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HomeMy WebLinkAbout0031 CAPTAIN BAKER ROAD - Health 31 'Captain Baker Road Marstons Mills. `; t A= 126—045 = ' I f D � dl�l��f CC��- S���9 ,�/ri , w ���� TOWN OF BARNSTABLE LOCATION Z( � � 4a�c f-� ��SEWAGE# VILLAGEM , QY ,Nkk ,ASSESSOR'S MAP&PARCEL 1.2) 940PR'S NAME&PHONE NO.4,,,_—AAA �'`�rf SEPTIC TANK CAPACITY 1®�jQ LEACHING FACILITY:(type) size) K `Q's'�X") NO.OF BEDROOMS OWNER 4 PERMIT DATE: j L"( COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S 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 B ♦ �a V Commonwealth of Massachusetts �11 �� Title 5 Official Inspection Form '9 _ l - i; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Captain Baker Road --- �� Property Address Housing Assistance Corporation Owner Owner's Name information is Marstons Mills MA 02648 _ April 5, 2019 required for every _ -- --- ----- — — page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information filling out forms on the computer,use only the tab Patrick T. Sullivan key to move your Name of Inspector cursor-do not Ready Rooter_ Excvating ----- use the return Company Name key. PO Box 89 _ _ --- -- Ult Company Address Forestdale MA_ 02644 v, City/Town State Zip Code nc 508-509-0802 S112843 Telephone Number License Number B. Certification certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails April 10, 2019 Inspectors 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. _ Please note: This report only describes conditions at the time of inspection and under the Conditions of use at that time.This inspection does not address how the system will perform Commonwealth of Massachusetts =, Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Hc, " 31 Captain Baker Road Property Address Housing Assistance Corporation Owner Owner's Name information is required for every Marstons Mills MA 02648 April 5, 2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N,)ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. / *A metal septic tank will pass inspection ifji is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. i ❑ Y ❑ N ❑ ND (explain below): t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form t� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Captain Baker Road Property Address Housing Assistance Corporation Owner Owner's Name information is Marstons Mills MA 02648 April 5, 2019 required for every — _ - page. CityfTown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or hig"tatic 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): i` ❑ broken pipe(s) are replaced ' ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): i ❑ distribution box is leveledo'`r replaced ❑ Y ❑ N ❑ ND (Explain below): I i /i ❑ 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): i ; i 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. i a. System will pass unless Board of Health determines in accordance with 310 CMR ` 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 1ide 5 official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts r Title 5 Official Inspection Form _ I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Captain Baker Road Property Address HousingAssistance ssistance Corporation _ Owner Owner's Name information is Marstons Mills MA 02648 Aril 5, 2019 required for everyp — page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. i ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. j ❑ 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 distan�e: i i r " This system passes if the we�/water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other-failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts _= - , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments lye 31 Captain Baker Road Property Address Housing Assistance Corporation Owner Owner's Name information is Marstons Mills MA 02648 A riI 5 2019 required for every �—_- _— page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"y�'s" or no to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system/is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IW,PA) or a mapped Zone II of a public water supply well t5insp.Aoc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form i; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Captain Baker Road Property Address Housing Assistance Corporation _ Owner Owner's Name information is Marstons Mills MA 02648 Aril 5, 2019 required for every _ — -- — page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® El information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface.Sewage oisposal System•Page 6 of 18 f Commonwealth of Massachusetts -_-=-;�; Title 5 Official Inspection Fora p Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a'! 31 Captain Baker Road _ V! Property Address Housing Assistance Corporation Owner Owner's Name information is Marstons Mills MA 02648 April 5, 2019 required for every -_-- --- page. City/Town State _ Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 — Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 349 GPD Description: Number of current residents: 0 - Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No 2017= 287 GPD Water meter readings, if available (last 2 years usage (gpd)): 2018= 296 GPD Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date r�019 Date t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Captain Baker Road Property Address Housing Assistance Corporation Owner Owner's Name information is Marstons Mills MA 0264$ April 5, 2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information (font.) 2. Commercial/industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): — — Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc): --- -- - Grease trap present? ;/ ❑ Yes ❑ No Water treatment unit present? / ❑ Yes ❑ No If yes, discharges to.- Industrial waste holding tank present? El Yes ❑ No Non-sanitary waste discharged t9/the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: -- -- Last date of occupancy/use. Date Other(describe below)-. 1 3. Pumping Records: Source of information: Last pump reported 2014 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallonsHow was quantity pumped determined? -- ---- - Reason for pumping: - t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts - -, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 31 Captain Baker Road Property Address Housing Assistance_Corporation Owner Owner's Name information is Marstons Mills MA 02648 April 5, 2019 required for every _ —_- _ - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Septic tank 20+-years old. D-box and leach system installed 02/10/2014. Certificate of Compliance on file at Health Dept. _ _Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 2.5 Depth below grade: 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.): t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Captain Baker Road _— Property Address Housing Assistance Corporation Owner Owner's Name information is Marstons Mills MA 02648 A rll 5 2019 required for every -- -- --- —�—=- page. City/Town State — Zip Code _ Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): l Depth below grade:p g 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: 8.5' x 4.5' x 5' 1000 gallons _ 6" Sludge depth: 28 Distance from top of sludge to bottom of outlet tee or baffle -- _ Scum thickness 12" at inlet-- 6" Distance from top of scum to top of outlet tee or baffle 6" --- Distance from bottom of scum to bottom of outlet tee or baffle 101, How were dimensions determined? Dip tube and tape measure -- Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet and outlet tees in place. Liquid level at outlet invert. Risers bring covers within 6" of grade. Tank needs to be pumped and cleaned. