HomeMy WebLinkAbout0046 CEDAR TREE NECK ROAD - Health 4 i CEDAR TREE NECK m o
n=075
�u r�Wl
i
S
� 1p►
�ve� ��
�-�
�, g�S� �
--- �®� G+�ii5+� cTN �"Ord �� Z '',er.?�
�..
i
i
i
1
•
Y
i
� �
._-'�
r
I;13 2016 16:42 Jim The Inspector Man 5085349919 page 1
Commonwealth of Massachusetts 076-Ddg
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r"
46 Cedar Tree Neck Road
Property Address
Hoby Cook
Owner Owner's Name
information is
required for every Marstons Mills MA 02648 7-12-16 r
page. Clty/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Pleas
e see completeness ch
ecklist
st at the end of the form.
i
i
filling
out forms A. General Information
filling out forms
on the computer,
use only the tab ���v1�..••• A ���i
key to move your 1. Inspector: ���� . '''• �,y�
cursor-do not
James D.Sears _ JAMESuse 't m
key.the return Name of Inspector :-wj
*A ri
Capewide Enterprises, LLC %
Company Name1� .....T
153 Commercial Street ��•,, '4:1rnE����•�` 4 Company Address
Mashpee MA 02649
City/Town State Zip Code _
508-477-8877 S 1623
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this addres's.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 16.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
_ 7-12-16
spector'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 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.
I'
t5ins.doc•rev.6/16 Title S Official Inspection Forrn:Subsurface Sewage Disposal System•Page 1 of 17
w�o
-Jul 13 2016 16:42 Jim The Inspector Man 5085349919 page 2
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments _
46 Cedar Tree Neck Road.
Property Address
Hoby Cook
Owner Owner's Name
information is
required for every Marstons Mills MA 02648 7-12-16
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E I 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 is a 1500 Gal. Tank D Box and 32 chambers.
t
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):
15lns.doc-'ev.6I16 - Title 5Official Inspection Form:Subsurface Sewage Disposal system•Page 2 of 17
is
i'
Jul 13 , 2016 16:42 Jim The Inspector Man 5085349919 page 3
N Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface'Sewage Disposal System Form - Not for Voluntary Assessments
w r 46 Cedar Tree Neck Road
Property Address j.
Hoby Cook
Owner Owner's Name
information is required for every Marstons Mills MA 02648 7-12-16
page. City[Town State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumpslalarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
I
r
❑ 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 s
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):
E.
l'
i
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe($). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
• i'
❑ 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
ISins.tloc•rev,6116 Title 5 Official Inspection Form!Subsurface Sewage Disposal System-Page 3 or 17
i
r
.Jul 13. 2016 16:42 Jim The Inspector Man 5085349919 page 4
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
46 Cedar Tree Neck Road
Property Address
Hoby Cook
Owner Owner's Name
information is required for every Marstons Mills MA 02648 7-12-16
page. CityfTown 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
El ® Liquid depth in is less than 6" below invert or available volume is less
than %day flow, E/,
t5ins-doc•'ev.6/16 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
.Jul 13 2016 16:42 Jim The Inspector Man 5085349919 page 5
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
"Y 46 Cedar Tree Neck Road
Property Address
Hoby Cook
Owner Owner's Name
information is required for every Marstons Mills MA 02648 7-12-16
page. CitylTown State Zip Code Date of Inspection
B. Certification (cont.)
i
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 wa
ter supply.
❑ ® Any portion
on of a cesspool I r privy is within aZ n 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 consl0erecf a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
zz
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 fee i rf❑ t of a tributary to a su ace drinkin water supply
Y rY 9 PP Y
❑ Elthe 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.doc•rev.V16 Title 5 Official Inspection Form:Subsur`ace Sewage Disposal System•Page 6 of 17
-Jul 13 2016 16:42 Jim The Inspector Man 5085349919 page 6
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
46 CedarTree Neck Road _
Property Address
Hoby Cook
Owner Owner's Name
information is required for every Marstons Mills MA 02648 7-12-16
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? -
® El available
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 CM 15'.302(5)]
D. System Information
Residential Flow Conditions: `
Number of bedrooms (design): 5 Number of bedrooms (actual): 4
DESIGN flow based on 310 CM 15.203(for example: 110 gpd x#of bedrooms): 550
t5ins doc•rev.6116 Title 5 Offioal Inspection Form:Subsurece Sewage Disposal System•Page 6 of 17
Jul 13 , 2016 16:42 Jim The Inspector Man 5085349919 page 7
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
r 46 Cedar Tree Neck Road
Property Address
Hoby Cook
Owner Owner's Name
information is required for every Marstons Mills MA 02648 7-12-16
page, Cit /Town State Zip Code Date of Ins
pection
ection
D. System Information
Description:
The system is a 1500 Gal. Tank D Box and 32 chambers. _
t
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundryon a separate sewage system? Include laundry system inspection P 9 Y ( Y Y p -
information in this report.) El ® No
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 2014 62,000GaIs
g ( y g (gp ))' 2015-61,000Gal's
Detail:
Sump pump? ❑ Yes ® No
Present
Last date of occupancy: date
Commerciallindustrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons Per day(9pd)
Basis of design flow(seats/persons/sci t., 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.tloc•rev.B116 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
b.
