HomeMy WebLinkAbout0202 BRIDLE PATH - Health 202 Bridle Path ,
Marstons Mills P
A = 125 048
1 �
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Certified Plot Plan
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Location.•
.202 Bridle Path
Wilcox iU�— ffarstons (fills, ffA
(�
SURVEYING - ENGINEERING prepared for peter and Ilona bullock
HOME PLANNING&DESIGN Scale: 1"= 40'
3 GIDDIAH HILL ROAD Pate: October 20, 2016
PO BOX 439
SOUTH ORLEANS,MA 02662
508-255-8312 CB
www.ryder-wilcox.com FND
CB
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FDA
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�._ LOT 18
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REFERENCE:
Assrs ' Map 125, Pcl. 48
Ctf. No. 1896387
L.C.P. 38325-B
ZONE:• RF
OF MgsS9cyG
DAV ID P
I certify that the dwellinLE
shown hereon is located o A. �,
as it exists o the ground and that as so located it " LY�T20
complies with the minimum property line setback � #34520
requirements of the Town of Barnstable. suR\o
!late:
Professio76L La d Surveyor Job No. 11787
I
TOWN
� OF BARNSTABLE
L��n�3CATION o�Qa `RR IC /g�{] SEWAGE# o`�0/y- WQ
A,LAGE �/`/��5 ASSESSOR'S/MAP&PARCEL ✓o?SlyB
INSTALLER'S NAME&PHONE NO.-1�Ja G al!`:/e
SEPTIC TANK CAPACITY ��O� G�}�• C�(t5(c C
LEACHING FACILITY: (type)sooC,f(.Ctf K3��C�J (size)
NO. OF BEDROOMS 3 I
OWNER 5 tr k l O hC`
PERMIT DATE:N_�02 O 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
FURNISHED BY
s
i 3
a
a : -- -- --
"�
E-o 0
30if
i
s7�S%�x- H-ao
' � t
( * i
No. 6 Fee �U
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
es
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01pplitation for Disposal 6pstem Construction Permit
Application for a Permit to Construct( ) Repair Q(l�Upgrade( ) Abandon( ) ❑Complete System � ndividual Components
Location Address or Lot No. a Da B I`NI e- mil`&t� Ow i s Name,Address,and Tel.No.
NA 1.
Ton.S M°�Its te�"cr Loua �ll0C
Assessor's Map/Parcel 3- 8 oZC9o2 r e�t R ,,K(,I.s
Installer's Name,Address and Tel.No. Sob- Designer's Name,Address,and Tel.No.
M�rucc aea.W-sTer. //ota 6-6 ,
Q
8 R?owp(lsr. L�e
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size Up sq.ft. Garbage Grinder
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 33 O gpd Design flow provided y gpd
Plan Date NARr,1+ t 7(40L4 Number of sheets Revision Date
Title
Size of Septic Tank 1,0W,614 — x►S►L-✓6 Type of S.A.S. oZ
Description of Soil 45
Nature of Repairs or Alterations(Answer when applicable) u5LBYIS L✓LS $&c* (�'rA , LKS IC.LI Yl�i✓d7 ��
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 Health.
Signed Date AkV.1411-101Y
Application Approved by Date (Lvkv
Application Disapproved by Date
for the following reasons
Permit No. 7 L Date Issued
No. l 11 µ-� Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
s
PUBLIC HEALTH DIVISkON'- TOWN OF BARNSTABLE, MASSACHUSETTS
2pplication for 33ispoSal 6pstem Construction Permit
r Application for a Permit to Construct( ) Repair^ U rade Abandon Com lete*S stem ndividual Com onents
Pg ( ) ( ) ❑ P Y ® P
Location Address or Lot No. Owner's-Name,Address,and Tel.No.
`
Assessor �IA STortS �'O11,S �t: ,r�� -t.LoN� �v11ciC�C
's Map/Parcel `-
Installer's Name,Addressll and Tel.No. J Designer's Name,Address,and Tel.No.
VAC
it
Type of Building:
Dwelling No.of Bedrooms 3 r Lot Size ,)3, t U U sq.ft. Garbage Grinder(IV9
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 330 gpd ;Design flow provided ��`/8 gpd
Plan Date rJA Rr#4 1� ,�pi H Number of sheets I Revision Date
wti �
Title
Size of Septic Tank A>06 G^1. - F x I sill a,C Type of S.A.S. A(• ctt,a,V1b c%S
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) US ec'a 1 9 vt At bi c w lac S I. e l
r r
t,vk T tN L( 0'1 ,��u+yF
Date last inspected: /
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
t• 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 Health.
Signed Date X v.
Application Approved by Date /I / / ( _
Application Disapproved by V Date
for the following reasons
Permit No. d/ Ll — V y Date Issued It !
--- -------------- ----------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
' Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(J-< Upgraded( )
Abandoned( )by ,5 H(.,,. e I,,"%-}E/ CU,1�-_
at -Q O o2 �2 , e /I�!�l ��7 rl/ 1 )t/,//S has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.j d/y' ggAated
Installer Designer j k E
#bedrooms Approved design flow 8 r gpd
The issuance of this permit shill not a construed as a guarantee that the system w' 1 nctio as designe ����� 1
Date Inspector
No. 1 I L( — Utj: Fee d
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Vsposaf *pstem Construction Permit
Permission is hereby granted to Construct( ) Repair(Y) Upgrade( ) Abandon( )
System located at ( ,-t-TV
L•L3
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
I
Provided:Construc ion mus be completed within three years of the date of this permit.
i
Date C/ / Approved by
d
Town of Barnstable
Regulatory Services
Thomas F..Geiler,Director
Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601.
Office:508-862-4644 Fax: 508-790-6304
_... .._ .--.Installe &Designer Certification Form _._.
Date: Z� kir ya Sewage Permit#4D/y Assessor's Map�Parcel /7S"" y�
al
Designer:. Inataiier J-rGe a �,` CS
�. 5.� �tS Address: C�aib'T- �S rv�� !�'
Address: e 26k A,,
/Jov:/�ao c'f _ G✓ l T� was issued a ermit-to install a
On Y C p
(date). (uistaller
septic system at aO& c1� c !� /`1•/Y based on a design drawn by
(address)
dated 1'14"e i?�R01
(designer)
certify'that the septic;system referenced above was installed substantially
according to the design,which may include minor approved changes such as i
lateralL 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 vertical relocation of any
component of the septic system)but in accordance with State&Local
Regulations. PI r vision or certified as b xiltzb designer to follow.
4staller's Signature) s
Alt
esigner's Signature) (A�x.Designer'.s Stamp.Here)
-=----:PLEAS ItIT6HBARNABLE gIC
HEM T$1�IVTSION CERTIfCATE OF.
COMPLIANCE WII�L NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.THANK YOU.
Q.Healt6/Septic/Desiper Certification Foim 3-26-04.doc
LOCATION SEWAGE PERMIT NO.
VILLAGE
�'f'oa AM+Ifs
INSTALLER'S NAME U ADDRESS
,!
I°Cobc-m-r ours Co
1�JrJ do W i C N
BUILDER OR OWNER
Is
DA T E PERMIT IS U E D 6 /I,3/ 7 6
DATE COMPLIANCE ISSUED f/-� a
Lei
ITAru K
07
3J
No.....1 7. !..... Fim............
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
.7170W..W................0 F.7?AIi... ._�..(.._1 41. .-----------......--------
Applira#iou for Disposal Works Tonstrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
----........��.a. . . . .`�:�....!�---------------------------- -----•.------------1- ...........----- ---------........................---------
....
cation-Address or No.
..........