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 16 i Commonwealth of Massachusetts =, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Captain Baker Road _ Property Address Housin Ag ssistance Corporation. _ Owner Owner's Name information is required for every Marstons Mills MA 02648 April 5, 2019 _— -- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal []fiberglass ❑ polyethylene ❑ other(explain): Dimensions: /1 Scum thickness i' Distance from top of scum to top of outlet tee or baffle Distance from bottom of scun�to bottom of outlet tee or baffle i Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related'to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: --- Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): i Dimensions: j Capacity: j� — gallons F Design Flow: gallons per day t5insp.doc•rev.7/2 61201 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form Not for Voluntary Assessments - % 31 Main Baker Road _ Property Address Housing Assistance Corporation Owner Owner's Name information is Marstons Mills MA 02648 April 5, 2019 required for every — -- — — page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: — Alarm in working order: ❑ Yes ❑ No i Date of last pumping: /� Date Comments (condition of alarm and float/switches, etc.): i i *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 011 — — 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.): One inlet, two outlets w/ speed levelers in place. Black substance on sidewall of d-box, unknown source. No high water stainin of effluent over outlet inverts. Riser brings cover within 6" offg_rade. t5insp.doc•rev.712 612 01 8 Title 5 Official Inspection Form.Subsuriace Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form T - _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments b.! 31 Captain Baker Road Property Address Housing Assistance Corporation _ Owner Owner's Name information is required for every Marstons Mills MA 02648 Aril 5, 2019 _-- — — � page. City(Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: / El Yes ❑ No* Comments (note condition of pump chjfiber, condition of pumps and appurtenances, etc.): i r * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: -- ® leaching chambers number: 2- 500 gal ea. w/ 4' stone. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: --- ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: -- — t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts n-_- Title 5 Official Inspection Form — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Captain Baker Road _ Property Address Housing Assistance Corporation Owner Owner's Name information is Marstons Mills MA 02648 April 5, 2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 3" of liquid in chamber at time of inspection. High water staining 10" below invert at time of inspection. Clean stone visible in sidewall. No sign of past hydraulic failure. Riser brings cover within 10" of grade. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration i� Depth —top of liquid to inlet invert — i Depth of solids layer Depth of scum layer i` Dimensions of cesspool Materials of construction % Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5insp.doc•rev.7/26/2048 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Fora -- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments \, 31 Captain Baker Road Property Address Housing Assistance Corporation _ Owner Owner's Name information is Marstons Mills MA 02648 Apriil 5, 2019 required for every - ----- --- — --- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: — -- i Dimensions Depth of solids f - Comments (note condition of soil, signs hydraulic failure, level of ponding, condition of vegetation, etc.): i i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts 3--� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Captain Baker Road — `� Property Address Housing Assistance Corporation Owner Owner's Name. information is MA 02648 April 5, 2019 required for every Marstons Mills _ — page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building_ Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately J � � O O f t5insp.doc•rev.MM2018 Title 5 official Inspection Form:suhw aaw sewage oisPosw sweet Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection. Form i, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^ � 31 Captain Baker Road Property Address Housing Assistance Corporation Owner Owner's Name information is Marstons Mills MA 02648 April 5, 2019 required for every — --- -- I page. CityfTown _ State Zip Code Date of Inspection D. System Information cont. 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells >5 Estimated depth to high ground water: feet Please indicate a I methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed. 1/24/2008 _ Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Chec{ed with local excavators, installers - (attach documentation) ® Accessed USGS database - explain: maps.mass ig s.state.ma.us/oliver.php You must describe how you established the high ground water elevation: Test hole in 2008 found no ground water at 120". Base of units 5' below grade. Units are above know high ground water, levels. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc...rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Captain Baker Road Property Address Housing Assistance Corporation _ Owner Owner's Name information is Marstons Mills MA 02648 Aril 5, 2019 required for every — — �— page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t51nsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 18 of 18 Commonwealth of Massachusetts. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Captain Baker Road Property Address PO Housing Assistance Corporation Owner Owner's Name - information is 01 required for every Marstons Mills MA ~02648 3/31/15 page. Cityrrown State Zip Code Date of Inspection F 4� Inspection results must be submitted.on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information % on the computer, use only the tab 1. Inspector: \/ key to mcv-e you cursor-do not Michael DiBuono use the return Name of Inspector key. .R r:: DiBuoho Sewer and Deain _ reb Company Name 8 Johns path _ Company Address S Yarmouth MA 02664 City/Town State Zip Code 508-364-9587 S113522 Telephone Number License Number r 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 3/31/15 Inspector'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. 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 I Commonwealth of Massachusetts w Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °�M ,•'' 31 Captain Baker Road Property Address Housing Assistance Corporation Owner Owner's Name information is required for every Marstons Mills MA 02648 3/31/15 - page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summay: Check A,B,C,D or E/always complete all of Section D .A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system contains a 1,000 gallon tank as well as a concrete Distribution box. All tees and baffles are in place. The Distribution box is level and at normal level. The leaching is made up of two 500 gallon leaching chambers. Dbox does not indicate levels have ever been over normal 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °�M ,•y''F 31 Captain Baker Road Property Address Housing Assistance Corporation Owner Owners Name information'is or every Marstons Mills MA 02648 3/31/15 page. CitylTown 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 leve! 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •'" 31 Captain Baker Road Property Address Housing Assistance Corporation Owner Owners Name information is required for every Marstons Mills MA 02648 3/31/15 _ page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z 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 °,M ,••''t 31 Captain Baker Road Property Address Housing Assistance Corporation Owner Owners Name information is required for every Marstons Mills MA 02648 3/31/15 page. Cltyrrown 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 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I� r Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 31 Captain Baker Road Property Address Housing Assistance Corporation Owner Owner's Name information is required for every Marstons Mills MA 02648 3/31/15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M ,•''- 31 Captain Baker Road Property Address Housing Assistance Corporation Owner Owners Name information is required for every Marstons Mills MA 02648 3/31/15 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system contains a 1,000 gallon tank as well as a concrete Distribution box. All tees and baffles are in place. The Distribution box is level and at normal level. The leaching is made up of two 500 gallon leaching chambers. Dbox does not indicate levels have ever been over normal Number of current residents: vacant Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ .Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): 2013 183,000 Detail 2014 96,000 383 GPD Sump pump? ❑ Yes ® No Last date of occupancy: vacant 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 L f Commonwealth of Massachusetts W Title 5 Official Inspection Four' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c�M 31 Captain Baker Road Property Address Housing Assistance Corporation Owner Owner's Name information is required for every Marstons Mills MA 02648 3/31/15 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: 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 Fora Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 31 Captain Baker Road Property Address Housing Assistance Corporation Owner Owners Name information is required for every Marstons Mills MA 02648 3/31/15 page. CItyffown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: wear Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: 18 "s 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.): System is vented th,rought the roof Septic Tank (locate on site plan): Depth below grade: 1 ft feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain) 1,000 gallon If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1,000 Gallon Sludge depth: 3"s t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 31 Captain Baker Road Property Address Housing Assistance Corporation Owner Owners Name information is required for every Marstons Mills MA 02648 3/31/15 page. Cityfrown 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 24"s Scum thickness 3"s Distance from top of scum to top of outlet tee or baffle 42"s Distance from bottom of scum to bottom of outlet tee or baffle "Sludge stick How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): System is near new. One year old. Grease Trap (locate on site plan): Depth below grade: NA feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 . ,\ Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �^M 31 Captain Baker Road Property Address Housing Assistance Corporation Owner Owners Name information is required for every Marstons Mills MA 02648 3/31/15 page. Citylfown 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.): Tees are in place and levels are normal. No pumping recommended at this time 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 9 El polyethylene El 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 Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Captain Baker Road Property Address Housing Assistance Corporation Owner Owners Name information is required for every Marstons Mills MA 02648 3/31/15 page. Cityrrown 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 At Normal Level Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution Box is level and at normal level with no signs of carry over or decay. 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 r Title 5 Official Inspection coon Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Captain Baker Road Property Address Housing Assistance Corporation Owner Owners Name — information is required for every Marstons Mills MA 02648 3/31/15 page. Cltyl own State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2-500 gallon ❑ 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.): No signs of carry over. no signs of h drualic 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 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Captain Baker Road Property Address Housing Assistance Corporation Owner Owner's Name information is required for every Marstons Mills MA 02648 3/31/15 page. Citylrown 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.): No signs of ponding or h drualic 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.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 31 Captain Baker Road Property Address Housing Assistance Corporation Owner Owners Name information is required for every Marstons Mills MA 02648 3/31/15 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 TOWN OF BARNSTABLE LOCATION SEWAGE# VII LAGE Jul e hoc,,`� �1 << ASSESSOR'S MAP&PARCELS 2 6' S INSTALLER'S NAME&PHONE NO.�'ti--4 C. SEPTIC TANK CAPACITY \(3�Z)� v-K LEACHING FACILITY:(type)a C� NO.OF BEDROOMS OWNERZ PERMIT DATE: _ COMPLIANCE DATE: Separatton Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching.Facility s Feet Private Water Supply Well and Leaching Facility(If any wells exist on j 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) i Feet i - fA . � 1 Commonwealth of Massachusetts ID Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 31 Captain Baker Road Property Address Housing Assistance Corporation Owner Owners Name information is required for every Marstons Mills MA" 92'648' 3/31/15 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+ ft 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: 2/4/14 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: NGE at 10 + ft according to test hole data on plan dated 2/4/14 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 Title 5-Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Captain Baker Road Property Address Housing Assistance Corporation Owner Owners Name information is required for every Marstons Mills MA 02648 3/31/15 page. CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary.D.(System..Failure Criteria•Applicable to All Systems) completed ❑ System Information— Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BAR�N(S�TABLE V LOCATION ` C,p�,��`,�,\�p1��s ISC� SEWAGE#QO VILLAGE4'vI.a M`. ASSESSOR'S MAP.&PARCEL oC A9 INSTALLER'S NAME&PHONE NO.';Z-,;-acSZ�l SEPTIC TANK CAPACITY \(30 LEACHING FACILITY:(type)a Ca,,c�>r'�.C,,, � e) NO.OF BEDROOMS OWNER<;�'-�.tw�,e�� U� PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S' 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) p Feet FURNISHED BY t ,�. , � -. a= \� �� ECG= �l7 � 6�f ; ss',r`. �, ,, �� / � `` _, I � O ��' _'a � � � � �, O � t (i � j��� �' (� 1 j-r a..:. e.�-1- �C� v Ste' V� f /. . , � f l t ` ` y � � "' �. �- _— �" t z • No. / Fee HE COMMONWEALTH OF MASSACHUSETTS Entered in co puter: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for MispoSal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(vf Upgrade( ) Abandon( ) ❑Complete System [a Individual Components Location Address or Lot No.—S\ Owner's Name,Address,and Tel. o.747—SS- �7S v�.w� • g.d�.�..r�.i cQ X V c r Cat Assessor's Map/Parcel ``�E; \ pcQ ��, S O Installer's Name,Address,and Tel No.Sew-a°'77- Designer's Name,Address,and Tel.No. 1M,.,4 0�63j Type of Building: Dwelling No.of Bedrooms Lot Size 'j,�I sq.ft. Garbage Grinder( ) Other Type of Building ���, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date L/ j'��( Number of sheets Revision Date Title Size of Septic Tank pcjcn Q& loG� � Type of S.A.S. D C_a ` Cn Description of Soil Nature of Repairs or Alterations(Answer when applicable)- -C es�o C1 ��0 /<�,A` Cow Grp"CC� e �-<�n�-A r S t•�� Y C-41 yK�w 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. OK i ed Date G Application Approved by Date Application Disapproved by Date for the following reasons Permit No. ! Date Issued I ---------------------------------------------------------------------------------- ry�h; s No. ' Fee VHE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 'PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplication for Misposal *pstem Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑91Individual Components Location Address car Lot Owner's Name,Address,and Tel.Vo.707--573-S_ Assessor's Map/Parcel ` 6 Q tl a S\ Installer's Name,Address,and Tel.No.S�`�-`? Z-s;6 SS Designer's Name,Address,and Tel.No. cG �Or s' ale Mq��� pcd CD'-, Type of Building: D ellingNo.of Bedrooms f Lot Size j sq.ft. Garbage Grinder( ) Other Type o r f Building No.of Persons F Showers( Cafeteria( ) Other Fixtures Design Flow(min.required) 33 C--) gpd Design flow provided `� gpd Plan Date ��/ �/�( Number of sheets Revision Date 4 Title- Size of Septic Tank 1 OCrJ .a gip G.,o G � .�:.v�J� Type of S.A.S. D - s Description of Soil Nature of Repairs orAlterations(Answer when applicable)�,,\<,_A\l ��-�� \A a O %Q) - --cc.J-JQ_��� S""�� �-rs� Co,,.c,�-�•'�. C c.,�..c w���,r-.S 4�� Y` o� so.,..�? 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. ig ed Date Application Approved by I& Date Application Disapproved by Date for the following reasons Permit No.9611 !77��( tl Date Issued -------------- --------------------- - ----------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(,/S Upgraded( ) Abandoned( )by at 3 Ca p�a �`3o��s— Q,,D Wl l(y\, has been cons uV* accnce with the provisions of Title5and the for Disposal System Construction Permit Noted Installer��<L- Designer r #bedrooms y Approved design flow /� /C gpd The issuance of this permit shall no a cons ed a guarantee that the system wil n tion as/design d.�/ii G{� Date Inspector �.��� i I jt//1 t�✓(� p 1 I ✓ , / No. /---- =-------- --- = -- - - - - - - - -Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstem 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:C tru do /u*bcompleted within three years of the date of this permit.Date Approved by v Town of Barnstable tHE Tpk� Regulatory Services Thomas F. Geiler, Director BARNSTABLE, Y MASS. $ Public Health Division 1639• $ A'E9. Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 2/15/08 Designer: _Shay Environmental Services, Inc. Installer: Rodney Fisher Address: P.O. Box 627 Address: 585 Kelley Street East Falmouth, MA 02536 Harwich, MA On 2/08/08 _Rodney Fisher was issued a permit to install a (date) (installer) septic system at 31 Captain Baker Road, Marstons Mills, MA based on a design drawn by (address) Shay Environmental Services, Inc. dated January 31, 2008 (designer) XX I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic sys ) but in accordance with State & Local Regulations. Plan revision or certified as b y designer to follow. —le7 € (H OF MAS`\ (Ii Her's Si nature) o` CAFRU1Z-y r E. o SHAY No. tgn s Signature) (Affix D 01 ere) PLEASE RETURN TO BA STABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form Town of Barnstable Regulatory Services Richard V. Scali,Interim Director * BAMSTABLB, M'E Public Health Division 059. ♦0 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: ,�- J I / Sewage Permit#d(N6 <O 3a Assessor's Map\Parcel 12 17LFO Designer: (�:i,� �q- ,cryo Installer: Address: l ox `)LO Address: On Q o _��,,�, , .� was issued a permit to install a (date) u (installer) i (.,)A fYI a�5 S � septic system at 1 ( �}�n=AOr (z 1 based on a design drawn by (address) Lf✓lci4 datedlV (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the IAA approval letters (if applicable) OF PINM a, (Installer's Signature) CIVIL � No.48W esigner' i ature (Affix amp Here) PLEASE RE TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc '- TOWN OF BARNSTABLE LOCATION 31 (f4V-V P 14 -V�qKr:, .. SEWAGE# ZOOS- O 39 VILLAGE M , Mi I`S ASSESSOR'S MAP&--PA`R_C-EL IA g JO A5 INSTALLERS NAME&PHONE NO._ �(���Q�, T)cS r X1f �4ko-a a6t� SEPTIC TANK CAPACITY C..�C twT 1 , 0W ack\., -�-O l k LEACHING FACILITY:(type)C2,A bu►c k A A4 (size) I cZ �� X a k2 X .1,5 1 NO,OF BEDROOMS ,3 IR C 16 OWNER X U2EP) PERMIT DATE: Z CQ. 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) N A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Al/h Feet FURNISHED BY �� o r- R do Li U a as i i°cosc-,�� D-B a�,5 laa�c Liw �oT• �vD��1' RO. Y Fee Alro No. r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Of pphCatton for Th5po al *p$tem Con0tructton Vermtt Application for a Permit to Construct( ) RepairX Upgrade( ) Abandon( ) ❑.Complete System>jndividual Components Location Address or Lot No. 3 k (2P►PTA 1 rJ Owner's Name,Address,and Tel.No. M ,M; 115 ,'milli m Xoev"_F3 Assessor's Map/Parcel 045 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 1ac�ne shec 6 t+qY q,s.j , 15 9 V CS. Type of Building: Dwelling No.of Bedrooms Lot Size 0 0 sq. ft. Garbage Grinder ( m A Other Type of Building No.of Persons Showers Cafeteria YP / g �n�Q +� ( � ( vS Other Fixtures �—A-iNg-azy . Design Flow(min.required) gpd Design flow provided 3(,� e P's gpd Plan Date ® Number of sheets Revision Date Title Size of Septic Tank O � 5 i,� I Type of S.A.S. 3 I X a i Description of Soilcr P�C Nature of Repairs or Alterations(Answer when applicable) p _ P o c, Date last inspected: Agreement: The undersigned agrees to ensure the construction a intenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Enviro a Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board alth. gned Date _ Application Approved b Date A � Application Disapproved by: Date for the following reasons Permit No. Date Issued ————————————————————————————————————-- No. e3 Fee THE COMMONWEALTH OF MASSACHUSETTS ' Emeredincompute— r:f� j PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for ;tgpogal *pgtem Con0tructton 30ermtt Application for a Permit to Construct O Repair'�f Upgrade O Abandon O . ❑.Complete System kndividual Components A Location Address or Lot No. 3` CP'IP!nl �i�� '_ 1� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel /y J I Installer's Name,Address,and Tel.No. Designer's Nre,Address and Tel.No. Shec ., NAY q,aJ , 52vcs. aka- �-a lc;a �_� -fig�L• j Type of Building: ^� � ! Dwelling No.of Bedrooms Lot Size 7c _ sq. ft. Garbage Grinder ( AIA Other Type of Building one No.of Persons Showers( t/) Cafeteria( (/S i Other Fixtures i1J►,-TLaY TCt-1 i Design Flow(min.required) gpd Design flow provided gpd TM Plan Date Number of sheets 6 Revision Date Title 5�� G \ Size of Septic Tank 0(10 CA e,,� �—X I S'i Type of S.A.S. A\'' a L I Description of Soil Nature of Repairs or Alterations(Answer when applicable) P19 Cnx- A-n C- o ! Date last inspected: Agreement: ' The undersigned agrees to ensure the construction and-nTaintenance 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 o'f alth. S,(gned Date '. Application Approvee/ b Date 1 Application Disappfoved by: Date •s, for the following easons Permit No. �O Date Issued a (Q t —————— ——————————-- THE COMMONWEALTH.OFMASSACHUSETTS BARNSTABLE, MASSACHUSETTS - Certificate of Compliance r , THIS IS TO CERTIFY,that e O -site Sewage!D,!i4s Xosal System Constructed ( ) Repaired (4--T' Upgraded ( ) Abandoned( )by at il,ff,/,771 has been constructed in accordance d C7�3� dated 'G with the provisions of itle 5 and the for Disposal System Construction Permit No. Installer Q� Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be constr d as gua tee that the system 11 u ct��ion as/designee a �— Date Inspector =------------------------�--- --1=--`-------- No. J'�G� �C' 3 Fee�� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS =tgppogar *pOtem Construction Permit Permission is herebyranted to Construct Upgrade Abandon g Repair� )/ P �) pg � ) � ) System located at .. and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction, /m_ust/be completed within three years of the date o'f th s' Date � i ) Approved-by Town of Barnstable o� Department of Regulatory Services i Public Health Division � 011 Date ffO 0 a� 200 Main Street Hyannis MA 0260Ail . .9 Date Scheduled ex, " Gf Time � Fee Pd ✓� Soil Suitability Assessment for Sewage Disposal a Performed By: L�1C'c`c��r� �- H J )H Witnessed By: p �,/�' , � LOCATION& GENERAL INFORMATION LocationAddres �1 C- a (�IGe2C,cl Owner's Name 2q�tmt���[� XUp21:15 Address Assessor's Map/Parcel: 1 0 Le 0 14 j Engineer's Name(2,a r m Sk-_-,x_ l NEW CONSTRUCTION R\EP`AIR` �,� Telephone# Land Use d �2C�T�0.1 Slopes M.- r�`7i Surface Stones n t� Distances from: Open Water Body ft Possible Wet Area AO_ft Drinking Water Well 11�ft Wa Drainage N I1�_ g Y ft Property Line —±L—ft Other ft I SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands(n proximity to holes) r_3 a Q Q --� rr V Parent material(geologic) nj+L..3 C,S Depth to Bedrock �0�)e. Depth to Groundwater. Standing Water in Hole: �,� cri �� (kG r Weeping from Pit Race ,V 004 5 r/ Estimated Seasonal High Groundwater � c�t P SS V n12 A DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in, Depth to soil mottles: In, Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj,fhetor— Adj.Groufldwater Level,,,® PERCOLATION TESL' Date, Time._____ - Observation _ i- Hole# �_ 71me at V r Depth of Perc Lon— Tlme at 6" Start Prre-soak Time @ 1 �n4��gi s 75me(9"•6") - End Pre-soak Rate Min./lnch LS M P\ Site Suitability Assessment: Site Passes]�� Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- �/" ***If percolation test is to be conducted within 100' of wetland,you must first notify the, Barnstable Conservation Division at least one(1)week prior to beginning. r Q:\.SEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Bole# J Depth from Soil Horizon Soil Texture .Soil Color Soil , Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. consistency, v © " L 31p, �o-L/O \ L t0Y(ZS� 5% DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.% 1a S L i 0 Y F�� Sec�c\ asp, • DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other . Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Flood Insurance Rate Man: Above 500 year tood boundary No_ Yes Within 500 year boundary No✓ Yes ' Within 100 year flood boundary Nov Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervio s material exist in all areas observed throughout the area proposed for the soil absorption system? e S -- If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environ en rotection and that the above analysis was performed by me consistent with the required trai ' e e ni rexperience described in 310 CMR 15.017. Signature Date Q:\SBPTI0PERCFORM.DOC I FPO°I :iJgwri cape engineering inc FAX NO. : 15083629880 Feb. 05 2008 01:37PH P1 down cape engineering, inc. SIEVE SOILS ANALYSIS-Shay 31 Cpt Baker.xls DATE OF REPORT: 2/5/08 JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 31 Captain Baker Road, Marstons Mills, MA LOCATION: Carmen Shay Testhole SIEVE ANALYSIS Weight Sample(Grams): 541,9 . SIZE RETAINED WT. RET. % RETAINED; % PASSED ;�wt on ind,sieve� (sump ----�------- -------------- .._. ._...._------_-----=--- ..... ---------------._ 1" 0.0: 0.01, 0.0%: 100.0% ---------------------------------I--------- . 