6
i
Jul 13 2016 16:42 Jim The Inspector Han 5085349919 page 8
Commonwealth of Massachusetts
= vTitle 5 Official i
al Inspection Form
-
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
46 Cedar Tree Neck Road _-
Property Address
Hoby Cook
Owner Owner's Name
information is arstons'Mills MA 02648 7-12-16
required for every M -
page. CitylTown 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: NA
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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
s
Jul 13 - 2016 16:43 Jim The Inspector, Man 5085349919 page 9
Commonwealth of Massachusetts
r Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
46 Cedar Tree Neck Road
Property Address
Hoby Cook
Owner Owner's Name
Information is Marstons Mills MA 02648 7-12-16
required for every
page. City[Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
1984 Permit 84 - 1008 Tank/ 2014 Permit #2014 185 D Box and Leaching.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer (locate on site plan):
22"
Depth below grade: feet
1.
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.):
Pipeing is 4" PVC SCH 40.
is
I:
Septic Tank(locate on site plan):
Depth below grade: 1 -
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
t
Dimensions: 1500 Gal. Precast. H-10
Sludge depth:
1"
t5ins.doc•rev.6116 Tille 5 official nspection Form:Subsurface Sewage Disposal System•Page 9 of 17
L =
r _
,Jul 13 • 2016 16:43 Jim The Inspector Man 5085349919 page 10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 5 p. Y ry -
y 46 Cedar Tree Neck Road
Property Address
Hoby Cook
Owner Owner's Name _
Information is s Mill t arsons MA 02648 7-12-16
required for every M I
page. Chy/Town State Zip Code Date of Inspection
D. System Information (cant.)
Septic Tank (cont.)
Distance from top of sludge to bottom of outlet tee or baffle 29
�r
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 18"
How were dimensions determined? Asbuilt- Plan -Tape
Sludge Judge
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank at working level. Tank and covers at V below grade. In and outlet tee's. No sign of leakage _
or over loading.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction: T.
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: date
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 =
•Jul 13- 2016 16:43 Jim The Inspector Man 5085349919 page 11
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
46 Cedar Tree Neck Road
Property Address
Hoby Cook
Owner Owner's Name
information is required for every Marstons Mills MA 02648 7-12-16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.) F
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.): _
i
Tight or Holding Tank(tank must be pumped at time of inspection) (locate an site plan): =
Depth below grade:
Material of construction: -
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.).-
Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No
i
15ins.Coc-rev.6116 Title 5 Official Inspectlon Form:Subsurface Sewage Disposal System•Page 11 of 17
Jul 13 ' 2016 16:43 Jim The Inspector Man 5085349919 page 12
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
46 Cedar Tree Neck Road
Property Address'
-
Hoby Cook _
Owner Owner's Name _
information is Marstons Mills MA 02648 7-12-16
required for every
page, City/Town State Zip Code Date of Inspection
D. System Information (cont.)
is
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 is 16"x16' 46"below grade w/cover at 26". Box is clean and solid w1four line's out. No sign
of over loading or solid carry over. Note: Inlet line has at PVC Tee_
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.):
I
*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:
t5lns.doc•rev.6/16 Title 5'Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
-Jul 13 2016 16:43 Jim The Inspector Man 5085349919 page 13
4 Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
y 46 Cedar Tree Neck Road
Property Address
Hoby Cook _
Owner Owner's Name
information is arstons Mills MA 02648 7-12-16
required for every M _
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 32
❑ leaching galleries number:
❑ leaching trenches number, length: _
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology-
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leaching is (32)ARC 36 HC H-20. Biodiffuser's set in four rows 1 1'-6"x40'x1 0 3'l4 camera out
and ck D Box. Chamber are clean. With wet bottom.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): _
Number and configuration
Depth—top of liquid to inlet invert
is
Depth of solids layer
is
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins.doc•rev.6116 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Jul 13. 2016 16:43 Jim The Inspector Man 5085349919 page 14
