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HomeMy WebLinkAbout0035 CAMMETT WAY - Health Cammett Way � Marstons Mills A= 099 - 014 _ w i� 4! NOW, THEREFORE, r�l���oi��s�, ,���1`, does hereby place the (owner's name) following restriction on his above-referenced land in,accordance with his agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 1. C,�}rv�rn la+A f may have constructed (address) - upon the I t a house cont ining no more than 0- `�" (-) bedrooms. 1 e� �� S 4 4. 4e_(7 agrees that this shall be permanent deed (owner's n me) - restriction affecting Nf located on'-'.,. 4. MA, and being shown on the plan recorded in Plan Book (7 Paged __911�. Or on Land Court Plan 17 S---o - For title of teethe following deed: Book , Page Or Land Court Certificate of Title Number dt) 1 �5 Executed as a sealed instrument M 1-Zday of Owner's signature. , t Owner's signature Owner's signature COMMONWEALTH OF MASSACHUSETTS ss JU A Pam- i y=' -, 20. X Then personally appeared the above named known to me to be ih6 person who executed the foregoing instrument and acknowledged the same to be free act and deed, before me, &kA Notary My commission expires: CKMeia McCaffrey ffrey (date) Notary Public OMMONWEALTHOfMASSACH y ComruissiorExpe ALgust 282 20 DOc e 1 s 392 s 369 03-12-2020 3 0 1$ BARNSTABLE LAND COURT REGISTRY DEED RESTRICTION WHEREAS, of (owner's name) t� .ram a�1'1 1 fl MA (address) , is the owner of �FJA-� located (address) . —J at .1mv f , MA (hereinafter referred to as ti and being shown on.a plan entitled "Subdivision of Land in . ntis 1�b MA, Property of et al, duly recorded in Barnstable County Registry of f Deeds in Plan Book M,l -C� , Page Or on Land Court Plan Number�' � �S0-0 WHEREAS, -e t as the owner of said lot has. . (owner's name) agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a. pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum , Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compiance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on this property, is requiring'that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, deedr v . Affidavit State of Massachusetts; County of Barnstable My current legal name is Nicholas Radaelli, and my current occupation is Plumber. I am presently ��,7years old, and my current address of residence is 35 Cammett Way, Marstons Mills, Massachusetts 02648. ' I am a-Licensed.Plumber iri the State of MA. and-1 reside at 35 Cammett Way for 3 years now. I am writing this Affidavit to clear any confusion about my intended use of my detached garage being converted and used as a bedroom. My home, that I and my brother share, has 2 bedrooms and is to small to support my life long hobby - Boxing. I bought the home recently and decided to save the gym membership fee by converting the free standing garage into my workout room (see Exhibit A). There is no kitchen nor a separate room on plan. My being a plumber led me to install a full bath area due to only the material costs. Again my efforts were only to have the space to train with the necessary equipment positioned and permanently installed. . I hereby state that the information above is true, to the best of my knowledge. I also confirm that the information here is both accurate and complete, and relevant information has not been omitted. Date 4 � 1 <57 Not ry Public Title And Rank A)Ornn PuLJI �t C. pate Of Commission Expiry A.��Mr�NArL �. AMANDAFREDETTE Notary Public Massachusetts My Commission Expires ./ Oct 3, 2025 TOWN OF BARNSTABLE LOCATION 35— SEWAGE# go'cl—0'7® J VILLAGE 44,,yn-"S 44,'11S ASSESSOR'S MAP&PARCEL E79-/`i/ INSTALLERS NAME&PHONE NO. J, G 44 /7f, j70g WS--94-`;� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �,��`�t�¢a�3 /3•,*)e O6 (size) 13,k Y,26 NO. OF BEDROOMS oZ nn OWNER - J W V PERMIT DATE: COMPLIANCE DATE:'- NO:q 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 nar 0'F n Dr/S-e r 13 a�® Q3 a % o 7` �a �,14 r ; aoo1- o No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Misposai 6pstent Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) KComplete System ❑Individual Components Location Address or Lot No. c�3��Gi`'yy�/frj�f}L(/ Own 's Name,Address,and Tel.No. r Assessor's Map/Parcel _ �,sill r'�J A, Installer's Name, ddress,and Tel.11q,. Designer's Name,Address,antl Tel.No. J.4 /6. c Cv" Spa.c7,a-� j�/h? fn //liy1LL Q.G �rn �_ St'v el 0-r j y h X 111,/ AM 0�� L: iJ CI J.l -i - 1 ew �-Fi L•'Y Type of Building: 5ok ya$ terry 5 Dwelling No.of Bedrooms �� Lot Size _sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 3Lf gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 H "alth Signed Date 3 - 3 0 Application Approved by - Date 3 Application Disapproved by Date for the following reasons Permit No. 0O O T6 Date Issued 3 3 d .l , No. 0 0 1 i7— T Fee ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppliLatlon for Misposal 6psteut Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) VComplete System ❑Individual Components Location Address or Lot No. S,5 �'� j��G�4e,-, Owner's Name,Address,and Tel.No. Assessor's Map/Parcel _ `( /Iyl v �, l,✓ llS v'f Installer's a e, ddress,and�yTel.No, Designer's Name,Address,and Te/l.N�o. o, &V 339 "VA aa��� " LL Tfpe of Building: 3ry V,7,V h y Dwelling No.of Bedrooms Lot Size 46) &Q sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) a V gpd Design flow provided t gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) f Da;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 a 16 4 4 Compliance has been issued by this Board of Health Signed Date 3 - 3 d- o Application Approved by Date 3- 20 -0 / Application Disapproved by Date - for the following reasons ti Permit No. ,2 o 0 9 - 076 Date Issued 3 C) ------------------------------------------------------------------------------------------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CE Ti1 Y, t the On-site Se sage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by \// O 6 at 35 has been constructed in accordance c� with the provisions of Title 5 and the for Disposal gystern Construction Permit No. 2 04 —070 dated 75- 3 D'd / Installer Designer #bedrooms 0 , Approved design flow_ d1 I CJ/ gpd t � �f The issuance of this permit shall n t be co/ s�tr�ued-as a guarantee that the system will'ction as designed. _ Date / (/ Inspector % ------------------------------------ ------ -------------------------------------- --------------- -----4 -- ------- ------ No. o 0o� - O7 U Fee 'y v THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION r BARNSTABLE,MASSACHUSETTS ]Disposal bpstem Construction Permit \ Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at 35 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. `- Date Approved by (M� / Apr 01 09 09: 16a iI p. 1 'Town of Barnstable �pp'fHE>p� hP Y� Regidatory Services Thowas F.Geiler,Director cLlluVsrnBX,E. " Public Health Division Thomas McXean,Director 200 Main Street,I1yanYlis,MA 02601 070 Office: 508-862-4644 0 Fax: 505-790-6304 lixnstaller &Designer Certificat.iou Form Date: Designer: l/GM�t,J,�- (.ot1� gueyA'-t- Installer: ---- Address: •1 21 Address: `�0 �✓�� 3 3 _ OIL 3-3/-O y �,c �►G /�� was issued a permit to install a {date) (installer) septic system at �� [ii 1 based on a design drown l y (ad es dated (designer) -� j...certify that the septic system referenced above was installed substantially according to .}lae desiga, which may include minor approved-changes such as latwi: relocation of the dis;Uibution box and/or septic tank- T. I certify that the septic system referenced above was installed with'-n*r changes (fe. greater the n 10' lateral relocation of the SAS or any vertical relocation of any component of the sepffeQ_system)but in accordance with State &X,oeal Regulations- Plan revision or certified as-built-by designer to follow. OFMgs DAVID (installez's Sit nature) . B. MASON ' No. s01 .T�Vk . _ AkJTAA�p (DU ' er s Signature) (A�fix gaer's Starhp Here) 4 PLEASE RETURN TO :BARN UABYX.PYJBLIC HEALTH DIVISION. C RTMCA,'l'E AS- OF COM�'�L,XANCE WiIJ, NLOT $E SUED� YH, BO'K'lrl T�.S�F4fiM A AS- BUILT CARD ARE RECEIVED BY,TUE, BAR• STABLIE PITIX HE !KV Si N THANK YOU. Q. Certirwah vn Pon,, ' Cr TOWN OF BARNSTABLE LOCATION = C £ '� y SEWAGE# VILLAGE /LL S ASSESSOR'S MAP&LOT /N 3 PF Zo INSTA I I 9,R /9 Kd 11x�C 'S NAME&PHONE NO. SEPTIC TANK CAPACITY -� //-5, !v!✓ LEACHING FACILITY:(type) (size) NO.OF BEDROOMS BUILDER OR OWNER / r�19 A,, /!2 P£^14If DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by <� r 9-3 s °57f .4/t 0 TOWN OF BARNSTABLE L•,OCA "ON �� G i4�3(��� �,�.id� SEWAGE #�' VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY-(type) size) (i,x,L NO. OF BEDROOMS PRIVATE WELL OR BLIC AR BUILDER OR OWNER w Inca C,:4 DATE PERMIT ISSUED: DATE -COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No (/ \ ( Y�2�7 '� �3 �� e���a� �.zss�o��.. ; � o �� ��.