3/4" 0.0� 0,0: 0.0%: 100.0% --------------'-------------------'---------- 10:---------•--------I---------------------Q 1i2l 32.0: 32.0; 5,9%: 94.1 /o -------------i-------------------L.......... :-------- r----- --------------a 19.3; 51.3; 9.5%; 90.5/o ------------------------ --- - 90.8- ------ 16=8% 83.2% #10 . ---------------------I-••-•-- ------------ #20 82.0: 220.7: 40.7%: 59.3% J-------------------J---"-_,._.,..,..4......._------------I.................. #40 184.5 405,2: 74.8%' 25.2% -------------r------------------i---•---------�-----------� o_;...........----......-_. #50------------------------63 3: 468.5;--------86.5/o; 13.5% #80 43.2; 511.7 94,4%: 5.6% ----------- = -------------------.............................%.-_ ............ --------------.o_._.................----.. #100 ----5_2:. 516.9:---------94.4/o;----------- 5_6% .._..._-___-_- _ #200- 19.-- 53-. ; 99.0%; 1.0°1° PAN: 5.3: 541.9: 100.0%: 0.0% -------------,-------------------, ------------------------------------------------- SAMPLE: 541.9: NOTE: TEST ON PASSING#4 ONLY, 29% RETAINED ON #4 <45% O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-3 (GRANULAR, SAND) (UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE MEETS : 44 100% (TEST ONLY MATERIAL PASSING#4) #50 10%-100% #100 0%-20% #200 0%-5% REQUIREMENT FOR "FILL" IN TITLE 5, <5% PASSING#200 SIEVE RESULTS: PERMEABLE MATERIAL-CLASS I<3 MINAK MATERIAL NONCOMPACTED DANK! A.Ac���� SOIL DESCRIPTION: SAND OJALA CIVIL �n No,46502 s -)N = Li TOWN OF BARNSTABLE G HAP-5�S Z LO,CATION3 G#Pr /A1 /Jg&k' /I/L/--S SEWAGE # VILLAGE i/)IWO rJAP/> //O ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITYAtype) 40 0 Q (Size) NO. OF BEDROOMS �3 �JPRIVATE WELL OR PUBLIC WATER BUILDER OR OWNE u ef< C- DATE PERMIT ISSUED: DATE .COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ' 1 ' � � a �� ��.y 2 � -v �� �* ,. TOWN OF BARNSTABLE LOCATION eja EWAGE # � VILLAGE .C-'JeTT�' ASSESSOR'S MAP & LO'T� 3�� INSTALLER'S NAME & PHONE NO. _G; Sx, t SEPTIC TANK CAPACITY &( t © � k LEACHING FACILITY:(type) � (size) 6�Ef�7�►c v NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER TAR OR OWNERS DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r + �'` � ,. � ' C�� .. � CX�� L��L � �! ��.!l �� �. _ � � � �� i �p,� . ��� � � �� w �-,.. ` No...l. �...L FEB.... � ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF !-HEALTH TOWN OF BARNSTABLE Appliratiun for Biupuiittl Works Tunutrnrtiun rrrnti# Application is hereby made for a Permit to Construct ( ) or Repair (t)__en Individual Sewage Disposal System at: ....-•-•-•......_. .......•- Loci'ion-Adddy6s ,^. or t No. ° .1L��!!�1t1?W`�1 d� 1 ��2-v_`�4?.� ...................... W h`{ 0� VP.��Z Y.ress�.f �y Gl a ......................... ......•... ._ '' Installer Address dType of Building Size Lot............................Sq. feet V Dwelling— No. of Bedrooms._............ . __Expansion Attic ( ) Garbage Grinder ( ) p`4 Other—Type of Building ____________________________ No. of persons_----.--___.__-____.___-___ Showers ( ) — Cafeteria ( ) Q' Other fix t d 1 W Design Flow........... ................................gallons per person per day. Total daily flow.._�3..7.Q--------------------------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.-_____1.......__.. Diameter---X_b----------- Depth below inlet.....(ea............ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by---- -------------•---••--•-•------•-•-•----••----••----•-•-••------•--... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit-_-____-.-________-_ Depth to ground water........................ a ...-•••••--•----•-----------•-•-----•--•••-•-----------------------••••••......-••••----•-----------......................................................... 0 Description of Soil........................................................................................................................................................................ W U --••••••-----•••-•••---•----•••-••---•-----------------••-•----•---------------•-•------------------•-•-•-••--••--•--•••---•------------••---•••-----•----•-----•-••--•-----....----.........-----•..... W .......................... -----------------------------------------------------•------------------•-------- -- UNature of epairs or Alterations—Answer when applicable.___ _W_S► \�._--1-q-Q -._ -euc. -• 1.7-......... .......{t`.• .....011....... ........................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee ss ed b the boar of health. Signed -------... . ...................... . . ... ............ ----- ............................. Date Application Approved B Date Application Disapproved for the following reasons: .... .... . ................ . .................................. ... . ........................... .............I-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------- ---------------- 9 t,� �-7 Date Permit No. l- 1 '....../�------------------------- Issued ................... Date No.. `�.....!_. 1 FEB _ U......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Alip iration for Biripnittl Wnrk.6 Tomitrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair (van Individual Sewage Disposal System at: ,� i/i�✓y ............ �...._......... -------------------------------•• --•--•--•---•-•••------•••------•--••-•-------•--•-----------••---•••--••--•••••...-----.......... 'n LocItlo 1-ild�drypss ,n I •or C t No. w_�A •----. V 1 r ................•.... •-----------------.A= v V11.._�-.�......... ..- r. ��.aa Owner Address Installer Address , UType of Building Size Lot%...........................Sq. feet Dwelling— No. of Bedrooms._---3------------.----------------------Expansion Attic ( ) Garbage Grinder ( ) aOther L Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) QI Other fixtures -----------------•-•----•-•---- - ----------------------------------------------------- ------ --------------------------- - w Design Flow:........... .. ......................gallons per person per, day. Total daily flow---------30...........................gallons. WSeptic Tank—Liquid capacity__.____---gallons Length----------- ---- Width---------------- Diameter__.-___.._..... Depth----_____t..... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area----------_---------sq. ft. Seepage Pit No........\........... Diameter...k.0%---------- Depth below inlet-----L............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY.......................................................................... Date........................................ Test Pit No. I................minutes per Inch Depth of Test Pit.................... Depth to ground water........................ f3, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ x ........................................................ ODescription of Soil........................................................................................................................................................................ x U w UNature of epairs or Alterations—Answer when applicable.._. ____-i o_o-n_..L:P .<.k.ip:1--_?.......... -••••••...••- . .c ....ST lJ 5`?> 1 ........ `...4.L�...-k" ` 3.C1.! vnn c_r !_a_ . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been•i'ssued b the board of health. Signed ----- - ApplicationApproved By ........... . ............................................. .....................----------"--`-----'--------.....-`-- ........................................ Dare Application Disapproved for the following reasons- ------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- Permit No. ........Cf.-�t..-..---7.5 ......................... Issued ---------------------------------------------------------D.are Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 11,erttfirate of Contyliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by -------------------------------------------- n6sr--cr .. ....-------- -------------------. ----------------------------------------------------------- ` « N �at ............ _. .. --1----- -p------ -- ,, . - - __..... ...... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .........cr7� /..