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HomeMy WebLinkAbout0105 BISCAYNE DRIVE - Health 105 BISCAYNE DRIVE, MARS.MILLS A= 012.013.008 r Commonwealth of Massachusetts of a -013 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Biscayne Drive Property Address Kathleen Evaul Owner Owner's Name information is Marstons Mills V, Ma 02648 4/28/2021 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information c51 5�o�f filling out forms on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. Co pang A Lane Co� mpany Address Centerville Ma 02632 Cityrrown State Zip Code 774-248-4850 smjonestitle5@gmail.com, SI4522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 4/28/2021 Inspector's Signatur Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Biscayne Drive Property Address Kathleen Evaul Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/28/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The property located at 105 Biscayne Dr Marstons Mills is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and 3 precast leaching chambers. Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Idle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I" Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 105 Biscayne Drive Property Address Kathleen Evaul Owner Owners Name information is required for every Marstons Mills Ma 02648 4/28/2021 page. City/Tcwn State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �n 105 Biscayne Drive Property Address Kathleen Evaul Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/28/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts in Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 105 Biscayne Drive Property Address Kathleen Evaul Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/28/2021 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure .criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a 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 CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 f c Commonwealth of Massachusetts Title 5 Official Inspection Form I. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 105 Biscayne Drive Property Address Kathleen Evaul Owner Owners Name information is required for every Marstons Mills Ma 02648 4/28/2021 page. Cityrrcwn State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I.- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments e 105 Biscayne Drive Property Address Kathleen Evaul Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/28/2021 page. Cityrfown State Zip Code Date of Inspection D. System Information 1. 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): 443 gpd provided Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes E. No Last date of occupancy: current Date t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �e Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � 105 Biscayne Drive Property Address Kathleen Evaul Owner Owners Name information is Marstons Mills Ma 02648 4/28/2021 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 105 Biscayne Drive Property Address Kathleen Evaul Owner Owners Name information is required for every Marstons Mills Ma 02648 4/28/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: system repaired 9/2005 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 6 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.): 2 Inlet tees in tank. Sewer pipe from house flushed without obstruction. Other inlet is from pool house, water to this is off and winterized, unable to check flow. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Biscayne Drive Property Address Kathleen Evaul Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/28/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) Tank is original for house and under 5'of cover. Outlet cover was not located If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 4 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Measurements not taken due to depth of tank Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank is 5' below grade, inlet cover is on a riser 6" below grade. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form �- a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 P Y rY 105 Biscayne Drive Property Address Kathleen Evaul Owner Owners Name information is required for every Marstons Mills Ma 02648 4/28/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doe•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form !." Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Biscayne Drive Property Address Kathleen Evaul Owner Owner's Name information is required for every Marscons Mills Ma 02648 4/28/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Cate of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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 was not located t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts !� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �n 105 Biscayne Drive Property Address Kathleen Evaul Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/28/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Biscayne Drive Property Address Kathleen Evaul Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/28/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments note condition of soil signs of hydraulic failure level of ponding, damp soil condition of vegetation, etc.): Leaching facility consists of 3 precast leaching chambers in a 40.5 x 10'x 2'trench. Chambers were video inspected from vent and found dry with clean interior and no sign of past overloading. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 105 Biscayne Drive Property Address Kathleen Evaul Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/28/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form I a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . � 105 Biscayne Drive Property Address Kathleen Evaul Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/28/2021 page. City/Tcwn State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 0 � t 2 � ,A Z �$ ear 92 53 6 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 105 Biscayne Drive Property Address Kathleen Evaul Owner Owner's Name information is Marstons Mills Ma 02648 4/28/2021 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Biscayne Drive Property Address Kathleen Evaul Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/28/2021 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 TOWN OF BARNSTABLE LOCATION _�4S �`S��¢v� �� SEWAGE # .Is AGE /�/®I/S ASSESSOR'S MAPS& LOT INSTALLER'S NAME&PHONE NO. ' SEPTIC TANK CAPACITY l���' 6re- LEACHING FACILITY: (type) JLV 4MV e&"iey (size) /O�c S�O.f ie.Z NO.OF BEDROOMS —�� BUILDER OpS ter' PERMITDATE: 9-� °��' COMPLIANCE DATE: Separation Distance Between the: �f'" 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) �$ d Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by rare ��� ���� ��o �--� �� Q � Q �Ir a�' \ 9'�` �k �� No. — ~ ' Fee �� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rpplication for Migpozaf *pztem Con5tructiun Permit Application for a Permit to Construct( )Repair(/Upgrade( )Abandon( ) D Complete System El Individual Components Location Address or Lot No. dD5 Owner's Name,Address and Tel.No. Asses or's Map/Parcel n /4?`l�S Installer's Name,Address and Tel No. Designer's Name,Address and Tel.No. 4 71010,�C) e ms, Type of Building: Dwelling No.of Bedrooms Lot Sizesq.ft. Garbage Grinder Other Type of Building.,9 95 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �Z D gallons per day. Calculated daily flow 7� gallons. Plan Date S � Numbe of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil /��t 70is ✓� z Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b is oar He lth. ��� _ Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. � —�Y N Date Issued q, 71� Fee� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes Z PUBLIC HEALTH DIVISION:-TOWN OF BARNSTABLE.,,MASSACHUSETTS ZIppYicationlor Migogal *pgtem Congtruct on Permit Application for a Permit to Construct(µy)Repair(/ )Upgrade( )Abandon( ) 0 Complete System U Individual Components Location Address or Lot No. SOS Owner's Name,Address and Tel.No. Assessor's Map/Parcel 2 --.8� �� s�nt�s AVA Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms # Lot Size q� ,_A?e sq.ft. Garbage Grinder Other Type of Building.,9 P 5% 7`'Oef No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow L _ gallons per day. Calculated daily flow J' 7. 3 gallons. Plan Date Number of sheets Revision Date 1 Title Size of Septic Tank f//)mvp 6�42_/ Type of S.A.S. :S`G'ly *al Description of Soil• Nature of Repairs or Alterations(Answer when applicable) Date last inspected: - Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b ,thus Board-o, Health. Signed �/� --�'�' Date ?/41s- Application Approved by Date /1 Application Disapproved for the following,reasons y t � 1 � Permit No. : a24' —q'y N Date Issued q "]1! THE COMMONWEALTH OF MASSACHUSETTS ?. BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the ite Sewa.a Disposal System Constructed( )Repaired( f' )Upgraded( ) Abandoned( )by 1 On �//,5 at 1�;-" f.~ /_ z ` ` g _111 'as been constructed in cordance with the provisions oof Title 5 and"the fqr Disposal System Construction Permit No.��� 9��� dated � �7 l Installer Designer. _ fl�L-' . The issuance of this permitit�s 1 n t be construed as a guarantee that the stem 11 c ion as designed. Date '�/ b Inspector THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migogal *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair( V ,U grade( )Abandon System located at &P 1?2_7 1Z.0/0 r 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: Con str ction must be completed within three years of the date of this permit. / Date:_ "7 Approved by /�/ 1 FROM :down cape engineering inc FAX NO. :15083629880 Sep. 20 2005 03:51PM P2 � � u eiac����ve / INV OUT S.TANK — 74.36' 1 / LOT 20 ^ " s0' INV IN DBOX — 74.06' ,9.1200 90.FT. INV OUT DBOX — 73.90' INV IN CHAMBERS — 73.34•' TOP CHAMBERS — 74.1' / r Cal 4 n'.Q N�NK- -- or A / y / caNCREre PPno Fi-7n.aSOL . POOL SHED y 1 �J L,� I / I �. 