The URL can be used to link to this page

Home My WebLink About0021 CAPTAIN DEYOUNG TERRACE - Health ,2 1 Captain Deyoung Terrace s Marstons Mills _- -- - - - 125 028 i Commonwealth of Massachusetts / f 1 a U - aag Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Captain Deyoung Terrace Property Address Garran Owner's Name Marstons Mills ✓ MA' 02648 6/3/15 City(rown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in ariyi way. A. General Information c 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 Telephone Number B. Certification 1 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 6/3/15 Inspector i ture 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. 21 Captain Deyoung Terrace-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 it Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 21 Captain Deyoung Terrace Property Address Garran Owner's Name Marstons Mills MA' 02648 6/3/15 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Pumping suggested every 3 yrs to prolong the life of the system B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: n/a ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed 21 Captain Deyoung Terrace-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 21 Captain Deyoung Terrace Property Address Garran Owner's Name Marstons Mills MA' 02648 6/3/15 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: n/a ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: n/a C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 21 Captain Deyoung Terrace•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 f Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Captain Deyoung Terrace Property Address Garran Owners Name Marstons Mills MA' 02648 6/3/15 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: n/a 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 1/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. 21 Captain Deyoung Terrace•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Captain Deyoung Terrace Property Address Garran Owner's Name Marstons Mills MA' 02648 6/3/15 Citylrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead 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. 21 Captain Deyoung Terrace•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 'p 21 Captain Deyoung Terrace Property Address Garran Owner's Name Marstons Mills MA' 02648 6/3/15 Citylrown 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)] 21 Captain Deyoung Terrace•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 I i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Captain Deyoung Terrace Property Address Garran Owner's Name Marstons Mills MA' 02648 6/3/15 Cityrrown State Zip Code Date of Inspection 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 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: March 2015 Date Commercial/Industrial Flow Conditions: Type of Establishment: n/a Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): n/a 21 Captain Deyoung Terrace•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 21 Captain Deyoung Terrace Property Address Garran Owner's Name Marstons Mills MA' 02648 6/3/15 Cityfrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: No recent pumping per owner 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): Approximate age of all components, date installed (if known)and source of information: Original septic tank from 1976, new d-box and chambers 2004 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No 21 Captain Deyoung Terrace•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Captain Deyoung Terrace Property Address Garran Owner's Name Marstons Mills MA' 02648 6/3/15 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) Compartment style tank If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000g Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle >12' Scum thickness trace- 1/2" Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? Measured 21 Captain Deyoung Terrace-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 21 Captain Deyoung Terrace Property Address Garran Owners Name Marstons Mills MA' 02648 6/3/15 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3 yrs to prolong the life of the system Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): n/a Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): n/a 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): n/a 