HomeMy WebLinkAbout0010 CAPTAIN BAKER ROAD - Health YYl CA I—S'e o n S 141 c L L $
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TOWN OF BARNSTABLE
LOCATION/Q CfO,,07'14/h 9,*A91- /QaN / SEWAGE#�020—OOLp
VILLAGE 10 4eSl; I205�/�/S`ASSESSOR'S MAP&PARCEL A�6
INSTALLER'S NAME&PHONE
SEPTIC TANK CAPACITY 1,5200 /
LEACHING FACILITY.(type) `�-�S Q(J �y��Nj�j1:�S(size) /.3 X;�!?
NO.OF BEDROOMS
OWNERa���
PERMIT DATE:.— 9—;2 O COMPLIANCE DATE:
Separation Distance.Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) �f4 Feet
BY FURNISHED
,q 3 1,33
No. n b Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es
2ppliCafion for loispo8al 6pstem Construction Permit
Application for a Permit to Construct( ) Repair Vl�_<Pgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No./O C41d7.4/`I 04kOr AW Owner's Name,Address,and Tel.No.
s�Br�a
Assessor's Map/Parcel 19 --0 y /'yll�i'S'� fW` �s Q%
Installer's Name,Address,and Tel.No.4r0 a'_Y-*3 9722 Designer's Name,Addre s and Tel.No. ,j O -,r27-,?G
Type of Building: rr��
Dwelling No.of Bedrooms 3 Lot Size c� sq.ft. Garbage Grinder( )
Other Type of Building lj 1 No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) J gpd Design
1�flow provided gpd
Plan Date ;�� Number of sheets d- Revision Date
Title
Size of Septic Tank )( 15 co Type of S.A.S. L(� I Oy 6o
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 141,711V111V1_04!/
Date last inspected:.
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signe Date l .
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. �(� Ono Date Issued
t" No. n - Fee oh .
v, THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: }
PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS a
01ppYitatiou for Misposal 6psteut Construction 3permit
Application for a Permit to Construct( ) Repair ija Pgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No./Q C14 f)1,41VI j o%/ ' /Qd Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel Jrr�/
Installer's Name,Address,and Tel No. ' ' - r - ' Designer's Name Address,and el.No. -
(� t 1r c T S /;1,f s /� { 5 ✓ V /G F f,.a�'/.r/ r r !;
.Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building i No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd 'Design flow provided ` gpd
Plan Date �20 Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.�7 _ tq_�� r 4- e6 _4
Description of Soil Old G 156 S 4
Nature of Repairs or Alterations(Answer when applicable) r,,i - v / _
//lu�;''� !/% li` ii / �n GJ' t ?i.'�i i�r' •ii/G7. y'
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed 1r%s ' —�I� - �1 ,, �r. Date
r
Application Approved by A. Date \
Application Disapproved by 13 Date
for the following reasons `
Permit No. o► ,n0?(r, Date Issued ) Q
J ]�'
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(�) Upgraded( )
Abandoned( )by ;
at111as been constructed in accordance _
r
with the provisions of Title 5 and the for Disposal System Construction Permit No. ated / 1�l /a C 1
Installer Designer
#bedrooms / Approved design��flow v gpd
The issuance of this ermit shall not be construed as a guarantee that the system will funL� n as de igned.
Date ( l+ ) l) Inspector
No. ��C�""r� Fee 1111/,
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE,MASSACHUSETTS
3Disposal *pstrm Construction permit
Permission is hereby granted to Construct( ) Repair(, Upgrade( ) Abandon( )
System located at
and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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
l .- -,.
Town of Barnstable
Replatnry Services
Richard'V.Scab,Director
DAMWAMAPublic Health Division
Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-8624644 Fax: 508-390-6304
Date: Sewage Permit# T --I d&/- Assessor's Map/Parcel lZwl—4Z
Ustaller Designer Certification Forte
Designer; Installer: arys
Address: �o�� I Z42 Address: 7T �
On 1 r e was issued a permit to install a.
��date) (inst ier)
septic system at -4/l based on a design drvvn by
(address)
dated_- JA y �� cs 2 20 �
(designer) f�
1 4 I certify that the septic system referenced above was installed substantially according to
the design, which may include minor'approved changes such as lateral relocation of the
distribution box and/or septic"tank. 'Stripout (if rewired) was inspected and the soils
N ere found satisfactory.
1 certify that the septic system referenced above was installed with major changes (i.e.
�f greater than 10' lateral relocation of the SAS or any vertical relocation of any component
`• of the septic systems.but in accordance with State& Locif Regulations. Plan revision or
certified as-built by designer to follow. Str pout(if required) eras inspected and the soils
were found satisfactory.
I certify that.the system referenced above was constructed its col%Ii` with the terms of
the UA approval letters(if applicable).
C.
k FIAH-FFTNY JR. N
/ ler' Signature) t fro. z 1
P�a/$YER'`o
ANN AR\P� 4
per' i e) (Aff x esi er's Stamp ffere
LAA _RETURN TO DARNSTART.E PiTruir 1w-ATjw T4 n , R ICATE
' LCEL. RUED THIS_ ` AND AS-
RV.
R CARDI ZYMM HAORNSTABLE KWIC C AJGTI SIt3N.
q:wrace tomwmig,madric k.doc
4,A� 6al 4-
yz
TROY WILLIAMS
L
SEPTIC INSPECTIONS
Certified by MA Department of Environmental Protection qQ (506) 385-1500
19 Hummel Drive
South Dennis, MA 02660
COMMONWEW.All OF MASSACHUSEITS
EXECUTIVE, OFFICE OF ENVIRONMEN`I'AI, AFFAIRS
DEPAR'I'MI,N'I' Oh ENVIRONMENTAL PRO'1'EC'I'ION
y "I HT F 5
OFFICIAL INSPECTION FORM — NOT FOIZ VOLUNTAIZY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
Cf:IZ"I'IFICATION !—1
Pr opert. Address: 10 Capt.Baker Road
Marstons Mills
Owner's Name: Fidelity Bank,c/o Karen Bates
Owner's Address: P.O. Box 3365
East Falmouth,MA 02536
Date of Inspection: August 28,2007
Name of Inspector: TroyM. Williams
Company Name: Troy Williams Septic Inspections \� `
Mailing Address: 19 Hummel Drive
South Dennis, MA 02660
Telephone Number: (508)385-1300 4j
a
CEIZTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the '4Yonnation_fe port cd
below is true, accurate and complete as of the time of the inspection. The inspection was perfonke(I based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a Qtp
approN ed s)stern inspector pursuant to Section 1.5.3.10 of Title 5(310 CM11 15.000), Tlie s%, em
e
f Cr;
a s sc s C.�7
Conditionally- Passes
_ Needs Flnthcr Evaluation b) the Local Approving Authtirit)
Fails
Inspector's Signature: — 2,/,r 1 _, Date: S /R S /0 7
The system inspector shall submit a copy of this inspection report to the Approving Authority(Hoard of I lealth or
DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving
authority.
Notes and Comments
Although system meets the minimum requirements set forth by the MaSSQchUSetls Department of
Environmental Protection,certification is not 10 be construed as a guarantee of future working condition
of system,piping or components. this Inspection represents the conditions of the system on the Date of
Inspection noted above.
•`"This report only describes conditions at the time of inspection and under the conditions of use at that
time. phis 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 pane I wr I I
Page 2 ill,I I
WSTIOVI INSITU-116N 1,0M
WA(-
101� A
10 Capt.Baker Road
Marstons Mills
Fidelity Bank
Pill" ol"I'"PediOW . August 28,2007
IIksIWcji(Il, Slmkm;ki-y: CliecIc AjI,C,I) III- fee ALWAYS c,ij!jIjlcjt:;III alStclibll I)l
A. Syslenk Passes;
I have III)( f mikil ally illiollimijoll which ilitlicitics (Bill it ill'like filkilol-c cl-iielia ticscl-ibed ilk 310 C'mit
15.303 ui ilk 3 11)CIA It I S-36,j cxisl. Any failure cl lick jit no ViIlklalctl art: indicill c I 1i clow.
Callillields;
----------- -------
II. Syslcul Coudilluually Passes:
----------- One of likolu Sysfclll ctimpollulkis its (Icticl-ibc(l in like filitfiliolml hiss"seclitin littil to be I-cphiced Of
!-cpailctl.Tht;system, kipall cooijklelitili of Icillace.!)tell(or repair, its iiIIIII tivetl by like II(Ill-ti Of I
altil, will pass.
Answcli,. Yes, fit,or mil ilcicimiiictl(Y,N,Nl)) in lite lol.the (allowing slillcillcols. Il", of delellylific(I"please
seplic liolL is Inclill alld ravel 20 years illtl* fit- Ilic tieplit; imik (whudi, 1-ticial tit 1.1ol) is shilchl(al ly
lolsollild, exhibits substantial illfilbalioll of ex1illi-illioll of fillik, Iii1lot; is ilml teal. Sysicin will pass ilkspeclifill ifilic
cicisfing jimic is lcplacctl W11111 it L0LiiI)Iyijkj;SL:IIjIG jijljk jks jkliptoVetl I)y Ilie I ojoil I f
. I lealt
'A mclid s(;I)Iic limL will pass iiisliccliolk if it is slillclopilly soolid, Ito ciihog mill.if it ("cifificate o(collillhimcc
indicatilig Ilkill Ow fillik- is less Illall 26 ycikj-4 ()Ill is avadolli1c.