-.72.25C�....... dated _----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........../- ... .. -- Inspecto�.......................... ---------- 41, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �y TOWN OF BARNSTABLE N FEE.— ...... �t��nstt1 nrk� �un�tr�rtilan �rrntit Y granted ........................... Permission is hereby ----- --------------- to Construct ( ) or Repair ( an Individual Sewage Disposal S stem atNo...-----•••••--......•----•-••--•-•--•-•..... -------C0-A-)-.......&j k e7-.......6 ------------------------------------------- ------------------------------ street q as shown on the application for Disposal Works Construction Permit No._-/_._� Dated....... ------------- ----------------------------••••-•-••••--••- _ � Board of Health DATE -------------- �� FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA 01,44 - OF....'. ... '..... Appliratiort -for Dispoottl Works Tortotrurtiou Vaniit Application is hereby made for a Permit to Construct ( ) 'or Repair ( ) an Individual Sewage Disposal Y st� at: A c� �.0-12 ........�/ zk J' on- dress r Lot IV ,j p - -------- ---------- esr ---------- ----- � wner ddress Installer Address Q Type of Building Size Lot----------------------------Sq. feet U Dwelling No. of Bedrooms._--- .................................Ex ansion attic Garbage Grinder Other—Type of Building ---------------------------- No. of persolls---___ ----_-_-.-----__---_ Showers ( ) — Cafeteria ( ) a' Other fixtures ...................................................... Design Flow......J—P.............................gallons per person per day. Total daily flow--------ZOO......... --------------gallons. WSeptic Tank—Liquid capacity/Q-? •.gallons Length................ Width------.-_---_- Diameter--------........ Depth-------.--.--... x Disposal Trench—No- -------------------- Width-------------------- Total Length.................... Total leaching area.;..................sq. ft. Seepage Pit No-------- ---------- Diameter._.-_-_1-........ Depth below inlet--41� ......... Total leaching area---ZX-T.....sq. ft. z Other Distribution box ( ) Dosing tank ( 1,6 "Ot �-- -'76 ~' Percolation Test Results Performed by.------..` --- '--------------------------------- Date---------------------------------------- ►.1 Test Pit No. l----------------minutes per inch Depth of ' est rt.--_---._.-.-.__._-. Depth to ground water-----------------------. fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ 4 Description of $eil. --•--•------ •-••-••- �1--�.1 `3 C � _. -c U ------------------------ ( •---••--•-------....------•--•-•-------•-••---•--------•----•-•-----•-••-•-•--------------•----._._....-----•-••----------------•---- - W U Nature of Repairs or Alterations—Answer when applicable.----------------------------------------------------------------------------------------------- --••-------•----------------•-••----•-------------------------------------------------•-----•---------•-•-••-•-•----------------------------- ----•------•-•------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code— The unders' led further agrees not to place the s stem in operation until a Certificate of Compliance has been ' e. th d health. Signe a--- --••- . .. .. .. Date Application Approved By.--..... ..... �-5.: 7 Date Application Disapproved for the following reasons-------------------------------------•----------•----------------------------------------------------------•-•-- -----•---------------------------------------------------------------------------------------------------.-•--.------------------•---•-••------•-••-•-----------•--•- ---------------------- ------------ Date PermitNo......................................................... Issued.............................---------•--••-----------• Date J Y� No......................... FR$......f.�..�..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH� ..... ---------OF......... ..f2g ..................... Applirtttiun -fur 'MiVo al Marko Tonstrurtion Vaniit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at: <"7 � / r9�ri�jvV J ut�i ;/....b -.i-••---------- 1L`5-- -••---..•------------------�°. .. ......----•-----------------••----•---....--•--•-•--- ��-' Lyc'ation- dress �J for Lot Noy/ �`T G'•i�Tv/c��/ c.,r�P------...-•------ �f/� ""jA�v✓ .�1 Y%� S?�G /, �4 --- /ocaner ddress J a .Gt AZT Ui C,t� l_'q /c/ .._...... .-'- --------------------------------------- Installer Address d Type of Building Size Lot----------------------------Sq. feet U Dwelling No. of Bedrooms-------2................................Expansion Attic Garbage Grinder p4 Other—Type of Building ---------------------------- No. of persons------`,/................. Showers ( ) — Cafeteria ( ) Otherfixtures ...................................................... W Design Flow...... .0..............................gallons per person per day. Total daily flow........Z RU---_-_---____-._-.._..-.gallons. WSeptic Tank—Liquid capacity/aC'-U_-gallons Length---------------- Width................ Diameter................ Depth...-----_-.-._-. x Disposal Trench—No- -------------------- Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.._......�.._..._.. Diameter......... ...__._.. Depth below inlet___r-_-.___-_-_.Total leaching area---47 ....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) U/ /°C� 1 J— -7G ~" Percolation Test Results Performed bY.___.__-.f:___ {ies�tlt _'--------------------------------- Date___......_______________.__.______._-_.. a ,a Test Pit No. 1----------------minutes per inch Depth of ...._........._.... Depth to ground water...------._----..-_ �rq Test Pit No. 2................minutes per inch Depth of Test Pit.---_-----__.__-___- Depth to ground water--.._._--------.--_--._. Ii --- ----• ----•-------J-------J-- ------- ....... .... ....................................•-• �....................•.... O Description of �o}1----- ......Q--!•. -3---------------- �` L�rG,: o-� l `y------- UW 7-`� -------------------------------------------------------------------------------------------------------------------------------------------- •--•------•-•-----••--...... �/ W U Nature ot-Repairs or Alterations—Answer when applicable._--------------------------------------------------------------------...................... ---. ---------------------------------------------------------------------------------------•-----------------•------------------•------------------------------•-------------------•- --------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersi ned further agrees not to place the system in operation until a Certificate of Compliance has been i ued' the- d health. Signer !1.= L• r - ..................................... Date // Application Approved BY----- '�'�! �- ! y Application Disapproved for the following reasons:............................................................................... ------•-•---.Date.........••... ----------------------------------------------------------------------------------•----•--•-•-•---•-••.•- ------- ------------ - - Date PermitNo.---.................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD?F HEALTH ....................OF..... .. ....................................... Tntif irttte of 0.1,11mphttnrr THPS IS TO C i ffIFY, Tl�tt�e Individual Sewage Disposal System constructed (�) or Repaired ( ) by .... ------... �J t---------- ----.----------------------- _ ^/ / ' / at... .v C�.......��` L�!1 �- - -".. �r, r�'-1�,i <T:/f� -1- fG.,r; !-_ '(�. _--'='•� ; I has been installed in accordance with the provisions of Ar icle XI of The State Sanitary Cod as described in the application for Disposal Works Construction Permit No. f '.......... dated--------7..--l-�L ..--?.�-----_---. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............ d`' ---------------------------•----------- Inspector---------- P-----------C42_oe----------------------•------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD Of / HEALTH :�U f.....(�... ��......of..-.... v r� Z---------------------------•-----........... No...... --�•---- FEE....4a ........ �rk;��C�on�trnrtivat �rrmit Permission is reby granted----- /n... ...-- ------------------------------- --------------------------------------------------.- to Con dct .............. or vair (y) a I r�tdiv' pal Sewage Dip.al Syste , at No �`-........ ,. !'�,... 'r G- __.......__� N�t4r4 �..� ... ...... Street as shown on the application for Disposal Works Construction Per ri%'t No.___J________------- D/ited-__.7--: '._'_.%/-........ Boar of Hearfh DATE...... ----------------------------------------• J FORM 1255 HOBBS & WARREN. INC., PUBLISHERS •P - r .+ F.X'w ,t. a7it4s" eS 1 _. 