21 Captain Deyoung Terrace•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GM , 21 Captain Deyoung Terrace Property Address Garran Owner's Name Marstons Mills MA' 02648 6/3/15 City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): n/a *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box 3' below grade and in very good condition Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 21 Captain Deyoung Terrace•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 21 Captain Deyoung Terrace Property Address Garran Owner's Name Marstons Mills MA' 02648 6/3/15 City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a 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 ❑ 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.): Chambers were video inspected, no indication of past backup, damp at this time 21 Captain Deyoung Terrace•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Captain Deyoung Terrace Property Address Garran Owner's Name Marstons Mills MA' 02648 6/3/15 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): n/a 21 Captain Deyoung Terrace-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 f Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE f LOCATION. "Z"S I WQC. SEWAGE 8_ ` v .LAGE tMars4zAs M:(it ASSESSOR'S MAP St LOT 12-2 o INSTALLER'S NAME&PHONE NO. W►y`.E.lLdb+nsw�+ SaP},c Srdwc{`7�� 7G SEPTIC TANK CAPACITY_ /6W &AL LEACHING FACII.rry:(type) rsdu(size) 0LYx /,JSY0 r NO.OF BEDROOMS BUILDER O 0 PERMrrDATE: ?I3oI a7 COMPLIANCE DATE: yil—ott Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Ile S►DE of K¢,t�s� V �g 13 �10 � Q http://www.town.bamstable.ma.0 s/assessing/HMdisplay.asp?mappar=125 028&seq=1 6/5/2015 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 21 Captain Deyoung Terrace Property Address Garran Owner's Name Marstons Mills MA' 02648 6/3/15 CityrT'own 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: >12 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Per elevation of home 21 Captain Deyoung Terrace•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 TOWN OF BARNSTABLE e,C LOCATION 21 G fl- Devoe crrc"CL SEWAGE # ` 3e3 V-ILLAGE VV r. -%40A5 d1n;�tt ASSESSOR'S MAP & LOT I �' INSTALLER'S NAME&PHONE NO. LJVA- C-- G %we- 9�7a SEPTIC TANK CAPACITY 10-)D 6 ft LEACHING FACIL=: (type) S'W Q ,4 (size) a YX 0, -,5-X 69 NO. OF BEDROOMS — BUILDER O� Le..5e-IL PERMU DATE: �j COMPLIANCE DATE: 97 g lag Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �� NIATINEp 9 6 r � Q` No. �U Al 0 0 .00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer.�,g!�' Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSAC.HUSETTS 2pplication for �Diopaal *p$tem COn0truction 3permit Application for a Permit to Construct( . )Repair(K )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 4 2 0—1 3 4 5 21 CAg� DeYoung Terr, Marstons Debra LaSalle Assessor's azcel 125/28 Mills 21 Capt DeYoung Ter, MarstonsMills Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4 Wm E Robinson Sr Septic Eco—Tech PO Box 10.89, Centerville 43 Triangle Cir, Sandwich Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grindef(o ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil, Nature of Repairs or Alterations(Answer when applicable) Install a new Title 5 leach system to plans of Eco—Tech, #ETE-1363. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue byXre of Hea Signed r Date Application Approved by Date 0 Application Disapproved for a following reasons Permit No. ar t) —3 3 Date Issued U —a DOO No: 3 v J - Fee Entered in computer: / THE COMMONWEALTH OF MASSACHUSETTS Yes '�j1 PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MAS"Ct USETTS 3pprication for Mi.5,ponl *patent Construction Permit Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. - Owner's Name,Address and Tel.No. 4 2 0—1 3 4 5 21 Capt DeYoung Terr, Marstons Debra LaSalle Assessor's Wp/Parce1125 28 Mills 21 Capt DeYoung Ter, MarstonsMills Installer's Name,Address,and Tel.No. 7 7 5-8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4 Wm E ' obinson Sr Septic Eco-Tech PO Bok 1089, Centerville 43 Triangle Cir, Sandwich Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder-70 ) Other T pe of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. w Description of Soil Nature of Repairs or Alterations(Answer when applicable�)) Install a new Title 5 leach system to