Commonwealth. of Massachusetts
= Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
46 Cedar Tree Neck Road
Property Address
Hoby Cook
Owner Owner's Name
information is arstons Mills MA 02648 7-12-16
req��ired for every M =
page. CitylTown State Zip Code Date of Inspection =
D. System Information cost.
Y ( )
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc. : '
l
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.):
is
t5ins.doc•rev.6116 Title 5 Official Irspection Forth:Subsurface Sewage Disposal System•Page 14 of 17
-Jul 13.2016 16:43 Jim The Inspector Man 5085349919 page 15
Commonwealth of Massachusetts
d
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
'f 46 Cedar_Tree Neck Road
Properly Address
Hoby Cook
Owner Owner's Name
information is Marstons Mills MA 02648 7-12-16 =
required for every -.—.-
page, CitylTown State Zip Code Dale 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
f q
13-1-:
✓�-� 35 -6
c -3 _ V9
C -y'rs3 , Po
s= 99 S 3
U O e
BOO
�! P EAR
r -
a =
t5ins.doc ev.0/15 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 or 17
-Jul 13.2016 16:44 Jim The Inspector Man 5085349919 page 16
Commonwealth of Massachusetts
Titles Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
y` 46 Cedar Tree Neck Road
Property Address
Hoby Cook
Owner Owner's Name
information-dre Marstons.Mills MA 02648 7-12-16
required for every
page. CityFTown State Zip Code Date of Inspection
D. System Information (cost.) _
Site Exam:
❑ Check Slope
❑ Surface water
p
❑ Check cellar
❑ Shallow wells
Na
Estimated depth to filth ground water: 10' _
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
5-8-14
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) t
❑ Accessed USG$database-explain:
You must describe how you established the high ground water elevation:
T.H. on design plan 5-8-14 no G.W. at 10'. Bottom of chamber's at 6' above T.H. Depth. _
Z.
Before filing this Inspection Report, please see Report Completeness Checklist on next page. E.
15ins.doc-rev.6116 Title 5 Official Insoecbon Form:Subsurface Sewage Disposal System Pape 16 of 17
r
Jul . 13 c 2016 16:44 Jim The Inspector Man 5085349919 page 17
Commonwealth of Massachusetts _
d Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "
46 Cedar Tree Neck Road
Property Address
Hoby Cook
Owner Owner's Name
information is Marstons Mills MA 02648 7-12-16
required for every t
page. CityfTown State Zip Code Date of Inspection
E. Report Completeness Checklist =
® Inspection Summary: A, 6, 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 r
9 P
drawn on page 15 or attached in separate file
Y P9 P
s-
t5ins.doc rev.6P6 Title 5 011(cial Inspection Form;Subsurface Sewage Disposal System•Page 17 of 17
f
Town of Barnstable
�Ito I
o� Regulatory Services
EMBMABEZ
Richard V. Scali,Interim Director
9� ' ASS. ���' Public Health Division
�Ea"A0�A Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
i
I
Office: 508-862-4644 Fax: 508-790-6304
i
Installer& DesiLyner Certification Form
Date: (.o"i 7 -Zoly Sewage Permit# 'a o
g y -185 Assessor's Map\Parcel
Designer:g 1K,140 .S T. Ci*d W ON�C_ j Installer: newii-f CA TedPf
Address: z) Sox 9 S F i Address: 1`53 C0vnw,erc,'1qr( cOT-
IM,4 D 2U.4q
I �
On (a-10 -Zo\y ,, a `( .tip Of,'le5 was issued apermit to install a
(date) (installer)
i
septic system at H(o Ceag&Tc-,__e (?exL, (t ,44 based on a design drawn by
(address) j
0A4 1 d 5. CAA i O A C dated n'1 (41 2 3� 201
(designer) - I —
l1 I certify that the septic system referenced above was installed substantially accordingto
the design, which may include minor approved changes such as lateral relocation of he
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
i
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the .AS or any vertical relocation of any component
of the septic system) but in accordance Itrip
ith State & Local Regulations. Plan revision or
certified as-built by designer to follow. out(if required) was inspected and the soils
were found satisfactory.
I certify that the system referenced abovl was constructed in compliance with the terms
of the IAA approval letters(if applicable)
FA
KAU
ler's Si ature) JAMES �
CAD
01060
Designer's Si na (Affi rap Here)
PLEASE RETURN TO BARNSTABLE PUBILIC 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
I
I
TOWN OF BARNSTABLE
LOCATION KJ SEWAGE# A6
tVILLAGE/'�i�s-f � ASSESSOR'S MAP&PARCEL Q
INSTALLER'S NAME&PHONE NO. En-je fses LLE,
SEPTIC TANK CAPACITY 1660
LEACHING FACILITY.(type) 3R A'XXIIC /Lolo) (size) JJ 6 X 40
NO.OF BEDROOMS
OWNER . o -/ A, . , r o� A Ile,Vl 6,6o
PERMIT DATE: (0.10 IIT_ COMPLIANCE DATE: � /7
Separation Distance Between the: ova rbvnc�uxa' f
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) A11A Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within n/
300 feet of leaching facility) ✓v Feet
FURNISHED BY C, j?M(g2l Djp-' —W, PEW ae,-- .