4 PV8,'PIPE.POOL 9Hm� 1 / MEAcnauma u10 mar msA&£) , i / / / JOB # OS•-203 SEPTIC AS-BUILT PLAN LOCATION 105 BISCAYNE DRIVE MARSTONS MILLS', MA SCALE ; 1 " = 50' DATE : SEPTEMBER 19. 2005 PREPARED FOR: REFERENCE ; LOT 20 PA 434 PG 95 BORTOLOTTI ASSESSORS MAP 12 PARCEL 13-8 C , RUCTION I HEREBY CERTIFY THAT THE SEPTIC SYSTEM ��,��t�0��q s9 ��;114 OFu4pS SHOWN ON THIS FLAN IS LOCATED ON THE C, ��P 9�c GROUND AS SHOWN HEREON. �0 ARNE G �o ARNE H c. H. 'T OJALa If 8-362— CJALA ii) v to 5aa JA2 u880 eAa No. 26348..E 4 CIVIL 0792 N down cnpe engineering, ink. 6� OF_ oa T� r S � CIVIL. ENGINFFRS :iURV LAND SURVEYORS 9.39 DATE REG. SURVEYOR main st, yarmaith, ma 02675 I FROM :down cape engineering inc FAX NO. :15093629geo Sep. 20 2005 03:51PM P1 Town of Barnstable Regulatory Services Thomas F. Geiler,Director a►nr LZ rr,.S& Public Health Division Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862.4644 Fax: 508-790-6304 Installer & Designer Certification Form g Z �--� Date: ,// Sewage Permit# Oo Assessor's Map\Parcel 1 Z /3 Designer: Installer: �t Address: Address: On �� ry�l0 ! was issued a permit to install a (date) (installer) i septic system at &,4ele based on a design drawn by dress) �7QZrvj dated designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e- greater than 10' lateral relocation of the SAS or any ygilicAl relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built designer to follow. 4 f^ c/c.-e _ISAofM�SsC Onst er's Signature) ;�� ARNE H s; OJALA CIVIL N e No. 30792 (Designer's Signature) (Affix D Here) LEA REnM TO BARN.TABL PUB H TH DIVISION. CERTIFICATE OF COMPLIANCE WU L NOT BE ISSUED UNTIL BOTH TIJIS FORM AND BUILT CARD ARE RECEIVED BY THE BARNSTABLE PVBLI HEALTHDMSION. TH NK YOU. Q;I•Iea1tIV9eptirlDcsigncr Certification Form 3-26-04_doc CERTIFICATE ®F ANALYSIS Page: 1 ^;,.:-I `.>• ip Barnstable County Health Laboratory Report Dated: 9/18/2005 Report Prepared For: Rick Shechtman Order No.: G0532489 Kinlin Grover GMAC P O Box 156 Barnstable, MA 02630 Laboratory ID#: 0532489-01 Description: Water-Drinking Water Sample#: / Smnplin anon: 105 Biscayne Dr.Marstons Mills,MA Collected: 8/15/2005 Collected by: Customer Received: 8/15/2005 Routine ITEM RESULT UNITS _ RL MCL Method# Tested LAB: Inorganics Nitrate as Nitrogen 0.59 mg/L 0.10 10 EPA 300.0 8/15/2005 LAB: Metals Copper BRL mg/L 0.10 1.3 SM 3111B 8/16/2005 Iron BRL mg/L 0.10 0.3 SM 3111B 8/16/2005 Sodium BRIE mg/L 1.0 20 SM 3111B 8/16/2005 I.LAB: Microbiology Total Coliform Absent P/A 0 Absent P/A 8/16/2005 LAB: Physical Chemistry Conductance 340 umohs/cm 1.0 EPA 120.1 8/15/2005 pH 7.6 pH-units 0 EPA 150.1 8/15/2005 Water sample meets the recommended limits for drinking water of all the above tested parameters. Approved By: (Lab ector) t �. i C - r.; ... �.o', M RL = Repgrting Limit MCL=Maximum Contaminant Level ' ' Superior Court House, PO. Box 427;`Barnstable, MA 02630 Ph: 508-375-6605 CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory Report Dated: 8/19/2005 Report Prepared For: Rick Shechtman Order No.: G0532489 Kinlin Grover GMAC P O Box 156 Barnstable, MA 02630 Laboratory ID#: 0532489-01 Description: Water-Drinking Water Sample#: 32489 Sampling Location: 105 Biscayne Dr.Marst.ons Mills,MA Collected: 8/15/2005 Collected by: R.S. Lap 12 P. cel.013-008:= —- Received: 8/15/2005 Routine ITEM RESULT UNITS RL MCL Method# Tested LAB: Inorganics Nitrate as Nitrogen 0.59 mg/L 0.10 10 EPA 300.0 9/15/2005 LAB: Metals Copper BRL mg/L 0.10 1.3 SM 311 IB 8/16/2005 .'Aron - BRL mg/L 0.10 0.3 SM3111B 8/16/2005 Sodium BRL mg/L 1.0 20`• SM3111B 8/16/2005 LAB: Microbiology Total Coliform Absent P/A 0 Absent P/A 8/16/2005 LAB: Physical Chemistry Conductance 340 umohs/cm 1.0 EPA 120.1 8/15/2005 pH 7.6 pH-units 0 EPA 150.1 8/15/2005 Water sample meets the recommended-limits'for drinking water of all-the above tested parameters. _ � Approved By: (Lal -lector) RL ='Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 LJ2 - No. ----e3--------00 -- Fee----�---`�-------- BOARD OF HEALTH TOWN OF BARNSTABLE Zipplicat ion-for Vell Con5tructionpermit Application is hereby made for a permit to Construct ), Alter ( ), or Repair ( )an individual Well at: --�D _—,C�iS��!U� nl�• - 012-0 (3--Do? — Location — Address Assessors Map and Parcel Owner Address Installer — Driller Address Type of Bu'_ welling _----------------_—__------- Other - Type of Building—=- ---- No. of Persons— ---- — Type of Well��1��/ Capacity -------- ----- Purpose of Well-- -- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Cer ' icate of Compliance has been issued by the Board of Health. Signed — -- d to Application Approved By --_— 2 11 6 3 — date Application Disapproved for the following reasons: ---------- --- -------------- - -------- ---- date tj Permit No. 200-2 — Issued 'e GI X0 3 -- - -- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by— -- Installer at has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private We P otection Regulation as