NO vxjilalli:
0I)stly4litill of'scwagc; I.Pilcimp 01 b1cak our a ligli slillit; wilici level in tilt;disil-ij)i1litili I)t)X dild In 111-6 wl of
ohslrncletl pipes)of illic to a I)Itlkcp, stliletl ill it vell ilisililmli(ilk box. Syslem will 11i I '(With
i1pploval Of ll.oillil o(ficillill):
isilibillitill ll()X j� !cycled or replaced
ND explain:
'rile sysicill I lil-ed I)IIIIIIIiII8 Ifloic IlIall 'I iilpos. it Yea I title to Ill-tIL-ell of pipe(s),'I'lic sysle"I will
pass jl1sI)tcIii)II it' kh appitivill.4 like lilkill-il ell'I 1pik.1110:
tkbSjI1IL:jib It is IC11106MI
explain:
' I'agc 1 tit*
1i. MNI
S01I5tlM AC.1�.
I'A MZ,i, A
I'1 operly Alltlrl s; 10 Capt.Baker Road
Marstons Mills
Owner; Fidelity Bank
Will;of 1„sl,ccliuu; August 28,2007
(.:. hornier V,va Ilia liml is ltetluiretl I,y Ilie jiui►l ll pf lleal1It;
-- _ Cuntlilions cxisl which icrluiic (miller evaluillion by the Dowd of IIcillih ill Older ill 1lcleiwine if the syslcul
is failing io prolccl public hcallll, siticly or(lit;cuviriiliroeril.
1. System will puss 1111less 1111ard ol.114'ii111► ticle111ki1kcs ill accol.tlal►cc w1I111I0 cNlit 153113(1)0)) fllal lht
syslcln is 11of Imicliulih►g ill it n►i►uucl• whicl► will Ili:glect public heallll,si►fcly llj►tl like Plivir 1111uelil;
Cesspool of 1liivy is willtio 50 (icl of a sullace %valci
_ cesspool.Ili privy is willihi 50 ldcl of a lwiticring vcgclawd wcllantl ui it still Irlais .
2. Syslcln will fail unless like Iluaril pf Ileallh(mitl i'uhlic Water Sk ,plier, If%►Ily) 4lelcl•1111lies lit;41 Ille
syslem is fuuctiooiug ill it kn:ulyF1 I11111 prpiccls }Ike l,ulllic licalill, lLly 511111 L'11VI14111�11e111:
•hc syslcul has it scplic lack Mid stiil absorpliou sys(ci SAS) aotl the SAS is williin l00 feel of a
sukfi11c walei supply or 11ilmiaiy to it sill(Oct; waIci supp
`I'hc syslcul lias it scplic lank and SAS lkilt) ilk 'AS Is wilhiu it Looc 1 ol•tt public watci supply.
•I'Iw syslcul has a scplic jank arul SAS .ul the SAS is wilhiu 50 Iccl uf•u piivale walei supply well.
'I'hc syslcot has it scplic lalkk am AS ukitl Ilic SAS is less Ilion 100 feel bill 5(1 lcel or IIIOIe hY)Ili a
piivalc walci supply well'''. ivied tI used Io ticicrruilic tlislaucc
}?l ills syslcln passes it'llw cll walei ilualysis,perli,rlttctl al it l)la1 ccililietl 1i111oig(ury, lilt cull fuit>I
hilclei a-ol yolil ile oI. uie co Il1ot tkc s iot cafes pal lilt: well s lice Illnk 10 111 ipl prlk thal Iitc ll 1t
I I 1 l I I li I. l 1 1. I 1. I fr i ,ly owl
llte plescllce of imill ,ilia nitrogen ulkil nilialc Ililippell is eilual to of Icss (hull 5 111111 pitivideil lhill Ito plliel
f ailtli�ciligla uk •iiggeied. A copy of the analysis utilsl he allaclicil U, Otis 1111-111.
Page 'I of I I
NOT114110 VOIAM'I'All'y
S I.j It's U It SEWAGE I)jSj'()S1�jS'YSTI rYI INSIkjujw)N 1"oltivi
10 Capt.Baker Road
Troller Ily Ailih,css; MarStons Mills
Fidelity Bank
August 28,2007
Date il(lo!;Ilecliall;
I)k. sysicill li'millre ClIlCk-iii, iillllliCklllC lit lkll SyStClk";
You 11111SI ilidwilic "YL;:i" tit "im" ill cacti (11,111c I,ollowillg lilj il!!illslit.clions:
Yes No
Backkil)ol'suWa8t; ilkla Ii-icilily ill system U111i Iltilical title to ovellOiltictl or cloggctl SAS or ceSsliatil
I)iSchill gi,ofpontling ciflilcill ill the 4111-jilct;o f the gi aillid til-surface willel-S title la all avel-la.atitil or
clogged SAS of cesspool
Al 14 Stillic litlidd level ill like dish ibkIii0Il bt)X iIIAIVC OkIllel jjjVCI I title lit kill Live------- joijiled or clogged SAS oi-
cesspool
hililid Llt;l)lll Ilk t iiiiiil is less Own 6"below wVC1.1 at ilvililiklilt; voitlific is less illao V.,day I'low
Re ylijc4l plinlikilig moic Ilialk 41 fillies ill 111P liksl year N(If-tilld it) clogged of tll)sll.ticlL;ti llipc(s). N11111licl
of linics litillipcil
y' Any poilitm of(Ike SAS, t:cssl)tltll or privy is below high glokilid wilicl.cicvilliolk.
I/ Any purlieu ofccssptitij ui privy
is Wi!lkill 1.OP fc o of it surface willcr silpilly or iliblifill-Y it)a sliffacc
Wiktt;l sill)[0y.
V, Aoy l)m*iioji ill'a cesspotil of privy is willljl►it Lillie I tit'it 111111lit, well.
Any P011ioll of CC!i!il)tltll ol plivy is wililip 50 I'Cct of piivilic wiktcl*supply well.
Ally poilion ofil i:csspotll of Illivy is less I ikiiii 100 I,L;cl bill 81calcl than 50 lect front ik pliviiii; Wallet*
supply well Willi lin ikctcl)lilljlc will(;j timilily allillysis. 1),jils sysicili lb;ksswi if the Well Wlk11Vj_ klkillySiS,
-illfqY, for colt ill liaclo-iii lkiltl yolikiiiL 01-galkic
pel-l"ol-Ilicil al. a WiT lce"Ill'icil jillial
ilitlicilles lbal lilt! well is II 11-am liallillitill il-tim likill (acilily allil itlit 11;_f!SCIIC4. t)( kIHIkItlI►jij
ljiI!-"9i!lk Mill Ilifi-ikIC Ilill-Ogtil IS tijllill 14$ to It;NS ilk;kik 5 Illilli, jib ovitict -kl ljo iklikcr failure cl-ilt:ria
ate li-Igget ell. A calky ill.file milklysis 111list lie ailachell fit this Itil.m.
(Ycs/No)'I'Iic sysscm fikik. I lulyt;ticlel-lijilicil illill title of Iliolt;al'ilic above filillile cllieila exist us
licscl liked ill 310 Civil-t 15.303, 111cl-0,010 like sysicill toils. 'I'll(;sysicill owlici shoill(I colifilel lilt: Iloald of
I leiklill it)tictc1lililic Wilill will be licccssill-Y Ili t;t)ii*ccl the filiblic.
he collsilh-cil it large sysitin the sysitlit Illusl $q-Ve it jacilily Willi 11 esigil $law of 10,1100 gpil Ilk 15,oho
You 11111s1. illilicilid bidicl."yes..ill."Ito' to cilch of till; It-111t)Wilig:
('I'lle foljowip cI-ilclia apply to likl8t;sysIcl.lis in 11(k Iiijoll to dw(;I-il is illlovc)
yes it()
the syslem is willkin 100 (,L:C;l ill'it sill f.ic- driilllit wilict sill-killy
lilt;sysicill is wilbill 200 iew of it 11 ibillm y a suifacc tliiuking willcl supply
Ilic syswill is locilictl ill it llij!ogulk se JIM;iii-cik (1111clim wuliliciltl I"Itiletliall Ai*cu—IWI'A)or a milillwil
ZoItc I I of it public willei.supply
11 yoki Ililve illIswactl "yes" Ili imy title loll ilk SccjjuJi Ii (.1ic syslelik is cm.isidule(I it Slbt)111ct1t14 flllcill, oY jillswol oil
yes" fit Scclioll t) above Ilkc lalgi; SIPIll JI04 1 4 ilcd- Tho owliel of f)I)cj-ojt)j-al'ittly 141gd sysicol
Src liolt Iiiijoll 111001.Spqlpl) sIujll 111)81-i LIO like sY414111 if'
I OPP;I-1101"ce will)4 1 NO
1530,17.,111V 4ysIcljj owlicl-sill tj contact like upliflllil48141 1 1hpol-
: 0 4
'1l i1gL' S Uf.I I
OF>FICIAr. INS1TC"1'ION VOWY! NOT MiOK VOLUNTARY ASSESSMENTS
'VI INSI'I? N'JONYOIUVl
110•aperly Adilress: 10 Capt.Baker Road
Marstons Mills
Owner: Fidelity Bank
Dale of Iuspccliou; August 28,2007
(.'Beef: if,Ills liillowiug him; litcll/Tolle. Yolk Ittllsl 111illciilc "yes ul"uu" ps to taci►ill'file Iollowirlg:
Ycs No
I'ulnping iuliuiluilliuli was III twitiutl by life owoei, ticcupillil, (if- 11ailld ol•Iltallll
✓ Wcic ally ill'[tic syslcnt cul►lponeills primped mil in flit pievious Iwo weeks'?
_._ _ Ilas 111c Syslcul iccuivutl ooiulal (lows ill llie pluviiills Iwo week peliutl '?