��`'� Itl Lam/ �x�w��.� �, Uwe_ C0 No...a.7./......I'Zo Fizz ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 'T ... ...................................OF7. .................................. I Appliration for Dispaoal Works Toustrurtion VarAft Application is hereby made for a Permit to Construct or Repair (L��n Individual Sewage Disposal System at: 14 YK M,'ji 17-T Location-Address or Lot No.. ............. ......................................... ................. ;6---�__- -------------------------------------------------------------- Owner 1. .4 Address ^141....................... i��...................... ............................W. ...4� Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms___._w.....................................Expansion Attic Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( ) Otherfixtures ...................................................................................................................................................... -) ---------------------_-gallons. Mikfi Flow..........=3, !5..7......................gallons per person per day. Total daily flow.....-a-x W, _/ ' 1 P4 , ;Zq"/'Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth.............__. Disposal Trenc h—No..................... Width.____..._........_._ Total Length..___..__._.____.... Total leaching area....................sq. f t. ,,.Seepage Pit No......./----------- Diameter...LjO.'....... Depth below inlet__._......__.... Total leaching area..................sq. ft. Z. Other Distribution box Dosing tank Percolation Test Results Performed by.......................................................................... Date........................................ as Test Pit No. 1................minutes per inch Depth of Test Pit.____.__...__....._. Depth to ground water..___________........._. 44 Test Pit No. 2................minutes per inch Depth of Test Pit____-___----____---- Depth to ground water_.______________-_______ x ............................................................................................................................................................. 0 Description of Soil....................................................................................................................................................................... U ......................................................................................................................................................................................................... ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable.....AVP..... . _ J_�)............. .....' ........................................................................................ .......................... :*'�..... Agreement: The-undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TT . 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliakc en issued b, the-bDar-d of health. i igned......it.......'- -------ID --- .... ---------------- ...2.3....n........ gned...... Date Application Approved By................. '�uc�.. . .................................. ........... Date Application Disapproved for the following reasons:................................................................................................................ ........................................................................................................................................ ---------------------------------------------------------------- Date PermitNo......Q..I--.-/_'`Llo---------------------------- Issued....................................................... No.__!a.�.�..,��C7 Fus.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ----------- U.....:-VL......OF.. .t4.,rK Appliratiun for Dhipoii al Workii Towitrnrfiun Prranit Application is hereby made for a Permit to Construct ( ) or Repair (L,�~,rn Individual Sewage Disposal System at: ............_ -•...C....A....V..h...M.....F_..i.•-`--t•�----•----w-------�_ ...--..•-- Location- ( _ Address or Lot No. W G ! L��r,Owner _ Address ,.a f:. - r r .A- kt O.J-/..... ----------------------- Installer Address UType of Building Size Lot............................Sq. feet ►� Dwelling—No. of Bedrooms-_---------------------------------------Expansion Attic ( ) Garbage Grinder ( ) a'4 Other—T e of Building No. of persons............................ Showers YP g ---------•-----------•------ P ( ) — Cafeteria ( ) Otherfixtures .---•---------- -------•------•-----•--••----------•--•----••-------------•-----------------••--•-•----••-----••-------....--•---•--•............... W Design Flow........ 5"'......................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---/...0.1._----_- Depth below inlet....&............ Total leaching area..................sq. it. 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-.--_----_---__-.--- -. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----._.-_-.-_----__---- P4 --•-----•---------------------••------••••-----....--------••------•-•-••-•--•--••-•----------------------•-••-••---•--------•----•--•...................... 0 Description of Soil........................................................................................................................................................................ W x --------------- -------------------------------------------------------•-•---------------•-••---•------•------••-------...------•------------•-----•-------••-•---------------•-•-••------..._.._...--- U Nature of Repairs or Alterations—Answer when applicable------A60----4,n_-C_.....�-_!{�....��.1...�-�!.�.?..!..__--.--. STa''` r' f a r = 7`- ----------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TT T i E 5 of the State Sanitary Code— The undersigned furti:er agrees not to place the system in operation until a Certificate of Compliaes en issued by She—boud of health. ' Signed......I "` Y ----•-•----------- --- _3 .`�...---•- Date Application Approved By................. 4 _t �� - ------------------------•--------- -•------- `! Date Application Disapproved for the following reasons:.......•........................................................................ •----------- •--•---------------- ....---....•--•-•-----•------•---•---••---••----•---------•--•--•------••----•---•--•----------------------••--------•--•------------•------•---•-•-•-•---------••--•---•-•-----•-----•.......------•--- � Date Permit No.---•-CCCJJJ Q-------------------------- Issued-----------------------------------------.------------ Dt, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l,.lJ► -�......OF... c.!a ....-e ...... ............................... (Irdifiratr of TompliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by--------------_----L 419..vt... .✓�. .✓J......� ` t' Installer at................................ . ......................................................A ✓wt ' i'`� t---------- ... F .....� t. has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-------- ------------ dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... ............ •• . ------•---.......--•••••••--..---- Inspector.. 4 , THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Q�/ ........ �!� ....."OF. ?R.....�......�.. 22 _ �10..1,�-f•:..�.� . _ ....................... FEE....eC�.`-�............ Disposal Vork.5 Tonotrnr#ion Vamit Permission is hereby granted....... ..{+: ... .U v`_C to Construct ( ) or Repair (>-,L4nIndividual Sewage Disposal System at No............... !--yr°-✓z�-=- '•----.^�-� � -- ----------4e*--j Street r as shown on the application for Disposal Works Construction Permit No.--Zi.-R6...... Dated.......................................... ................................... ..---L,...................................................... DATE.............3. 