described in the application for Well Construction Permit No.W g_00 3"Oo3 Dated Z � — THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-- - Inspector ��-=-------- BaRD OF HEALTH TOWN OF BARNSTABLE ZppYica ion-for Vell Con0ructionpermit Application is hereby made for a per l to Construct ( \� Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel Owne Address Installer — Driller �— i j Address Type of Building t,l welling — --- ---------- \\� \� Other - Type of Building-- -- No. of Persons--- Type of Well ' — —-- Capacity------------------- Purpose of Well — i Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Cer ' icate of Compliance has been issued by the Board of Health. Signed t11� Application Approved By -- ----- Z /I d 4 date f. Application Disapproved for the following reasons: -------- ____ —_ _ date —� Permit No. 200 3-f•�3 — Issued--- 2 f! — -- - —- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) _Installer has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.W2LQ3 "�03 Dated �4 ---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-- Inspector---------- -- --- --- BOARD OF HEALTH TOWN OF BARNSTABLE Yell Corigtruct ion Permit No. Fee Permission is hereby grantedto Construct ( ), Alter ( ), or Repair ( ) an Individual Well at: 1 No. — /D.� /�li - Street as s_ 2n the application for a Well Construction Permit . �_00 2 163 as shown on t Dated-�' 1, - Board of Health DATE 2 � � -- .� l C ��s� h�/� I TOWN OF.BARNSTABLE LOCATION /--O / (")PyVCSEWAGE # j VILLAGEAc, tCroAT /nIlK. ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. ��' (��is��� gr_�-au SEPTIC TANK CAPACITY /,6W LEACHING FACILITY:(type) Le-llL Pj"I (size) % NO. OF BEDROOMS_ :RI WEL OR PUBLIC WATER BUILDER OR OWNER 1,112GeA &)ftf .,e J. DATE PERMIT ISSUED: a� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 7715) e 1 1 l" K, t No................_..... Yzim..............: THE COMMONWEALTH OF MASSACHUSETTS ,�- D f 2 01.3 BOARD OF HEALTH oF.............. ..sT ........ Appliration for R-4posal Works Tanstrurtion tirrmit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at Loca on-A re s or t o. Owner Address . .............................. �... Installer Address Q Type of Building Size Lot...... _O..Sq. feet v Dwelling—No. of Bedrooms........... -----------------------------Expansion Attic (40 Garbage Grinder ((�) p Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixture-- ---------............... . . . ...... W Design Flow...................... � __=_� llons per person per day. Total daily flow............... ....._._..__....._gallons. 9 Septic Tank—Liquid'capacity._ gallons Length................ Width................ Diameter__._____-___--_ Depth................ Disposal Trench—No..................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed _e...(--�_ ... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •----------------------------------------•-•--•-••---------•----------............-•--------•-------......................................................... 0 Description of Soil---------------------------------•------........----...............-----•-----------•------------------•----------------t--------------------------------------.------ x W e r - U Nature of Repairs or Alterations—Answer when applicable._-__0E=51G1VTIV� ENOIP�E fI h�DuT �F °�F. INSTALLAT1t3N--i�NDE C•E�„�tl-`—_, IVP'T NIG------- THE-SY`S'i€M•ifVA;S Agreement: A%ORPANCE TO PLAN. The undersigned agrees to install the aforedescribed Indivi ual ewage Disposal System in accordance with the provisions of iT: y g g p . y 5 of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has:bee ued the board of health. lSigned.. .... .:........._..--• -•- •-•------- -....-----------------• ---- -t---- --- ..._ Application Approved By--•-----�-".. . ---M �--------------•-------•----•----•-•--. 2 Date Application Disapproved for the following reasons:-------•------------------------•-----------•---•-------------.-------------•_-.. ......•_ -----.......» ----------•---------•----•--••---------------------------------------------•--------------......------....--•--•--•--•----------------------------------------•------------------------------------------ ��' - L./ Date Permit No. C ---- --------- --------- Issued...» _ �. .� ..... ate a a r Noel �.. FES-- ... THE COMMONWEALTH OF MASSACHUSETTS .E- D 122, 0 BOARD OF HEALTH - f � , 1. OF.............. . .-.' . °= ............ Appliratiun for Uiipuuttl Works Tonfitrurttun ramit Application is hereby made for a Permit to Construct (y) or Repair ( ) an Individual Sewage Disposal System at ................ ........ - r f _ -E............................................. ` Loc lion Adores �, or Lot No. ---..:... _._�'-t -- .. ; _._...C... :: ........................._..... W �. F �� �Ow�er � Address..................... . Installer Address �( Q Type of Building Size Lot----------� Sq. feet Y ,/ �--- aDwelling—No. of Bedrooms........... :••.........................Expansion Attic ((sle) Garbage Grinder Nll) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ...... W Design Flow............................