6 •Y e4 ,� +R` d ,fir t � :,w- *,,7, � f x r i ry t f 'te a r - A I. « * - r r" . t#X;%-z ° _ "�" a �+., '-'y'£ ^r=:'"{'. k"`"' $ky7Yrs.�' '<t, c z ray "yam '"�*i^�- 'i's"'�.''t'!' -' " ',p; r,. pp. t: /, + v ✓ t t Lr Xx - . ":Yef�`�Y x l r�y� , � ,tom "€ ! y ....-++sr.t-+...-�x+.-et.w�-*r- :, 0..a,r:. r Yk ' R '"'J ram_ f.73. 'r #' +t At(• r. 4 '�' a -: ..f•. 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EXISTING INFORMATION AVAILABLE AT THE TOWN OF INSTALLER TO VERIFY THE LOCATION OF ALL BARN5TABLE BOARD OF HEALTH.INCLUDING INFORMATION FROM A PLAN ENTITLED'PROPO5ED 5UB5URFACE SEWAGE ��` UNDERGROUND AND OVERHEAD UTILITIES LOCO$ Race Ln ACTIVITIES AND RELOCATE A5 NECESSARY DISPOSAL SYSTEM'PREPARED BY CARMEN E.SHAY PRIOR TO THE START OF ANY EXCAVATION p ENVIRONMENTAL SERVICES,INC.DATED FEBRUARY 4,2005, (5EE NOTE#1 5) Capp Stud! N 630 ��` i N my 300 20 5 • mA �r o 4 49 W 25 �`` 1 V 0, LOT 9 R%hToFw Area=20,092 S.F.± &15b g Septic Comp entS tO SITE LOCUS 2Sv be Abandoned(See Alote.422) co.o I NOT TO SCALE I .)Assessor's Map 12G Parcel 045 2.) Deed Book 27382 Page G4 \� IP-1 9 3.)This property 15 in a Zone it of a Public W-Z i Water Supply 4.) Flood Zone: C g9 3G.I' I / 'O � .i / i min i Exlstm t i g 3 Bedroom Dwell,, '• Top of Foundation ___ g � EL=100.0± - LEGEND •° % �i Abandoned Leach Pits e \ ! �•a ` i 12.3 EX15TING SPOT GRADE 505bng 5ept�c Tank to be •• Utdaed(See Note#2/)I 24x5 PROPOSED SPOT GRADE EX15TING CONTOUR •,Existmg•Paved'� —24— PROP05ED CONTOUR a, Drive w— WATER 5ERVICE LINE 87, U83 k UTILITYOVERHEAD—O UNDERGROUND UTILITY LINES G GA5 SERVICE LINE � a �-0 + BENCHMARK EDGE OF CLEARING a ''• • o\ Top Concrete at Fireplace FENCE �a EL=50.00 (Assumed Datum) TEST HOLE LOCATION 97.1 �\\G -- 5T SEPTIC TANK �yZNOF4% DB DISTRIBUTION BOX Qt.s N63o 3•g�, 'G �O } �� ` py 5A5 501LAB50RPTION 5Y5TEM LI N DA J. GN C w o PINTO - — R=30.00 " CIVIL a 10, St 1. ,� No.46504 Pub/,c 41 ,p L = 3G.97'\ \ 07.2 i � tSTE�� �SS10 A E (�� PLAN- n i �' I Prepared for: L/"i'V w, I � CSN ,� #3 1 Captain Baker Rd. Mar5ton5 MIIIS, MA 1 VMS, - SCALE: ! " = 30' �15b� Engineering Proposed Sewage D15po5a1 System �L��' O 30 60 90 3 1 Captain Baker Rd., Mar5ton5 Mills, MA P.O.Bos201 Phone:(508)896-1513 PAGE I OF 2 Brewster,MA 02631 Far.(508)896-1783 SCALE i "=3�' C:\CSN\RR-Captain Baker\RR-Captain Baker-SDS Plan.dwg Date:02/04/14 Scale: As Shown B : WP Gheck: MLA Project No.OS-1402G TOP OF FOUNDATION 24°0/AMf7ERCONCRETEC0VER3 CONSTRUCTION NOTES EL=100.0± R4/5E9 TO W/TH/N 6"OPPIN/5H GRADE(OR A5 NOTED) 4 1.)ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE,TITLE 5(3 10 CMR 1 5.000):STANDARD REQUIREMENTS FOR THE SITING,CONSTRUCTION, INSPECTION, UPGRADE,AND EXPANSION OF ON-51TE SEWAGE TREATMENT AND DISPOSAL SYSTEMS AND FOR THE EL=99.6+ EL=99.B± EL=99.6(max) TRANSPORT AND DISPOSAL OF SEPTAGE,AND THE LOCAL BOARD OF HEALTH REGULATIONS. 2.) ANY SEPTIC SYSTEM COMPONENT INSTALLED IN A LOCATION WHERE THERE 15 POTENTIAL FOR VEHICLES OR HEAVY EQUIPMENT TO PA55 �\\//\\/ "' \�\\/�\\/ My .-•" "Y" \/\\/�\\/ \/\\/�\\/ OVER IT SHALL BE DESIGNED TO WITHSTAND AN H-20 LOADING, IF UNDER AN IMPERVIOUS SURFACE,SYSTEM SHALL BE VENTED TO THE ATMOSPHERE. tt to 3.)TO MINIMIZE UNEVEN SETTLING,SEPTIC TANKS SHALL BE INSTALLED ON A STABLE MECHANICALLY-COMPACTED BASE ON SUC INCHES OF / CRUSHED STONE, - < / 4.)COVERS OVER THE INLET AND OUTLET TEES OF THE SEPTIC TANK,THE DISTRIBUTION BOX,AND THE SOIL ABSORPTION SYSTEM SHALL BE M ! GV FLAC/LE FABRIC 113 -- (/N PLAGEOP//4° WISED TO WITHIN 6°OF FINAL GRADE. LPACHING FIELDS,TRENCHES,AND OTHER SOIL ABSORPTION SYSTEMS WITHOUT ACCESS MANHOLES Q _ E BOTTOM OF THE 501L . l/2"PPASTONEJ SHALL HAVE AT LEAST ONE(I)INSPECTION PORT CONSISTING OF PERFORATED 4 PVC PIPE PLACED VERTICALLY TO TH g7.p+ 96.75 i a 96.5+ 96./7 96.00 95.80 N 3/4°- l-//2°STONE ABSORPTION SYSTEM WITH A CAP,TIED WITH MAGNETIC MARKING TAPE,ACCESSIBLE TO WITHIN 3'OF FINAL GRADE. a N 5.)PIPING SHALL CONSIST OF 4'SCHEDULE 40 PVC OR EQUIVALENT. PIPE SHALL BE LAID ON A MINIMUM CONTINUOUS GRADE OF NOT LE55 v THAN 2%FROM THE BUILDING TO THE SEPTIC TANK,AND NOT LE55 THAN I%OTHERWISE. GAS BAPPl-' 93.60 TWO(2J SHOREYPRECA5T 500 G.)DISTRIBUTION LINES FOR THE SOIL ABSORPTION SYSTEM SHALL BE 4'DIAMETER SCHEDULE 40 PVC(OR EQUIVALENT)LAID AT 0.005 FT/FT. ;N. . . .'. GALLON LEACH CHAMBER5�W/TH UNLESS OTHERWISE NOTED.LINES SHALL BE CAPPED AT END OR AS NOTED. Longest Run 4'Of 5TONE ALL AROUND /2'- }--36P /6 (END V/M 7.)LINES FROM THE DISTRIBUTION BOX TO BE LEVEL FOR THE MR5T TWO(2)FEET BEFORE PITCHING TO THE SOIL ABSORPTION SYSTEM. 051-3 DISTRIBUTION BOX SHALL BE WATER TESTED TO A55UU EVEN DISTRIBUTION. EX/5T/NG /OOO GALLON H-20 Rated LLPAG`-1 8.)GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE STRUCTURES IN ORDER TO PROVIDE A WATERTIGHT SEAL. 5fP7-lC TANK D--BOX CNAMBf R5 9.)HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE SEWAGE DISPOSAL FIELD DURING THE COURSE OF ( CONSTRUCTION OF THE SYSTEM. Ir LO V,h/ �O E I�E 61 10.)IN ACCORDANCE WITH 3 10 CMR 15.22 1,ALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC MARKING TAPE. i NOT TO SCALE 1 1.)THERE ARE NO KNOWN WELLS WITHIN I00'OF THE PROPOSED SOIL ABSORPTION SYSTEM. 12.)FROM THE DATE OF THE INSTALLATION OF THE SOIL ABSORPTION SYSTEM UNTIL RECEIPT OF THE CERTIFICATE OF COMPLIANCE,THE PERIMETER SHALL BE STAKED AND FLAGGED TO PREVENT USE OF THE AREA THAT MAY CAUSE DAMAGE TO THE SYSTEM. Bth Kdchen Bth Bdrm _ SYSTEM DESIGN CALCULATIONS 13.) THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE SYSTEM AS DESIGNED UNLE55 CONSTRUCTED AS SHOWN ON PLAN, ANY CHANGES Living SHALL BE APPROVED IN WRITING BY THE DESIGNER. Garage D n,ng Bdn„ Bann 14.)THE BOARD OF HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN AGENT OF THE BOARD OF HEALTH AND THE DESIGNER. THE 5fWA6EDE5/6N PLOWREQU/RED.•3 BEDROOM DWELUNG Qa //O GPD/BEDROOM =330 GPD REQU/RED DESIGNER SHALL CERTIFY IN WRITING THAT THE SEWAGE DISPOSAL SYSTEM WAS INSTALLED IN ACCORDANCE WITH THE TERMS OF 111E PERMIT AND THE APPROVED PLANS. 48 HOURS ADVANCE NOTICE 15 REQUESTED. Second Floor SEWAGE DES/GN FLOW PRO(//DED: TWO(2)500 GALLON LEACH CHAMBER5 WM/TH First Floor 4'OP5TONEALL AROUND 15.)LOCATION OF UTILITIES IS APPROXIMATE AND CONTRACTOR SHALL BE RESPONSIBLE FOR DETERMINING THE LOCATION OF ALL UNDERGROUND AND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF ANY WORK.THIS INCLUDES,BUT IS NOT LIMITED TO,REQUESTS TO FLOOR PLAN Vt=((25.0x/2.63)t 2(25.0 f /2.63)x 21x,74 DIG5AFE,ANY PRIVATE UTILITY COMPANIES,AND THE LOCAL WATER DEPARTMENT. =349 3 GPD PROVIDED 16.)CONTRACTOR SHALL VERIFY THAT ALL WASI•ELINES ARE CONNECTED BY WATER TESTING WITHIN THE DWELLING PRIOR TO INSTALLATION OF NOT TO SCALE 349 GPD PROVIDED>330 GPD REQUIRED ANY SEPTIC COMPONENTS. 5EPTIC TANK CAPAC17YREQU/RED: 330GPDX 200%=6606PD REQUIRED 17.)CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS MOP TO INSTALLATION OF ANY SEPTIC SYSTEM COMPONENTS. 5EPT/C TANK CAPAC/7YPROVD6D: Lxl5TlNG/000 GALLON PROVIDED 15.)INSTRUMENT SURVEY WAS NOT CONDUCTED TO ESTABLISH PROPERTY LINES. SITE PLAN SHALL NOT BE USED FOR STAKING. TEST HOLE LOGS A GARBAGED/SPO5AL/5 NOT PERM/TIED WITH TH/5 DE5IGN PLOW r 19.)THIS PLAN DOES NOT CERTIFY.GUARANTEE OR WARRANTY COMPLIANCE WITH DEEDED OR ZONING BYLAWS,SPECIFICALLY,BUT NOT LIMITED TO,SIDELINE SETBACKS AND BUILDING HEIGHT RESTRICTIONS.OWNER IS RESPONSIBLE FOR OBTAINING SUCH A DETERMINATION Test Hole#I (EL=99.b:Q ,: ti�Sti1 OF"L'1" FROM THE APPROPRIATE AUTHORITY. 20.)IF SOILS DIFFER FROM THOSE SHOWN IN THE SOILS LOGS, DESIGN ENGINEER IS TO INSPECT THE SOILS PRIOR TO PROCEEDING WITH Depth Layer Sod Class Soil Color Comments LIN�A J. Gu, INSTALLATION. 0'-G' Ap Sandy Loam I OYR 312 O PINTO 25' U ^4 2 1.)EXISTING 1000 GALLON SEPTIC TANK TO BE UTILIZED. PVC TEES TO BE INSTALI.ED ON INLET AND OUTLET PIPES IF NECESSARY,AND A G'-40' Bw Sandy Loam I O'r'R 5/G CIVIL cn '-120' Cl fine Sand 2.5Y 7/4 4' a.5'-�r-5.5 4' GAS BAFFLt INSTALLED IN THE OUTLET TEE. 40 ' Perc Qo 60° NO.46504 !P 22.)EXISTING SEPTIC COMPONENTS TO BE LOCATED,PUMPED DRY,FILLED WITH CLEAN SAND AND ABANDONED IN PLACE. AREA TO BE v O �G1ST� \��� COMPACTED TO MINIMIZE SETTLING. Test Hole#2(EL=99.8±) Chambers S M L � N Depth Layer Sod Class Sod Color Comments v 0'-12' Fill p 1 2'-18' Ap Sandy Loam I OYR 3/2 Prepared for: 18'-48' Bw Sandy Loam 1 OYR 5/G D_Box 48'-1 20' Cl Fine Sand 2.5Y 7/4 CiVi V #jj 1 #3 1 Captain Baker Rd. Marstons Mills, MAPLA VivDATE OF TESTING: OI/24/08 N VIEW (TYP.) Engineering SOIL EVALUATOR: CARMEN E.SHAY,R.5.,C.S.E. NOT To SCALE Proposed Sewage D)s posal System BOARD OF HEALTH AGENT:' DONNA MIORANDI,B .ARN5TABLE HEALTH DEPARTMENT Marstons Mills, PERCOLATION RATE: _ LESS THAN 5 MIN/INCH PER SIEVE ANALYSIS 3 I Captain Baker Rd., MA P.O.Bax201 Phone:(508)896-1513 Brewster,MA 02631 Fax. 508 896-1783 NO GROUNDWATER ENCOUNTERED PAGE 2 OF 2 ( ) C:\CSN\RR-Captain Baker\RR-Captain Baker-SDS Plan.dwg Date: 02/04/14 Scale:As Shown I By: UP I Check: MIA I Project No.0S-1402G i 2-18" DIAM. ACCESS MANHOLES r z (((((( ttf IDS S#$ Y�}F#SIJ,'f {I3}T}I#' I�I� $tt �Jlt �T VENT PIPE (O Least 24 Inch" tall) a• ;• . e.r'..,• ti, ; syFree} 3 10' min. from 'NOTE: ALL PIPES ARE TO BE 4 SCHEDULE 40 P.V.C. Schedule 417 PVC w/Charcoal Oda FNtsr #t t1fl ��1t, I } • : il..1lt.