�. .-- s� P�4b1D,�...... .... a'---. s�RU..I JU = � ?�!?D..�........
ner
W <1 ..i3. ......_. _Uwe------------------------------------------ ----- ass....---- R wf•C�L
Installer Address o
Type of Building Size Lot.93t,._.._U.....Sq. feet
Dwelling—No. of Bedrooms ........... .Expansion Attic ( } Garbage Grinder (AJQ
-------------------------- —
P4 Other—Type of Building �_"�..................... No. of persons............................ Showers ( ) Cafeteria ( )
Q' Other fixtures ............................ .
- ------•--------•-----------------------
Design Flow...... ..,________________________'___.__gallons per person p r day. Total daily flow.._... -
W .-. gallons.
WSeptic Tank—Liquid capacity/0!?�_..gallons Length...... ....... Width----- -------- Diameter---------------- Depth...p......
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.Z.l_e.......sq. ft.
Seepage Pit No---_---------------- Diameter....._-------------- Depth below inlet.................... Total leaching area..._..............sq. ft.
Z Other Distribution box (off,) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I...2 0.._._minutes per inch Depth of Test Pit.....'L--------- Depth to ground water..:_-.................
fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 -- -----------------------------�-•--------••--------•--//----------------------------.....-----......---------•----------...............---...........---...._.
O Description of Soil.--O-:-a ...... 0 �!^-- -.Sl v.�a 3E a f ---•------ �. ------ A u r A.I+J. .........
x
x ----------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------
V 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 iITL E 5 of the State Sanitary, de— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has ee issued by the ealth.
6,
Signed ................... ._ .S
-------- ----- .
Application Approved By------. - --14
ate
u
ApplicationDisapproved f"theowing reasons: . - ....----•-. •-- --_--------................................................. --—•-------•-------•-----------•-------------------------------------------------------------=-----------------------------...----
Date
Permit No...... ----------------• Issued.---.7 ---A- --7A...........
Date
J
No...,,?'�I_t...... Fics........... �.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
a. ..Y�l oF..._ z.. s.�----------------------------
Appliration for Disposal Works Tnnitrnrtinn amit
A'ppl>cation is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage'''Disposal
System at: N9 _
............... .. .h. .L. .. ............................. _...._...._....._. ............._.......... -•-_ ._.....__...._._._................._....•.
,Location-Address /` or r,�t No
...... .� .s�.. 11.1. �:,.
C:;- s�i .. Ja.�.•1_ fir,KJs...:1.._......
...... ..
Owner ddress
w = ..1.
Installer Address GG
U Type of Building Size Lot_t�_�'_O _!......Sq. feet
3 Dwelling—No. of Bedrooms.__________ ___________________________Expansion Attic ( ) Garbage Grinder PQ
per., Other—Type of Building 1_1...................... No. of persons-........................... Showers ( ) — Cafeteria ( )
Q' Other fixtures ...------------_--------------•--------------------•-------------------------------------------
Q
w Design Flow......KI_...............................gallons per person per day. Total daily flow..........._._S�
..........................gallon5.
WSeptic Tank—Liquid capacity �?g4d.___gallons Length.__..j....... Width____ _________ Diameter.........:...... Depth....t..........
x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area_[,__(o........sq. ft.
Seepage Pit No____________________ Diameter.................... Depth below inlet.................... Total leaching area......._..........sq. ft.
Z Other Distribution box ( ,) Dosing tank ( )
Percolation Test Results Perj'ormed by.......................................................................... Date....................................
M _..
j
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........................
----------------------------------------------------------------------------•--••-------•-----------.........................................................
O � u `!
Description of Soil__Q._._ .. "" ► ` t
U •-••-•--...••-•---••-••-•••••••--•-••......_•••-•....•-•••-•--------•-•--•-•-•••-•-•-•••••...-•••-••-•-••-••-•-•••-•-•-----••-----•--•-•-•-•----•-••••••••••.....••-•••••••---•--••...-•-•-•......•••...
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 TITi.;.
p 5 of the State Sanitary, de— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has &eed issued by the �ealth.
Signed_ r :_ _. __...= _ •••. ..................... ............. �-_S--
G Date
Application Approved BY yf .. /3- 7�
----- -----
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------•-•--
...._.._...•••----•--•-•-•-...--•-----•-•-•-•--•-•••_-•---•-••••••-•-•--•...•---••-••--••••••••••---...._•-•---••-•-••-•-•••-••-•-•-------•-•---...••--•••••••-•---•--•-----•--•-----•-•••••-•••-----••-
Date
PermitNo......FI--�1......................................_ Issued.......................................................
Date
'a.
THE"COMMONWEALTH OF MASSACHUSETTS
_„..�..
BOARD OF HEALTH
l
............:. .0 ..IQ.........OF..... .. l..l�.........................._...
a:�., t �rrtif irtttp oaf �unt�rli�nrr
THINS 1TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
b ...........d.0 1 L...--••-- ----- ---------•---._._...------------------------------------------...._...__.._..._..------------
Installer J�
has been installed in accordance with the provisions of TITIZ j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No-----------_T162................... dated.........t-13^._7�_._.._..._______.
THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........................•-------------------------------•--•-......•........--.. Inspector....................................................................................
THE COMMONWEALTH.,OF MASSACHUSETTS
BOARD OF HEALTH
1 1
� No........-•--�-.7.... FEE---,�Q..P.....
Dispaval Vork,5 %=11t Ilan rrmit
Permission is hereby granted.......-•--� t- C-11 I J ......-- :_
to Construct, (?r,) Repair ( ) an§inl�dividual Sewage
�Disposal S stem ,r
Street
as shown on the application for Disposal Works Construction rmit Dated__________________________________________
4
—7 ! Board of Hea
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS - k
��e
�• k. t1� �� 1,. .- � r t c t•.`aj 4 ' i�._ r _ 'R ` ..,% ' S i �;
r'• ! " • . . ark 1, } '" i 'f •1 "ft Ji t
14
.f` "Jr..
r N l rx
d 3.
y- ld9` �► -� /000 GAL. \ '1 �z
.a $" TANK• < r
07 � IOvo GAL/00
EXPAMSIO�
to
Y. o� ROBERT ��y
P.
{ 3, h ,
--- _ NIKIS•' y
kV
r o Ma 22162
15 40
GIs
ot
IrIONAL
E�tOST1RIG LNEVA I C.E_RTIFlED-:'- -PLOT "` ;
SPOT E TON Ox0 _ .� ,�PL`AN
_ _
{
1NIS.�ED SPOT ELEVATION O.O ,8R1DLE-. ATNI
FIN.I SHED . CONTOUR 0 M�2_STO/VS' L45.
4$
APPROVED = BOARD OF HEALTH
k ®� ®t SNA
4
DATE AGENT'." ',. t SCALE- l t'--TV" DATES S�ZL: 78 .,
_ G CO
CLIENT �uRh ``` :,: ,•
--_-- I CERTIFY THAT THE PROPOSED
EGISTERE REGISTERED J0B�N0. ZZO 9 6 BUILDING, SHOWN ON THIS PLAN
CIVIL LAND
• ENGINEER SURVEYOR DR.BY fF,�}=� CONFORMS TO THE ZONING LAWS
OF BARNST B E MASS. �`
CH. BY:
33 ',NO. MAIN STY 712 MAIN ST' G'/S.�j� �r �� _• <4:..
SO: YARMOUTH, MASS. HYANNIS, MAWS.