7
C-3.:*7
El
Cstu�rgC, .
t No. — 1 " Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ftpliLAtion for Misposal �6pstrm Construction Permit
Application for a Permit to Construct( ) Repair(A Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.46 Gam? iL'YQ�&EO(-ZZ Owner's Name,Address,and Tel.No.
M M 1A0Ba40-t�_ wo[<
Assessor's Map/Parcel e15 to 4:9 tQ
Installer's Name,Address,and fel.No. -?j77 Designer's Name,Address,and Tel.No.
ENS Cfi-- Po�cz GE-Bcu A<- v
Type of Building:
Dwelling No.of Bedrooms Lot Size G�1 sq.ft. Garbage Grinder( )
Other Type of Building t!E5[DjeL)TE4-C_ No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 5,s gpd Design flow provided `�� gpd
/
Plan Date 5 -,)-3 -�v�� Number of sheets 1 Revision Date
Title G-'Mp jWEcy- A-b MR5— g u-[.LLC ' '! ,I
Size of Septic Tank 15 Cab 0#-��o0 Type of S.A.5C3 ��. �, tTf.° �1-1n g�Oa lFt
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) ().SiE �`t�(�(-�r '5���� )LL
N
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 Healt .
ZSimwmv Date 6 -C Q
Application Approved by Date
Application Disapproved y Date
for the following reasons
Permit No. t.q— Date Issued 6 / (o t Z61
-- - - - r-- - -----------
i
a ,No. 3 �s � p ` Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Rp licatlon for IDisposal,6pBtrm Construction 3permit
Application for a Permit to Construct( ) Repair(A Upgrade( ) Abandon( ) [:]Complete System ❑Individual Components
Location Address or Lot No.46 GOT YO _ Owner's Name,Address,and Tel.No.
MM WQ5A0-T s UA-f 8-►-A C00K
Assessor's Map/Parcel &q.5
Installer's Name,Address,and fel.No. 56S-+77`�%77 Designer's Name,Address,and Tel.No.
��GWL-_ t�G�IS C�CG �O CA aICLI�{
Type of Building:
Dwelling No.of Bedrooms Lot Size G� 1f t� sq.ft. Garbage Grinder( )
N Other Type of Building bESCbf3 "( k No.of Persons Showers( ) Cafeteria( )
.,* Other Fixtures
' Design Flow(min.required) ��1 n gpd Design flow provided 5�L_r� gpd
Plan Date y//C� Number of sheets Revision Date
Title—q<, 4 E. p =06;5p riL P2.�Ak,5jMy C
r Size of Septic Tank I p.0 C30 Type of S.A. Are- 0 %ICZ(GEUSE�
Description of Soil
r
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Healt
Signed7 Date CD —l6 — I �
Application Approved by i Date 1p /o
Application Disapproved t i- Date -
for the following reasons
Permit No. (}� (�1� Date Issued 6 /�o i d
TH E COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance -
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired,(�O Upgraded( )
Abandoned( )by Wej
has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.'J j_dated (1) O 14
Installer IAA & ( Designer Pt-
�WAL� ►/-[
#bedrooms Approved design*flow '� gp)d
The issuance of thisivernut sliall ndt.be construed as a guarantee that the system wilb funclo des/i� e/d:
Date } `A t' Inspector ;'"//llf' / % /� f/• �/ / � 1'
----- - ---:----- ---- ---- --- - - - _ ---
q Fee--1 �—
No.
v THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal 6pWrm Construction permit
Permission is hereby granted to Construct( ) Repair(k) Upgrade( ) Abandon( )
System located at 41(o C ':TZ
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.
i Date� 1 l7o/C/ Approved by
i
r
4 ,
'own of Barnstable
TMf r � Regulatory Services
Richard V. Scali,Interim Director
"UT 0 ' Public Health Division
1639.. Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 508-362-4644
Fat: 503-790-6304
Homeowner Certification Form for Alternative Systems
Property Address: ,� \i ,R l ip IuEu� --��)
' t
Assessor's Map\Pareel: O'7.