►...!•� .1•iL.:sa� ..•i cs., :1 ! # 3 s r tt y }} -•�. #S Iz I #S 1 tit tt f tsykf Existtn Foundation se to septic tank t# II3 ;} } # ;## g eP TOP OF FOUNDATION ELEV. 100.00 tank come must be - cover must ba g if11N 6 1% d finished grads in. of Anblad gradeOrede ever Sgtle Task- 8828 O/Ode Over D-Boe- g800 OVa SAB- 9800 �ESTA8USi1ED KO[TATM COVERC/ 4 INLET ,;! 4}}y j 3 s ryy , ityr r a s {{ 0.02YW M M-10 , ti ' 1 S - 8 HOLE .w ,'. a' ,..•n••.. 1• . ... 1•.• ti`.• �' �, . +.. BACI(Fitl W17N CLEAN BAND THE ACCE35 QOKRS FOR THE SEPTIC TANK, ', "ti` . 1 Ai'h d :1''v: l l,l..«.•. .1 h`,�"t,, l:''y } DISTRIBUTION BOX AND LL1Oi11MO COMPONENT ST. BOX I. �•i, t •1 1' a }l; ♦ NATIVE OR PERC SANG s,' l# iE:, #,,}. S-QOt 3' Meaknsen Cover t, .1. •(' . 't. ,• ,• 1.1 t, !. T�•'t" �. . :�" 1 .::•, •� -+1 •Ir-• > TnC T• Te SET DEEPER THAN 81NCMEs BELOW SHED ,,.;', iss,�},at, tef.t< ar,. €t{sst EXIST. 4"PVC(CAPPED)INSPECTION PpIT TO ae ,' ::� :.1'+•'"�i' r..« +:' 1:•! ::� •* '.1'' l•��,. .. P:'�•1 t IC-i: •. >w• i� s I 1 �� r' ,i d�• � ��, 1'• 1'�:i 1^Y'' .1 �' I. GRADE SHALL 8E RAISED lb WITHIN 8 OF O' 0 INSTALLED AND TO K WITi44 8"OF GRADE q'w d.«�•:IL,• ,+•�•' ' ' :.�!•'.4 ♦' w ,,,J• '•,� ..t' Ex�T. '1'� 1DDD VAL J- //yy • ,1 ''1.• 1''''1•'' .•ti• �'/' o QVI" ••'t . /:• ••. ,• 'll'• y ••'/ 1: •1� '1 T' a •.�." .r..., 'J '•+•••A; FINISHED GRADE. .•t. , n 20' Per mot '►'' r• "T:'#: STEEL REINFORCED PRECAST CONCRETE }I, t. #.,. 1:<s, t Trot TIC TANK o - .' ..:., •�..s .�, T'', r �' FROM EXIST. FOUMDA �p SEPTIC sA (1W0 IOTA TOP a UNIT[LLVA11011 8428 �:, +•�;' +' I �• 3, •1' �.':,''ti.,. ::ti.1.'•�:,+,•'!' s s t3; #, a t 8 i.••i,Y, rye ,' y - fI £S JI f t r z I O! �j •, ....,.1�• 'tip f.t fS � v ,. .I:,.t• ,•�'..'. .. . •.....,,•• . ,.t.,'•. :;•,'• •,.: ,1 PLAN VIEW INSTALL TUF nTE OAS BAFFLES oR EQUAL! t, sfFFSttffSl !:#f£tyf4Sf }� r ;3.,.�::. 5 :;# N •�aNl N 8 I H-3/140 ' 11t•;•,:•1.•\:•'',:,p' ,••M~�:vM ;n'<,• ;.• ''I L!r�i.l•,�•1r • ' • �tI vod}fa1 I Ii�Nt#Nt its#t 71 CONCRETE WWt INV. ELEVATIN 5-24 REMOVABLE COVERS 1; sE r t#I t>� 3 f }3� �r;'�Fy'fs � #tk:EI St I- },1 It ##1.,t f S SI; 1> rt ii�' • ,,�;t r4} 81 S E #I va 1 N�e {iiw�rtii�• t i''s i'3 oompacted stone al BOTTOM ELEVATION - 9&23 tl� . .,•, •, 4' ; e a „ 4 ROWS OF 6 UNITS AT 0,UNIT+ 2 END CAPS• 26.00' min•'d.aan«' T•• GENERAL NOTES 3 SYSTEM PROFILE INLET 6 min 2'min. inlet to outlet e.„Irl �� 'r mu OUTLET 1. Contractor is responsible for Digsafe notification, VERIFICATION Not to scale s in.oT 3/4•-1 1/2" BONOR1 of Test Mole 1 °i" a7'60 W MIN ABOVE BOTTOM of 4" @ 4' o•min Lam'"�,r 1 and protection of all underground utilities and pipes. compacted ,tons � TEST PIT OR GROUND WATEII a �f NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE EFF. 97DTH f 2.70' \EXISTING SUITABLE MATERIAL e' -7" + s' -7' 2. The septic / diatri¢.4ion box shall be set level or 6 of 3 4 -1 1 2 stone. ' an �: Liquid espy, 3. Backfill should be clean sand or gravel with no ;is over 3" in size. Bona : B Or TP-1.: SOIL ABSORPTION SYSTEM (SECTION) 4. This system is subject to inspection during installation ►•.;. .1 .+• .. , • ' »; • �"' ,1 by Carmen E. Shay - Environmental Services, Inc. INFILTATROR QUICK 4 (H-10 LOADING)/ GEDRGE D'BRIEN (OR EQUIVALENT) s'-o" 4' -10' 5. The contractor shall install this system in accordance CROSS SECTION END-SECTION with Title V of the Massachusetts state code, the approved plan NOTE: OVERALL HEIGHT OF INFILTRATOR IS t2" and Local Regulations. 6. If, during installation the contractor encounters any _ TYPICAL 1000 GALLON SEPTIC TANK soil conditions or site conditions that are different - NOT TO SCALE from those shown on the soil log or in our design installation must halt dt immediate notification be made to Carmen E. Shay - Environmental Services, Inc. 7. No vehicle or heavy machinery shall drive over the PERCOLATION TEST septic system unless noted as H-20 septic components. 8. Install Tuf-Tits gas baffles or equals on all outlet tee ends. Date of Percolation Test: JANUARY 24, 2008 9. All Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes. Test Performed By: CARMEN E. SHAY, R.S., C.S.E. 10. All solid piping, tees & fittings shall be 4" diameter Results Witnessed By. DONNA MOIRANDI EXCAVATOR: Shay Env. Svcs. Schedule 40 NSF PVC pipes with water tight joints. Percolation Rate: <5 MPI • 48" 11. MUNICIPAL WATER IS AVAILABLE TO THE SITE and Surrounding w - - Test Hole Test Hole Properties. NO PRIVATE WELLS WITHIN 150 FEET of PROPOSED SAS No. 1 No. 1 •`�` DEPTH SOILS ELEV. DEPTH SOILS ELEV. 0 9Q00 0 96.00 LOT #4 sandy Loom THE PROPERTY LINES ARE APPROXIMATE AND •`�`�� 10 rR 3/2 FILL "COMPILED FROM THE PLAN BY BARNSTABLE SURVEY CONSULTANTS, MA, ENTITLED PLOT PLAN OF 31 CAPTAIN BAKER RD, M.MILLS., MA A, a7.5o o'-t2' a7.00 Sandy Loom Sandy Loam AND IS NOT DATED NOT 8, 1976 INTENDED TO BE A SURVEY PLOT PLAN 10 YR e/e 10 YR 3/2 IT SHOULD BE USED FOR NO PURPOSE OTHER THAN THE SEPTIC SYSTEM INSTALLATION. a 4O" B- 94.87 12'- 1r!' As 96.50 Fine Sandy Loam Sand NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE Zs Y 7/4 10 YR s/s FROM THE EXISTING LEACH PITS TO BE DISPOSED LOT #5 4W- 126 C, ee.00 1e"- 48" Be 94.00 OF AS PER BOARD OF HEALTH SPECIFICATIONS. Fine Sand EXISTING LEACH PITS TO BE PUMPED DRY do Zs Y 7/4 4e"- 120 8e.00 FILLED IN PLACE �Ir 29, ASSESSORS MAP 126 LOT 045 ?S F ZONING - RESIDENTIAL OOT Perc #t ` SS E4$FM Depth to e O PerrcRate- Less thane I ANALYSIS 5 MP per SEIVE ANALYSIS 060" x FNl Groundwater Observed - NONE'No Observed ESHwT NO WETLANDS ARE LOCATED WITHIN A 200' RADIUS RjC QF THE PROPERTY lee? yl OF i ADJUSTED H2O Elev. - None ALL OUTLET PIPES FROM THE DISTRIBUTION BOX SHALL BE / `•� SET LEVEL FOR AT LEAST 2 FT. 12 CONCRETE COVER LEGEND 6 - 5" OUTLET ,ir«+1'.0 •A.+Ir 2 O, ,�� KNOCKOUTS 4`' ' f 0 `9`9• '`6 �' SHED � \ TI ET � r 12" I N� 8X0 DENOTES PROPOSED LOT # ----------------'- @ OU ' 7' �.\ % ;'• SPOT GRADE 1 ++ X 104.46 DENOTES EXISTING D-Box ST HOLE #2 \�.i 15.5" 4" - SCH. 40 T 1.75 SPOT GRADE TEST HO #1 ELEV.i 98.00 ," PLAN-SECTION CROSS SECTION PL --99 PROPERTY LINE Jr_- --- ELEV.- 98.00 0 0 LEACH PITBOO i,, o• o 6 HOLE DISTRIBUTION BOX PROPOSED CONTOUR EXISTING �pl`�• 9 NOT TO SCALE 97-- -- - -97 EXISTING CONTOUR _ EXISTING 9 BEDROOM O y // i Design Calculations GARAGE HOUSE EXIST. ; 0 DEEP TEST HOLE & i S ptic Tank ; A PERCOLATION TEST LOCATION J #91 Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gal./Day Min. per Title V) Garbage Grinder. No FENCE i Leaching Capacity Proposed: 330 Gal./Day Minimum (Mtn. Per Title V) \, --- --_` Septic Tank : - 2 x 330 Gal./Day - 660 USE EXIST. 1,000 GAL. Septic Tank. EXIST. _----- - `� i SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch PRIVATE DRINKING WATER WELL ASPHALT , `�� ; Bottom Area: 0.74 gal/sq. ft. x 490.88 sq. ft. - 363.25 gallons DRIVEWAY ---------ppt r � � Sidewall Area: NOT USED Providing: - 363.25 gallons REVISIONS Lisa: 4 ROM OF 6-OUICK4 STANDARD CHAMBER UNITS WITH NO NO, DATE: DEFINITION STONE FOR AN SAS HAVING THE DIMENSIONS: 12.7' x 26.0' PROJECT BENCH MARK Bottom Area: (General Use Approval for 4.72 SF/LF of INFITRATOR TOP OF FOUNDATION 6 UNITS + 2 END CAPS per ROW - 26.0 FT ELEV. = 100.00 (Assui4d) 1 ,� �� 4 ROWS x 26.0 x 4.72 SF/LF - 490.88 , , DESIGN FLOW PROVIDED: 0.74(490.88 S.F.) - 363.25 GPO •�� : ' �� LOT #9 (4o i ,20,0912 Square Feet +/- �� i i Four .� PROPOSED - R/�tir � --- ,- PREPARE D FOR : °Fwq � --,-'' SUBSURFACE SEWAGE DISPOSAL SYSTEM 36,97 L OF 30.00 MR. RAYMOND XUERB #31 CAPTAIN BAKER ROAD 0 \��`---------------""-�-� MARSTO N S MILLS, MA # 1882 AMY AVENUE SANTA ROSA, CA 95401 PREPARED BY: �k4x �rkA�, "RHEIV E, SHA Y Bedroom $ 1$ 0 20 40 50 "` 8 Kitchen <; c� ENVIRONMENTAL SERVICES, INC. 8 185 ASHUMET ROAD Bedroom Bedroom :3 Dining MASHPEE, MA 02649 SCALE: 1 "=20' s;"�Ir"��P j TEL/FAX : 508-539-7966 3 BE HOUSE FLOOR SCHEMATIC SCALE: 1"=20' DRAWN BY: CES DATE: FEBRUARY 4, 2008 T (Description Provided By Owner) PROJECT#SD-1076 ILENAME: SD1076PP.DWG SHEET 1 OF 1