SHEET— OF QAT•E `'
R,E'G. ' LAND SUR.Y.6bW.,
.:7-.4NiK OR
/EffC.W//! 4G. P/7" AFPE /'"IORE_: 7-,q,A.N /Z•'B'ELO/M
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s ";Sj�r.�L L.'�� 5R®L/�Ad Y TO BRA A
CONCRLaTL? h'EAVy CAS7. /�®N C®!/E'/�t' .S/y.QGL L3E USED
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EL. /O p. COdiER$� IB Asq,A'T r 3 /F/N.. L7/�/VE1�9/.�4 y
_ 2fa /�!�/d.
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o. - - 0.7�•�®E� co.VER
' CL E,4N SAME
o , eACK/�/LL
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'b MIN.PITCIa� CAL. ° e e a • e : o • o e o ' p 2�NE
�4 WA5HP0 57
%4 PAR �T $APT/C TANK. D/ST.. . o • e ® • • o o • • o ®®n ,, q
p 0 • 0 ® • of p °
6CJ� r, � e • ,
• - c o • o DEPT1/ • ® • • ®i a o WA5AF.P S70
of
° o o • o 0 0 0 • • e p�p n
s e PRECAS T SE.EPA6 E
.. o a 1 c
o ` o • o e o ® e e • o ` �+ o P/T OR EQU/✓•
1 AIVAER'T 4w4 E1/AT/o7/OrS o '
INVERT A-r S/1/LD/N6
INLET SLEPT/C' T.4N/K _ 9S.S FY FT. O/AJ+'I. t C(SEE TABUL.4TJ0N�^,
0U71-ET'SEPTIC TAM K 95.3 Fr
INLET®/STf�/DI/?/OA/ ®X 95.0 = GROuNO WATEFL 7A61LE
OUrLETD/ST'R/BUT/OIV BOX 514 9 F7 SECT/®/V OF"
//VLETSEEPACE PI T 9 4•S FT. .SEN/�GE ®/.S'/®G �.L. .SY.S'T�/�'J —rAS411-AT/40/9/
�,.. DIMEM.3L0 N
DES/GIB C�/T'E/�/�1 _} SCALE �4 / p/R9.EN5,/oN — -F'T• -
NUA9BER OF®EDI�00/'9S 3 " D// /ENS/ON Ce 4- FT. Mr
N
0,4ROAG�L9/SPOSAL - SD/L- l OC _.
T®Ti9d EST/N9.edTEO /=LONf/ �3'o' G.41. DAY SOIL TEST 01- SOIL solo,•L. 'TEST'-F4
IVUI�BER OF SEEPAGE P/TS_./ / E[Ls!/ 9� O L"LEd/ O.a4TE'OF SO/�. TEST �7�
SIDE GE'ACH/NG PER P/T, /78 5q F'T. O _ Z �� g RESud.3'S dV/TNE�SED BY'� T� 3 VAe?i� S
4!pOTT'O/•9 L.zqCN//VG PER PIT so. Par LVA. $c+ :. 'PEJ�O®LAT/O!V R-47-os ,01 zA M/NIIJNGH
TOTAL, LEAG'f•///VG AREA �� SQ. FT. Sa/sSBrL � PlE>aCOLAT/aN RATE 0 MIN. /NCH
R�s.�RVE L:E.�c'a/N6 AREf+ 5Q. F T '
2 a— %i' ,e< - o T
ROBERT /V-7 Al /L 4.
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ties y .o 'Q NiQ
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, �t O , F --%7/2 1WAIN..ST '-: 3.3 /d0.MA/NS'P.'
ONA� N®wa/Q'®[1Np YQ!.ATB'A' �NCOtJN'TEREO _ a�
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AsBuilt Page 1 of 1
..�- TOWN OF/JBARNSTABLE p
LOCATION ���. `r,D � � SEWAGE # 9,2.- ✓�/
VILLAGE f _ ASSESSOR'S MAP & LOT��-
INSTALLER'S NAME G PHONE NO. W Ark
SEPTIC TANK CAPACITY 1660
LEACHING FACILITY:(type) 1(S7 (size)_ 16,0 a
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER _G
DATE PERMIT ISSUED: CJ}�
DATE COMPLIANCE ISSUED:�3S 7 " ✓ �3--
VARIANCE GRANTED: Yes No
n
L r .
�y
http://issgl2/inttanet/propdata/prebuilt.aspx?mappar=125048&seq=1 3/15/2010
Town of Barnstable P#
Department of Health,Safety,and Environmental Services
�99 Public Health Division Date
367/Main Street,Hyannis MA 02601 "`
i BARNBTABIL, • J Y jF 'e 1
163 . e
ArEo �► Date Scheduled Time Fee Pd.
/
Soil Suitability Assessment for Sewa DIs�posa s
L !. P i G r, r r7pr.d
',i ..
Performed By: J�C/aid c y:..:) /yw4,✓fi'a , Witnessed By:
7 7
LOCATION & GENERAL INFORMATION
Location Address Owner's Name �Gu
Z- 61L, 4 C• P A-r-1-L Address
JW-*-ST
Assessor's Map/Parcel: vv Engineer's Name
NEW CONSTRUCTION REPAIR cif. Telephone# Sua 3Le— a is Z-
Land Use 12 �5o,b 4t-f.-s-'-7 A'C Slopes(%) 1-2_. Surface Stones AA-)
Distances from: Open Water Body ft Possible Wet Area " ft Drinking Water Well ft-
Drainage Way ' It Property Line %L ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
t .
6C. I
�M1a
Al
Parent material(geologic) Depth to Bedrock _r
Depth to Groundwater: Standing Water in Hole: )° Weeping from Pit Face
Estimaied Seasonal High Groundwater
D TERMINATYON FOR:S ASONAL IIGH iYATER'TAIILE
Method Used: rC•l<2•�,� G �c c'✓.r
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment R.
Index Well#_ Reading Date:—.__ Index Well level Adj.factor_ Adj.Groundwater Level
-- . _ _ -
.. .....
PER�OLA.TIOI�ITEST: nat r,Bte
_ .
Observation
Hole# r Time at 9"
rt ,
Depth of Perc Time at 6"
Start Pre-soak Time @ Time(9"-6")
End Pre-soak
Rate Min./inch 2
Site Suitability Assessment: Site Passed V Site Failed: Additional Testing Needed(YM)
Original: Public Health Division Observation Hole Data To Be Completed on Back j
Copy: Applicant
r
I);EEP;OBSERVATION HOLE LOB Hole# 1
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency.%Gravel)
v h
C,
DEEP OBSERYATION;HOL LOG Hale# ;;
_.
Depth from Soil Honzon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency.°
A L`S /v ;n
i
Hole#
DEEP OBSRYA '�ON;HOLD LQG
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency.%Qraveh
DEEP;OBSERVATION HOLD L Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(m.) (USDA) (Munsell). Mottling (Structure,Stones,Boulderes.
Consistency,° ravel
Flood Insurance Rate Man:
Above 500 year flood boundary No— Yes
Within 500 year boundary No_'� Yes
Within 100 year flood boundary No Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? t'S
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on I (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
the required training,ixpertise and experience described in 310 CMR 15..017.
Signature. � � Date
MAP
ECOJECH PARCEL. , ® 4
Environmental L0T ,l
www.eco-techms
THIS FORM IS A FACSIMILE OF THE STANDARD SEPTIC INSPECTION FORM ISSUED BY THE MASSACHUSETTS DEPARTMENT
OF ENVIRONMENTAL PROTECTION(revised 6/15/2000)
TITLE 5
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 202 Bridle Path
Marstons Mills
Owner's Name: Steven&Doris McCarthy RECEIVED
Owner's Address: 202 Bridle Path
Marstons Mills,MA 02648
Date of Inspection: April 10, 2004 APR 13 2004
Name of Inspector: (Please Print) David D. Coughanowr,R.S. TOWN OF BARNSTABLE
Company Name: Eco-Tech Environmental HEALTH DEPT.
