TZ?- `..a ------------- VNature 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 AI1LU 5 of the State Sanitary Code The undersigned further agrees not to place the system in operatio*n until a Certificate o i nc as been ' d b the board of health. lg .......... ........................................ ..27 ..._ Application Approved BY (` 'C1 t .........°. ...-'D�e-�� - G Date Application Disapproved for the f ollowin easons:.............................................................................................................._ ...........•--------•---•-•-••-•--...--•••--•----•----------••••---•.....-•••---•••----•••...............------------------------------......---...----------------•-----•-----•---- ••-•-•-•....._ Date PermitNo......................................................... Issued....................................................... Date L 'e No.............. Fim............._............ _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ .......7G'.....................OF....... ��.'�nr-5TF3/3G Appliratiun for Disposal Works Tonutrur#inn "prrntit Application is hereby made for a Permit to Construct (v) or Repair ( ) an Individual Sewage Disposal System at: , ra fir,r IVZCZ l�r� 4�Te.o 7- �tj T fr ----------------__.............................:......................................_-......__ •------.-.-.----------.--..........-------•..------•----••---------...._..............___......... Location-Address or Lot No. • rJ Ll�>0,�_ L+ 1/ /-Y/'; rI - L: C .7r �✓'%� T1 7"7e ( r_' r;-L7�� 144e .................. _........... ........................... . .............-------•..........---.........• •-r--____-•---••......._...�..---.........--- Owner Address , 4t:e 6 Installer Address Type of Building Size Lot... `?�. .........Sq. feet U Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder Other—Type T e of Building No. of persons............................ Showers C�1 YP g ---------------------------- P ( ) — Cafeteria ( ) Gr Other fixtures --------------------------•••-•• . .. W Design Flow..........:%j...........................gallons per person per day. Total daily flow...........`.....��....._. ....._._._..gallons. WSeptic Tank—Liquid capacity.�sQ ..gallons Length_ G_....... Width..�_6."... Diameter................ Depth.._`_....... x Disposal Trench—No..................... Width............ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter..... ......... Depth below inlet........ _f...... Total leaching area..... ..............sq. ft. Z Other Distribution box ( ) Dosing tank ( )_ '-' Percolation Test Results Performed by.._ '? "'. "'`1!.` ,`.................................... �" ' • Date-•-----•- .-----------------------•- a Test Pit No. L.:'_._a.....minutes per inch Depth of Test Pit.../4 ........ Depth to ground water...... fiL Test Pit No. 2._�-_ ....minutes per inch Depth of Test Pit....................... Depth to ground water-----_7.............. a •------••-•-----------•---•--••.....-•--•-•---.......--•---•---......-•-------•...-•-••---•-••............................................................... Descriptionof Soil -----....../ ....................................... ---•--•-•-•-•--•-•---•--. - ►'4' /�"- G/�'/J 1i'......................................�..Z? ,/C �! I...... S/.... �G?GL. d1= Z ...G --...........?G..........................................7.................................................... . _?T7.'�7. ----...•/!1/C'/ - :----'/-T��j----------------•----------- U Nature of Repairs or Alterations—Answer when applicable...........................•l_.._._........_............................__...........•.•....._.. -•------------------------------------------------------------------------------------------------•••---•---•-•-•----•---•------•-•-•---------••--•-----------•••••••••........----•----.....••-•••.---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of TITIE 5 of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate�o C ance'tlas been i b he board of health. igited----� .�- .......................... �"� '- �f Application Approved BY x '!U' " �' (� 1�A Date Application Disapproved for the following\reasons_.............................................................................................................. ..........................•--••--••-----------•---....----------•••----•---••--------••-••-••------------•-•--............._......-•----------------................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS 7 BOARD OF HEALTH `.`:'.h1�r.......oF....... /r�c 1vsT./I....... .."............. Trrtifiratr of Tontphaurr THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed (f or Repaired ( ) roc i 7-1 ,- G' 6 ti,-kt'.