` _-__..gallons per person per day. Total daily flow..---------------..._._ ._....................... _.-gallons. 1:4 Septic Tank—Liquid capacity..JOW.gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.. f:V!J,`---%6.,1_F_. .................... .... Date......................................... ,.1 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_._-_------.-.-..-._.-_- ( Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-•••-••••---••-------------•••--•--••••----••••••---••--------...._....--•.......------•-••----._.....--•---•-••---•----•...••-•---••••--------•------..••-- 0 Description of Soil........................................................................................................................................................................ W V •••••-•••••••-••-•••-•••-•--••••-•---------•-•-•••••-••-----•••---•-•-•------•.................•-•-•------••--••-••-•-•-•--••••-••-••••--•-•••-•----•••---•-•-----••-•...._......-•-----•-•--•-•--•-•--- W ------------------------------------------------------•-------------------------------------------------------------------------------------------••------•------•--------------------.....-•--••--••- U Nature 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'TTLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee i sued the board of health. / Signed............ = f�� � � i?: ........... � he 6a...... ApplicationApproved By••••-......--•-•-. .................'"---•----•----•-•------•-------•----•-•-•---••---•-• ---- `---8-------------- Date Application Disapproved for the following reasons:------••---------•------•--...------•--•---------------•----•-•---------------....•-•--•---••-•-••••......-•--•- ..-------••-••••-•-•-•-•--•--•--•-•---•................••-•-•---•---••••...._.......••-----••------------••.._..........._..---•--•--••••---•-•--••-••-•••••-••----•-•---•--•••-----•---•-•••-----•----- Date L Permit No.......... :� ......... Issued........... ' 4t-_7��te THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... A)...........OF........���..?..:.����,.�e�`f�.�..6 .................. Trtif irtttr of Toutpliatta TH'S IS TO CEI,TI,Y hat the Individual Sewage Disposal System constructed (, ') or Repairedby ( ) ----------------------------------------------------------------------------------------•........----------------------------- at 5 has been installed in accordance with the provisions of T'!` C of_The State Sanitary Code as desfribed in the G-_-c_application for Disposal Works Construction Permit No..... -_.-_5.. (....... dated-.------ _ -f.-�-_ -�'�_.--._...._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAiiANTEE THAT YHE SYSTEM WILL FUN T N SATISFACTORY. DATE........................ Inspector... ......:.:.:.............. 01�. 3 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......OF........ l ......... F dr J ......................... EE. ,. .........--- iuust1 10orkv Tonotr rrntt Permission s hereby granted_.,::;..-..=�-----. ._.. 2. -----------•-------•-------...............--------....._.........._.... to ConstTucti ( �) or Repair/� an Individual Sewage Disposal Systemp 7 at i�TO. 1 9� v t s 4 ° f ° ">j L__ a`}' C f,j. J.S 1t z t •-•--- --------- ._ --- Street r as shown on the application for Disposal Works Construction Permit N `��.. c�...._ Dated_.__.:'a as ............................... � --------••-•• ............................. DATE- s 7 Board of Health �" FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS � J Departmbnt of Environmental Management/Division of Water Resources WATER WELL COMPLETION REPORT WELL LOCATION Address/moo 1- 4— City/Town G.S.Quadrangle Map Grid Location �r2 ,t�s�y►21 �/e)ofJrn�nt) At- WELL?USE OwnerAddress�UJC � -"6 ca �CX V%ll 0�-(03 CONSOLIDATED WELL Domestic 9 Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones Method Drilled T7//)UgQX 1) From To 2) From To Date Drilled q 30 - 3) From To -- ' 4) From To CASING it Depth to Bedrock Length �Ro Diameter Type 10V, UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface J16 , Sand: fine❑ medium❑ coarse( Date measured 9-36- S;7 Gravel: fine❑ medium❑ coarse❑ GRAVEL PACK WELL Screen: Yes ❑ No Slot#/_length -,3 from 100 to 63 Split Screen (or 2nd screen) WATER QUALITY TESTS MADE Slot# length from to Chemical ❑ Biological; Depth To Bedrock PUMP TEST Drawdown feet after pumping days hours at GPM. How measured Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To O l C/ d 3 DRILLER cb ti 4v,l 2 Firm 1.c111ord Well Drilling CAG 15-6 Address .- 0. Box 430 City Sn. %rmouth. M7{ 02664 Registration No. i T Operator's ignature Please print tirmly CUS_T_OM P. COP, 15M-2 84-176>471 • Log' Number: • 7190 Bottley# E 735 Date: October'5. 1987 BARNSTABLE COUNTY HEALTH.AND ENVIRONMENTAL DEPARTMENT SUPERIOR COURT HOUSE ' BARNSTABLE, MASSACHUSETTS 02630 o • Ass DRINKING WATER LABORATORY ANALYSIS PHONE: 362.251 1 Ext. 337 Client: Greenbriar Development Corp. Collector: Clifford Well Drilling Mailing Address: Box 510 Affiliation: Well Driller Centerville, MA 02632 Time & Date of Collection: 1011/87. 