Ilavc laigu voltiolcs ol,wilicr Ilueo iWro ll.CCd lu lbc SySleol Iccclllly ill*as pilii of Ibis InSptclioil'>
....__ Wcru as liuill plans of Ibe syslcul oblailicil and cXillpiuctl•? (ll'llicy were nnl available Holt its N/A)
_✓ __- Was 111c Iltcilily ill dwelling inspecieil fill sll;us iif sewage back, up'?
Was Ills silc iusliccled fill signs ill'bleA oul Y
-- Wuic all syslco►conlpnllcllls, excluding 1111;SAS, lucalcil oli silt
_ Wuie dic st;p6l; lank ii).imb lies ulu;ilvcicil, opuucd, autl (flu jniciioi ill lilt laak inspecicil lill-lilt cundilinn
ul`llic balllcs ur Ices, ulalciid ill Coilslluclioll, tltntensiillls, ifeplll ill Iitplid, duplll o1,41114ge doll dtp111 u('scuill?
Was Ilk,; lilcilily OWoer(atltj occulliiiils 11 illllcl'cnl Ilollt uwilcr)Illovillcil Willi inf 1pl align Oil Ilse Ilfnper'
liwiulcuancc ol'subsuitacc Suwagt; ilisposal sysieins
"1'1lc size Iwtl localioy u(Ibc Soil rlllsurlllluf► Sysf cm(SAS)nil lilt sill:bas ball(►elelnlil►e(i baseil np:
Yes uu
-Z r xislillg inl•oilliiiiiali. Dili exunillle, a plan Ill file 1-Itlaitl uj l lcallb.
✓ Deleiwilletl Ill Ilic flcltl (it, inky ill ibc liiilil!C LIilcliil lelalcil to pall (: is at Isslic appluxiq►aijoll Oklislailce
is a liweeplahle)(3In CM It 15.3420)(li))
I'agc 6 ul.
01"I'ICIAI. INSITC"I'lON 1"OH YI -- NOT FOR VOIA-ANTI' 11Y ASSI�SSIVI N"I'S
SlJBSjlltlfA(' SEWAG I)ISJ'OSA1, SVS I J!IVI INSI'I_.C'I'I()N 14.)RM
��S'I��i�M �NM'�-?I?►Y���'I'NQIy
Propel-ly AtI111'C5S; 10 Capt.Baker Road
Marston Mills
Owner: Fidelity Bank
I);IIc ul IuslICC(iuu: August28,2007.
1"I.uvy �.(iNl�l'I'l�l►vS
Nunfbcr of betliooms(ticsign): 3 NwnUci of betlruotns (acltlal): 3
1)I=S1GN Ilow basal mil10 Ctv11t 15.203 (li)r cxaniplci 110 glut x 11 ojUeilrutiflfs): _
Nu(ubcr of cuiicol I'esIdUnts: _4)
Does resiticllcc llilvG it garbage grifi.ler(ycs fir no): A!o
Is lauutlry till if sclfaralc sewage syslcin(ycs (ir nit): Ella lil-yes sclimille inspection ieilmicil)
•I.auuiliy syslciu ifispecletl(ycs tit fill): At 49
Scasoual usc. (ycs or fill): ma
Watci lllcici icatliugs, if avaiblbic(IIasI 2 years usage (glut)):alo_`-(QZ_f�b(1-�,��� D y `L/wuv 5.clfoyS
Suntli puoyf(ycs or llu): JWO
Last dale tifticcupafu:y .1/fEi,_'„y:_/' w (i_ ` plo��. 3''"`uH S o7
It' III NI)lUS'1'ItIA1,
'I ylfc tijesluUlisbnfeul:
Dcsigfi Iltiw(hasctl tiff 310 CNIlt 15.203): glxl
Oasis ojllesigfi jltiw(scuts/persou�/syll,cic,):
Ciieasc liap hicscul(ycs of nti): _
Intlusliial weslc Iwltlifig lafik preseol(ycs fir nti): _-
Non-sanitary waste thscbaigctl litIbc`I'illc 5 system s it
uti):
Walcr iliclei rcatliugs, II available:
--asl dale of ticcfipancy/usc: — - — --
O'I'I11'Il (ticscribc): •
I:ICNI�ItAI_NNI�4)Itn�l��'1'ION
I'unfplug 12ccul'tls
Source it(ifl(uiufaliow -tALo_.:J.w,�..•..
Was syslclil Iullupctl as pall nt Ibc Inspcclitio(ycs "I llti). A/o
II'ycs, vtilunic Ilnfiflictl: galltius lluw wits flflilnlily puuipi l tlelernunctl'/ -
ltcasun luj pllnil)ifig' ---- ------- ------- --- --------------- ---- --
!I'yl' !'sus rlvl
Schlit l;ll1JC, tlist!ibntioo box, soil tlhsnjl)IIt�II syslelll
cessluiiil
_ Ovejl)ow cesspool
--- I''lvy
- Sluljetl sysicill(yes fir no)(it yes, illlacll plevious 'nsput:lioll jccortls, ifany)
_Innovalive/Allejnativc Iccluiology. Allacll a cully nl'tbc culicnl upcjallon alit! (naUllellallce cnnljact(to be
oblaiiwil J)oll)syslcrli owncr)
-_ I"lglll Iajlk -- Allacll a Cully nflhe I)fa' III)I oypl
(Jllu:j(tlesciibe):
Appioxinialo age ol'all confptioc.ltls, ilalo ills1ii1hul(il'�llowll) ullil sotlice of infolItllllitirl:
QYi. tea- !
Wcrc sewabl;utlojs ticiccictl wlleu u►ljyiyg ltl lllc-Silt;(ycs or ll(l):LVo
i-
OFFICIA1, INSIT("I'l(M ji3Oltm Y!, 11f)lt VOIAWFAItY ASSESSklli'
NTS
SOBSURI"ACCI SKWA(.-Vj!: DISJ�OSAL S)(S'J';-:ryj INS111-WIVAIN ITORIVI
SWITIVI INFORMATWN (coliliollc(l)
Vrolwriy 10 Capt.Baker Road
Marstons Mills
Fidelity Bank
1)illt; ill'I ospecl loll: August 28,2007
SE'WER (locale on sill;plan)
I'vialcl-ids ofconslikiction: V/-citsi iloll 10 PVC t)tlkcl (t;xljlmo):
Oistalict; Ilom pi,lvatt; Wilict stii)14 well tit sticlit)" liot:
Cunuucnls(till colldilltill ofjoijils, Vcliling, cviticlicc of lcalkagc, c1c):
I(-------------------.__--...._.._.....-------.__ --------
(lucalt till silt;ldikli)
0cpth bolow gl-atic:
fvlalcl till tit colisl1*11clitlil: ✓Coocicit; lkloal 1-1bulglilss ptilyclllylcnc
If lack is 111clill list agc: Is iigccollfililiked by it (allaclia callyal,
---------52 X
Slodgi;
Distiloct; fi I'll till)ofshitl8c; ill hollool oft,1111c, let; ill liall1c:
�Oclllkl Ihic k I less:",, -,tq-J. ill
Dislanct; ficlill loll ol'sclim loyll�)p of willcl let;ill-ballic: �211
I)islanct hum bolloill ol'scmil to bollom ill'ilillict ltx Of bilffic.
I low %vt;li; dioicositilks (IcIcimilictl:
fxu
C'milokcills tolk poolpi,ij; IGCti111111CIIl Ii1nU11 S, illlcl and 111111cl Ick, ill bal 1IL:colidiliml, ziliticlimill imcgi-ily, Ii(I1!itl levels
its I-clillctl to millcl lovcil, cviticocc o(1cilkil;c. cic.):
up
(,jWASjtfftAj'; _(locaic till site plim)
J)rplh bclow p1dt;:
malcdal o(cpIlsilliclioll: --concidt;---mclill
J)islallix fiolli fill) (11'scull) Ill lop o(olillul let;ol-jbillfic;
1)islalicc ji�ollj ImIloill o f sell]1.1 Ill bol(olli o(mll let jec;tit affic.
L L 041c of Iiisl pilipping: ............
Conillielils(1,111 Illimplikl; i ccal Jill icililil jolls, inicl ill oillicl Ice (it 110,11c;condition, sil,oclilrill jtile�l ity, lif) litl lcvtls
as I-dikitti.1 to 811114! illvcl 1, cviticlicc,ol'Icakag- t L.):
—------------------
'Page 8oCI1
()JI'VICIAL INS1Tif-"j'j()N MI'OWY1 - NO'j' j?()jt 'Vf)1-JJNT0Y ASUr SMI.KM'S
SAll SYS'1IOVI lmslile-cN ON wom
PA W1, C
1'riiperly Atltiress; 10 Capt.Baker Road
Marstons Mills
Fidelity Bank
I�i1lC ul IuspCCtio'!' August 28,2.007
AN IC;R (lank Iliusl l;c 1,!Iny,ctl al Iilnc o(iospe ion)(loc;!Ie un 4ilc plan)
malcrial of t i,nslru( iuu: --t uucrcic-- —!uCl�ll ---lih(r8liiss I,illyCll,yleue /1II1Cj(exliluinj:
(71111CnSltlll9: __ - -----
Capacily' ------- -- - —gullolls
1)csigu [low: _ 8allons/i�ay
AJilili►pl-esenl(yes ui llo)-- -
A la,ln level: -- Maim in woikiug(1rtic yes of!w):
Dale Of last polly,ing: -- -
C'ouuucnls(condilitiu of alailil awl I)ua wilcllcs, Cie.).