Mailing Address: 43 Triangle Circle
Sandwich,MA 02563
Telephone Number: (508)364-0894
CERTIFICATION STATEMENT:
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:
X Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature �`. ���� '`' �S Date:APh
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
NOTES AND COMMENTS
Inspector's Note—> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger
any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed
on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination.
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page I
Page 2 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 202 Bridle Path
Marstons Mills
Owner: Steven&Doris McCarthy
Date of Inspection: April 10, 2004
INSPECTION SUMMARY: Check A,B,C,D or E/ALWAYS complete all of section D:
A] System Passes:
Yes I have not found any information which indicates that any of the failure criteria described in 310 CMR
5.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
COMMENTS:
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.
Answer yes,no, or not determined(Y,N,or ND). in the_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.
ND explain:
Observation of sewage backup or breakout or high static water level in the distribution box is due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pass inspection if(with
approval of Board of Health).
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced.
ND explain
The system required pumping more than four 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
obstruction is removed
ND explain
2
Page 3 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 202 Bridle Path
Marston Mills
Owner: Steven&Doris McCarthy
Date of Inspection: April 10, 2004
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 and 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
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 by a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form
3) OTHER
3
Page 4 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 202 Bridle Path
Marstons Mills
Owner: Steven&Doris McCarthy
Date of Inspection: April 10,2004
D)System Failure Criteria applicable to all systems:
You must indicate either"yes"or"no"to each of the following for all inspections:
I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.
The basis for this determination is identified below. The Board of Health should be contacted to determine what
will be necessary to correct the failure.
yes no
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool.
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool.
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool.
X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
X Any portion of the SAS,cesspool or privy is below high groundwater elevation.
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well
X Any portion of a cesspool or privy is within 50 feet of a private water supply well
X 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 by a DEP certified laboratory, for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form)
No (Yes/No)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
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
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.
4
Page 5 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 202 Bridle Path
Marstons Mills
Owner: Steven&Doris McCarthy
Date of Inspection: April 10, 2004
Check if the following have been done: You must indicate either"Yes" or"No"as to each of the following:
Yes No
Y _ Pumping information was provided by the owner,occupant or Board of Health.
N Were any of the system components pumped out in the last two weeks?
Y _ Has the system received normal flows in the previous two week period?
N Have large volumes of water been introduced to the system recently or as part of this inspection?
n/a Were as built plans of the system obtained and examined?(If they were not available as N/A)
Y _ Was the facility or dwelling inspected for signs of sewage back-up?
Y _ Was the site inspected for signs of breakout?
Y _ Were all system components,excluding the SAS. located on site?
Y _ Were the septic tank manholes uncovered,opened,and the interior of the septic tank inspected for
the condition of the baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge and depth of
scum.?
Y _ Was the facility owner(and occupants,if different from owner)provided with information on the proper
maintenance of subsurface disposal systems?
For information on the proper maintenance of subsurface disposal systems please go to:
WWW.ECO-TECH.US
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
N Existing information.For example,Plan at the Board of Health.
Y _ 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(3)(b)]
5
Page 6 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 202 Bridle Path
Marstons Mills
Owner: Steven&Doris McCarthy
Date of Inspection: April 10, 2004
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): n/a Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a—No plan on file at Health Dept.
Number of current residents 4
Does the residence have a garbage grinder(yes or no): no
Is laundry on a separate sewage system(yes or no): no :(If yes, separate inspection required?
Laundry system inspected (yes or no): n/a
Seasonal use(yes or no): no
Water meter readings,if available(last two year's usage(gpd): 204 gpd
Sump Pump(yes or no): no
Last date of occupancy: current
COMMERCIAL/INDUSTRLAL:
Type of establishment:
Design flow(based on 310 CMR 15.203):: gpd
Basis of design flow(seats/persons/sgft/etc.):
Grease trap present: (yes or no)_
Industrial waste holding tank present: (yes or no):
Non-sanitary waste discharged to the Title 5 system: (yes or no).
Water meter readings,if available:
Last date of occupancy/use:_
OTHER: (Describe):
GENERAL INFORMATION
PUMPING RECORDS
Source of information: System pumped in summer 2004(Owner)
Was system pumped as part of the inspection: (yes or no) No
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM:
X 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/Alternate technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight Tank Attach a copy of the DEP approval
Other(describe)
APPROXIMATE AGE of all components,date installed(if known)and source of information:
Age: approximately 26 years System is assumed to have been installed at time of dwelling's construction in 1978
Were sewage odors detected when arriving at the site: (yes or no) no
6
Page 7 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 202 Bridle Path
Marstons Mills
Owner: Steven&Doris McCarthy
Date of Inspection: April 10, 2004
BUILDING SEWER_(Locate on site plan)
Depth below grade: 1.5 ft
Material of construction:_cast iron X 40 PVC_other(explain)
Distance from private water supply well or suction line 20+
Comments: (on condition of joints,venting,evidence of leakage,etc.)
Sewer is vented through roof and appears structurally sound with no evidence of leakage or backup into dwelling
SEPTIC TANK:Yes (locate on site plan)
Depth below grade: 10 inches
Material of construction: X concrete_metal_fiberglass_polyethylene
other(explain)
If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(yes or no):_(attach a copy of
certificate)
Dimensions: 8.5 ft x 5 ft x 5 ft(1000 gallon)
Sludge depth: 8 in
Distance from top of sludge to bottom of outlet tee or baffle: 26 in
Scum thickness: 1 in
Distance from top of scum to top of outlet tee or baffle: 9 in
Distance from bottom of scum to bottom of outlet tee or baffle: 14 in
How dimensions were determined: Probe to top 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.):
Pumping recommended within 1 year and maintenance pumping is recommended every 2 years. Liquid level at
outlet invert.Tank and tees appear structurally sound and functioning as intended.No evidence of leakage in or out.
GREASE TRAP: none (locate on site plan)
Depth below grade:
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:
Comments: (on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
I
Page 8 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 202 Bridle Path
Marston Mills
Owner: Steven&Doris McCarthy
Date of Inspection: April 10, 2004
TIGHT OR HOLDING TANK: none (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/day
Alarm present(yes or no):_
Alarm level:_ Alarm in working order(yes or no):_
pumping:Date of last
Comments:(condition of inlet tee,condition of alarm and float switches, etc.)
DISTRIBUTION BOX: Yes (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: at outlet inverts
Comments:(note if box is level and distribution to outlets is equal,any evidence of solids carryover,any evidence of
leakage into or out of box, etc.)
D-box appears structurally sound with no evidence of leakage in or out.Effluent level at outlet inverts.
Some solids in tank.
PUMP CHAMBER: none (locate on site plan)
Pumps in working order: (yes or no)
Alarms in working order: (yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
Page 9 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 202 Bridle Path
Marstons Mills
Owner: Steven&Doris McCarthy
Date of Inspection: April 10,2004
SOIL ABSORPTION SYSTEM(SAS): Yes (locate on site plan;excavation not required)
If SAS not located, explain why:
Type:
X leaching pits,number 2
_leaching chambers,number
_leaching galleries,number
_leaching trenches,number,length
_leaching fields,number,dimensions
_overflow cesspool,number
—innovative/alternate system Type/name of Technology
Comments: (note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.)
Soils above leaching pits appeared unsaturated.No evidence of surface ponding,breakout,lush vegetation,or
other evidence of hydraulic failure was observed. Effluent was heard splashing down into leach pits indicating__
that full capacity had not been reached.