Property Owners Name: Uo5AF; �. My
In accordance with Massachusetts DEP alternative system approval letters, the following certification
information is required by the Owner of record. The Owner of record must place an "x" in the
applicable box next to each line certifying the information.
Yes N\A
❑ I have been provided a copy of the Title 5 UA technology Approval letters.
�(15 page Standard Conditions letter and the specific technology letter)
ElL`1 I have been provided with the Owner's Manual
❑ VI have been provided with the Operation and Maintenance Manual
❑ VFor Systems installed under a Remedial Use Approval, I agree to fulfill my
responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10)
and the Approval
❑ For Systems installed under a Remedial Use Approval,
pp , I agree to fulfill my responsibilities to
provide written notification of the Approval to any new Owner, as required by
310 CMR 15.237(5)
❑ If the design does not provide for the use of garbage grinders, the restriction is understood
and accepted
❑ Whether or not covered by a warranty, I understand the requirement to repair, replace,modify
or take any other action as required by the Department or the LAA, if the Department or the
LAA determines the System to be failing to protect public health and safety and the
4nvironment, as defined in 310 CMR 15.303
1 �r �0 0 U agree to comply with all terms and conditions above.
P rated name
72
VV
Property Owners Signature b
e
Note: This form must be submitted alonDr with the se tics stem dis os I works Emit
application for all I\A systems includin new construction re airs\u rades with and
without aggregate (stone) and with conventional design criteria or credited design
criteria.
QASeptic\IA homeowner certificarion.doc
COMPLETE •N. COMPLETE THIS SECTIONDELIVERY,
■ Complete items 1,2,and 3.Also complete A. Signs re
item 4 if Restricted Delivery is desired. X VAddre,-
so ent
■ Print your name.and address on the reverse see
that we can return the card to you. B. Received by(Printed Name) C.Date o el'v
e Attach this card to the back of the mailpiece, Y'
or on the front if space permits.
D. Is delivery address different from item 1? ❑Yes
1. Article Addr d to:.
=s If YES,enter delivery address below: ❑No
Hobart , u& Myrna A. Cook Jr.
46 Cedar* _ .'a Neck Road
% Lisa— . n 3: Service Type
23535 Wi l glom Street , ❑Certified Mail ❑express Mail
West Hills;�°CA 91304-5359 l ❑Registered ❑Return Rece( t forMerchandise
---- ❑Insured Mail :❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number --
(Transfer from service labeo 7 012 1010 0000 2851 3771
PS Form 3811.February 200A Domestic Return Receipt 102595-02-M-1540
UNITED STATES ? LECE First-Class Mail
ut .r Postage&Fees Paid
USPS
MAY I , Permit No G-10
I • Sender- Please print your name, address, and ZIP+4 in this box •
I
I '
I
i Town of Barnstable
J, Regulatory Services Department, .
i 1 Public Health Division .
i' 200 Main Street c:
Hyannis, MA 026011 ;
illHjq III 1 lflllii i'il11ii1 i'd ll"I ' '1i3",
ri •. •
ITI x
OFFICIAL:
FIIA USE
1rI
CO Postage $
n1J
Certified Fee
O
Postmark Vie?
0 Return Receipt Fee Q Heret '
a (Endorsement Required) 2�1
AAY j
Restricted 2cted Delivery Fee ��H
r3 (Endorsement Required) /
.
O Total Postage&Fees US P 7
ru` Hobart A> H> & Myrna A. Cook Jr. 9
i c3 46 Cedar Tree Neck Road
% Lisa Gilman
23535 Windom Street
West Hills, CA 91034-5359
Certified Mail Provides:
o A mailing receipt
n A unique identifier for your mailpiece
c A record of delivery kept by the Postal Service for two years
Important Reminders:
e Certified Mail may ONLY be combined with First-Class Mails or Priority Mails.
o Certified Mail is not available for any class of international mail.
NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables,please consider Insured or Registered Mail.
e For an additional fee,a Return Receipt may be requested to provide proof of
delivery.To obtain Return Receipt service,please complete and attach a Return
Receipt(PS Form 3811)to the article and add applicable postage to.cover the
fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for
a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is
required.
o For an additional fee, delivery may be restricted to the addressee or
addressee's authorized agent.Advise the clerk or mark the mailpiece with the
endorsement"Restricted Delivery".
o If a postmark on the Certified Mail receipt is desired,please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is not needed,detach and affix label with postage and mail.
MPORTANT:Save this receipt and present it when making an inquiry.
S Form 3800,August 2006(Reverse)PSN 7530-02-000-9047
t
Town of Barnstable Barnstable
Regulatory Services DepartmentNAM
1ARN3fAHLE, ' I I.