3:_ �� Board of Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS YOU WISH TO'OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed farm to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. i DATE: — Fill in lease: s srhµa APPLICANT'S YOUR NAME/S: "w�+ �6 BUSINESS YOUR HOME ADDRESS: J Y'i3n�i°'0 ac6L1- ,1 . TELEPHONE # Home Telephone Num er - J �,, v.:Jat tifgra�, #: E_MAIL: t;,... NAME OF CORPORATION:. \' ' NAME OF NEW BUSINESS TYPE_O_� . .MESS t �� IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS. MAP/PARCEL NUMBER ' ` (Assessing) (�'�c'S OCAS (�'1•�114J,, r ��'� When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of. Barnstable. This form is intended to assist you,in obtaining the information you may need. You MUST GO TO 200 Main St. -. (corner of Yarmouth Rd. & Main Street) to make sure you have;the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIO 's OFFICE MUST COMPLY WITH HOME OCCUPATION This individual has be fo kr ed f a y permit requirements that pertain to this type of business. RULES AND REGULATIONS. FAILURE TO COMPLY MAY RESULT IN FINES. Authorized Signat re* COMMENTS: 1) hlfi� A © O0 MgIZ'F' e& l 2. BOARD OF HEALTH - This individual has been i or h t requirements that pertain to this type of business. Authori ed Signa. ure COMMENTS: 3. _.-.__ LICENSING AUTHORITY . This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: , bq9-ai Commonwealth of Massachusetts IFTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ` 35 Camme t Way Property Address rV Jackie Corley co Owner Owner's Nameinfiorrnation is required forte emy Marston Mills,� MA 02648 101I 2016 pap Cityrrown state Zip Code Date of trrsp wbm C'j , Inspection results must be submitted on this form.Inspection forms may not be altered in anp way.Please see completeness checklist at the end of the form. 'r,°1wbrie� A. General Information on the computer. use only the tat, 1. Inspector key to move your cursor-do not Paul Martin use the return Name of Inspector key. Cape Cod Septic Services -�I Company Nam 350 Main St Company Address W.Yarmouth MA 02673 Cayyrrown state Zip Code 508-775-2825 S15016 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was per kaned based on my training and experience in the.proper function and muintenance of on site sewage disposal systems.l am a DEP approved system inspector pursuant to Section 15,340 of Tide 5(310 CMR 15.000).The system: Pis ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the.Local Approving Authority 1020/2016 trrspecWs Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.lf.the system is a shared.system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection:and:under the conditions of use at.that time.This irspection does not address Prow the system wilt.perform in the future under the same or different conditions of use. thins-3113 Title 5 oftW kWecbm Fomr Skaraw Sewage Disposal System•Page 1 d 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Cammett Way Property Address Jackie Corley Owner Owner's Name information is Marstons Mills MA 02648 10/14/2016 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: System in working condition B) System Conditionally Passes: ❑ one or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Plg Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Cammett Way Property Address Jackie Corley Owner Owner's Name information is Marstons Mills MA 02648 10/14/2016 required for every page City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4M 35 Cammett Way Property Address Jackie Corley Owner Owner's Name information is Marstons Mills MA 02648 10/14/2016 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool, ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Cammett Way Property Address Jackie Corley Owner Owners Name information is MA 02648 10/14/2016 required for every Marstons Mills page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 3.10 CMR 15.304. The system.owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 35 Cammett Way Property Address Jackie Corley Owner Owners Name information is required for every Marstons Mills MA 02648 10/14/2016 page. Ci fTown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 110x3= 330gpd t5ins•3/13 Title 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 Cammett Way Property Address Jackie Corley Owner Owner's Name information is required for every Marstons Mills MA 02648 10/14/2016 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No 2014=88gpd Water meter readings, if available (last 2 years usage (gpd)): 2015=90gpd Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank.present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 35 Cammett Way Property Address Jackie Corley Owner Owner's Name information is required for every Marstons Mills MA 02648 10/14/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: No Records Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Cammett Way Property Address Jackie Corley Owner Owner's Name information is Marstons Mills MA 02648 10/14/2016 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2009 Per BOH records. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2211 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: +10'feet Comments(on condition of joints, venting, evidence of leakage, etc.): Line checked with sewer camera and was found to be clean, properly pitched with no sign of root intrusion. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500Gal Sludge depth: 3-4" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 N ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Cammett Way Property Address Jackie Corley Owner Owner's Name information is required for every Marstons Mills MA 02648 10/14/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 1" 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 How were dimensions determined? Estimated Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1500Gal H-10 tank in good condition. PVC tees in place and clean. Tank at normal operating level. Covers 12" below grade. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom.of outlet tee or baffle Date of last pumping: Date t5ins•3113 Title 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,V•"� 35 Cammett Way Property Address Jackie Corley Owner Owner's Name information is MA 02648 10/14/2016 required for every Marstons Mills page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 35 Cammett Way Property Address Jackie Corley Owner Owner's Name information is Marstons Mills MA 02648 10/14/2016 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): H-10 DB-6 with 1 line in and 4 lines out. Box is clean and solid with minimal solids carryover. No sign of overloading or hydraulic failure. Cover 12" below grade. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Cammett Way Property Address Jackie Corley Owner Owner's Name information is required for every Marstons Mills MA 02648 10/14/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: Infiltrators ❑ 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.): Infiltrators in a 13.8'x26'field configuration. Soil found to be only damp at time of inspection. No sign of overloading or hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17. Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Cammett Way Property Address Jackie Corley Owner Owner's Name information is Marstons Mills MA 02648 10/14/2016 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 �I — Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 35 Cammett Way Property Address Jackie Corley Owner Owner's Name information is required for every Marstons Mills MA 02648 10/14/2016 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y� 35 Cammett Way 4M Property Address Jackie Corley Owner Owners Name information is required for every Marstons Mills MA 02648 10/14/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: +10' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record 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: Hand auger to 10'with no water encountered. Max bottom of leaching is 4'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 ' Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,•�° 35 Cammett Way Property Address Jackie Corley Owner Owner's Name information is required for every Marstons Mills MA 02648 10/14/2016 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 r TOWN OF BARNSTABLE LOCATION 35-co—,yr+rtl w-:t SEWAGE#Rffry 070 VILLAGE. 4,y,i"S A4,'115 ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. 3 L Aw /Av S ok 1-12-96 1 S- SEPTIC TANK CAPACITY LEACHING FACILITY:(type) -j,,,4'%wtWf 10"aC (size) /3.