9:3Oam Telephone: Type of Supply: Well Sample Location: Lot 20 Biscayne Dr. Well Depth: 63' Marstons Mills, MA Date of Analysis: 1 Q/1/S7s 1 :05pm PARAMETER SAMPLE RESULT RECOMMENDED LIMITS Total Coliform Bacteria/100 ml 0 0 H 5.3 Conductivity (micromhos/cm) 69 500.0 Iron ( m) <.1 0.3 Nitrate-Nitro en ( m) 0.8 10.0 Sodium ( m) 5 20.0 I • XX Water sample meets the recommended limits for drinking of all above tested parameters. II . Based only on results of the parameters tested for this sample, the water is suitable-.for drinking but may present the problems checked below: A. Water sample has higher than average levels of. Nitrate. Future monitoring is recommended (2-3 times per year) to establish any upward trends. B. The low pH of the water may shorten the useful life of the house's plumbing. C. Water may present aesthetic problems (taste, odor, staining) due to D. Water sample has high levels of sodium. Persons on low sodium diets should consult their doctor. III. Due to one or more of the reasons checked below, this water sample is unfit for human consumption: A. High Bacteria B. High Nitrates The Barnstable county Health and Environmental REMARKS: Department shall no interpretations or conclusions made by anyone else concerning these results without written consent. ------___Barnstable' Board' of Health CC: Clifford Wef 1' Drilling CC. N` Laboratory Director 1 /7/85 __- . � 1 Explanation of Test Results Total Coliform,Bacteria Coliform bacteria are an indicator of the sanitary quality of a water supply. Water supplies may become contaminated from malfunctioning septic systems, cesspools and surface runoff. A total coliform count of zero indicates that your water supply is safe and approved for human consumption. A total coliform count of greater than zero is most often the result of accidental contamination of the sample bottle through improper sampling methods. For this reason, it would be advisable to retest any well water that is not approved. PH PH is the measure of acidity oralkalinityof the water. On the pH scale,the number 7 is neutral, less than 7 is acidicr and more than 7 is alkaline. The pH of water on Cape Cod tends to be acidic in the range of 5.0 to 6.5. Conductivity Conductivity is a measure of the dissolved salts in solution.,Amounts in excess of 500 micromhos/cm are generally considered unacceptable and may have a laxative effect upon users. Iron The presence of iron in water in concentration of..3 ppm or greater may: give the water a bittersweet astringent taste, cause an unpleasant odor, often gives the water a brownish color and cause staining of laundry and porcelain. The average concentration of iron in Cape Cod's water is .2 - .6 ppm._Although the.presence of iron in water may cause the problems listed above, it is not considered deleterious to health. Iron may be removed by use of an iron removal system. Nitrate-nitrogen The Massachusetts Drinking Water Regulations have set a maximum contaminant level for nitrates at 10 ppm. Excessive concentrations may cause methemoglobinemia (an infant disease) and have been suggested to form potentially carcinogenic nitrosamines. Contamination sources include fertilizers, cesspools and industrial wastes. Copper Due to the acidic nature of the water on Cape Cod, copper tends to leach from'pipes. This normally does not present a health hazard; however, concentrations in excess of 1.0 ppm may cause,a metallic taste, and/or a bluish-green stain on porcelain fixtures. Sodium A concentration of sodium over 20 ppm is only,of concern to people who are on a low sodium'diet. If.the water irvisupplyhas more than 20 ppm sodium,it is up to the people who are on such a diet to find another source of drinking <a titer.or contact their doctor to determme'if consuming the water is advisable. Concentrations exceeding 50 ppm ,,,,,indicate that tliere may be ocean water or.-r'oad salt runoff water getting into the well. j. - r . d LEVY, ELDREDGE & WAGNER ASSOCIATES, INC. ENGINEERS-LANDSCAPE ARCHITECTS-PLANNERS LAND SURVEYORS 889 WEST MAIN STREET CENTERVILLE,MASSACHUSETTS 02632 (617)775-2244 April 4, 1988 The Greenbrier Corp. P. O. Box 510 Centerville, MA 02632 Dear Mr. Covill; Transmitted herewith are three (3) copies of the as-built septic system for Lots 14 & 20 Biscayne Dr. Barnstable, MA. The septic system has been installed as indicated on the enclosed plan. Very truly yours, LEVY, ELDREDGE & WAGNER ASSOCIATES Paul e , PAL/mlw #1027 88 WAVERLY STREET FRAMINGHAM,MASSACHUSETTS 01701 LEGEND 4� ASSESSORS MAP 12 PARCEL 1 3-8 100.0 PROPOSED SPOT ELEVATION _ BISCAYNE DRIVi � WAKEBY ROAD \ / 100x0 EXISTING SPOT ELEVATION 100 PROPOSED CONTOUR \^ 100 EXISTING CONTOUR \`� - 3. I Z EXIST. I WELL 83.2 / A i Z I 00' 83.4 R S GOMMODOR � G /V F 82.1 / 7,5 D / 63.1 O' LOT 20 BOARD OF HEALTH 49,120± SO. FT. 