CESSPOOLS: none (cesspool must be pumped at time 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 or no):
Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,
etc.):
PRIVY:none (locate on site plan)
Materials of construction:
Dimensions:_
Depth of solids:
I Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 202 Bridle Path
Marstons Mills
Owner: Steven&Doris McCarthy
Date of Inspection: April 10, 2004
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100'(Locate where public water supply enters the building)
LEACH LOCATIONS
PIT A B
LEPTH ' I 42 ft 31.5 ft
2 47.5 ft 27.5 ft
SEPTIC TANK 3 51.5 Ft 24.5 Ft
3
zo 4 52.5 ft 34.5 ft
D-BOX 5 65 ft 29.5 ft
A
B
EXISTING # 202
DWELLING
W
7
J
W
W
N
G
3
BRIDLE PATH NOT TO SCALE
10
Page 11 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 202 Bridle Path
Marstons Mills
Owner: Steven&Doris McCarthy
Date of Inspection: April 10,2004
SITE EXAM
Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to ground water: 20+ feet
Please indicate(check)all methods used to determine high ground water elevation:
Obtained from system design plans on record-If checked. date of design plan reviewed
Observed Site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of health-explain:
Checked local excavators,installers-attach documentation)
X Accessed USGS database
You must describe how you established the high ground water elevation.
Barnstable GIS department records indicate that property is over 20 feet above groundwater table.
11
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated
6/1612000. Inspection forms may not be altered in any way.
A. Certification
Important:
When filling out 1. Property Information:
forms the 2 � I
computer,
r,use 202 Bridle Path �Z� `'�
only the tab key Property Address
to move your Today Real Estate 1"a q� • OLW2)
cursor-do not Owner's Name
use the return
key. 1533 Falmouth Road
Owner's Address
��\S MA 4R6 o 2-L,qee)
�-- Cityfrown State Zip Code
Date of Inspection: 12/01/07
Date
2. Inspector:
MR. ROBERT A. DRAKE --A
Name of Inspector
KCJ ENGINEERING [ o
Company Name } c-) ..�1
66 GREENVILLE DRIVE
Company Address
FORESTDALE MA 2644 _F11 LP
City/Town State ip Code
508-477-5048
Telephone Number Q M
Certification Statement:
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system: _
® Passes ❑ Conditionally Passes SDF MAs
S,gcy
❑ Needs Further Evaluation by the Local Approving Authority Q ROBERT oRcN
A;<E
-R -
G i642
Inspector's Signature Date o FGksl
The system inspector shall submit a copy of this inspection report to the 9oF ��G\ rity(Board
of Health or DEP)within 30 days of completing this inspection. If the system i ed system or
Y 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.
202 Bridle Path-T51NSP[1].doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 1 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
A. Certification (cont.)
202 Bridle Path
Property Address
Marstons Mills: MA 02648
City/Town State Zip Code
Today Real Estate 12/01/07
Owner's Name Date of Inspection
f �
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:
ALL COMPONENTS APPEAR TO BE STRUCTURALLY SOUND AND WORKING PROPERLY.
COMPONENTS WERE LOCATED IN THE FIELD AND ARE WITHIN 12-INCHES OF GRADE.
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.
Answer yes, no or not determined (Y, N, ND) in the ❑ 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.
ND Explain:
202 Bridle Path-T51NSP[1].doc•11/200. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-
Page 2 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
y` Subsurface Sewage Disposal System Form
A. Certification (cont.)
202 Bridle Path
Property Address
Marstons Mills MA 02648
City/Town State Zip Code
Today Real Estate 12/01/07
Owners Name Date of Inspection
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
❑ obstruction is removed
❑ distribution box is leveled or replaced
ND Explain:
❑ 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
❑ obstruction is removed
ND Explain:
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
f 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
202 Bridle Path-T51NSP[1].doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 3 of 16.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
` Subsurface Sewage Disposal System Form
A. Certification (cont.)
202 Bridle Path
Property Address
Marstons Mills MA 02648
Cityrrown State Zip Code
Today Real Estate 12/01/07
Owner's Name Date of Inspection
C) Further Evaluation is Required by the Board of Health(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
coliform bacteria and volatile organic compounds indicates that the well is free from pollution from
that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5
ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached
to this form.
I
3. Other:
202 Bridle Path-T51NSP[1].doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-
Page 4 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
M y•y,•
A. Certification (cont.)
202 Bridle Path
Property Address
Marstons Mills MA 02648
Cityrrown State ZipCode
Today Real Estate 12/01/07 .
Owners Name . Date of Inspection
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
El ® 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 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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the
presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm, provided that no other failure criteria are triggered.A copy of
the analysis must be attached to this form.]
Yes No
❑ ® 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.
202 Bridle Path-T51NSP[1].doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 5 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
M
A. Certification (cont.)
202 Bridle Path
Property Address
Marstons Mills MA 02648
Cityrrown State Zip Code
Today Real Estate 12/01/07
Owner's Name Date of Inspection
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.
202 Bridle Path-T51NSP[1].doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 6 of 16
, J i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
` Subsurface Sewage Disposal System Form
B. Checklist
202 Bridle Path
Property Address
Marstons Mills MA 02648
Cityrrown State Zip Code
Today Real Estate 12/01/07
Owner's Name Date of Inspection
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
YES NO
1 ❑ ® 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(3)(b)]
202 Bridle Path-T51NSP[1].doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 7 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
M
C. System Information
202 Bridle Path
Property Address
Marstons Mills MA 02648
Citylrown State Zip Code
Today Real Estate 12/01/07
Owner's Name Date of Inspection
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
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system?[if yes separate.inspection required] ❑ Yes ® No
J i
Laundry system inspected? ® Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 129 gpd
9 ( Y 9 (gpd)):
Sump pump? ❑ Yes ® No
Last date of occupancy: A couple ofmonths ago
Commerciallindustrial Flow Conditions:
Type of Establishment: N/A
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:
Last date of occupancy/use: Date
Other(describe):
202 Bridle Path-T51NSP[1].doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 8 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
° Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
C. System Information (cont.)
202 Bridle Path
Property Address
Marstons Mills MA 02648
Cityrrown State Zip Code
Today Real Estate 12/01/07
Owner's Name Date of Inspection
General Information
Pumping Records:
Source of information: N/A
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: N/A
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)
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
House built in 1978, septic tank, D-Box and leaching pit appear to be original.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
202 Bridle Path-T51NSP[1].doe•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 9 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
M
C. System Information (cont.)
202 Bridle Path
Property Address
Marstons Mills MA 02648
Cityrrown State Zip Code .
Today Real Estate 12/01/07
Owner's Name Date of Inspection
Building Sewer(locate on site plan):
Depth below grade: feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: N/A
feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Sewer pipe appears to be in good condition. No signs of leakage.
Septic Tank(locate on site plan):
Depth below grade: 1.01+/
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
Tank and components appear to be structurally sound and tees are inplace. Inlet cover is within 18"
of grade. Tank is located within a gravel driveway.
If tank is metal, list age: N/A
years
Is age confirmed by a Certificate of Compliance? (attach a copy of ❑ Yes ❑ No
certificate)
Dimensions: 1,000 GALLON
Sludge depth: APPROX. 4"+/-
Distance from top of sludge to bottom of outlet tee or baffle APPROX. 30"+/-
Scum thickness APPROX.4"+/-
Distance from top of scum to top of outlet tee or baffle APPROX. 12"+/-
Distance from bottom of scum to bottom of outlet tee or baffle APPROX. 12 +/-
How were dimensions determined? MEASURED IN FIELD
202 Bridle Path-T51NSP[1].doc-11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-
Page 10 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
y` Subsurface Sewage Disposal System Form
C. System Information (cont.)
202 Bridle Path
Property Address
Marston Mills MA 02648
City/Town State Zip Code
Today Real Estate 12/01/07
Owner's Name Date of Inspection
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
All components appear to be structurally sound and in good working condition. Water level is at the
invert of outlet pipe. No signs of leakage.