Public Health Division 200�
200 Main Street, Hyannis MA 02601
Office: 508-862-4644 Richard V.Scali,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL # 7012 1010 0000 2851 3771
May 22, 2014
Myrna& Hobart Cook, Jr.
% Lisa Gilman -
23535 Windom Street
West Hills, CA 91304-5359
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 46 Cedar Tree Neck Road, Marstons Mills,MA,was last
inspected on 3/17/2014, by Patrick O'Connell, a certified septic inspector for the State
of Massachusetts.
The inspection of the septic system showed that the system" Fails" under the guidelines
of the 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool.
You are ordered to repair or replace the septic system within sixty (60) days from the__
date you receive this notification.
Failure to rep air/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE BOARD OF HEALTH
t:o2mas McKean, R.S. CHO
Agent of the Board of Health
Q:\SEPTIC\Sample Failure Ltr\46 Cedar Tree Neck Rd MM May2014.doc
Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=4566
:-,.H-E
07
ff I "P
t„�. j
AN,
Logged In As: Parcel Detail Tuesday, May 13 2014
Parcel Lookup
Parcel Info r Par ceDl075-028 Developer ILOT 8 _
Pri
Location 146 CEDAR R TREE NECK ROAD f Frontage 457
Sec1--_,_____,_._. _____. _.--- .__._._.____ Sec
Road' � Frontage
Village IMARSTONS MILLS ( Dist lict C-O-MM
Town sewer exists at this Road 0264
-- ----— -address;No Index
Asbuilt Septic Scan: Interactive
075028_1 Map
Owner Info
Co
Owner;COOK, HOBART_A H JR&__.____MYRNA A Owner IC/O GILMAN, LISA
Streetl 123535 WINDOM ST Street2l
City IWEST HILLS _ State� Zip�9 31 04-535�9 Country,_
Land Info
..._..... ... . . ...._.... ..... .._. _
Acres D -01 Zoning Nghbd2 m 30110 ��
Topography jAbove Street � � Road[Paved��
Utilities I Public Water,Gas,Septic Location
Construction Info
Building 1 of 1
Year i 985 Roof Gable/Hip Ext Clapboard
Built ---- Struct Wall
Living 3068 Roof jAsph/F GIs/Crop I AC Central J
Area' Cover Type _, � wox
_ _ -----_._ 4� 1
wuKr � YI4K r,,
StyleColonial IntWall Drywall RoomsBed 5 BedroomsAt
--- _ Int __ Bath ___�__ UAi `��t'T Fus_ __ _ _
Model;Residential Hardwood i4 Full+ 1 H sAn C- r'
Floor Rooms4
�_ Heat------ Total,-"--... __ . .
Grade!Luxury Minus Type IHot Water Rooms
'10 Rooms
Heat __ Found-
;
' �
Stories 12.4 Fuel!Gas ation 1Poured Conc.
Gross
http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=4566 5/13/2014
Cll
ff)�y
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
46 Cedar Tree Neck Road
Property Address
Hobart Cook
Owner Owner's Name
information is
required for Marstons Mills MA 02648 March 17, 2014
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out A. General Information
forms on the ,
computer,use 1. Inspector:
only the tab key I
to move your Patrick M. O'Connell
cursor-do not Name of Inspector
use the return
key.
Company Name
ren PO Box 1487
Company Address
Marstons Mills MA 02648
City/Town State Zip Code
508-776-4186 SI 12855
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000). The system:
❑ Passes ❑ Conditionally Passes ® Fails
❑ Needs Further Evaluation by the Local Approving Authority
March 17, 2014
In pector'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 10,00.0 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.
I I
t5ins•3/13 Title 5 Official Inspection Vurfacewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
_ Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
c�M •'' 46 Cedar Tree Neck Road
Property Address
Hobart Cook
Owner Owner's Name
information is required;or Marstons Mills MA 02648 March 17, 2014
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
46 Cedar Tree Neck Road
Property Address
Hobart Cook
Owner Owner's Name
information is required for Marstons Mills MA 02648 March 17, 2014
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further.Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b) that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•3113 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
46 Cedar Tree Neck Road
Property Address
Hobart Cook
Owner Owner's Name
information is required for Marstons Mills MA 02648 March 17, 2014
every page. Cityfrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or .
more from a private water supply well".