plans of Eco-Tech, #ETE-13 3. i Date iast inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by this o o�Z_ . Signed ' Date -'3,Q70 L2 Application Approved by ''1 - {�S > Date V Application Disapproved for t1he following reasons Permit No. DC;V - 3 D Date Issued ------------------------ ---------- THE COMMONWEALTH OF MASSACHUSETTS Lasalle BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( X)Upgraded( ) Abandoned( )by Wm E Robinson Sr Septic Service at 21 Capt DeYoung Terrace, Marstons Mills has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 Q 0 L4-Z E*3 dated-71 () 61/ Installer Designer The issuance of this �ermit shall not be construed as a guarantee that the syrt m�will function as desig-ed, � ( Date �k 1 . Inspector Y.� r /��-)- --------------------------------------- No. Li- F&1 O 0.0 0 LaSalle THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS litpoar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 21 Capt DeYoung Terrace, Marstons Mills and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this f ermitt. Date: 3 U 1, Approved by r v f TOWN OF BARNSTABLE £� LOCATION d�( C A. Dtyo a SEWAGE # 3e-? VILLAGE Acrs4DAS ANJLJI - ASSESSOR'S MAP & LOT_I INSTALLER'S NAME&PHONE NO. W MA. C, f bw Wk Scene,, SEPTIC TANK CAPACITY /60 G • LEACHING FACILITY: (type) ax SM Drv,.�tjk (size) AYx Oif Y a NO..OF BEDROOM''S BUILDER O)tYOWNF PERMTTDATE�: JJ�agy , COMPLIANCE DATE: 9laq Separation Distance Between.the: • Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If.any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �Nwey a 6 a �G 0 f t �Y��VI r - - Barnstable Assessing Search Results Page 1 of 2 a aft ro Home: Departments:Assessors Division: Property Assessment Search Results 'E'r 21 CAPTAIN DEYOUNG TERRACE Owner: LASALLE, DEBRA S Property Sketch Legend Map/Parcel/Parcel Extension 125 /028/ Mailing Address LASALLE, DEBRA S � hs � 1240 OST-W BARNS RD MARSTONS MILLS, MA.02648 2004 Assessed Values: A3ri y Appraised Value Assessed Value1,3? Building Value: $82,300 $82,300 Extra Features: $5,100 $5,100 Outbuildings: $300 $300 Land Value: $ 124,100 $ 124,100 Interactive Property Map: ap requires Plug in: Totals:$211,800 $211,800 1 have visited the maps before Show Me The Man April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: LASALLE, DEBRA S 6642/107 $ 1 LASALLE,JOEL A 3933/021 $42,000 CADMAN, $42,000 2004 Tax Information: Tax Rates: (per$1,000 of valuation) Town Tax $ 1,400 Town Fire District Rates Other Rates 6.61 Barnstable 2.01 Land Bank 3%of Town Tax C.O.M.M. FD Tax $232.98 C.O.M.M. 1.10 Cotuit 1.52 Land Bank Tax $42 Hyannis 2.03 West Barnstable 1.36 http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/`... 7/30/2004 Barnstable Assessing Search Results Page 2 of 2 Total: $ 1,674.98 Due to rounding differences these values may vary Land and Building Information Land Building Lot Size(Acres) 0.51 Year Built 1976 Appraised Value $ 124,100 Living Area 984 Assessed Value $ 124,100 Replacement Cost$95,697 Depreciation 14 Building Value 82,300 Construction Details Style Cape Cod Interior Floors CarpetVinyl/Asphalt Model Residential Interior Walls Drywall Grade Average Heat Fuel Oil Stories 1 1/2 Stories Heat Type Hot Water Exterior Walls Wood ShingleClapboard AC Type None Roof Structure Gable/Hip Bedrooms=-Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 2 Bathrooms Total Rooms 6 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value BRR Bsmt Rec Room 576 $2,500 $2,500 FPL2 Fireplace 1 $2,600 $2,600 SHED Shed 48 $300 $300 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/... 7/30/2004 Town of Barnstable ��FtME ram, Regulatory Services Thomas F. Geiler,Director BARNSTABLE, v� MASS. 3. ° Public Health Division ArE p '�° Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: —C?—6 � Designer: Eco-Tech Installer: Wm E Robinson Sr Address: 43 Triangle Circle Address: PO Box 1089 Sandwich Centerville On Wm Robinson Sr Septic was issued a permit to install a (date) (installer) septic system at 21 Capt DeYoung Ter, Marstons bMsbd9Dn a design drawn by (address) Eco-Tech dated 07-20-04 (designer) 1'.1 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 system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. tN OF oavro 1 D. (Installer's Signature) Cc!