'fie/z LOCUS 3 -� APPRDVED DATE MA DECK Qi G 1 V� U U J 0 / LOCATION MAP Q�P\ \•C 8t.a EXISTING DWELLING / 8 TOP FTION 83.a' / ?k 1.5 t I � , BENCH MARK - CORNER OF 8D / NOTES: CONCRETE PATIO EL. = 76.0' EXIST. USE 79`�V 8 1 aEGK 1 t?,ICT. ST / 0 5�-- 1 F L (`:=E NOTE) 1. DATUM IS APPROXIMATE NGVD / + 77.E 1, 2. MUNICIPAL WATER IS NOT EXISTING 81.9 �U i °^' 8c_ 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT: 7 '-",2 / ' 4. DESIGN LOADING FOR ALL PRECAST UNITS TG BE AASHO H- 10 . / o + 75.5 ^ SHED \I 82.0 5. PIPE JOINTS TO BE MADE WATERTIGHT. 7 OAKS % 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. / m ez.o ENVIRONMENTAL CODE TITLE V. I 175.3 a1s 828 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE 7 . z,3 USED FOR LOT LINE STAKING. 7 .. 7a. ` �sa 6 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. U.POLE WITH FLOOD LIGHT / +�S'1 �/ (L�' _ JUNGLE GYM / SCHED 40 ELEC. PVC �' 78.2 /y "ty p 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT UNDERGROUND (LOCATION , 75 + 78.3 o= ' ,GARDEN PLANTIN INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED UNKNOWN NOT VISABLE) I i�`� ® /¢ �p / j. 6, ( FROM BOARD OF HEALTH. 4- aa / �p "OAK }63.1 / 10. PUMP & REMOVE (OR FILL WITH CLEAN SAND) EXISTING LEACH PIT. -� 78.7 t 7a- GO`' 7S0 79 74.0 '+/ Il y eos TO 4yfC POOL 78.4j ( C 2 18.3 ��e575a 78 GO`,G SHED ? . H SHEET 1 OF 2 78. ^ � 7 ° TITLE 5 SITE PLAN a 78.4 se. �+ 78.6 OF 105 BISCAYNE DRIVE i \ 7e5 + 78 4" PVC PIPE 10 POOL SHED_ IN THE TOWN OF: WITH BATH i +\++'78.2 / PER KE CHOOM FROM(OWNERN - _ _( MAR TONS MILLS) BARNS TABLE ABLE UNDERGROUND AND NOT VISABLE) PREPARED FOR: BO RTO LOTTI O / CONSTRUCTION/DAMERY e.sae wz aeeo / H OF MASS �(H OF 6lc� 30 0 30 60 90 I I down cope engineering, inc. ARNE �o�' ARNE H CIVIL ENGINEERS H• OJALA LAND SURVEYORS Uo OJALA o CIVIL Nm SCALE: 1" = 30' DATE: AUGUST 30, 2005 4 0. No.26348 N 079 j 939 main st. yarmouth, ma 02675 0 C' OFESS�O� � G7 T NAL 05-203 / ARNE H. 0 , P.E., ATE a / I , 1tt i SYSTEM P'R ❑ FILE TOP FNDN. AT EL. 83.4' — ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) ACCESS COVER (WATERTIGHT) TO MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM ELEV. 78.4' RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE FOR FIRST Z EXISTING 1000 BASEMENT SLAB AT GALLON SEPTIC 77 0'+* 76 8' ELEVATION 76.3' TANK (H- 10 ) GAS (RE-USE) BAFFLE o0000`�3 76.13' o 76.30' oo � [� o0 0 0000 0000 76.0' DEPTH OF FLOW = q o o a o a a o 0 0 0 6" CRUSHED STONE OR MECHANICAL [] 0 0 0 0 Q 0 TEE SIZES: COMPACTION. (15.221 [2]) �0 2' o a o a o a a a o aSo 74.0' INLET DEPTH = 10 c� ( 1 % SLOPE) ( 1 % SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE OUTLET DEPTH = 14 - FOUNDATION EXIST. SEPTIC TANK 64' D' BOX — 15' LEACHING FACILITY *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL UTILITIES AND ,ALL 1 . TEST HOLE LOGS BUILDING SEWER OUTLETS AND ELEVATIONS 5.5 PRIOR TO INSTALLING ANY PORTION OF j LISA LYONS, RS SEPTIC SYSTEM ENGINEER: THE INSTALLER SHALL CONFIRM MINIMUM SEPTIC D. DESMARAIS, RS TANK SIZE OF 1000 GALLONS, AND DETERtrlINE ? WITNESS: SUITABILITY FOR RE-USE. REPLACE WITH 1500 GAL. _ DATE: 8/29/05 TANK IF NOT SUITABLE FOR RE-USE & ADD PERC. RATE _ < 2 MIN/INCH REQUIRED TEES AND GAS BAFFLE 68.5.' CLASS I SOILS P# 11070 SEPTIC DESIGN: (GARBAGE DISPOSER is. NOT ALLOWED ) ELEV. 0" 79.5' 0" Q 80.1' DESIGN FLOW: 4_ BEDROOMS (110 GPD) = 440 GPD A A USE A 440 GPD DESIGN FLOW I'S LS SEPTIC TANK: 440 GPD ( 2 ) = 880 5" 1OYR 5/3 4„ 10YR 4/2 - USE A 1000- GALLON SEPTIC TANK (RE-USE EXIST. - SEE NOTE) B B LEACHING: LS LS SIDES: 2(40.5 + 9.83) 2 (.74) = 149 SHEET 2 OF 2 1OYR 7/4 10YR 7/6 BOTTOM. 40.5 x 9.83 (.74) = 294 TITLE 5 SITE PLAN 29 77.1 26 77'9 TOTAL: 598 S.F. 443 GPD OF 105 B I S C AY N E DRIVE USE (3) 500 GAL. H-10 CHAMBERS (ACME OR IN THE TOWN OF: PERC C C PERC EQUAL) WITH 2.5' STONE AT SIDES, 3.5' AT ENDS (MAR STO N S MILLS) BARN STABLE AND 4' BETWEEN UNITS - _ CS CS H OF�,/qss PREPARED FOR: BO RTO LOTTI 2.5Y 6/4 �o`�� ARNEH 9°ti� CONSTRUCTION/DAMERY 10YR 5/6 o OJALA CIVIL % SCALE: 1" = 30' DATE: AUGUST 30, 2005 No. 792 132" 68.5 120" 70.1' NGWE N W GE ARNE H. P.L.S. DATE 05-203 1 20 FT MIN. i TOP of FOUND . SOIL TEST EL. s i0. 10 FT MiN. I � As DATE OF SO 1 L TEST _ `'• 1 C � r'-;p:, 27 CONCRETE 4.. Y W i TNESSED BY TE ;�' +i SCH 40 P C PIPE CLEAN SANG COVERS MIN PITCH 1/8 PER FT. PERCOLATION, RATE MKI INN OBSERVATION HOLE I OBSERVATION HOLE 2 ,,. 12 CON 0 ERS 2"RETE LAYER OF ELEV. ' c_� ELEV. CAST IR N PIPE 69. Z (OR EQUAQ MIN. 1/8"- 1/2" WASHED 1 PITCH 1/4 PER FT x - STONE TOP i Sv6Soi L EI EV 3 - i 7 FLOW L INE MEOIIJM 5A?4D EL ' 11 MIN. _ - - L.s /L 19 2'0i" EL ' �- 7 -EVE �ol .�i .J _� Z 03,4 EL=fie: �Z O; - � © '��z.� D I S T EL. _ � _ s � o EL 1�.. -- �`` BOX • • • /0 Z 40 *%TER AT I (a = EL.= � WATER AT -- EL.= --- V 3/4"- 1 1/2" v •i �— � c o Q GALLON WASHED STONE � ;c -9 0 00 ► SG 1 SEPTIC TANK W EL.