PIST111014'16N 11OX; --(ii`prt:scul irlusl lit;opcuctl)(localc o site plan)
Deplll ti f litluitl level above oulicl iuvcl1:
Lopuucnls(pow it box is level ;uld tlisliilmilali to oullcls load, ally cvidupcc ol'solids caijyover, any evidence p(
leakage iillo ui uul ol'box, cic.):
1'VIVI1'("lWY111r,It: ___---(lucalc oo silt:plan)
1'1!Illps ip wnjkiug pi(lei(yes of Ito): — -
AI(Ir►ns ilk wolkillg oidcj(yes or iu,):
Coluulellts(IIUIL'CUII(llllnll Ul pU1np CI1i11111,L'1, ct,t Moll ill'punlps ,Intl uliliuilCnauces, elc.j:
1NS1'j�UT1()N 1,01M --- NOT FOR VOL ONTARY OSKSSIVIENIS
10' C
VJ."Pel-ty Agliffess; 10 Capt.Baker Road
Marstons Mills
Owner: Fidelity Bank
August 28,2007
SoW AllSiMPTION SYSTJi M (SAS); _Z (JilCiklj till Sile J,Ljjj, eXplyiijitill llj$j I-j!(lljIl-j!jj)
if-SAS lint Incilictl explilill wily:
............ ------ ---------
Icilciling Ails, 11111111wr P"l-
-----------
collillicills (hole colitlitioll ill Sail, sigil's,ofily(bilillit, fililm-
C, level ofil.olitling. thillill) Sail, colitlidim OfVC841aliall,
e,-Vld--- � le— 41
(ccsspotll milsi he lilili-illcil as Iml of ilispCclioll) Late till silt; plan) c's e--c-
illid Collfigmillioll. ...... .............. ..........
lop of 11ititlid l(i illict illvcl 1:
I)CI)III ill'solitis laycl-:
)L:I)Ijl ill Sclill-I likycl:
lildicillitiq ill,81-ollikilwalvi. inflow ycs ill'lit
collilliellis(yule colidition(11'soil, Sips 'ItyiIjilillic fi-jilme, jcvCI tiflitilkililig, cillithlioli fifvr8clilliall, Cie.):
—-----------
(jocilic till Si1c; phill)
-vel tli`lyll-ill r L
('11!pIncills(1111le callitlifioll ill'soil, sigils ill'liytll ill ,* lilil!llc,
loge 10 of I I
INSPECDON P01111d -- NOT 14W VOj,UN'j'AjZV ASSI!sSIVIIWJ'S
10 Capt.Baker Road
!'j'aperly Address: MarStpnS Mills
Fidelity Bank
%V Ike I-; August 28,2007
11111c of
Slc V'11:1 10 1"S K IqA 1;K I"SPOSA 1.symm
long do a skelch of Ow sewage UPON qsPn MAP IN 14 01 WMI MO PUSOUIsM cWhInwe WmhWAs al-
be1kchmalks. l.ticaw all wells WIN 106 fec( l.twalt; wiltp;polliji; wawf YWOY emwo "m
A
P c,
0
IL/
0
7
I'cigc I I it I I
OFFICIAL IINSI'I!:(.:•HON 1"011OVI - NOT !"Olt VOLUNTARY ASSLStWEN`I'S
SUf1SURPACT'l SVWA(,1t SYS• ICA/I INSPECTION 1�1')IiNI
S yS"I'I?M INiI'4)�2�YN�1'1'JON (ct„tliilued)
1'I opel(y Atltlress; 10 Capt. Baker Road
Marstons Mills
{),vile,; Fidelity Bank
Hate of lusliccliuo; August 28,2007
SUF1'. LX.AN1
Slop
Silt Iacc walci
Check ccllai ✓
Shallow wells
Iisliu,alctl ticf,ll, to 81111111tl willci 3 Z•I 'Iccl Acliusli:d I,IgI, giouud wale( elevation 30.2 feel
I'Icasc iudicalc (clunk) all i,tclluxis used lu ticicttuinc Iltc lit It gtouud walci cicvaliou:
Ultlainctl fruit System design luaus ou iccuttl - If cllucht:(,, chic ufdcsigu plau levicwed:
_- Oltsctvctl site(altulliut; lit opcily/ultsci Vitt iou little willlill I ill feel ul SAS)
Cl,cckctl wills local Iloatd of l lcalilt cxplaiu:
(.'Itcckctl will, local cxcavali,is, iuslallcls- (a11a(:I1 tlocuit,culaliou)
Accessed t1S(iS
You „oust`dcsclil,c how you cslablisl,cd Il,c I,igll giuN1itl jvalcl cicvaliuu: /
.. .._._...._U._.cJ--�-S--.��J..t�(-�.I-A�.��.r.._e!�.k.�--f.!�Z'2,J.k,...fj.._..�..-__.�.-v,:.-..;./'L-lvLc•_.5_`7.a.�....r._---�4.eu_✓_�.-_.��ls��-f•..--
--G,.4-_c.'��.-s��C.�.. ...��.....1."..___..._/Qn C1-�-,......,..V.�'...../�c�....u�..; 4c1 .c` j-_.._...$_<._[Z.'-`•u c—•-_�/....---�—'E'�-�-o...�.�_ayo u—
r 3z I
I ltis fepoll leas peen piopaied and Ilia sys1e11-1 lllspecletl as 61 Ilia dale of inspecdoft. -1-lils f6poil is Pal a,
walianly o{Ouaialitee tllal the systettl will fuliolo,t Pf41'elly Inflip fillufa. 7fte{8 have peed no waf(allties of
0uarar►lees, eill)et exl-ifessecf, wfillell of l{{Irllecl, (dIP111*10 10 1110, 9yetelp, Ole insl)ecllon alld/of INS fePO(l.
II ,
TOWN OF BARNSTABLE
LOCATION /O 13,okw SEWAGE # 2Oo7- 5Ie3
`rII;LAGE �i�rS7o�9S ��1/s ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. 568-1;'20-97M� ,�f4e ,(L&gA,-"-F
SEPTIC TANK CAPACITY X000
LEACHING FACILITY: (type) _j" 3050 C'`j�eer���r3 (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMIT DATE: /D- 2S 07 COMPLIANCE DATE: /0-1G -627
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 leachin fV Feet
Furnished by
Cock
a
� O
lh9/�Ecridti {�OrT
—_• �- TOWN OF BARNSTABLE
LOCATION �� C:�0�79a/� �t*6/L Pam—SEWAGE#
�4
..VILLAGE ASSESSOR'S MAP&PARCEL
(IINSTALLERS NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS 3
OWNER
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 Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) _ Feet
FURNISHED BY 'fiG
oc� a7, 1997
s �
P � �
� A
A� y�
3y4
O
r
No. .�Do (�3 Fee I 01D
Entered in computer:
THE COM MONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Application for �Digpogal *pgtem Cou0truction Permit
Application for a Permit to Construct- Repair(4�-<pgrade( ) Abandon( ) ❑.Complete System ❑Individual Components
54 i�1 �q ki!5, /Z
Location Address or Lot No. d G/;~ Owner's N e,Address;and Tel.No.
mwl�5ro-'175 C.
Assessor's Map/Parcel f 2 — t7'z
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. f'�g" 'I%O- 9'270
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures 7
Design Flow(min.required) j 0 gpd Design flow provided 3 3 ( 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 ap licable)
/9 ,; r 000 6 l
Date last inspected: 00' �/ •5�� l �.-
Agreement: l�l,
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date to
Application Approved by 0 Date �0 n y
Application Disapproved by: U Date
for the following reasons
Permit No. vZ00 - g3 Date Issued 0 }
"1 No. moo L g� :f ` r Fee 00
G Enteredan computer:
TH iCOMMONWEALTH OF MASSACHUSETTS Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS {
rication for i5 oar pgtetn Conotruction � rlfiit
6'.' ' Application for a Permit to Construct g> Repair(Q/L?pgrade(,) Abandon( .Complete System ❑Individual Components
Location Address or Lot No. /O�/�}/d r� /,�` k� ': Owner's Name,Address;and Tel No.
l29i//f
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No.,t"OF Designer's Name,Addressand Tel.No.f""�
i
Type of Building: - -
s Dwelling No.of Bedrooms_. -3 Lot Size + sq.ft. Garbage Grinder ( )
' Other _ Type of Building No.of Persons Showers yp g ( ) Cafeteria( )
Other Fixtures 2 Z
; Design.Flow(min.required) 3 gpd Design flow provided 7 J 6 gpd
Plan Date Number of sheets ' Revision Date
Title s
Size of Septic Tank Type of
Description of Soil
C
11 F I 't
Nature of Repairs or Alterations(Answer when ap licable) ;"(/ �yq
a -
Date last inspected:
Agreement: �V'► v //�
L The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in vu�
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date to " L S-C) �*
Application Approved by Date o ^ S
Application Disapproved by: Dale r
for the following reasons
Permit No. A O 0 7_. 9 23 Date Issued (0" `�`5 '
I— s-----.--------.-------------------------------
r THE COMMONWEALTH OF MASSACHUSETTS
! BARNSTABLE, MASSACHUSETTS
(Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed.( 4-i+Repaired ( G-)a Upgraded ( )
Abandoned( )by
at ���' d Tpa��+ �ei=s- � �vS mod,S' ?rl�� has been constructed in accordance
2 dated 1 4. with the provisions of Title 5 and the for Disposal System Construction Permit N .o� � y
a �' q a
Installer 1�C���i���v�„�S' Designer
#bedrooms Approved design flow gpd
The issuance Pf this pe hall n t b construed as a guarantee that the system wi n ion as.dee i ne . Q A.