&rra6 NO.OF BEDROOMS oZ OWNER D PERMIT DATE: 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 Beaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY NY O�n3/j< a 3 �f 13 a asp 3� k3 70- . yy 0 0 0 s � l�0 4 LY 7 6a 7 N 6qA I f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Cammett Way Marstons Mills Property Address Wells Fargo C/O Ann Quinlin Remax Real Estate Owner Owner's Name information is required for 167 Lovell s Lane, Marstons Mills MA 02648 February 4, 2009 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. Important: A. General Information When filling out SI ��2 forms on the computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name 189 Cammett Road Company Address Marstons Mills MA 02648 Citylrown State Zip Code 508-428-1779 S1 12855 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority February 4, 2009 Ins ector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 09.14 Wells Fargo.doc•08/06 Title 5 Official Inspection Form.Subsurface Sage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Cammett Way Marstons Mills Property Address Wells Fargo C/O Ann Quinlin Remax Real Estate Owner Owner's Name information is required for 167 Lovell's Lane, Marstons Mills MA 02648 February 4, 2009 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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: ❑ 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 09-14 Wells Fargo.doc•08/06 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 35 Cammett Way, Marstons Mills Property Address Wells Fargo C/O Ann Quinlin, Remax Real Estate Owner Owner's Name information is 167 Lovell's Lane, Marstons Mills MA 02648 February 4, 2009 required for ry every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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 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. 09-14 Wells Fargo.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Cammett Way, Marstons Mills Property Address Wells Fargo C/O Ann Quinlin Remax Real Estate Owner Owner's Name information is 167 Lovell's Lane, Marstons Mills MA 02648 February 4, 2009 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_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. 09-14 Wells Fargo.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Cammett Way, Marstons Mills Property Address Wells Fargo C/O Ann Quinlin Remax Real Estate Owner Owners Name information is required for 167 Lovell's Lane Marstons Mills MA 02648 February 4, 2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area Interim Wellhead ❑ ❑ y 9 ( e head 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. 09-14 Wells Fargo.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Cammett Way, Marstons Mills Property Address Wells Fargo C/O Ann Quinlin, Remax Real Estate Owner Owner's Name information is 167 Lovell's Lane, Marstons Mills MA 02648 February 4, 2009 required for ry every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have.been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 09-14 Wells Fargo.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 I f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Cammett Way, Marstons Mills Property Address Wells Fargo C/O Ann Quinlin Remax Real Estate Owner Owners Name information is required for 167 Lovell's Lane, Marstons Mills MA 02648 February 4, 2009 every page. Citylrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): N/A Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Unknown 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 Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 6 Months prior to inspection. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 09-14 Wells Fargo.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �. 35 Cammett Way Marstons Mills Property Address Wells Fargo CiO Ann Quinlin Remax Real Estate Owner Owners Name information is required for 167 Lovell's Lane, Marstons Mills MA 02648 February 4, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: None Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ® Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Overflow pit installed in 1989. Were sewage odors detected when arriving at the site? ❑ Yes ® No 09-14 Wells Fargo.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Cammett Way, Marstons Mills Property Address Wells Fargo C/O Ann Quinlin Remax Real Estate Owner Owners Name information is required for 167 Lovell's Lane, Marstons Mills MA 02648 February 4, 2009 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): ' Depth below grade: 1 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.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? 09-14 Wells Fargo.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Cammett Way' Marstons Mills Property Address Wells Fargo C/O Ann Quinlin, Remax Real Estate Owner Owners Name information is required for 167 Lovell's Lane, Marstons Mills MA 02648 February 4, 2009 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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.): 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): 09.14 Wells Fargo.doc•08/06 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Cammett Way, Marstons Mills Property Address Wells Fargo C/O Ann Quinlin Remax Real Estate Owner information is Owner s Name required for 167 Lovell's Lane, Marstons Mills MA 02648 February 4, 2009 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 09-14 Wells Fargo.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 35 Cammett Way, Marstons Mills Property Address Wells Fargo C/O Ann Quinlin Remax Real Estate Owner Owners Name information is required for 167 Lovell's Lane, Marstons Mills MA 02648 Februa 4, 2009 every page. Cltyfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: One 6x6 pit. ❑ 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.): Pit is in hydraulic failure. 09-14 Wells Fargo.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for VoluntaryAssessments is `M 35 Cammett Way Marstons Mills Property Address Wells Fargo C/O Ann Quinlin Remax Real Estate Owner Owners Name information is required for 167 Lovell's Lane, Marstons Mills MA 02648 February 4, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration One with overflow pit. Depth—top of liquid to inlet invert 2' Depth of solids layer 16" Depth of scum layer T Dimensions of cesspool 6x6 Materials of construction Block Indication of groundwater inflow ❑ Yes ® No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Liquid level was below outlet pipe at time of inspection due to vacancy, observed solids on top of tees indicating system is in hydraulic failure 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.): 09-14 Wells Fargo.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Cammett Way, Marstons Mills Property Address - Wells Fargo C/O Ann Quinlin, Remax Real Estate Owner Owner's Name - --------------- ------- information is required for 167 Lovell's Lane, Marstons Mills_ - _. MA 02648 February 4, 2009 — _ every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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 supply enters the building. Cammett Way Water Service 4+ \ 6 2 • r r / r r / r !\r\r\ !\! 37 41 7 � 43, $y T Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Cammett Way, Marstons Mills Property Address Owner Wells Fargo C!O Ann Quinlin Remax Real Estate Owners Name information is required for 167 Lovell's Lane, Marstons Mills MA 02648 February 4, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to ground water: N/A 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: 09-14 Wells Fargo.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 COMMONWEALTH OF MASSACHUSETTS Z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION y � d F l� 1 b� 350 MAIN STREET WEST YARMOUTH,MA 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 35 Cj,\ *IET WAY MARSTONS MILLS,MA 02648 Owner's Name: FRANEY,AMY a Owner's Address: _100 ALDER.RROOK LANE VEST BARNSTABLE,MA 02668 Date of Inspection JUL Y 6,2005 (W ' Name of Inspector:(please print) JAMES D.SEARS <I N ., Company Name: A&B Canco — Mailing Address: 350 Main Street M West Yannouth,MA 02673 ` Telephone Number: 508-775-2800 c b� t-- CERTIFICATION STATEMENT rn I certify that I have personally i.isi cted the sewage disposal system at this address and that the inform tion reported below is tine,accurate and comptete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: 1 Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 9 The system inspector shall submit a ccr"c!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 tot he buyer,if applicable,and the appro'ing authority. Notes and Comments "This report only describes conditions at the time of inspection and under;:he 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 1 Page 2 of 11 , OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 35 CAMMET WAY MARSTONS MILLS,MA 02648 Owner: FRANEY,AMY _ Date of Inspection: NLY 6,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ./ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A 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 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 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: Title 5 Inspection Form 6/15/2000 2 Page g � OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 35 CAMMET WAY MARSTONS MILLS,MA 02648 Owner: FRANEY, AMY Date of Inspection: JULY 6,2005 C. Further Evaluation is Required by the Board of Health:N/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety,or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or 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 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. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 35 CAMMET WAY MARSTONS MILLS,MA 02648 Owner: FRANEY, AMY Date of Inspection: JULY 6, 2005 D. System Failure Criteria applicable to all systems: N/A You must indicate"yes"or"no"to each of the following for all inspections: Yes No ✓ Back-up 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 N/A 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''/z 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 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 CUR 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: N/A To be considered a large system the system must service 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 i.l 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 is 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. Title 5 Inspection Form 6/15/2000 4 f ' Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 35 CAMMET WAY MARSTONS MILLS,MA 02648 Owner: FRANEY, AMY Date of Inspection: JULY 6,2005 Check if the following have been done. You must indicate"yes"or"no"as to each of the following Yes No ✓ Pumping information was provided by the owner;occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ Were all system components,including the SAS,located on site? ✓ Were the manholes uncovered,opened,and the interior inspected for the condition of the 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)has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. I ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CNM 15.302(3xb)] Title 5 Inspection Form 6/15/2000 5 I i Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 35 CAMMET WAY MARSTONS MILLS,MA 02648 Owner: FRANEY, AMY Date of Inspection: DULY 6, 2005 FLOW CONDITIONS RESIDENTIAL./ Number of Bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 220 Number of current residents: 0 Does 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): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no) NO Last date of occupancy: UNKNOWN COMMERCIALANDUS TRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow f 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: N/A Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped deternuned? Reason for pumping: TYPE OF SYSTEM soil absorption system _T 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 copy of the DER approval Other(describe): Approximate age of all components,date installed(if known)and source of information: PIT INSTALLED 1989 PERMIT#89-120 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 35 CAMMET WAY MARSTONS MILLS,MA 02648 Owner: FRANEY, AMY Date of Inspection: DULY 6,2005 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 101, Materials of constriction: Cast iron ✓ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): N/A Depth below grade: � II Material of construction: concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to the bottom of outlet tee or baffle: 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: How were dimensions determined: Conuiients(on pumping.recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage;etc.): GREASE TRAP(located on site plan) N/A Depth below grade: Material of construction: cone!-re 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.): Title 5 Inspection Form 6/15/.2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 35 CAMA ET WAY MARSTONS MILLS,MA 02648 Owner: FRANEY, AMY Date of Inspection: DULY 6,2005 TIGHT or HOLDING TANK: N/A (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): Date of last pumping Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: N/A (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.,).: PUMP CHAMBER: N/A (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.): Title 5 Inspection Form 6/15/2000 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: 35 CAMMET WAY MARSTONS MILLS,MA 02648 Owner: FRANEY, AMY Date of Inspection: JULY 6, 2005 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) T If SAS not located explain why: Type •/ leaching pits,number: 1 leaching chambers,number: _ leaching galleries,number leaching trenches, number,length leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Continents(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) LEACHING IS ONE 1000-GALLON PRE CAST PIT,PIT'&COVER AT 26"BELOW GRADE.PIT IS DRY WITH STAIN LINE AT 18". NO SIGN OF OVER LOADING OR SOLID CARRY OVER. MAIN CESSPOOLS: (cesspool must be pumped as part of inspectionxlocate on site plan) Number and configuration: _ 1 Depth—top of liquid to inlet invert: 5' Depth of solids layer: 4" Depth of scum layer: 0" Dimensions of cesspool: 6' Materials of construction: BLOCK Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): MAIN POOL 6'BLOCK WITH COVER AT 14"ONE INLET TEE—ONE OUTLET WITH TEE. NO SIGN OF OVER LOADING, F WATER. PRIVY: N/A (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.) Title 5 hnspection Form 6/15/2000 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: 35 CAMMET WAY MARSTONS MILLS,MA 02648 Owner: FRANEY,AMY Date of Inspection: JULY 6,2005 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 supply enters the building. 60 17 r as O _3 0 Tide 5 Inspection Form 6/15/2000 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: 35 CAMMET WAY MARSTONS MELLS,MA 02648 Owner: FRANEY, AMY Date of Inspection: JULY 6, 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater 12 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: �— Observation 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: TEST HOLE 12'NO WATER. TEST HOLE 4' BELOW BOTTOM OF PIT. BOTTOM OF PIT 8'BELOW GRADE. is 41 E3'OITa.� j PiT I Title 5 Inspection Form 6/15/2000 11 e� Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection One winter Street Boston Ma. 02108 John Grad ' D.L.P. 'Title V Septic hispector P.O. Box 2119 Teaticket, MA 02536 WILLIAM F.WELD (508)564-6813 Governor ARGEO PAUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 35 Cammett Way Marstons Mills Add ass of Owner: Date of Inspection: 3130198 (If different) — APR y Name of Inspector: John Oraci Kathrine Taylor:Cammett wa 'Maarstons Mills 026481) 19g'8 I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: e rV CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported-belo "s true,accurate and complete as of the lime of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x Passes This inspection Is based on criteria defined In Title V Condition I SSeS code 310 CMR 16303.My findings are of how the system is y performing at the time of the Inspection.My Inspection does _ Needs F th Evaluation By the Local Approving Authority not Imply any warranty or guarantee of the longevity of the Falls septic system and any of Its components useful life. Inspector's Signature: Date: 412198 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D: Al SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 3W CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B1 SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no, or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of CoThplfance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal, Is cracked, structurally unsound, shows substantial infiltration or exfillration, or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04M7t37) One Winter Street • Boston,Massachusetts 0210E . FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 35 Cammett Way Marstons Mills Owner: Kathrine Taylor:Cammett Way Marstons Mills 02648 Date of Inspection:3/30199 _ Sew.aae backup or,breakout or hiah.static water-level observed.in.the distribution box is due to a broken, or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(witt,approval of the Board of Health): broken pipe(s)are replaced obstruction is removed 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 the public health, safety and the environment. i) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of•the following: _ I have determined that the system violates one or more of the following failure criteria as defined 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 Backup of sewage .n facility or system component due to an 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 Cloggt:d cesspool. SAS is in hydraulic failure. (revised 