Grease Trap(locate on site plan):
Depth below grade: N/A
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.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade: N/A
Material of construction:
4 ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
202 Bridle Path-T51NSP[1].doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 11 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
5.�
C. System Information (cont.)
202 Bridle Path
Property Address
Marstons Mills MA 02648
Cityrrown State Zip Code_
Today Real Estate 12/01/07
Owner's Name Date of Inspection
Tight or Holding Tank(cont.)
Dimensions: N/A
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.):
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert At invert of outlet pipe..
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-Dox appears to be working properly. No signs of solid carryover or leakage.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
202 Bridle Path-T51NSP(11.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 12 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
C. System Information (cont.)
202 Bridle Path
Property Address
Marstons Mills MA 02648
City/Town State Zip Code
Today Real Estate - 12/01/07
Owner's Name Date of Inspection
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System SAS locate on site. Ian excavation not required):
P Y ( ) ( plan,
.If SAS not located, explain why:
Type:
® leaching pits number:
1-1,000 gallon
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leaching pit appears to be working properly, no signs of ponding and vegetation is normal.
202 Bridle Path-T51NSP[1].doc•11/2004 Title 5 Official Inspection Form:Subsurface'Sewage Disposal System
Page 13 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
y` Subsurface Sewage Disposal System Form
C. System Information (cont.)
202 Bridle Path
Property Address
Marstons Mills MA 02648
City/Town State Zip Code
Today real Estate 12/01/07
Owner's Name Date of Inspection
Cesspools(cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration N/A
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.):,
Privy(locate on site plan):
Materials of construction: N/A
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
202 Bridle Path-T51NSP[1].doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 14 of 16
i r T
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
C: System Information (corn.)
202 Bridle Path
Property Address
Marston Mills MA 02648
cityrrown State Zip Code
-Today Real Estate 12101/07
Owners Name Date of inspection
Sketch Of Sewage Disposal System: Provide a sketch 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,suppiy enters the building.
O
n
A l — Lo
Az
A LA _ G
0Ll '
202 Bridle Path-T51NSPj1j.doc•1112004 Tie 5 official Inspection Form:Subsurface Sewage Disposal System
Page 15 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
` Subsurface Sewage Disposal System Form
C. System Information (cont.)
202 Bridle Path
Property Address
Marstons Mills MA 02648
Cityrrown State Zip Code
Today Real Estate 12/01/07
Owner's Name Date of Inspection
Site Exam:
Slope
I
Surface water
Check cellar
Shallow wells
Estimated depth to ground water:
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:
Barnstable GIS Department records indicate that the ground elevation is approximately at elevation
60.0' +/-which is over 20' +/-above the groundwater table.
202 Bridle Path-T5INSPII].doc•.11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 16 of 16
THE Town of Barnstable
OF Tp�
Regulatory Services
,CABLE
Thomas F. Geiler,Director
- 1639. A Public Health.Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
This septic system inspection report was completed by a private inspector who is certified
by the State of Massachusetts, Department of Environmental Protection.
Although the Town of Barnstable Health Division received the original/copy of this
report; this Division does not warranty the functionality of the septic system in the future
nor does this Division agree with any technical observation s and interpretations
contained within this report.
In addition,by receiving this report the Town of Barnstable Health Division does not
automatically approve the number of bedrooms listed within this report. The actual
number of bedrooms approved at a particular property would-be listed on the "Disposal
Work Construction_Permit".
If you should have any questions regarding this report, please contact the certified Septic
System Inspector who conducted the inspection.
TOWN OFQBARNSTABLE
LOCATION es -1� !". � SEWAGE # ✓7,�
VILLAGE M _ ASSESSOR'S MAP & LOT ^-
INSTALLER'S NAME & PHONE NO. UIMt I,UJI�,-�.l
SEPTIC TANK CAPACITY �, 66 O
LEACHING FACILITY:(type) g-6 (size) c�
NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: S - 7 J ;3—
VARIANCE GRANTED: Yes No
r
�Y
R {�
;a
'ASSESSORS MAP NO: _ , - a, : ,. ..
PARCEL NO: C3 Zt t
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Appltratiutt for Uigpuual 10urkii Toustrurtt Trutt
Application is hereby made for a Permit to Construct ( ) or Repair (,'<) an Individual Sewage Disposal
System at
.... ................................................. --._••.._._.-----....----• -f.----•--- ... - .........
ation-Address or Lot No.
/. Ownnerer.......................................... ..........--..............................• Address...........................................
........••----••--•-------------
Installer Address
Q Type of Building Size Lot............................Sq. feet
U Dwelling No. of Bedrooms.............................. .__..Ex Expansion Attic a g— --------- p ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
QOther fixtures --------------------------------------------------------•---•-•---•----•-------------------------•---••-••--.
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
rX4 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................
P4 -----•••-•---------•-•------•-•-•••••••-••---•-•-------•--••••••••-•...............•---•••--•.--_............................................................
0 Description of Soil............................................................................... ---------------------------------------•--------------------------------............•---
x
c,
UW -----------------------------------------------------------------------------------------------------------------
Nature of ,epairs or Alt ra 'o —Answer when applicable__-___-__-/N� 1�.___L�-.._.__.____•......._._.�. ......................
-•-------•-W� z-..5------------------------------------------------.--------------------------------------------------------------------------.._._..._
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issged by the board of health.
Signed .. ---------------------------------------------------------------------- -- ---- / 9-�.
t
ApplicationApproved B ........ 4� .�� ..... ........ .... ............................... -------------------------------------------------------- Date .........
Application Disapproved for the following reasons- ----------------------- - --- ------------------------------------------ -----------------------------------------
.................................................. ................................................................. ... .......................................................................... .. ........................................
Permit No. s to
-- ------- .�����........................... Issued ...........
Date
0LiIs
No._. ` � Fps... .........._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
--Annlirafion for Dhipviial Workii Tomitrurtion/ rrmi#
Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal
System at
... °. .�D ......------�'...-- 1----------------------------------- ..................`--...... ....L. .......
/ _bl/ ,,,, ation-Address ....or Lot No.
... ............................. ---..._...........---•-•.................._........_... •....
.....
---------------................
W /i t�/� Owner Address
a ----•-••----•-•--•--•-._.....----•---•-••..............................•-.....-••--........------. ••--•---•-•••-•---•---------------•----------•-..............•---•••..................•...........
Installer Address '
UType of Building \ Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building .............. No. of ersons.....___................._.. Showers
a YP g -------------- P ( ) — Cafeteria ( )
� Other fixtures ----------------------------------------------------------•••----•---------------------------------•••....------------•--•-•......---•-•.._..--.-•--•
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width----_........... Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
fr Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 r---••-•--•--------------------•--•-•----...---•-•--•---•••--•---•-•--•-------•...---------•-----•--.........-•------•----•---••-•---•-----•---•-•----••-•---.
0 Description of Soil........................................................................................................................................................................
V .............................•--•---•----....---•-----------•-----•-•-•-------•.....---•----•-•-------•------------••--•---•-------•••----•-••----------••-•......-.........
. ..........
Nature of I�epZrs,o A e s—Answer when applicable._...______tlN_ —......... .........�. ......................t
----•-•--•--•----------------•------------------•-••------------........-------------------••-••------•------•-----•-----•---•--•-•-------•-------•---------.
Agreement:
,The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance/ has been lss d by the board of health.