Date II)o Inspector /
VW V
———— ———
� v
No. �� �`'t 0� ---------------------- .. — Fee 1Vo
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
'Wi5 ogar p Stem Construction Permit
I. Permission is hereby granted to Construct Repair ( e,4_ Upgrade ( ) pAbandon ( �`)
System located at 9,ek.,5e
i
and as described in the above Application for Disposal System Construction Permit.The appli ant recognizes his/her duty
to comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this 43 f
Date f — Z d Approved by
II
OCT-30-2007 08 :06 AM LYONS 5087909270 P. 01
Jj
Town of Barnstable
Regulatory Servim
I I 'Y!'Iromas F.Geiler,Director
Public Healtb Division
Thames McKean,Director
Zoe Main Street,Hyaimis,MA 026M
office: 508-8624644 Fax: 508-7W6304
Installer Ak.ft- - ner CerNflcadon Form
Date: to SewagePesmit# 2Qd 7- 343 Assessor's Map11'arcct l " 4-2-
Designer. WSA_L-�►o+�s.s installer: JvF'5�s Tt c-
Address: 42- W• �1,yAf�1N1 Q�'GB Address: k
V 'lAN�t02.f00 t � ro�r
On 1 ^ of was issued a permit to install a
ate)— (installer)
septic system at (D Co r�1 12AKzk!- FRW'based on a design drawn by
(address
U 5 S dated - Z?r=COP2- A
(designer)
t�I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box andtor septic tank.
I certify that the septic system referenced above was installed with moor changes (i.e.
gmater than 10'lateral relocation of the SAS or any vertical relocation of any component
of the septic system)but in accordance with Stele d:Local Regulations, plan revision or
certified as-built by designer to follow, U
I rr .Jt
NN-1 �0�"�SS�I
LISA C. "•.;+
eT s Signature) LY 0 N S
'+. ".�LIC, #1143�1
igner s S%phh* (A er's Stamp Here)
PLEASE RETURN _TQ BARNSTAWX PUBLIC REA&= DIVISION, CERTHIC&U OF
C910JAKE WILL NOT B2I55 URD„I= WM TAIS FORM AND A§:BUIOLT CARD ARE
RECEIVED NY THE BMIWAIALE PUBLIC EXALTH DIYISW. .THANK YOU.
Q.HoWth/Septic/Nidgm CecdficWon Form 3-2604doc
, 9 Ill'II
"I"I'1('IAV INSI'I'(='1'ION 11't)pIVI .- NOT FOR VOL ON'1 AItY ASSI!;SSNII?N"1'S
�1/1i.5111t1t:1(:I! SI!, VISII0SAI. SyS'I' iM ;
I� INSI I�c���'Ic)N Itc)I�m
SYSTI!NI IN!"001VI,- TION (Lonlinncil)
1'l ol,crly Atltll Lss: 10 Capt. Baker Road
Marstons Mills
c)wuc,c Fidelity Bank
I)alc ill-l uspcclii,u: August 28,2007
S<lll, r111S(lltl''1'I/)N (localp till sllc Illnn, cx�;!yailuq nul It lulrctl)
II SAS nol lucalctl crl)li,iu wlly: _
_ Icacl,ing l,ils, uuullwi: (, G Lam,, vl t 1�, F w fly I r 5IVA,
__ ._ Icacl,iug cllmull,ers, luuul,cr: '
___... leaching galiciics, nnnlbci:
Icachilig licnclics, uullll,cl, Icugll,: -
caialiu
-. ....... (, I-►cltls, ttuntl,ci, t�ltucnsluns:
uveilluwccssptiul, uun,i,ci: - --- - - -
uuwvalivc/allcnullivc s slcul ,c/manic of Icclilitilogy.
Cuuuuculs(uillL Luntlitiuu til soil, signs of Irytlrmulic lililuic, Icvcl ofi,uuiliug, tlallip suit, coutliliun of vegLlaliou,
l'I S5I'7)`QI.S: (ccssl,uul ZbLs pail ul'illsl,eclion) calc till silc plan) 0�-C✓�;.' ,(
Nillul,ci mull cuullgmilllun:
)c llll ...._.. ......__........._l l _ loll ul'Iltluul lu iulcl iuvlayci: _.._._.. -
PCIII)t ol'ScuL,l lmyel:
ti(cesslloul: -- -
li,lluCuULUL,IIs(►Inlc Llllltlllltiu ill stillL lillltlie, IcvLl ill`ptIlli itlg, ctintlliinu nI VCgelilllAll, BlL'.);
(IucillL tin silt plan)
Ivlalcrials u(cAl.iiy'ucllun:
1 uucuswns:
C',tilluticuls(vole cuntlilitill ul.sull, sighs ill'hydii„ C IidIuiL, Icvc) ofl,iultling, coullilion of vegeli►lioll, tic.):
i
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Dept. of Environmental Protection
kir
rad
One winter Street,Boston,Ma. 02108 John Septic
D.E.P. Title V Septic Inspector
P.O. Box2119
Teatick 36
WILLIAM RWELD
Governor
ARGEO PAUL CELLUCCI �? Q `t
Lt.Governor SUBSURFACE SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION CID CT 2 7 199�
TOWN OF BARNSTABLE
10 Captain Baker Rd.Marstons Mills Address of Owner: HEALTHDEPL cc
Property Address: �
Date of Inspection: 10N4197 (if different)
Name of Inspector: John Graci Estate Abraham Hoffmann
I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) e9
Company Name,Address and Telephone Number:
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of 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
Conditional Passes code 310 CMR 16303.My findings are of how the system Is
Y performing at the time of the inspection.My Inspection does
_ Needs FulitheVEvaluation By the Local Approving Authority not impty any warranty or guarantee of the longevity ofthe
Falls septic system and any of Its components useful life.
Inspector's Signature: Date: 10121197
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:
A] SYSTEM PASSES:
x I have not found any information which indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
COMMENTS:
B] SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system,upon completion
ti 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
Co7hpliance(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 exfiltration, 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 Wealth.
(revised 0412J197) I
One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 is Telephone(617)292-5500
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 10 Captain Baker Rd.Marstons Mills
Owner: Estate Abraham Hoffmann
Date of Inspection:10114197
_ Sewage 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(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
Cj FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board or Health in order to determine if the
system is failing to protect the public health, safety and the environment.
1) 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 f 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
DI 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 in 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 clogged
cesspool.
SAS is in hydraulic failure.
(rerlaed 04R7191)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 10 captain Baker Rd.Marstons Mills
Owner: Estate Abraham Hoffmann
Date of Inspection:10114197
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 042719T)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 10 captain Baker Rd.Marstons Mills
Owner: Estate Abraham Hoffmann
Date of Inspection:10114197
Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following:
,c_ — 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.
_c_ — 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)]
(revised 04l227)97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 10 Captain Baker Rd.Marstons Mills
Owner: Estate Abraham Hoffmann
Date of Inspection:10114197
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 33D g•p•d./bedroom for S.A.S.
Number of bedrooms: 3
Number of current residents: 0
Garbage grinder(yes or no): No
Laundry connected to system(yes or no): Yes
Seasonal use(yes or no): No
Water meter readings,if available:(last two(2)year usage(gpd):
rda
Sump Pump(yes or no): No
Last date of occupancy: summer1997
COMMERCIAL/INDUSTRIAL:
Type of establishment: nla
Design flow:0 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: n1a
Last date of occupancy: nra
OTHER:(Describe) rda
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System has not been pumped In the last year.
System pumped as part of inspection: (yes or no)Nc
If yes,volume pumped:0 gallons
Reason for pumping: rda
TYPE OF SYSTEM
x Septic tank/distribution box/soil absorptions system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no)_( if yes,attach previous inspection records,if any)
I/A Technology etc.Copy of up to date contract?
Other:
APPROXIMATE AGE of all components, date Installed(if known)and source Information:
1976
Sewage odors detected when arriving at the site: (yes or no) No
(reylsed 0427197)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 19 captain Baker Rd.Marstons Mills
Owner: Estate Abraham Hoffmann
Date of Inspection:10114197
SEPTIC TANK: x
(locate on site plan)
Depth below grade: 8"
Material of construction:x concreate_metal_FRP_Polyethylene—other(explain)
If tank is metal, list age o . Is age confirmed by Certificate of Compliance No (Yes/No)
Dimensions: L8.6"H6'7"w410"
Sludge depth:"'
Distance from top of sludge to bottom of outlet tee or baffle:26"
Scum thickness:3"
Distance from top of scum to top of outlet tee or baffle:6"
Distance form bottom of scum to bottom of outlet tee or baffle: 15"
How dimensions were determined: Measured
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.)
septic tank and all components are structurally sound.Recommend pumping system every two years for maintenance.
GREASE TRAP:
(locate on site plan)
Depth below grade: raa
Material of construction: _concrete_metal_FRP_Polyethylene_other(expiain)
Dimensions: rda
Scum thickness:nta
Distance from top of scum to top of outlet tee or baffle:ria
Distance from bottom of scum to bottom of outlet tee or baffle:ria
Date of last pumpingn,
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.)
n1a
BUILDING SEWER:
(Locate on site plan)
Depth below grade: i,
Material of construction:_cast iron_40 PVC_other(explain)
Distance from private water supply well or suction lin0own
Diameter: 4"
Qmments: (conditions of joints,venting,evidence of leakage,etc.)