Method used to determine distance:
** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or "No" to each of the following for all inspections:
Yes No
® ❑ Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
® Liquid depth in cesspool is less than 6" below invert or available volume is less
than_day flow
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°�M •'- 46 Cedar Tree Neck Road
Property address
Hobart Cook
Owner Owner's Name
information is required for Marstons Mills MA 02648 March 17, 2014
every page. City/Town State, Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply. -
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
® ❑ The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes' or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area— IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owrl 3r 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 CM 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
46 Cedar Tree Neck Road
Property Address
Hobart Cook
Owner Owner's Name
information is required for Marstons Mills MA 02648 March 17, 2014
every 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 of`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): 4
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 Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
46 Cedar Tree Neck Road
Property Address
Hobart Cook
Owner Owner's Name
information is
required for Marstons Mills MA 02648 March 17, 2014
every page. City/Tow•n State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 2
Does residence have a garbage grinder? ® Yes ❑ No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected?
❑ Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d N/A Pool and
g ( y g (gp )) Irrigation.
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: Currently
Occupied.
Commercial/Industrial Flow Conditions:.
Type of Establishment:
Design flow (based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection For
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
46 Cedar Tree Neck Road
Property Address
Hobart Cook
Owner Owner's Name
information is Marstons Mills MA 02648 March 17, 2014
required for .. ..
every page. Cityrrown 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: None
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system.(yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other (describe):
t5ins-3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 8 of 17..
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
46 Cedar Tree Neck Road
Property Address
Hobart Cook
Owner Owner's Name
information is required for Marstons Mills MA 02648 March 17, 2014
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
,Approximate age of all components, date installed (if known) and source of information:
Unknown
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 1
feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Septic Tank (locate on site plan):
'
Depth below grade: 1
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' long x 5.2'wide - 1000 gal.
Sludge depth: 3"
t5ins•3/13 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
46 Cedar Tree Neck Road
Prope-ty Address
Hobart Cook
Owner Owner's Name
information is required for Marstons Mills MA 02648 March 17, 2014
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank (cont.)
Distance from top of sludge to bottom of outlet tee or baffle 27
Scum thickness 3
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
10"
How were dimensions determined?
Measured
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Liquid level was at bottcm of outlet invert and tees were intact and clear.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping:
Date
t5ins•3113 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
46 Cedar Tree Neck Road
Property Address
Hobart Cook
Owner Owner's Name
information is Marstons Mills MA 02648 March 17, 2014
required for
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
•''y 46 Cedar Tree Neck Road
Property Address
Hobart Cook
Owner Owner's Name
information is
required for Marstons Mills MA 02648 March 17, 2014
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0
il
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.):
Liquid level was at bottom of outlet invert.
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 apput tenances, 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:
!Sins•3113
Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection For
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
46 Cedar Tree Neck Road
Property Address
Hobart Cook
Owner Owner's Name
information is
required for Marstons Mills MA 02648 March 17, 2014
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number:
One 6x6 pit
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimens+ons:
❑ 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.):
Liquid level was observed 5-6" below inlet pipe. Town requires a minimum of 12" below inlet to pass
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
°M 46 Cedar Tree Neck Road
Property Address
Hobart Cook
Owner Owner's Name
information is
required for Marstons Mills MA 02648 March 17, 2014
every page. City own State Zip Code
Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
�r� Title 5 Official Inspection Form
r s! Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
\? 46 Cedar Tree Neck Road
Property Address
Hobart Cook
Owner -- --..........
Owner's Name
information is required for Marstons Mills MA 02648 March 17, 2014
every page. CitylTown State Zip Code Date of Inspection
D. System Information (cost.)
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
ok.,;
27
36
33 53
7 u
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
46 Cedar Tree Neck Road
Property Address
Hobart Cook
Owner Owner's Name --
information is
required for M'arstons Mills MA 02648 March 17, 2014
every 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: N/A
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:
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
46 Cedar Tree Neck Road
Property Address
Hobart Cook
Owner Owner's Name
information is
required for Marstons Mills MA 02648 March 17, 2014
every page. City own 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
l:
Town of Barnstable Barnstable
Regulatory Services Department
RIMNWABM
KAM
639. Public Health Division D
1`�-
' p 200 Main Street, Hyannis MA 02601 200�
Office: 508-862-4644 Richard V. Scali,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL # 7012 1010 00:00 2851 3771
May 22, 2014
Myrna&Hobart Cook, Jr.
% Lisa Gilman
23535 Windom Street
West Hills, CA 91304-5359
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 46 Cedar Tree Neck Road,Marstons Mills, MA, was last
inspected on 3/17/2014, by Patrick O'Connell, a certified septic inspector for the State
of Massachusetts.
The inspection of the septic system showed that the system" Fails" under the guidelines
of the 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool.