0427)87) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Add ress: 35 Cammett Way Marstons Mills Owner: Kathrine Taylor.Cammett Way Marstons Mills 02648 Date of Inspection:3130199 D]SYSTEM FAILS(continued) Yes No "Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: _ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04r17lB7) i I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 35 Cammett Way Marstons Mills Owner: Kathrine Taylor:Cammett Way Marstons Mills 02648 Date of Inspection:3130199 Check if the following have been done:YOU must indicate either"Yes"or"No"as to each of the following: ,t_ — Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been introduced Into the system recently or as part of this inspection. x As built plans have been obtained and examined. Note if they are not available with N/A. x The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _X— The site was inspected for signs of breakout. x All system components,excluding the Soil Absorption System,have been located on the site. x The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions, depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site'has•been determined based on — — The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue,approximation of distance,is — — unacceptable)[15.302(3)(b)]• I (revised e4Q7187) I F SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 35 Cammett Way Marstons Mills Owner: Kathrine Taylor:Cammett Way Marstons Mills 02648 Date of Inspection:3130199 FLOW CONDITIONS RESIDENTIAL:Design flow: 220 g•pd/bedroom for S.A.S. Number of bedrooms: 2 Number of current residents: 1 Garbage grinder(yes or no): No Laundry connected to system(yes or no): No Seasonal use(yes or no): No Water meter readings,if a'v ilable:(last two(2)year usage(gpd): rda Sump Pump(yes or no): No Last date of occupancy: nla COMMERCIAL/INDUSTRIAL: Type of establishment: nla Design flow:o gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: nla r Last date of occupancy: nra OTHER:(Describe) rda Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: n/a System pumped as part of inspection:(yes or no)No If yes,volume pumped:0 gallons Reason for pumping: nla TYPE OF SYSTEM Septic tank/distribution box/soil absorptions system x Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes,attach previous inspection records,if any) x I/A Technology etc.Copy of up to date contract? Other: 1000 gallon leach pit APPROXIMATE AGE of all components,date Installed(if known)and source Information: 26 yeen old whh new ph Imtelled In 1999 Sewage odors detected when arriving at the site:(yes or no) No (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35 Cammett Way Marstons Mills Owner: Kathrine Taylor:Cammett Way Marstons Mills 02648 Date of Inspection:3130198 SEPTIC TANK:_ (locate on site plan) Depth below grade: rda Material of construction: concreate metal FRP Polyethylene—other(explain) If tank is metal, list age rue . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: rda Sludge depth:rda Distance from top of sludge to bottom of outlet tee or baffle: rda Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:rda Distance form bottom of scum to bottom of outlet tee or baffle:rda How dimensions were determined: rda Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage, etc.) rda GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: _concrete_metal_FRP_Polyethylene_other(explain) Dimensions: rda Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle: rda Date of last pumpingr*d Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) rda BUILDING SEWER: (Locate on site plan) Depth below grade: 1- Material of construction:_cast iron_40 PVC_other(explain) Distance from private water supply well or suction lineto Diameter: 4° rr;imments: (conditions of joints,venting,evidence of leakage,etc.) (revised 04127)87) f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 35 Cammett Way Marstons Mills Owner: Kathrine Taylor:Cammett Way Marstons Mills 02648 Date of Inspection:3130199 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_metai_FRP_Polyethylene_other(explain) Dimensions: rda Capacity: rda gallons Design flow: rda allons/day Alarm level:—rda —Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) Ma DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: rda Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.) rda PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)Yea Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) rda (revised 04r27W) I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35 Cammett Way Marstons Mills Owner: Kathrine Taylor:Cammett Way Marstons Mills 02649 Date of Inspection:3130199 SOIL ABSORPTION SYSTEM(SAS):x (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: n1a Type: leaching pits,number: VxV leachpu leaching chambers,number:nla leaching galleries,number: We leaching trenches,number,length: we leaching fields,number, dimensions:rda overflow cesspool,number:Na Alternate system: we Name of Technology:_Na Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) System and all components are structuraily sound and runctloning properly. CESSPOOLS:x (locate on site plan) Number and configuration: one Depth-top of liquid to inlet invert:2" Depth of solids layer: 4.. Depth of scum layer: 1" Dimensions of cesspool: Bxs Materials of construction: block Indication of groundwater: n1a inflow(cesspool must be pumped as part of inspection) n1a Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Mein cesspool and ell components are etructuraliy.Recommend pumping system every year for maintenance. PRIVY: (locate on site plan) Materials of construction: We Dimensions: n1a Depth of solids: n1a Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) n1a (revised 04127187) f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 35 Cammett Way Marstons Mills Kathrine Taylor:Cammett Way Marston Mills 02648 3130198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) �cv�lye aO a 37 Pay P of 10 (revised 002T19T) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 35 Cammett Way Marstons Mills Kathrine Taylor„Cammett Way Marstons Mills 02648 3130198 Depth of groundwater 12. Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutt4ng property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers x Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS maps and charts (revIsed0412T19T) page 10 of 10 40 A1� , Cb SUDSURFACE SZWAGE DISPOSAL SYSTEM XNSPECT YORK�Cf� 19 Address• of property .�5 C�H"''�T�' c"� �''a,s'r�"`"�•/ ✓UN e 3 Owner's name K c C l��-5 Date of Inspection �'Ay/9y­ 4 PART A CHECKLIST Check if the following have been done: 'X Pumping information was requested of the owner, occupant, and Board of Health. •r�r None of the system components have been pumped for at least! twoa veeJcs ,; and the system has been<receiving normal flow rates during that period. Large volumes of water have not been introduced. into the system recently or as part of this inspection. �y ` , -As built plans have been obtained and examined.. Note if they{areenat - available with N/A. ., Hp The facility or dwelling was inspected for signs of sewage back-up.,,F ;} V The site was inspected for signs of breakout. 4 All system components, excluding the SAS, have been located on the . •• site. The septic tank manholes were uncovered, opened,.. and the interior of .. the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. { The size and location of the SAS on the site has been determined based,., on existing information or approximated by non-intrusive methods. �fz + K_ The facility owner (and occupants, if different from owner) we" r provided with information on the proper maintenance •of .SSDS. 0 iMl 4�y g 4✓�fY+ ` �'-. ' r v key�y�� t^, . lix c , l Tkt tl..ulr..d'il :. •. _ AG. 2 t Nµ d✓1}`b w. Y4#' _r,''y • 4 S A SUBSURFACE BEAAOE DISPOSAL SYSTEM INSPECTION FORM PART 8 SYSTEM INFORMATION FLOW CONDITIONS. ; If residential number of bedrooms number of current residents =_ garbage grinder, yes or no, Ws laundry connected to system, yes or no in seasonal use, yes or no If nonresidential, calculated flow: ' Water meter readings, if available: , Last, date of occupancy GENERAL INFORMATION y Y fs�Pu�mping records and source of information: �,r"t5.N'Srw-`k ''j S .• ,,:c {4.•"SL' gj�'"."f3J'f' 'i -, - ." (q System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: Typti of system , Septic tank/distribution box/soil absorption system , tt Single cesspool > ,, Overflow cesspool ., x Privy r� Shared system (yes or no) (if yes, attach previous' inspection atY records, if any) , Other (explain) �Approximate age of all components. Date installed, if known , Source'. ,'information: n4 Sewage odors detected when arriving at the site, yes or no ir!