(revised 04127197)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 10 captain Baker Rd.Marstons Mills
Owner: Estate Abraham Hoffmann
Date of Inspection:10/14197
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade: rda
Material of construction:_concrete_metal_FRP_Polyethylene_other(explain)
Dimensions: n1a
Capacity: nia gallons
Design flow: rda gallons/day
Alarm level:_nfa Alarm in working order?_Yes_No
Date of previous pumping:
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
rda
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: Na
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)_vea
Comments:
(note condition of pump chamber,condition of pumps and appurtenances, etc.)
rda
r P
(ravlaed 04117197)
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 10 captain Baker Rd.Marstons Mills
Owner: Estate Abraham Hoffmann
Date of Inspection:10114197
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:
Na
Type:
leaching pits,number: 1A00 gallons leach pn
leaching chambers,number:Na
leaching galleries,number: nla
leaching trenches,number,length: nra
leaching fields, number,dimensions:r0a
overflow cesspool,number:n1a
Alternate system: nra Name of Technology:_nra
Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
The leach pit le structurally sound and Functioning properly.It was empty at the time of the Inspection,Pit has not had more than MCA
CESSPOOLS:
(locate on site plan)
Number and configuration: nla
Depth-top of liquid to inlet invert: nla
Depth of solids layer: nra
Depth of scum layer: Na
Dimensions of cesspool: nla.
Materials of construction: nra
Indication of groundwater: nra
inflow(cesspool must be pumped as part of inspection)
nfa
Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
rda
PRIVY:_
(locate on site plan)
Materials of construction: nra Dimensions: nra
Depth of solids: n/a
Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
rda
(revised 04127197)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
10 Captain Baker Rd.Marstons Mills
Estate Abraham Hoffmann
10114197
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)
P
!a9• ! of 10
(revised 04WJ97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
10 Captain Baker Rd.Mustons Mills
Estate Abraham Hoffmann
10114197
Depth of groundwater 12,
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from design plans on record.
Observation of Site(Abutting prcperty,observation hole, basement sump etc.)
Determine it from local conditions
Check with local Board of Health
I
Check FEMA Maps
Check pumping records
Check local excavators;installe s
X Use USGS Data
Describe in your own words how you Established the High Groundwater Elevation.(MUST be completed)
USGS Maps and Charts
(revised04)2TST) ?ago ]0 of to
Page 1. of 1
TOWN OF BARN)TABLE
LOCATION / C h ' /" 0.v SEWAGE# 1007 :'6 3
VILLAGE ^0,I,SfiVS 1 'i//s ASSESSOR'S MAP
INSTALLER'S NAME&PHONE NO. Sb8-9'20
SEPTIC TANK CAPACITY /000 /LEACHING FACILITY: (type) ff- (s Rs,.t C,5 k/O,s
NO.OF BEDROOMS 3
BUILDER OR OWNER (loIIL�/�//
PERMUDATE: /0- 2 S 077 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 leachin facili Feet
Furmished byf✓
C�,oj��� />a�crr Ka• i
8
vh
' r3•�.k
Ec(c i
n
/n9�Ecto., oarT
7/31/2019
LOCATION : /-.7 SEWo,C;E PERMIT UO.
VILLAGE
AWSTQLLERS 1J& AFZ ADDRESS .ter
. Lr�s - - - - - - -
.
BUILDER 1J ANIE ADDRESS,
DATE PERNA T ISSUED
. f
DTATE COMPLI W dCE ISSUED ,
rh I/s Ir
_. • - :=� /a G. ;ova _ 60.6
No.-- .1/ 6 Firm.l(6......
r `� THE COMMONWEALTH OF MASSACHUSETTS
BOARD PHEALTH
S .-----O F........ . ... .. ........----
Co�''r , ApplirFation -for Bispviial Workii Cn�aa�#raar�i�aa
Application is hereby made for a Permit to nstru ( o Repair ( } an Individual Sewage Disposal
Syst t
--- ------ ............. .................
ocatio dress � or Lot No�-0
ner Address
a ... ..........................................
q Installer ' Address
Type of Building/ Size Lot--- ___�44_-Sq. feet
Dwelling—No. of Bedrooms___ _________________________-~:'_Expansion Attic ( ) Gar age Grinder ( )
p, Other—Type of Building -__-_-------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures _________________��-_--_________
d .............Z -------------------•---------••-----.
W Design Flow------------------ �___-'._gallons per person per day. Total daily flow-----.---_•---_______e.-d........_gallons.
—;
Septic Tank Liqtud capacity/la__gallons Length---------------- Width................ Diameter................ Depth................
xDisposal Trench—No_____________________ Width.___.___. ...._ 1 Len otal leaching area--------------------sq. ft.
Seepage Pit No----------/--------- Diameter.., __ epD "tbe ow let " 'Total le ing area------------------sq. ft.
z Other Distribution box ( ) Dosing tank ( ) &4 — G �5 Y.
aPercolation Test Results Performed by--------- .......................................................-........ ate----- ------------------------- -
a Test Pit No. 1-----------_....minutes per inch Depth of Test Pit.................... Depth to ground water..-_-__---___.---_.-_---
fs Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ----•------•--------------------
O
Description of Soil - ------d-c'`'"� - 3 " "
x
W
--------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------
VNature of Repairs or Alterations—Answer when applicable._.__...........................................................................................
---------------------------------------------------------------------------------------------------------------------------------------------------------------------.............--•-•---------•_-----
Agreement:
The undersigned agrees to install the aforedescribed In. ividual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— T undersigned fu the agrees not to place the system in
operation until a Certificate of Compliance has bee ' the board of h lth.
Sig d V
.• Date
A lication A roved BPP PP y-- ' � �4 �' ��7 `�
Date
Application Disapproved for the following reasons:--••---•---------------•------------ --••-------............-•---.......----•-----•--•----•---••--•-......••••--
•--.....---•-••--•-•.•-------------------•-•--------•----------•----••-••-•--•---•--.--••-
Dat
Permit No.•••--•--•-•---•--•--•-------•---••-•-•-•.............. Issued•-- �� �`._Y
.._......
Date
AWO
.. Flmla. .........
..��-'"'r
THE COMMONWEALTH OF MASSACHUSETTS
cna HEALTH
---- OF...... ' .
Allp iration -for Ii-4poottl Marko Tonotrnrtton Vrrnift
Application is hereby made for a Permit to C stru ( o Repair ( } an Individual Sewage Disposal
syst t
} """`i`��r`' - ------------
cauo ress / /� ,/ - or Lot Iva. _
f1
�Ins
Address
. . Address
Type of Buildin-aZ Size .Lot.--���'�___ J_.Sq. feet
., Dwelling—No. f f Bedrooms_`l --------------------'-___---_o._--oT---_-E,pansion Attic ( } hoovers GarbageCGfetedria er ( )
PL, Other—Type o Bud g N p S ( ) ( )
a
d Other fixtures • ------. ---•-••--------------------------`----------------• --._.-------------------------•• .. -...--------------------------------
Design Flow... ..............: 1llons per person per day. Total daily flow.-_--_- `�. . .gallons.
� Septic Tank-Liquid capacity allons Length---------------- W>dth.. Diameter_...; Delitll _ ... .
W Disposal Trench No.__..___...'y___.._. Widt i___- engt -- otal'leaching area_.--.--------. ._--•sq. ft.
x r
Seepage Pit No..........!!__..___.. Diameter___ _ _________ epth e ow.` et__._-_..__ ._.._.: otal leacl ing ,trea._._..._..______.sq. ft.
z Other Distribution box ( ) Dosing tank ( . ) * " Xate
7y,
Percolation Test Results' Performed bY--------- -------- - --- ---.......------------ ------- _-_-.-----------------------------------
Test Pit No. I................minutes per inch Depth of TestrPit.................... Depth to ground water._._.-.--.-.-.--....._
(s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_. ----_-_-._---_--. -
t
D Description of Soil --------- -------- -d-f
----�--- l w�_.> 1 !� d.��M--`----- ---�----------
x
�.,
W -------------------------------------------------r_:__--•-_--____-__-_-__:____--__----•--•--:-•---•---.__________-----_-_-__-_-___•-:-----.---•-.-....._.........._..-.:.__--:--.__--_------_____--_----
UNature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------.:..-.._.__-_._----_--.....
---------------------------------------------------------- •-- ---------••------•----------•- ;;-7 -
Agreement:
The undersigned agrees to install the aforedescribed In iyidual Sewage sposat System in accordance with
the provisions of Article XI,of the State Sanitary Code=.T undersigned fu . ie agrees not to place the system in
operation until a Certificate of Compliance"haibee` the board of h th.
Sig. . -------------------
Da `
Application Approved BY - -------------------- / .
Date
Application Disapproved for'-'the following reasons-----------------------=-----------------------------------------------------------------------------------------
..................................
.........................................
................
...
..............................................
•-••••---•••--•-•.-••-........-••••-•-••••-•-•-•••----
........
Date
Permit No. ......................................I. Issued. ;Z
"' -....
Da ..-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF. HEALTHY r
X �.140............
....OF............ .
Trrf'f ira#r of mphanrr .--
TH S IS TO CERTI Tha he ndividu Sewa posal System constructed ( ) or Repaired ( )
J-r .......................
bY---•� -•-- -••• ...... --
-------- •.a4AXV _�_--
has • ........
er s r, sta er
at......... .......... ..... --� --- .. ........ ........... !.._ ..been installed in accordance with the provisions of Article °/�i'Tte Sanitary Code s de cribed in the
' application for Disposal Works Construction Permit No........:.....7_j�_.._.............. dated....��_ ____1' ..... y,/_._.........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUAR TEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.................................................................................. Inspector-------- - ---
Y
/ r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD EALTH �
� . :.. ..OF .
No... 7.--•••..... 'FEE--------------•---------
i-nS1ii ork� ion ixr ' ai rrntiP3001"
Permission is h y granted -..... -.
to Constru ( or Re air ( ' ) a IndiLvidua :Sewa isposa tem
�`'j't
--at N ----- - ,treet
as shown on the application for Disposal Works Construction P t No._ Dated___++Z �_ T' .`.__._.__
Board o Health
DATE. .............. :. ....................................