�19L -. j, Ipsta ler (\� - at.................... _ �.- ---------•--•....-•--------------•--••--••••-•-•............._...•-•-•---••-•--•••---..........._ has been installAd in accordance with the provisions of TI T Lr, 5 of The State Sanitary Co4eas scribed in the r_. application for Disposal Works Construction Permit �'o.. '��. ....�:���a... dated_._......YY. .�_� �--------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL F TION SATISFACTORY. _77- 2/ DATE4� 0 . ....................... Inspector...... _.....__............_....._.:::. >_. THE COMMONWEALTH OF MASSACHUSETTS -� BOARD OF HEALTH r............7 �^'ni OF �, �r�s7;JI- 6C No......................... ..... Disposal Works Tonslrlwiion Irrmit Permission is hereby granted.............ft e e�-1 Co�S'f'e�'c't ry 0 ......... ......................•------••--................... ...... to Constru ( or gepai ( J an In idua Sewage Deposal Systtm, at No... 1 j { 6 d� { K IF(Z J� It.. c lZ Yam` �'.�,. 1 ------•--•-•-•------------- ..--..--------------...--•--•• ---- - ------ ._..... ... Street as shown on the application for Disposal Works Construction Permit No. '...a Dated..,_(,aQ---t�4-_-_-----6-------.-.-. DATE. _ _ oard of Health ---•--------------- FORM 1255 A. M. SULKIN, INC., BOSTON I • F.G. �� . ' `, ' A?i%tzox. t2 a FG. y? 1 1500 Gallon v Top El. 79 Septic Tank -.1. _ z - Sot.E! �p Liz_ t • r. -_ ��,�: may. — / Bedding as Pet? Title 5 0 5,,.� DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM " 0 o Not to Scale / QQ T�L / Z�' s r^ Finish Grode TEST HOLE -1 F Filter 7/2/02 EL. 42 Fabric_—� 'Cornpa:fed Fill MULCH PROPoSsD2" 41.83 LAYER 10YR 3/6 HOVS COOL POOL-SE a Psc" A Stone DARK YELLOWISH BROWN a % `� 9Q ;., EL ' 12" MED. SAND W1 SOME SILTS 41 gAS ?tv.chInq B LAYER 10YR 4/6 rnber 3/4"-1 1/2' DARK YELLOWISH BROWN _7 C> :] Double Wasfied ` stone 29" MED. SAND 39.58 S PA I -to ! C LAYER2.5Y 6/6 OLIVE YELLOW COARSE SAND CROSS SECTION OF CHAMBER 122" NO GROUNDWATER ENCOUNTERED 31.83 NOT TO SCALE. APPROX.GROUNDWATER @ EL.5 CD GROUNDWATER ZONE: AP / Design Data N OF / \ Pool House-No Bedrooms \ Designed for 2 Bedrooms w/ S )a \ No Garbage Grinder 00,297 Daily Flow=110 x 2= 220 GPD Ch% Septic Tank:220 GPD x 200%=440 GPD Use 1500 Gallon Septic Tank o 0 o Leaching Area 220 GPD/0.74=297 SF Required EX lS T I N v Sidewall=2(8'+23')2=124 SF E X I S T I N y S E PT=tC Bottom Area=8'x 23 =184 SF SY 5T_M -)_=L►N.G 308 SF Total Provided SITE PLAN Leaching Chamber Design PROPOSED SEPTIC SYSTEM / All Pipes to be Schedule 40. Use 2-500 Gal. Leaching Chambers in a AT MAP 075 f Ai'C E L O21 $'x 23 `"ached Stone Field as Shown. 162 BAXTERS NECK ROAD LOT F R ^ p ` MARSTONS MILLS, MA ���` � I V I �1�t\�C BY „ NOTE: Topography Shown was Obtained SULLIVAN ENGINEERING From the l OSTERVILLE, MA ,L Z I O Town Of Barnstable G.I.S. Maps. DATE: JUNE 28, 2002 t _ t t TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS 4"CAST IRON 2��MAX. m 12"MAX. ' Aft OR SCHEDULE 4� 4"SCHEDULE 40 PVC.(ONLY) y , P.V.C. PIPE PIPE- MIN. LEACH i ,• PITCH 1/4"PER. PITCH I/4"PER.FT PIT PRECAST •'• J "• LEACHING i �_ �� / / / ! \ •• EL.4WB.T- R.. �INVERT� NVERT i . �? PIT OR SEPTIC TANK El 'f?.g.9 DIST. �¢7.58 >_ EQUIV. 1 _ �. } .• INVERT GAL. INVERT BOX , *- �, .4 I 3O �/ //'' / / . ,. .SoO INVERT W W p. :�: / p - 0 9L Q' 3 4 TO I V2 �,, i •, EL. ? :.`f.. EL'f77+� 4 o .•: ,a o: .• . WASHED STONE Jr WDIA. OF E +GROUND WATER TABLE PR OR OF SEWAGE DISPOSAL SYSTEM =- .Pc--ram o�-s efA r7�z/,9 c. NO SCALE t Z V��/F/E7J rAT 77I�`' WITNESSED BY : SOIL LOG GATE M`�Y �� .� TIME. . ... . . :. .. f�?/1£� Co.uLt�..• BOARD OF HEALTH . . it srZVv4C WiGSa./ d 6se . . . . ENGINEER 45 TEST HOLE 1 TEST HOLE 2 65 \ ELEV. . .S/, -- - - ELEV. .4`�:3a. . . DESIGN DATA '. $ve-soif. NUMBER OF BEDROOMS . .. . . . . . : . . . i -. _ ' ` _ �', - \ � ` EZ ✓r/�•3o � �1- �7.�u TOTAL ESTIMATED. FLOW . GALLONS/DAY - - \ orsir, F �,o_ CdoSG' BOTTOM LEACHING AREA 7e'J�'. . SQ.FT. /PIT`C.P.D. rE3T * ` N \ \I, \\ w qco oG S7TZg�if7rD SIDE; LEACHING AREA . . ��3f: :� . . SQ.FT./ PIT/47, C RD, Z GrivE�.-fev. ' \ E2. �J.Sa $qn.D GARBAGE DISPOSAL .Y;!5 . (50% AREA INCREASE) Tom/' °F 1' �.3Y- �. � o � ` �o srrarrfiev TOTAL LEACHING AREA . . SO.FT 77 PERCOLATION RATE L�3s /�^' 7w" MIN/INCH �d'Ync LEACHING AREA PER PERCOLATION RATE .��c'a.. SQ.FT./c,RD, j Lr. it I WATER ENCOUNTERED y �sT� WiTX� NUMBER OF LEACHING PITS ., 7,Lvo, � 1 `� �. 4 B� , { - _ _ .� \ . . ;�-Z"7,-,6f• --577>it/�r dam/ v6}2L. /DE5 - LaT APPROVED BOARD OF HEALTH 7Wo . lo a _ ` \ _ Pr L De v LID OF Zo.� 6E. .•c 4 �Ji -nit As, \\ / �J �� �/ 11 �-= $.t A'P�4tAd' r r 46 44 r r' /✓aTGc` Co.�7rit�.C�S f'��� ON �9 /-LAr_i /�G" �/q cl-1 AS �O7 ' /j IV ey 7-�,,T-s P,17 P TS f'