�i•}. xt3 f 0 i ',Jt,,�k 4.4'�'aV��V` r rn., r r , ..SUBSURFACE SEWAGE DISPOSAL BYSTEK INSPECTION FORK PART B BYBTEK INFORMATION Continued SEPTIC TANK: (locate on site plan) depth below grade: material of construction: __concrete _metal _FRP other(explain) dimensions: ■sL. sludge depth ' distance from top of sludge to bottom of outlet tee or baffle 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 Comments: (recommendation for pumping, condition of inlet and outlet tees or,.baffles,' depth of liquid level in relation to outlet invert, structural integrity,, . :,evidence of leakage, recommendations for repairs, etc.) F x} } i. t µlb A attj r1� j ,-DISTRIBUTION bate"'on site: plan)'. p 1 b L +, depth"of"liquid level above outlet invert' Y w,r $¢p "' "i% #C 94 omments. g - ote, if level and distribution is equal, evidence of solids:.carryover k'Fevidence of leakage into or out of box, recommendation for repairs, etc j�_ �ty3• x -�? ,� -'—PUMP`CHAMBER:_ X ;} r k Yr x (locate on site plan) ~, F pumps in working order, es or no x,= P P 9 . Y f ��r �. . omments: 114, Sx .r note condition of um chamber condition of( pump , pumps and appurtenances, ..; F recommendations for maintenance or repairs,etc.) r.S.r• f P .+' i N @ M,r i fr k. - ' H i F r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART 8 SYSTEM INFORMATION Continued SOIL ABSORPTION SYSTEM (SAS) : (locate on site plan, if possible; excavation not . required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type. leaching pits and number o hr i leaching chambers and number leaching galleries and number leaching trenches,- number, length leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level 'of ponding; condition of vegetation, recommendations for maintenance or repairs;'etc..) CESSPOOLS (locate on site plan) : yAp number and configuration depth-top of liquid to inlet invert _y • depth of solids layer -_ zJdepth of scum layer 1 , -;--•:dimensions of cesspool x 6, x 8- , materials of construction �i6 , � 4indication of groundwater o AA44f}* p i'nflow cess ool° must be • -.,( p pumped as • � . • rpart of inspection) _ .� & ': , r 1.. �Co/Nauents:.«+. q+ a rY \?+r•+'v.All, k . � (note-condition of.soil, signs of hydraulic 'failurelevel, oftponding, k��condition of vegetation, recommendationw 'for maintenance,::or..xepairs;etc:) 4} 1 L • a PRIVY: W (locate on site plan) t � P, t materials of construction ' dimensions ji + ?,depth of solids :_ . :hr Comments: o f vw rtr`° t°2Jtir � (note condition of soil, signs of'•hydrauiic failure, level. of ponding; Y , 44 ,condition of vegetation,• recommendations for maintenance or 'rep airs;etc�.a )' "5i�*;•I W..N%'k'q... • • 4 ?.:>?xJ. G6�ME T • r l�j�lj( f �• • L1 �1 BUBBURFACE BZWAGE DI8P0BAL BYSTLN INSPECTION ,FORM . PART 8 . SYBTEN INFORMATION Continued SKETCH OF SEWAGE E.SPOSAL SYSTEM: include ties to at, least two permanent references landmarks or benchmarks locate all wells within 100' • 1 5 x `eO ✓ l,3 a TU. d - .` 1 V '' v> .• KMi• >24''.'+i,sy �llF" ��.s�y Y`xk'�S�y, qr ; ' .. S� :i h��r i •�l��a R _. s "� .'ik���`iw• ��rS 3{(A ,y... Y .Sj b �Jr°�.�` `�'��t 'R ^'dx ,� * '�� �ts`�`4 n y`�:, .r;. � # ✓ r. '�`3 '� �a3 ` �". ,''rg av 'fir �'� �i � dt �` �"+ „''ir DEPTHT . GROUNDWATER C j d . J! }b � •✓� f ly.. P {a i':{'n ' fi.f-t i .sP3,P 1. 3 if:P,Y u,. �° 3 L!. "+i;. "F:}.,;-•' _ E' .s r 1 �2:. a",. 9 3 S' .- } _+n • ..1�'•.t,P.._S a'T 4q A� +. A ' YO depth to,groundwater i Vg method of' determination or approximation: � � 0 f U f ;: , err r .n r ;ref Tie 4 � � 'x'U 4C.n•Fr.i �rd - r 3„ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C d � _ tF FAILURE CRITERIA ;J indicate or yes, no, or not determined (Y, N. or ND) . Describe basis"of etermination in all instances. If "not determined", explain :whynot) Backup_ of sewage into facility? d ba a! }� Al , Discharge or ponding of effluent to the surface- of the ground or surface waters? V Static liquid level in the distribution box above outlet invert. V Liquid depth in cesspool <6" below invert or available volume< 1/2 d; flow? `� . Required pumping 4 times or more in the last year? number of times pumped ty! k • °.v fir-. is - Septic tank s metal? cracked.7 structurally unsound?.., substantial, � ��• infiltration? substantial exfiltration? tank failure imminent-.) Is any portion of the SAS, cesspool or privy: below the high groundwater elevation? V j within 50 feet of a surface water? _ ' — within 100 feet"of a surface water supply or tributary to a rsurface A water supply? . rj within a Zone I of a public well? $ r Zv t ti' 1V within 50 feet of a bordering vegetated wetland or saltrmarsh` ' (cesspools and privies only, Il the SAS)? . a T ►s � �,�„ J%' i a t Ss�i .;. qkv ,:�- zS -` �� r� ,' •,.•_ .' Y ..; .. .-... x1 , �`{ ;�„��g.,� ' 9. � yi v'It, k`,• ':`S { .s �d r� AY 44x ywitbin 507,jfeet= ofF;a private water supply well? � Tk 3i� a'i4i}a�wC ,py ,FrI-trt i.,,a`'ir Frd i'�r ,� } y, r-a ., F ,,,' ,,• , •• • .p.� , r�t5 ka..;♦a�..x*�kM4� Ns}sa�S'fr,�s�#dMw�6 ud^%;�d-a��&n q.ria,W:uu z v>1 m5k#7-�.'}a^5,k4.:s;�11'9v .w.aa4i�nayz�s'a+lk•.^..m, ryn..'�f�mri ✓ r �' ess,'-th nr 10:0 eeet,but .greater, than„•50,:feetlafromK�a�private wat s' z •-,fit, ,•i:. ,� supply,,wel 1 with-=no• acceptable water:.quality,.analysis? If the well. i � ��- harp been„analyzed to "be acceptable, -attach copy of.,..wellwater analy fn"for colifonn bacteria, volatile organic compounds, . ammonia° nitrogen ro fs # wn'HSE"h . 4 •w and nitrate nitrogen. tr�} r rp,..vp.'1r vt.w•, .w '.,»4.aAvkt. a.• c• �} r,},.a OV SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector /;�. �rr e/tea _ 6 Company Name Cape f ° ' Cv. ompany Address h Yu $ Certification Statement , I•certify that I have personally inspected the sewage disposal system.at � •• g this address and that the information reported is' true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and maiitenance of on-site sewage disposal ' systems. .?,•; Check one: ;rf; •.;. _� 'I have not found any information which indicates that the system 'fails to adequately protect public health or the environment as defined.in -� ' 310 CMR 15.303. Any failure criteria not evaluated are as stated;.in "; : the FAILURE CRITERIA. section of this form. y ` I have determined that the system fails to protect public,healtWt' d, the- environment as defined in 310 CMR 15.303. The basis 'for this 44 s determination is provided in the FAILURE CRITERIA section of thisaNM4' form. Inspector's Signature Date Original to system owner to U si r' V Buyer (if applicable) Approving authority � /tA • 4 �^� Tyr' ag�"��"�L ��,s � c g :,l y,.{swl sry"� A 3i �z ` s ., F•�:', , s., � X s� ' ,a�'�� .rt�' ,fi.� t,. 5 y� U ",�~ { •''T t F�.f,( Yiyy f i x '7 it .��.�j,l1--' /W..i� .. 1•yi* �wtit it..• v: .. 4' .,"'T q, , h'k^ Commonwealth of Massachusetts Town of Barnstable 200 Main Street- (508) 862-4038 BOARD OF FIRE PREVENTION REGULATIONS APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Permit No: TE-19-1381 Date Received: 6/24/2019 Job Location: 35 CAMMETT WAY, MARSTONS MILLS Map Parcel 099-014 Contractor's Name: JOHN F SHEA Phone: Contractor's Address: State Lic. No: 28539 SAGAMORE BCH, MA 02562 License Type: Journeyman Electrician Class E Home Owner's Name: CRUZ, SHEILA Home Owner's Address: 235 CAMMETT ROAD Home Owner Phone: Work Description: change to 2 meter service for office/garage authorization number 246330 Utility Authorization No. Details: No.of Recessed Luminaries: 0 No.of Cell.