FORM 125 HOBBS & WARREN. INC.. PUBLISHERS Y
,. 4
- -
N .
L C/
v
-25
ry
)fP
COORDINATE INSPECTIONS CAPA r�.�l 1L��.. � � �-� • � '�
ITY SIDE�
CAPACITY BOTT
CAPACITY TOTA
BATH BATH KITCHEN THIS SYS�EM
BEDROOM AC CO M OD A TE
DISPOSAL
THREE
SEASON IN-LINE ELEVATION
ROOM
LIVING INV. ® HOUSE
BEDROOM BEDROOM ROOM INV INTO TANK
INV OUT OF TANK
C"T j-U-N R RO" INV INTO D—BOX
INV OUT OF D—BO
INV INTO INFILTRA'
BOTTOM OF INFILT
9��TTOV Or, ODE
WATER TABLE
STON .j�
PAVED DRIV SOIL LOGS
DRIVE G
TH ? � OBS
�96,3 I ELEV.
96.9
W A LOA
10'
96.1
96,9
B LOA
X X � i 9, 93.9 C
I
LOA
THREE x
GARAGE SEASON #1 O / 6
� l massive
ROOM
stones a
X
86.9
toll
DECK e ' p /yam I NO GROUND
1 PERC RA7
fU
I / � 19
01 SCALE
1iE 1 : 20
X Xxi— X X X
SEF
'BENCHMARK SET ''t 1 s R S • `� . l L f 7 PLAN SHOWING:p
LEACH PIT TO SAS DIMENSIONS R. CORNER OF 1ST STEP = r -1 ,43: _ / FOR
BE REMOVED � 'L ��C�. = COLDWE
3- 3050 CHAMBERS WITH END CAPS E I e v. 10 0. 0 A S S u m �� •. o,r,�: LOCATION:
3.1' STONE ON SIDES; 2.95' STONE ON ENDS sF�°•::;I;;;. �� %�` 10 cnPTAl
���Sr�R o '�� {J LOT#:
OVERALL DIMENSIONS 10.5 x 28.5 4 Au�������►h �- � M126 P42
LISA L N S.
W C 1 CERTIFY THAT THIS PLAN CONFORMS TO
LISA
TITLE 5 AND BARNSTABLE B.O.H. REGULATIONS HYANN
(EXCLUDING WAIVERS SPECIFIED)
I _ t
f
r - t
j
LOCUS DATA
�� �� Q 99.5 f.
CONCRETE :. = i ?- i A-4 6 y"
CURRENT OWNER DRISS & YOUSSEF B0UND& HELD ND / /�Q 8g' $ EDWAARD �
ESSABSABI STON
.2 8
PLAN REFERENCE 274-34 _
DEED REFERENCE 22546-190 / G Q E
ZONING DISTRICT RF / WP
FLOOD ZONE 'Y' 96.E
ASSESSORS MAP 126
I
97.8
PARCEL 042 91i
F
OVERLAY DISTRICT ZONE II ,
96.2
LOT AREA 21,877t S.F. 98:5 9 i 9� ��
X 99.3
€ SITE Bc SEWAGE
REPAIR PLAN (� \
1 #7 0 I \ i EXISTING
3 BED200M LOT B:
CAP THIN BAKER ROAD � � � � DWELLING x ss.s 21,877t S.F.
IN l
MAR T I �\100.3
I
S ONS MILLS, MA I I
DATE: JANUARY 6, 2020 z I l GARAGE DECK
w ` 99.5
OWNER/APPLICANT: \ °
w
DRISS & YOUSSEF o \ �� 99.7 20.6'
,3.7
ESSABSABI \ ° ��
10 CAPTAIN BAKER RD. 20-0100
\G ,
MARSTONS MILLS, 02648 j o ; 221G$ - RgcE
I SHEET 1 OF 2 Q LAN£ oPK s�
i e N M
98.6 D.T. ��- E CH ARK
PREPARED BY: 99'5 CORNER OF CONCRETE LOCUS
EXISTING 1,500 BULKHEAD EL=100.00 a g
E A S SURVEY I N C. 1'�1' �9 GALLON SEPTIC m N
9 . TANK TO REMAIN Z s9
cF
P. O. B O X 1729 cpABANDONREMOVE PROPOSED ACCORDANCE WITH �p
SANDWICH, MA 02563 OAK "D=' BOX 11 TLE 5. 0 20 30 4o
PROPOSED S.A.S: PROPOSED(2) 500 GALLON H 20 5 OVERDIG ALL
CELL (508) 527-3600 `j
CHAMBERS WITH 4' OF STONE AROUND S.A.S. To GRAPHIC .SCALE: '
EAS.SURVEY@YAHOO.COM ALL AROUND (13'x29'). COARSE SAND 1 INCH = 20 FEET LOCUS MAP
NOT TO SCALE:
SYSTEM DESIGN
RAISE COVERS TO..WITHIN 6" OF FINISH GRADE -
TOP OF FOUNDATION
ELEV. 100.80 FINISH GRADE RASE CENTER CHAMBER
WITHINR6RIS� DESIGN FLOW
FINISH GRADE �' OF FINISH GRADE 3 BEDROOMS AT 1 00 GPB/D 330 GPD
o` ELEV. 99.3 ELEV. 99.2 ELEV. 99.2
/ ELEVATION 98.7
\ REQUIRED SEPTIC TANK
TOP ELEV 96.30 MAX. COVER _330 x 2 660
GAL.
48'®5=0.03 6' ®S= 0.03 SEPTIC TANK PROVIDED = 1500 _GAL.
SCH 40 4' PVC 4" PVC. SCH 40
:? - 2 MIN-3 MAX O 00 OO o o O 0ilV
0
= XISTING INV. O O O o o O 1 SIZE OF LEACHING FACILITY REQUIRED
1 97.24 10"TEE 14"TEE INV.=
eo INSTALL 97.04 6" 0000000 o c 000
kS�TM� JGAS BAFFLE 3 OUTLET STRIPOUT TO DESIGN PERC RATE C2 _JVIIN./INCH
0 V H-20 D63 TWO 5'-0"x8'-6"x3'-O" CHAMBERS COARSE SAND LONG TERM APPL. RATE 0.74 GPD/S.F.
INV.=95.65 INV.=95.30d PER 310CMR
INV.=95.48 15.255 SIZE OF LEACHING SYSTEM PROVIDED: I
N t S.A.S. (13.0' x 29.0' 93.30
STRIPOUT (23' x 39'� c� ../ 330 _ 0.74 SF/GPD = 445 S.F. MIN. REQ.
EXISTING 1,500 GALLON SEPTIC ELEV. 87.2 USING H-20 CONCRETE LEACHING CHAMBERS
SgarT�►R TANK TO REMAIN WITH 4' OF STONE ALL AROUND
O O O o o O O O BOTTOM (13.0' x 29.0') = 377 S.F.
O O O O SIDE WALL (13.0' + 29.0') 2x2 = 168 S.F
20-0100 00000 0 0 00000 545 S.F.
CONSTRUCTION NOTES: 0 0 8 0 0 0 0 00 0 0 0 00
545 S.F.x 0.74 G/SF = 403 GPD
1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES.AND
SITE & SEWAGE ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING 4.0' 5.0' �(�4.0--1•____J 403 GPD PROV > 330 GPD REQ. =73 GPD RES.
WORK ON THE SITE. �I
REPAIR PLAN 2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE ( NO (GARBAGE DISPOSAL / GRINDER ALLOWED)
WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT 13.0'
IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. SIDE VIEW � 19-211
#1 D 3. ENGINEER TO VERIFY REMOVAL OF UNSUITABLE SOILS PRIOR D.T.H. #1 ib D.T.H. #2
TO INSTALLATION OF NEW SEPTIC SYSTEM. DATE: 11-2219 DATE: 11-22-19
i CERTIFY THAT I AM CURRENTLY APPROVED -
. BY THE '
CAP THIN BAKER ROAD 4. NO PARKING OVER SEPTIC TANK IS ALLOWED. DEPARTMENT OF ENVIRONMENTAL PROTECTION TO GROUND ELEV. 98.7 GROUND ELEV. 99.2
IN GENERAL NOTES: CONDUCT SOIL EVALUATIONS AND THAT THE RESULTS OF ADJ G.WATER. 87.2 ADJ G.WATER. N/A r
1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. MY SOIL EVALUATION ARE ACCURATE AND IN
M A R S TO N S MILLS MA TITLE V AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS ACCORDA TH 310 15.100 UGH 15.107. A A
LOAMY SAND LOAMY SAND
FOR SUBSURFACE DISPOSAL OF SEWERAGE. 10YR B 3/3 6" OYR B 3/3
DATE: JANUARY 6, 2020 2. AT LEAST ONE ACCESS POINT OVER TANK TEES SHALL.BE
ACCESSIBLE WITHIN 3" OF FINISH GRADE, WITH ANY REMAINING EDWARD A. STONE CERTIFIED SOIL EVALUATOR 12"
ACCESS PORTS BROUGHT TO WITHIN 12" OF FINISH GRADE. LOAMY SAND LOAMY SAND
OWNER APPLICANT: 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE DATUM: 10YR 6/8 10YR 6/8 34"
CAPABLE OF WITHSTANDING H-10 LOADING UNLESS 28" C-1
OTHERWISE SPECIFIED. VERTICAL DATUM: ELEV 96.4 LOAMY SAND
D R I S S & YO U S S E F 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION ASSUMED / 2007 SITE PLAN 10YR 6/4 �
OF ALL UTILITIES PRIOR TO ANY EXCAVATION. BENCH MARK USED: 60"
E S S A B S A B I 5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE ELEV = 94.2
10 CAPTAIN BAKER R D. OR WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. ELL V OF
CONCRETE00.00 BULKHEAD
6. FINISH GRADE SHALL HAVE A .MINIMUM OF 0.02 FEET PER
FOOT OVER THE S.A.S. AND DISTRIBUTION BOX. INDICATES DEEP ELEV = 93.2 72"
M A R S TO N S MILLS, 02648 7. SEPTIC TANK SANITARY TEE'S SHALL BE CONSTRUCTED OF DTH #1 0 TEST HOLE C `=/ C-2 ASSUMED
SHEET 2 OF 2 SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6" ABOVE COARSE SAND COARSE SAND
THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND �� 138" INDICATES ADJ. GROUNDWATER 2.5Y 6/6 2.5Y 6 6
LOCATED DIRECTLY UNDER THE CLEAN OUT MANHOLES. 10% GRAVEL 10% GRAVEL
PREPARED BY: 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN NO OBSERVED GROUNDWATER
2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT NO G.WATER `°� " NO G.WATER "
ELEVATION OF THE OUTLET PIPE. INDICATES 138 138
E A S SURVEY, INC. 9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES PERC TEST ELEV = 87.2 ELEV = 87.7
THE OBE EQUIPPED NTH A
P. O. BOX 1729 10 BAFFLE•4L ET INCHES INRDIAMETERTEEALL D AND CONSTRUCTED OF 4"GAS PVC B O DAVE STANTON
11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND GROUNDWATER A JUSTMENT _ SOIL EVALUATOR
SHALL BE SLOPED 1/4 INCH PER FOOT MIN. EXCEPT FOR THE
SANDWICH , MA 02563 - ED. STONE
FIRST TWO FEET OUT OF THE DISTRIBUTION BOX WHICH SHALL DEPTH TO BOTTOM OF HOLE 11.5' BACKHOE OPERATOR.