Signed ....----- ) j� 9
! ce
Application Approved B ..... % ? ......................... - -------------------------------------------------------
/%i��'� Dare
Application Disapproved for the following reasons- ------- --------- ---- ----------- ------------ ----------- --------------------------------- -------------------------
----. ------------------ ------------------------------------------------------------------------------------------------------- ------------------------------------------------- ........................................
e
Permit No. ` /
............................................
Issued .. .-...... -
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
11trtifira e of Compliance
THIS IS RTIFY That the Ind"ivid al Sewage Disposal System constructed or Repaired
by _-------- � .�� G 5 r�GvG�TTa�g P Y ( ) ( )
f ... In -
/J.. Installer
at ------ ... t// /{... .....-----
has been installed in accordance with the provisions of TITLE Qf The State Environmental Code as descri ed in
the application for DisposalWorks Construction Permit ............ dated..,7�_ .....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. b
DATE............................. 7 L _ -............................... Inspector ,----------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
,, TOWN OF BARNSTABLE
No....................... FEE.......................
Disposal sal V
Tuon rudivit rmi�
//,, // e- s-D'�ic , e)A�
Permission is hereby granted........Uv ....... ............._.....
to Construct ( ) or I,2e air ( x) an I dividual Sewage Disposal System
atNo........ dL....`.......... ------------------------.--------------------------------------•-----•------------------.....----------••--•------......
Street
IC-
as shown on the application for Disposal Works Construction Permit N _ `Dated. ''�'_-----"----------------
......................... 1'�daa�oY�Fi`�alt)�-•--;---f.*=-•-- x�--••---
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS
Barnstable Assessing Search Results Page 2 of 2
Lot Size(Acres) 0.53
Appraised Value $112,000 > mlView Interactive Maps >>
V
Assessed Value $112,000 FEE..
Sales History:
Owner: Sale Date Book/Page: Sale Price:
BULLOCK,PETER W&ILONA A Sep 29 2009 12:OOAM C189637 $1
BULLOCK,PETER W&ILONA A Mar 4 2006 12:OOAM C185383 $324,900
DEUTSCHE BANK NATIONAL TRUST CO Feb 25 2008 12:OOAM C185303 $351,000
MCCARTHY,STEVEN J&DORIS Feb 15 1994 12:OOAM C132926 $109,000
BUFFINGTON SCOTT C& Sep 15 1992 12:OOAM C127804 $109,000
BOWEN,MARK S&GAIL A Aug 15 1984 12:OOAM C97733 $75,900
CAHOON,DENNIS F&LINDA J Aug 10 1978 12:OOAM C75109 $0
Extra Building Features
Code Description Units/SQ ft Appraised Value Assessed Value
FPL2 Fireplace 1 $3,700 $3,700
SHED Shed 64 $800 $800
Property Sketch Legend
BAS First Floor,Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished)
BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished)
CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished)
FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished)
FCP Carport GRN Greenhouse UUA Unfinished Utility Attic
FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished)
FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck
FOP Open or Screened in Porch TQS Three Quarters Story(Finished)
http://www.town.bamstable.ma.us/assessing/2010/displayparcell0map.asp?mappar--l25048 3/15/2010
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6' OF FINISH GRADE 3' MAXIMUM COVER
=- FIRST 2:' TO INVERT OUT SEPTIC TANK: 10/:0 DESIGN FLOW:
MIN 2* OF PEASTONF INVERT IN DI ST. BOX: 100.67 3 BEDROOMS AT 1/0 G.P.D. PER I. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION
VE LEVEL OR FILTER FABRIC
INVERT OUT DIST. BOX 100.5 BEDROOM EQUALS 330 G.P.D. : OF THE SEWAGE DISPOSAL SYSTEM ONLY.
4' D'" PIP %t.s 3/4- I I/2- OIA. INVERT IN LEACH CHAMBER: 100.4
•
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/01.0 5 2' go DOUBLE WASHED STONE BOTTOM OF LEACH CHAMBER: 98.4
GAS /00.67 0 100.4 �+ 98.4 ADJUSTED GROUND WATER: N/A SET. SEE SI TE PLAN.
BAFFLE R GROUND.W N/A SEPTIC TANK REQUIRED:
2-500 GAL LEACHING CHAMBERS -OBSE OBSERVED G UND WATER:
3 OUTLET _ 330 G.P.D. X 20OX - 660 GAL. J. ALL CONSTRUCT/ON METHODS AND MATERIALS AND
EXISTING W/4' STONE AROUND. 12,8'w `x 33'I x 2'd OTTOM OF TEST HOLE tel: 92. 1
D ROX - SEPTIC TANK PROVIDED: 1000 GAL. EXISTING MAINTENANCE OF THE SEPTIC SYSTEM SHALL
1000 GAL CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL
SEPTIC TANK
6' CRUSHED STONE OR I SOIL ABSORPTION SYSTEM REQUIRED:: BOARD OF HEALTH REGULATIONS.
' COMPACTED BASE DESIGN PERC RATE C 5 MIN/INCH
r c SOIL TEXTURAL CLASS - 1 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER
PROF. I LC : NOT TO SCALE - , EFFLUENT LOADING RATE - 0.74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER
330 GPD / 0.74 GPD/SF - 446 S.F.:REOU/RED THAN 3' IN DEPTH SHALL BE CAPABLE OF W I TH-
STANDING H-20 WHEEL LOADS.
PROVIDED: 2-500 GAL LEACHING CHAMBERS
l
W/4' STONE AROUND. A-606 S.F." S. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR
CATCH BASIN 606 S.F. x 0.74 448 G.P.D. APPROVED EQUAL.
i 1\► 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED
/vH FW Y SOIL TEST P I T D A T A PRECAST CONCRETE OR APPROVED POL YETHYL ENE.
BOTH SHALL BE WATERTIGHT. D-BOX SHALL BE WATER
\ INDICATES INDICATES
/ I PERCOL�A T l ON _ OBSERVED TESTED FOR LEVEL "WHEN THERE IS MORE THAN ONE
f I TEST = GROUNDWATER
OUTLET.
P l 4271
I TP •/ TP •2 - 7. BEFORE CONSTRUCTION CALL 'DIG-SAFE-.
% \ HORIZON TEXTURE COLOR HORIZON TEXTURE COLOR 1-888-DIG-SAFE AND THE LOCAL WATER DEPT.
0 /03.6 0 103.6
/ 1 FOR LOCATION.OF UNDERGROUND UTILITIES.
1 LOAMY IOYR LOAMY IOYR
1 A SAND 2/2 A SAND 2/2 .
1 Q 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE
l L O I 18 8' - - - - - - - - - - - - - - - - - - - - '102.9 9 - - - - - - - - - - - - 102.8
23. 100+ S.F. SANDY IOYR p SANDY IOYR
DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION
LOAM 9/6 O LOAM 4/6 OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE
A , l CONSTRUCTION INSPECT IONS.
28" - - - - - - - -- -- - - - - - - - - - l0/.3 26 - - - - - - - - - 101.4
Y 0/
MED-COARSE IOYR MED-COARSE IOYR
Y
C l , -:SAND 6/6 �l `:.SAND 6/6 9.< EXISTING .LEACH PITS TO BE PUMPED DRY AND
BACKF I LLED.
EXISTING SEPTIC_TANK TO BE PUMPED AND CLEANED.
S2" INSPECT AND REPLACE INLET TEE IF REQUIRED.