_,,y� y k Os3 TO (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN 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:Health/Septic/Desiper Certification Form SOIL. TEST LOG DESIGN CALCULATIONS - DATE OF TEST: . JULY 19. 2004 DESIGN FLOW: 3 BEDROOMS X 110 GPD - 330 GPD + SOIL EVALUATOR: DAVID D. COUGHANOWR. RS - WITNESSED REQUIREMENT WAIVED NO VARIANCES SOUGHT SEPTIC TANK: 330 GPD X 2 DAYS - 660 GALLONS NO GROUNDWATER ENCOUNTERED TEST PIT I PARENT MA iERIA 2 MIN/INCH INCH IA N C TWASH USE EXISTING 1000 GALLON SEPTIC TANK IF IS SOUND STRUCTURAL PER ELEVATION - 65.25 ;- CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) DISTRIBUTION BOX: USE 3 OUTLET D-BOX. DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELU MOTTLING i SOIL ABSORBTION SYSTEM: A 24 ft x 12.5 ft x 2 ft LEACHING GALLERY CAN LEACH Abot - ( 24 x 12.5 ) - 300 sf 0-6 A LOAMY SAND 10 YR 4/4 NONE FRIABLE A s d w - ( 24 - 24 12.5 { 12.5 ) x 2 - 146 s f Atot - 446 sf 6-30 B LOAMY SAND 10 YR 5/8 NONE FRIABLE Vt 0.74 x 446 - 330.04 GPD 30-126 C MEDIUM SAND 10 YR 6/4 NONE LOOSE USE- A 24 ft x 12.5 ft x 2 ft GALLERY. Vt - 330.04 GPD > 330 GPD REQUIRED I JCS GROUNDWATER ADJUSTMENT LEACHING GALLERY EXISTING GROUNDWATER LEVEL CONSTRUCTION DETAIL - BASED ON BARNSTABLE GIS DEPARTMENT RECORDS DRYWELL UNIT STONE INDICATED GW: 41.0 $•-2 4-�f1 EF F. DEEPTPT y 2 H INDEX WELL: SDW-252 24.0 ft ZONE: C READING: JUNE 2004 LEVEL: 47.3 ADJUSTMENT: 2.8 ft M ADJUSTED GW: 43.8 to Ln NOTES N 1) GARBAGE GRINDER NOT ALLOWE-D WITH THIS DESIGN 3.5- 8.5' 8.5 3.5- 2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. NOT TO 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS 24.0 ft SCALE OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. _ 5) EXISTING SOIL ABSORPTION SYSTEM TO BE PUMPED. COLLAPSED. AND FILLED. OR. REMOVED . 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES .AND DUST IN PLACE 7) LINES EXITING D-BOX TO RUN LEVEL FOR 2 O,,%yB'EEORE PITCHING DOWN ' SEWAGE DISPOSAL SYSTEM PLAN 8) . ECO-TECH ENVIRONMENTAL RECOMMENDS T,HEr!PSTACLATION OF. LOW FLOW FIXTURES AND APPLIANCES. AND BIANNUAL PUMPING OF THE SERTIC TANK ; -T0. SERVE EXISTING DWELLING ti 9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULb- R;LOADING. DO NOT, ems` PARK OR DRIVE VEHICLES OVER SEPTIC SYST DE6RA LASALLE' 10) INSTALLER TO OBTAIN DISPOSAL WORKS `PERMIT`.c.-SEFORE' STARTING WORK. 21 CAPT DEYOUNG TERRACE MARSTONS MILLS. MA, 11) SEPTIC TANKS SHALL BE. INSTALLED LEVEL AID TRUE TO GRADE ON A LEVEL STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH ECO-TECH ENVIRONMENTAL : ti SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING _ 1 2) SEPTIC TANK TO BE PUMPED DRY AT .TIME OF SYSTEM;REPAIR AND CHECKED 43 TRIANGLE CIRCLE SANDWICH MA' 0256" FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. - 1' ETE-1363 MARCH 5. 200,3 2/2 MARSTOW MILLS ,�m o PLAN :'REFERENCE CONTOURS • PL- al ; A 0 RC L 00 PLAN BOOK .274 PAGE 34 EXISTING - - - - - - - 66 N ASSESSOR'S MAP: 125 MINIMAL GRADING PROPOSED . <F (� LOT: 28 �m cAPrAiN r Sr WOO �m �QpU0gD m t" 7 _ DEYOUNO ` N s W TERRA CE Locus TERRACE oJ< w<:-z LOCUS MAP LLz �fi oN� �� ^�.� ;W� NOT TO SCALE w cn t w v)o J N J N U 3 U J > ��OGE V` A �G m LOT 21 � o a Q —I M N AREA - 22004 sf .- LEGEND EXI9TM z GALLON W J ` SEPTIC TANG Q o �' \ TEST PIT u, r tK� ^� a / \ urcrrr POLE O Q w} o 1— J N ac o �S / DRAIN z� o '^v_ < 8X1ST/IVG W� u� ml "AID LL N= w Ll / `2 sjo 1llf+f TC (�0 z< �ZOW `/ ��lrrr NO IC of `�� ti ` a CONTRACTOR IS TO LOCATE WATER EXISTING LEACHING FACILITY �+� AT THE OF REPAR F IT 24 ft x !25 ft x 2 ft FALLS WITHIN TI-E AREA OF LEACHING GALLERY THE PROPOSED LEACHING '� e GALLERY THEN IT IS TO BE + o P` r REMOVED AM CONTAMINATED o = ui SOILS REPLACED WITH CLEAN �� $ ' MEDIUM SAND. AL TERNATEL Y THE CONTRACTOR MAY (D BENCH MARK RE ITAIG OF TFE $ ST ECO-TECH FOR W z TOP OF FOUNDATION ELEVATION - 67.03 w w O Z USGS DATUM ASSUMED LL ? � �' SEWAGE DISPOSAL SYSTEM PLAN �m Q U. x V �O �' — _ 92.77 ft -TO SERVE EXISTING DWELLING I'� wow DEBRA LASALLE n 4 o + " yG 21 CAPT DEYOUNG TERRACE MARSTONS MILLS.'MA y M PLAN � D. ECO-TECH ENVIRONMENTAL �HA�iovrR �,. LL ;. SCALE: 1 in 30 ft # 1093 �, Q '�F 43 TRIANGLE CIRCLE SANDWICH MA 02563 .� „ W 'f AA�*� 508 364-0894_.. L S ETE-1730 FJULY 20. 2004 1/2 THS PLAN IS TO BE CONSIDERED A DRAFT PLAN UNLESS IT J, BEARS THE STAMP AND SIGNATURE OF THE DESIGN ENGINEER ORIGINAL PLANS INTENDED FOR SUBMITTAL,TO THE BOARD OF HEALTH WILL BE SIGNED N BLUE AND STAMPED N RED. ;