BE LEVEL JOE DeBARROS
VARIANCES REQUESTED
12. CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION SOIL TYPE 1
CELL (508) 527-3600 TO EAS SURVEY INC. FOR B.O.H. AND DESIGN ENGINEERS REVIEW NONE: PERC RATE. d MIN. PER INCH
EAS.SURVEY@YAHOO.COM AND APPROVAL _ LOADING RATE: 0.74 GAL/SF/MIN
13. MAGNETIC TAPE ON ALL COMPONENTS.
SEPTIC TANK - SEE NOTES DISTRIBUTION BOX INFILTRATOR 3050 CHAMBERS CROSS SECTION Locus PLAN
NOT TO SCALE NOT TO SCALE NOT TO SCALE NOT TO SCALE
BM: 100.0 99.0 MIN 0
a \��\ \\��\��\��\��\��\��\��\��\��\��\��\��\��\��\��\��\��\��\��\��\��\��\��\��\��\��\ �\��\/ \\!\\�\\�\\�\\�\\�\\�\\�\\�\\�\\�\� RACE LANE
COVER TO BE Vn=6"OF GRADE
INSPECTION PORT TO BE WITHIN 6" OF GRADE Li
4"SQL 40 P.V.C. 3"MIIVII�UJM ^ MIN.9"COVER /4"-1 1/2"DOUBLE WASHED STONE
Y ` 4"scxo4olr�v c " 1/8"-1/2" WASHED STONE ti
existing 13 3" �� 1 4" o oioli� (OR FILTER FABRIC) I a Y
�4 _ i
97.4 \ \ °¢°
7 i
3
2
40
96.9
96.2
W
2 0 �/
10.0 96.8 94.2
/ ¢
MIN
W
:::6nor�Ttiri iii nEi 2Ai?K 2 9�,1 22.6' -I2.95'� 3.1'- 4.25'-3.1'
�bTTOM OBS 84.3' 10.5'
SITE SPECIFIC NOTES DESIGN CALCULATIONS GENERAL NOTES
TANK TO BE RESEALED AT SEAM AND ADD GAS EXISTING BEDROOMS 3 0 110 G.P.D.- ALL PIPING TO BE SCHEDULE 40 P.V.C.
1 13AFFLE OR REPLACED WITH 1500 GAL.TANK. FLOOR PLAN ALL LOCATIONS Of UTILITIES SHOWN ARE AS
NOT TO SCALE MARKED BY DIG-SAFE AND ARE TO BE
M126 P42 VERIFIED BY INSTALLER PRIOR TO
LEACH PIT TO BE REMOVED. LINE TO BE DE H UNITS 3 3 3 d CONSTRUCTION
ARE
DEPTH BELOW INV. 2' THERE ARE NO KNOWN WETLANDS WITHIN
WIDTH REDIRECTED TO INFILTRATORS AS SHOWN 219 77±SF LENGTHz8 s' UNOLESS SHOWN.PROPOSED LEACHING FACILITY
INSTALLER TO NOTIFY DESIGNER 24 HOURS PRIOR TO SIDEWALL AREA .o SF HERE ARE KNOWN POTABLE WELLS WITHIN
29
BOTTOM AREA 299.25 SF 150' OF THE
PROPOSED LEACHING FACILITY,
BEGINNING OF JOB TO COORDINATE INSPECTIONS FIRST FLOOR TOTAL SQUARE FEET 455.25 SF THERE WITHIN 50'AGILITY E OF THEOWN ROPOSEDnLOEACH`ING s
CAPACITY SIDEWALL 00.74 115.44 G.P.D.
`fir+ CAPACITY BOTTOM 0 0.74 221.4 G.P.D. THIS PROPERTY DOES NOT FALL WITHIN A
CAPACITY TOTAL 336.84 G.P.D. FLOOD ZONE AS SHOWN ON FIRM MAP
THIS DESIGN DOES NOT REQUIR)E VARIANCES
A BATH KI OR
TCHEN THIS SYSTEM NOT DESIGNED TO BARNSTABLE SUPPLEMENTAL REGULATIONS.
BEDROOM ACCOMODATE A GARBAGE
ALL CONSTRUCTION SHALL BE IN ACCORDANCE
DISPOSAL NTH TITLE 5 AND BARNSTABLE SUPPLEMENTAL
REGULATIONS.
THREE
SEASON IN-LiNE ELEVATIONS PROPOSED AS-BUILT SURVEY INFORMATION
ROOM
LIVING INV. ® HOUSE (EXISTING) PROPERTY LINE DATA FROM
BEDROOM BEDROOM ROOM INV INTO TANK 97.65 Tom Kelley Engineering/Surveying 5/73
INV OUT OF TANK 97.4
CAPTAIN R ROAD INV INTO BOX 96.97 PLAN T BE USED FOR INSTALLATION
INV OUT OFF D-BOX 95.8 OF SEPTIC SYSTEM ONLY
INV INTO INFILTRATOR 96.2 NOT FOR DETERMINING PROPERTY LINES
BOTTOM OF INFILTRATOR 94.2
BENCH MARK •-
STON
WATER TABLE NONE ENCOUNTERED R. corner of bulk head 100.0 (ASSUMED)
.l•
PAVED � DRIVX . SOIL LOGS GATE: OBSERVED BY: WITNESSED BY:
DF'.IVE G OCT 11, 2007 LIS501LAEVALU�OR BOARD OF HEALS DONNA TH
TH 2 OBS. HOLE #1 OBS. HOLE #2
96.3 ELEV. DEPTH ELEV. DEPTB
W 96.9 011 96.3 "0
A LOAMY SAND A/E LOAMY SAND
-O�T H 1 96.1 10YR 3/3 10" 95.3 10YR 3/2 12
96.9 B LOAMY;SAND B LOAMY SAND
X x 1 OYR 6/8 1 OYR 6/8
93.9 C 32" 93.5 C 34"
LOAMY SAND 0 54"
66" LOAMY SAND
SEASON
GARAGE THREE #10 x 2.5Y 6/4 2.5Y 6/4
ROOM massive,friable with
stones and cobbles massive,friable with
L� stones and cobbles
X � 86.9 1 120" 84.3 1144„
DECK NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED
x
N I x PERC RATE<2 MTNS./INCH
Ah
x / -
. . .. SCALE 1 : 20 P# 14976
0
X x x x x x
°:.�'::::A�ti SEPTIC DESIGN PLAN
SAS DIMENSIONS BENCHMARK SET l PLAN sxownJa:PROPOSED SEPTIC SYSTEM REPAIR LET BARNSTABLE
LEACH PIT TO R. -CORNER 0 F 1ST STEP - _ ►-y FOR: DRAWN BY: LISA C. LYONS
BE REMOVED 3 - 3050 CHAMBERS WITH END CAPS LI 1143:�= COLDWELL BANKER DESIGNED & CHECKED BYC. LYONS
E l e v. 10 0. 0 A s s u m •�� O�r\��� LOCATION: REVISIONS:DESCRIPTION: DATE:
3.1' STONE ON SIDES; 2.95' STONE ON ENDS �F ,I,; ; QO �. 10 CAPTAIN BAKER RD,MM
,
OVERALL DIMENSIONS 10.5'x 28.5' '� ,������ ��s LOT# DATE:
M126 P42 OCT 16,2007
LISA L N .S.
1 CERTIFY THAT THIS PLAN CONFORMS TO LISA C. L Y 0 N S, , S, (508) 790-9270
TITLE 5 AND BARNSTABLE B.O.H. REGULATIONS (774) 487-i638
(EXCLUDING WAIVERS SPECIFIED) HI'ANrTIS, MASSACHUSETTS