I ► 1 ��\, �'fooF NO WATER NO WATER
/ e 1 /38- 92. 1 /20' 93.6
cainH SET nor 1 9` y�� d� 104.0 DATE: JANUARY 29. 2014
� I <`bo � ° �c.� LEACH TEST BY: STEPHEN HAAS
I p 0 O PIT
! _ - +104.7 WITNESSED BY: DONNA MIORANOI
if PER IRATE: C 2 MIN/INCH
104.E
\ o Ilk,
1 _ Ids ;, .>�.,. ,_••t:•,
6 .-. ... ,... ? S00 GALLON
EX I STJNG
- - LEACHING CHAWERS
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SEPTICTANK t
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I
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O i/YORANT
STERHEN A . HAAS
/ 4AS LINE
OHW- OVER HEAD WIRES
� LIGHT POST _ ENGINEERING , INC
-E- ONDERGROUND ELECTRIC LINE
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C61DH FN0 -T.- NDERGROUND TELEPHONE LINE Y a r mo u t h p o r t M A 02675
e CTV NDERGROUNO CABLEVI S/ON LINE Y 62
+40.4 POT ELEVATION-
-:, CONTOUR _
LOCUS MAP D l0 20 AO i OPOSED CONTOUR JOB NO: 13- 116
_ 40 - R
I
j
ACCESS COVERS MUST BE WITHIN 9" MINIMUM. INVERT ELEVATIONS : DESIGN CR I TER I A : GENERAL NO TES :
6. OF FINISH GRADE 3 MAXIMUM COVER
FIRST 2' TO INVERT OUT SEPTIC TANK: 10/.0 .DESIGN FLOW:
BE LEVEL MIN 2" OF PEASTONE INVERT /N DIST. BOX: 100.67 3 BEDROOMS AT 1/0 G.P.D. PER I. THIS PLAN /S FOR THE DESIGN AND CONSTRUCTION
OR F I L TER FABRIC INVERT OUT D I ST. BOX: 100.5 BEDROOM EQUALS 330 G.P.D. OF THE SEWAGE DISPOSAL SYSTEM ONLY.
4" DIAM PIPE 101.4 INVERT IN LEACH CHAMBER: 100.4
3/4" - 1 //2" D lA. NO GARBAGE GRINDER 2. VERTICAL DATUM IS ASSUMED. FOR BENCH MARKS
GA l0/.0 /00.5 w DOUBLE WASHED STONE BOTTOM OF LEACH CHAMBER: 98�4
SET. SEE SI TE PLAN.
BAFFLE I00.67 21m 100.4 v 98.4 ADJUSTED GROUND WATER: N/A
SEPTIC TANK REQUIRED:
3 OUTLET 2-500 GAL LEACHING CHAMBERS . OBSERVED GROUND WATER: N/A 330 G.P.D. X 200% - 660 GAL. J. ALL CONSTRUCTION METHODS AND MATERIALS AND
EXISTING D-BOX W/4' STONE AROUND. 12.8's x 33'l x 2'd 'BOTTOM OF TEST HOLE *1: 92• 1 SEPTIC TANK PROVIDED: 1000 GAL. EXISTING MAINTENANCE OF THE SEPTIC SYSTEM SHALL
IOOO GAL H-20 CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL
SEPTIC TANK 6" CRUSHED STONE OR SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS.
COMPACTED BASE DESIGN PERC RATE ( 5 MIN/INCH
SOIL TEXTURAL CLASS - I 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER
PROFILE : NOT TO SCALE EFFLUENT LOADING RATE - 0.74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER
330 GPD / 0.74 GPD/SF - 446 S.F. REQUIRED THAN 3' IN DEPTH SHALL BE CAPABLE OF W1TH-
STANDING H-20 WHEEL LOADS.
PROVIDED: 2-500 GAL LEACHING CHAMBERS
W/4' STONE AROUND, A-606 S.F. '' 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR
CATCH BASIN �
606 S.F. x 0.74 - 448 G.P.D. APPROVED EQUAL.
N
6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED
CB/OH FND SOIL TEST PIT DA TA & PRECAST CONCRETE OR APPROVED POLYETHYLENE.
\ INDICATES INDICATES
BOTH SHALL BE WATERTIGHT, D-BOX SHALL BE WATER
_�
I
PERCOLATION --- OBSERVED TESTED FOR LEVEL WHEN THERE IS MORE THAN ONE
TEST - GROUNDWATER OUTLET.
� i \
TP -#l P*14271 TP #2 7. BEFORE CONSTRUCTION CALL -DIG-SAFE
l /
I 1-888-DIG-SAFE AND THE LOCAL WATER DEPT.
HORIZON TEXTURE COLOR HORIZON TEXTURE COLOR
I 0" 103.E D" 103.6 FOR LOCATION OF UNDERGROUND UTILITIES.
/ I
I '4 LOAMY IOYR SAND 2/2 '4 LOAMY IOYR SAND 2/2 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE
LOT 18
8" - - - - - - - - - - - - - - - - - - - - 102.9 9" - - - - - - - - - - - - - - - - - - - - 102.8 DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION
23. 100} S.F. B B SANDY IOYR SANDY IOYR
OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE
LOAM 4/6 LOAM 4/6 CONS TRUCT l ON /NSPECT I ONS.
28" - - - - - - - - - - - - - - - - - - - - 101.3 26" - - - - - - - - - - - - - - - - - - - - 101.4
MED-
MED
SAND ARSE 16 C / SAND
COARSE 16 9. EXISTING LEACH PITS TO BE PUMPED DRY AND
y \
SAND 6/6 SAND 6/6
BACKF I LLED.
l 0. EX l S T l NG SEP T/C TANK TO BE PUMPED AND CLEANED.
\ /
/ \\ \ , ��•��c. 52" INSPECT AND REPLACE ,INLET TEE IF REQUIRED.
/ \ 1
I I 1)
NO WATER NO WA TER
138" t 92. 1 120" 93.6
I #G
CB/DN SET �oz t 9` �yoap 104.0 MATE: JANUARY 29. 2014
LEACH TEST BY. STEPHEN HAAS
PIT +104-7 W1 TNESSED BY: DONNA MIORANDI
PERC RATE: ( 2 MIN/INCH
104.6
2-500 GALLON
EXISTING � � N;?'
\\ GPD BM. CORNER BH -` LEACHING CHAMBERS ] s
SEPTIC TANK W/4' STONE AROUND
\ \ EL-!04.88 LEACH D.=BOX. 4
PIT
V •.• 10"OAK
24"PINE
TP*!
16"OAK ,� 0 SEP T / C SYS TEM LIES 1 ON
TPs2
��• \ 1 202 BR / OLE" PATH . MAP l 25 P,4RCEL_ 48
\�h BARNS TABLE ( MARSTONS MILLS ) MA .
PREPARED FOR
sT L EGEND
RgCE Lq y� pc�Q\\�\ P E T E R l L O N A B U I L._ O C K
F \
■ CB CONCRETE BOUND
�Qv -W WATER LINE SCALE I - 20 MARCH 1 7 . 2014
L 0 S \ / O HYDRANT
c \ / -G OAS LINE
STERHEN A . HAAS
W' OVER LIGHT HEAD
WIRES
_ ENGINEERING , INC
POSUNDERGROUND ELECTRIC L l NE
923 Route 6A
`- / �.��� ! � i�� Yca rmou t h o r t MA . 02675
CB/OH FND --T- . UNDERGROUND TELEPHONE LINE // �. -- ''� P
-CTV- UNDERGROUND CABLEVIStON LINE - �`�- //� ( SO8 ) 362-8 1 32
+40.4 SPOT ELEVATION
.. 40--••.._ EXISTING CONTOUR
LOCUS MAP 0 10 20 40 40 PROPOSED CONTOUR JOB NO: 13- 1 16