= r DESIGN CALCULATIONS PRECAST LEA0,ING NUMBER OF BEDROOMS BASIN OR EQUI\, I 2 t Q GARBAGE DISPOSAL UNIT V 6 OIAM' 2 Y ► TOTAL ESTIMATED FLOW SEWAGE DISPOSAL SYSTEM PROFILE IM - GAL /8R /DAY X OR l GAL /DAY NOT TO SCAL� , REQUIRED SEPTIC TANK CAPACITY GAL ACTUAL SIZE OF SEPTIC TANK GAL, kt(v 1-1 9OTTOM OF T=ST HOLE 1W- U9G9---P"*ft-C- WAfiER--T*et-E-fL ==,L LEACHING AREA REOUIREMENTS OBSERVED WATER 'ABLE ( / - / ) EL = -- SIDEWALL AREA tiAL./tf. J BOTTOM AREA GAL./SF } LEACHING CAPACITY ( BOTTOM♦ SIDE*k.L) 1� 6AL.� f• LEGENDS tom' - �. � 4x 5 ti � • � �31, KS-� �-� , EXISTING SPOT ELEVATION OOxO RESERVE LEACHING CAPACITY r-4 GAL EXISTING CONTOUR — - - - 00- -- - wEi� FINAL SPOT ELEVATION � NOTES- FINAL CONTOUR - 1— 1 i ALL WORKIIPANSHIP AND MATERIALS SHALL COINFORM TO OE 0 71 72_.8� Q SOIL TEST LOCATION TITI F 5Akin T►AC' •-+u,. EL _ T' Q -3 L_ D T i l REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE TOWN VWAT E R �� + • " t`ri4 71 CATCH BIAS IN ( � ! 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 12 OF FINISHED GRADE . l 3 EXISTING AND FINAL. GRADES SHALL REMAIN ESSENTIALLY THE SAME. 1 _ `• 4 ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H- 10 LOADING UNLESS THEY ARE UNDER OR v r� 17 WITHIN 10 FT OF DRIVES OR PARKING AREAS H-20 LOADING MN. FRONT SETBACK - SHALL BE USED UNDER OR WITHIN 10 FT OF DRIVES OR PARKING. `B W MIN REAR SETBACK S. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE .�� e Wtl- SIDE SETBACK SHALL BE MORTARED IN PLACE. 6. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH �T J '~" . ___�-_ ___— -�--_- -. __ =_-�_-__ -I DEEDED OR ZONING REGULATIONS OWNER /APPLICANT IS TO +� / ,ti S l 3 t9 Itt! - �,�► rlS 60I L-T L F— N t •r� f ��yL T / — OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY 0.00 ACTUAL AS 3jl «-T F-LE VAT N w. Z T14 APPROVED : BOARD OF HEALTH -�- ,4CTuht~ hS gvI L_T L_ocAT (oN AS 13L)iLi- Lo�S T 2vLT I vr� 3lZi /Se . SEE L E ,,i SORVEY 43ooc a ZZ(,o ti DA AGENT <� - a� �b�� Y PO*JFZT LOCATION: Az 1r ij - T t ► I 9ll 1 I TA i 10 Z - to F' � �9 '� � :r �. �0 APPLICANT - T') 1 40 i ! ' 47 r ,�� '� f Levy, Eldredge & Wagner Associates Inc. G --� Engi► n Landscape Architects Planners LmC &xwyors 889 West Main Street LUCJS o� Cen.terVide Mo. 02632 '4 , ­400 lay LEVY .a � <\'F�, ,• �^"l JOB NO. �OCATiON MAP �— 1 02 -j SHEET OF TOP OF FOUND. 20 FT. MIN. SOIL. TEST EL. = , 7L i -* 10 FT MIN. mi GATE OF SOIL TEST � j((o(f37 AS Cowl ' �� - < < T'�- - WITNESSED BY - )k,}NI,tIN CONCRETE 4" SCH. 40 P,yC PIPE CLEAN SANG PERCOLATION RATE MIN INCH 7COVERS MIN, PITCH 1/8 PER FT. OBSERVATION HIOLE I OBSERVATION HOLE 2 CONCRETE � 2 � LAYER OF ELEV. s (.o_�_ ELEV. SL^0 EL = (S. I� 4 11 CAST IRPN PIPE 12 COVERS 1/8"- I/2�� WASHED (OR EQUAL,! MIN. TOP i SU13S01 L PITCH 1/4 PER FT STONE 1.5,M! r.. Sr ELEV 3.5 FLOW LINE\� _�1011 N MEDIUM 5AtJD MIN. DEL. = �?• � ..• • _ _ , 2 2 EL.= 9 20" EL = (� .2 EL= LEVEL �_ _ ELEV. l�.5 EL. = o DIST = _El_. Li NO WATER AT 6 EL.= • I WATER AT — EL. Y BOX '�` C is �--0__��l >_ _ -- 3/4 - 1 1/2 00° t; Do GALLON WASHED STONE %0 0 ° o DESIGN CALCULATIONS 0 SEPTIC TANK PRECAST LEACHING w C EL jr NUMBER OF BEDROOMS BASIN OR EQUIV. I I GARBAGE DISPOSAL UNIT to 6 DIAM. g TOTAL ESTIMATED FLOW Q ( GAL./BR /DAY z BR.) 330 GAL./DAY SEWAGE DISPOSAL SYSTEM PROFILE ICv. > L M. It (,j REQUIRED SEPTIC TANK CAPACITY GAL. NOT T') SCALE\ i }- ACTUAL SIZE OF SEPTIC TANK /000 GAL. (REG _ — -" ? LEACHING AREA REQUIREMENTS -V BOTTOM OF TEST HOLE OR tt"11-- PROBAf9LE- W*TER TABLE -£-t- _ -�.. . —� � `. OBSERVED WATER TABLE ( / / ) EL.= ---- SiOEWALL AREA GAL./S.F. BOTTOM AREA GAL./S.F. ci LEACHING CAPACITY ( BOTTOM t SIDEWALL) GAL. + (314 �sx�x i.o) - LEGEND RESERVE LEACHING CAPACITY 5-, 9, 7 "L EXISTING SPOT ELEVATION OOXO =5'Z .Sa , EXISTING CONTOUR — - - - 00- --- WEtt`t \ FINAL SPOT ELEVATION ® NOTES 0 FINAL CONTOUR --{-� I. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E Q E 71 I ` Bc SOIL TEST LOCATION TITLE 5 AND THE TOWN OFA<<1 i'_ RULES AND 7Z UTILITY POLE _0- REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE , )�bny TOWN WATER W =W 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO 71 CATCH BASIN ®� WITHIN 12 OF FINISHED GRADE . I: 7U 3. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE SAME. 70 ' i 4. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING N- 10 LOADING UNLESS THEY ARE UNDER OR `k- \ I� Z WITHIN 10 FT OF DRIVES OR PARKING AREAS. H-20 LOADING MIN. FRONT SETBACK SHALL BE USED UNDER OR WITHIN 10 FT OF DRIVES OR PARKING. MIN REAR SETBACK 5 ANY MASONARY UNITS USED TO BRING COVERS TO GRADE ��` � r MIN. SIDE SETBACK SHALL BE MORTARED IN PLACE. \� 6. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING REGULATIONS OWNER /APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. -rA 7 Ht>k 1zJNTAL Ek.T- 1C/+ " L:•N i kuL APPROVED : BOARD OF HEALTH DATE AGENT ,e \ �-- _ _ o DES PROJECT LOCATION too P ' ' - _____ ` GH ` SYSTEM PLA M Fc3(Z LOT Zv 64 — a \ ,��1 . ,;� E� 'S C d v!.� - >R!�✓t~ 3 A R tJ S TA 3 L E. , MA L b T4 2 t� APPLICANT:� .• V► \ L. HE TIJ 67 Levy, Eldredge & Wagner Associates Inc. R b. `, '� Engineers Landscca e Alchitectss Planners Land Surveyors +� p yor 889 West Main Street Lac ; , Centerville Ma. 02632 v�?`� w r _ LOCATION MAP ,,�, -T SHEET i OF �' IVa.' �.—