-Susp(Paddle)Fans 0 No.of Transformers 0 KVA 0.00 No.of Luminarie Outlets: 0 No.of Hot Tubs 0 Generators 0 KVA 0.00 No.of Luminaries: 0 Swimming Pool 0 No.of Emergency Lighting Battery 0 Units No.of Receptacle Outlets 0 No.of Oil Burners 0 Fire Alarms Zones 0 No.of Switches 0 No.of Gas Burners: 0 No.of Detection and Initiating Devices: 0 No.of Ranges: 0 No.of Air Conditioners: 0 Total Tons 0.00 No.of Alerting Devices 0 No.of Waste Disposers: 0 Heat Pump Number Tons KW No.of Self-Contained Detecting/ 0 Totals: 0 0.00 0.00 Alerting Devices No.of Dishwashers 0 Space/Area Heating KW 0.00 Type of Connection No.of Dryers 0 Heating Appliances: 0 KW 0.00 Security Systems 0 No.of Water Heaters 0 No.of Signs 0 No.of Ballasts 0 Data Wiring: 0 No.of Hydromassage Bathtubs: 0 No.of Motors 0 Total HP 0.00 Telecommunications Wiring: 0 Others: THIS IS A PERMIT L�_ O 1L Commonwealth of Massachusetts Town of Barnstable UIF 200 Main Street- (508)862-4038 BOARD OF FIRE PREVENTION REGULATIONS APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Panels: ES Amps: 0.00 ES No Meters: 0 NS No Meters: 0 ES Volts New Amps: 0.00 NS Underground: False ES Overhead: False New Volts: Sub Panel#: 0 ES Underground: False NS Overhead False Sub Panel Amps: FOR A SERVICE CHANGE, A HOMEOWNER CANNOT CUT &TAP. A CUT &TAP MUST BE DONE BY AN E- 1 ELECTRICIAN WITH A PERMIT OR THE POWER COMPANY. Estimated Value of Electrical Work: 0.00 Work to Start: 06/24/2019 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. Insurance Coverage: None Specified I certify, under the pains and penalties of perjury, that the information on this application is true and complete. Company Name: JOHN F SHEA 6/24/2019 Signed: Applicant Date Telephone No. If the licensee does not have insurance, then the Owners Waiver must be signed,and attached to this Permit Application. *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: IMPORTANT:A separate permit is required for the installation of smoke detectors.Fire Alarm inspections are performed by the FD having jurisdiction. Estimated Construction Costs/Permit Fees Date Paid Amount Paid Check#or CC# Pay Type Total Project Cost: $0.00 ` Total Permit Fee: $0.00 Total Permit Fee Paid: $0.00 THIS IS NOT A PERMIT Town of Barnstable I.-RECEIPT M�" ,P' 200 Main Street, Hyannis MA 02601 508-862-4038 - . Application for Building Permit Application No: TB-20-745 Date Recieved: 3/9/2020 Job Location: 35 CAMMETT WAY,MARSTONS MILLS Permit For: Building-Alteration INTERIOR Work Only-Residential Contractor's Name: PROJECT MANAGERS LLC State Lic. No: 155863 Address: 15 LEXINGTON LN. YARMOUTHPORT MA Applicant Phone: 02675, , (Home)Owner's Name: RADAELLI,NICHOLAS A Phone: (Home)Owner's Address: 35 CAMMETT WAY, MARSTONS MILLS,MA 02648 Work Description: EXISTING GARAGE RENOVATED TO BE USED AS A SEASONAL GYM FOR OWNER ONLY Total Value Of Work To Be Performed: $8,500.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued, it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: WILLIAM F PLANINSHEK 3/9/2020 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $8,500.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $93.35 � - _....� . ......... ..... --- _.. Total Permit Fee Paid: $0.00 THIS IS NOT A,PERMIT <^- '• MAP PLAN LEGEND OVERLAY DISTRICTS: G.P., R.P.O.D., ESTUARY Z.O.C., ZONE II . • = CESSPOOLS TO BE ABANDONED fIZ� ss o = FINISHED GRADE NOTE: 1 \ �. EXISTING CESSPOOLS SHALL BE ABANDONED PER TITLE V = EXISTING CONTOURS Y � REQUIREMENTS x = EXISTING SPOT ELEV. or \ o = EXISTING GAS LINE = EXISTING WATER LINE U z& BM: TOP OF FOUNDATION 102 q16 - ELEV.=100.0 x 100.8 41- DATUM: ASSIGNED �//jam 7 /ems \ P'ZW9Rtn Quesl lrc. +vs:•''""'\ .:�. R 0.ife'P9 POQ9�NAYTEO a TCIU:Ca: rr \fir � LOCUS MAP LOT 2 / '`" i 1�� `7 `�\ PLAN REF 29500A SH 2 t CERT REF 177483 ;f 0)CO �, ��' r, ASSESSOR'S MAR- 099-14 0 56.4ft G V \ X 100.7 yy 39. ft �.`� � � ZONING.- "RF" / G SETBACKS.- 30'15'15' FLOOD ZONE- "C" X 100.6 P500 6ALD✓j Al PANEL NUMBER.- 250001 0015 C �0 TANK I / 2EBE ROOM J� QsQ l\ DATED. 08-19-1985 ✓, DWELLING \\ 39.7ft h� 99 oX o , SEPTIC UPGRADE PLAN PROPOSED INFILTRATOR rl �°zx' � x ,oo.s O o gg o .: OFLAND r CHAMBERS IN FIELD 0 CONFIGURATION o ss.o WITHOUT AGGREGATE c X EXISTING X 100 .7 i — / � se.o GARAGE ,• ti0 LOCATED AT / VENT 73� C 0 ! �P� OFM �35 CAMMETT WA Y \ ~6' �N 8\_\ MANIFOLD �f ' t o=� DAVID �' MARSTONS MILLS /) y 39.7ft �� i ��� m MASON c 100.4 r� 0 N0.1066�a �y LOT 3 lb s MARCH 27, 2009 20000.0 S Q. F II . i� �,��` LOT 4 REV- �' 0.5 ACRES I v' o � �� ����d� REV.• 1 T p l I ►' ��N of 414CS �� REV _ s - °����G�cT�R�o ct PSTEPHEN �'n4; YANKEE LAND SURVEY J. GRAPHIC SCALE 4 o DOYLE N s , CO. INC. 30 0 15 30 60 o 41 7 v (FNo) . F=-: : 40 INDUSTRY ROAD 114 Pv���.° MARSTONS MILLS; MA 02648 1 inch = 30 ft. TEL• 508-428-0055 FAX 508-420-5553 k , SHEET 1 OF 1 JOB ,¢� 54489 JF 1 SEWAGE SYSTEM PROFILE VIEW N . T . S . f. T.O.F. EL. 100.0 FIN GRADE = 99.0' co RISERS = FIN GRADE = 99.7t f 20" 20" �r INV EL. DIA. DIA. tMIN6. 6" PVC INSPECTION PORT WITH SCREW CAP 96.9, ' FIN GRADE = 100t GEOTEXTILE FABRIC TO WITHIN 3" OF FINISHED GRADE (4 TYP) i / � SEE PLAN VIEW. INV EL. 10" MIN. f 14" MIN. INV EL. EL.95.63' 96.65' —� �— 96.40' INV EV EL ° ° ° ° ° ° ° ° ° ° ° ° ° ° °° ° ° ° ° ° BELOW FLOW LINE ° ° LIQUID LEVEL 48" 95.726.52' ° ° ° ° ° ° ° ° ° o ° °GAS BAFFLE J'a ° ° oo° ° ° °DISTRIBUTION BOX ° °° ° ° ° a EL.93.89' PROPOSED 1500 GALLON TANK 34» CLEAN MED 6" SEPARATION BETWEEN ROWS (TYP.)IUM SAND PRECAST REINFORCED CONCRETE DISTRIBUTION BOX , TEES SHALL BE CONSTRUCTED OF SCHEDULE 40 PVC AND SHALL EXTEND A INSTALL ON A LEVEL BASE WITH WATERTIGHT COVER 13.8,3 MINIMUM OF 6" ABOVE THE FLOW LINE OF THE SEPTIC TANK AND BE ON MINIMUM WALL THICKNESS = 2" THE CENTERLINE OF THE SEPTIC TANK LOCATED DIRECTLEY UNDER THE MINIMUM INSIDE DIMENSION = 12" USE FOUR ROWS OF (4) HIGH CAPACITY INFILTRATOR CHAMBERS CLEAN—OUT MANHOLE. OUTLET INVERTS SHALL BE EQUAL TO EACH OTHER AND AT TOTAL CHAMBERS = 16 THE INLET PIPE ELEVATION SHALL BE NO LESS THAN 2" NOR MORE THAN 3" 2" MINIMUM BELOW INLET INVERT. ABOVE THE INVERT ELEVATION OF THE OUTLET PIPE. THE DISTRIBUTION LINES FROM THE DISTRIBUTION BOX SHALL ALL HAVE SEPTIC TANK SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL, EQUAL INVERTS AS DETERMINED BY FLOODING THE DISTRIBUTION BOX TO STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON WHICH THE HEIGHT OF THE DISTRIBUTION LINE INVERT AFTER ALL LINES HAVE BOTTOM OF SOIL PIT = EL. 88.8' 6" OF CRUSHED STONE HAS BEEN PLACED TO ENSURE STABILITY AND BEEN SEALED IN PLACE. NO GROUND WATER OR TO PREVENT SETTLING. INVERT ADJUSTMENTS SHALL BE MADE BY FILLING WITH DURABLE AND REDOXIMORPHIC FEATURES OBSERVED SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9" NONDEFORMABLE MATERIAL PERMANENTLY FASTENED TO THE LINE OR TWO 20" MANHOLES WITH READILY REMOVABLE IMPERMEABLE COVERS RECONSTRUCTING THE LINES UNTIL ALL INVERTS ARE OF EQUAL ELEVATION. OF DURABLE MATERIAL SHALL BE PROVIDED WITH ACCESS PORTS. MIDDLE ACCESS PORT SHALL BE 8" DIA. MINIMUM. THE OUTLET TEE SHALL BE EQUIPPED WITH GAS BAFFLE. DESIGN DATA: SEPTIC TANK CAPACITY: EXISTING TWO BEDROOMS — NO INCREASED FLOW 2 X 110 = 220 GPD REQUIRED FLOW 4" w} REQUIRED — 349 GALLONS AT 200% VENT PROVIDED — 1500 GALLONS USE 16 HIGH CAPACITY INFILTRATOR CHAMBERS IN FIELD CONFIGURATION WITHOUT AGGREGATE FIN GRADE = 100f (16 X 6.25) X 4.72 SF/LF = 472 SF EL.95.63' 472 X 0.74 = 349 GPD TOTAL DESIGN FLOW ° °° F GENERAL NOTES: MED 1 . ALL THE WORKMANSHIP AND MATERIALS SHALL CONFORM TO DEP RESERVE FLOW = 129 GPD SAND TITLE V AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS GARBAGE DISPOSAL NOT ALLOWED ° s° FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 25 �I 2. ACCESS PORTS OVER TANK TEES SHALL BE ACCESSIBLE WITHIN 6" 26' OF FINISHED GRADE 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF USE FOUR ROWS of (4) HIGH CAPACITY INFILTRATOR CHAMBERS WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' TOTAL CHAMBERS = 16 OF DRIVES OR PARKING. H-20 LOADING SHALL BE USED UNDER OR WITHIN T.P. #1, PE'RC <2 M/INCH T.P. #2 PERC <2 M/INCH 10' OF DRIVES OR PARKING, UNLESS NOTED. 4. THE EXCAVATOR/CONTRACTOR SHALL CALL "DIG SAFE" AND VERIFY THE LOCATION EL. 99.8' 0.l LL. 100.0' 0" z. OF SITE UTILITIES PRIOR TO ANY EXCAVATION, AND SHALL BE RESPONSIBLE FOR 10 YR 4/2 10 YR 4/2 ALL MATTERSRELATING TO ELECTRIC AND/OR GAS EASEMENTS. "AO" "LS" "AO" "LS" r 5. SEWER PIPES SHALL BE SCHEDULE 40 PVC. (4" DIA. UNLESS UTHERWISE NOTED) .LS�. 10 YR 6/8 "LS" 10 YR 6/8 SOIL DATA: - 6. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE "B" "B" �, TEST DATE: 03-20-2009 MORTARED IN PLACE. EL. 196.3' 2" EL. 96.5' 2 SOIL EVALUATOR: DAVID B MASON 7. FINISH GRADE SHALL HAVE A MINIMUM SLOPE OF 0.02 FT. PER FOOT. COARSE COARSE APPROVAL DATE: 10/94 8. EXISTING SYSTEM COMPONENTS — IF ANY — SHALL BE ABANDONED PER 11c1 11 SAND 11C111 SAND HEALTH AGENT: DAVID W STANTON TITLE 5 REQUIREMENTS. 1 10 YR 7/2 10 YR 7/2 9. THE EXCAVATOR/CONTRACTOR SHALL BE RESPONSIBLE TO CONTACT YANKEE EL. 88.8' 132" EL. 89.0' 132" SURVEY 24 HOURS PRIOR TO ANY REQUIRED INSPECTIONS. 10. ALL COMPONENTS SHALL BE MARKED WITH MAGNETIC TAPE OR NO G\WATER OR NO G\WATER OR COMPARABLE MEANS IN ORDER TO LOCATE THEM ONCE BURIED. REDOXIMORPHIC FEATURES REDOXIMORPHIC FEATURES SHEET 2 OF 2 JOB NUMBER 54489. tO I. PLO,R-ti^l f,-FT ELEVATtO(N _ � �cePac�r su�v4�5—ice I I {;v i I ' I li i FRONT Ek- V,1 10N ! U r i awP uy 4c o'f 1-4t. NA lfR3 I i I _.._._.. la:LO JV✓�tiC:L LChOw —._ PROPOSED FLOOR:'t'L N (cos osr n nil-V-A�T10w I ROJECT MANAGERS CC,LLC Bruce Devlin Designs 3S c<,Uc; LT'W/-Y isLaWngtonLmO I RsCovS'f�'iLL vammMp�4n67S u � s; 4C. we•aWI47e z @Opyright