You are ordered to repair or replace the septic system within sixty (60) days from the
date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE BOARD OF HEALTH
Ltr not sent system
already repaired
Thomas McKean, R.S. CHO
Agent of the Board of Health
Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\46 Cedar Tree Neck Rd MM May2014.doc
capewide
ENTERPRISES, LLC
J.P. MACOMBER & SON •Since 1928
153 Commercial Street
Mashpce, MA 02649 ,tune 2, 2014
_ PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT:
I NAME: Hoby & Myrna Cook ADDRESS: Same as Opposite —�►
I ADDRESS: 46 Cedar Tree Neck Road
Marstons Mills, MA 02648
HONE: 508-420-6880 EMAIL: MacMyrna ,gmail.com
Capewide Enterprises, LLC proposes to furnish all materials and labor necessary to construct a
Title V septic system in accordance with 310 CMR: Department of Environmental Protection.
The
subject
1 property at 46 Cedar Tree Neck Road, Marstons Mills is afour-bedroom dwelling
!i with a design flow of 440 gallons per day.
i
Work To Include:
• Complete the permitting process using a customer supplied plan drawn by Ronald J.
Cadillac, dated May 23, 2014 and provide a disposal works construction permit.
• Pump existing leaching pit and abandon per Title V.
• Pump existing 1500-gallon septic tank as needed at time of construction, supplying
new sanitary tees and gas baffle as needed.
• A new distribution box will be set on a level mechanically compacted base per plan.
• Construct a new leach field in accordance with engineered plan.
• After town and engineer inspections the impacted area will be backfilled and graded
using existing onsite material.
Loam and seed or existing sod will be spread over all impacted grassy areas as
weather permits. "
Phone: 508.477.8877
Fax. 508.477.4977 Septic Contract,46 Cedar Tree Neck Rd 6/2/14
Rich@.Capewidefinterprises,com
1oaoCa Capew ideEnterprises.com
www-CapewideEnterpriacs.com Initial: fy
�T_
i
Work Not Included: (Unless otherwise noted in above included work)
Any inside plumbing.
• Movement of any large sub surface boulders or of any fences, sheds or other obstacles
that may be encountered.
• Movement of any underground utilities IE water, electric, gas, phone or cable. This work
would be performed by Capewide Enterprises for an additional fee.
• Any upgrades to electrical service
• Any representation at Board of Health or Conservation (i.e., variance, meetings, filing)
The material is guaranteed to be as specified, and the above work to be performed in
accordance with the drawings and specifications submitted for above work and completed in
a substantial workmanlike manner, for the sum of
With payments to be made as follows:
n signing
` l at start of work
ompletion
*Every attempt will be made to cut and re-use existing lawn. Loam and seed will be spread once;
Guarantee of growth and maintenance are the homeowners'responsibility.
-if irrigation repairs are needed additional costs will apply based on damage; or to be done by
homeowner's agent.
NOTE - This proposal may be withdrawn by us if not accepted within 30 days. Any alteration or deviation from
above specifications involving extra cost will be executed only upon written order, and will become an extra charge
over and above the estimate; payment for the extra is due in full before the change is made. Alterations and
deviations from the above proposal may be due to unsuitable/impervious soil conditions or water table elevations
I not being favorable. All agreements contingent upon strikes, accidents, or delays beyond our control. In the event
that any underground utilities are obstructing the system, the customer is responsible for the cost of resituating
them. We are not responsible for any irrigation lines, trees, bushes, shrubs, or plants unless specified in writing by
Capewide. Capewide Enterprises is not responsible for driveway damage due to the weight of
equipment/machinery. If the design plan uses the existing septic tank as part of new system, Capewide is not
responsible for the condition of the sewer line from the house to the septic tank. Customer will be responsible for
any additional costs if trench permit and trench protection are needed.
Capewide Enterprises, LLC
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereby accepted. You
are authorized to do the work as specified. Payments will be made as outlined above.
Customer Signature
� - � t ` Signature
9 v
Date G Q.
Authorized Ca wide nterprises Representative
Septic Contract,46 Cedar Tree Neck Rd 6/2/14
Initial:
C9
j
J �
i
June 17, 2014
Town of Barnstable
Mr.Thomas McKean, RS CHO
Agent of the Board Of Health
Regulatory Services Department
Public Health Division
200 Main Street
Hyannis, MA 02601
CERTIFIED MAIL#7012 1010 0000 28513771
Dear Mr. McKean:
We are in receipt of your May 22, 2014 letter. Your original letter went to our
Accountant in California and not our home or mailing address in Marstons Mills.
This is the reason for the delay in acknowledgement of your notice regarding the
repair to the existing Septic System at 46 Cedar Tree Neck Rd.
We have hired Capewide Septic Systems to repair, expand and install a new
Title V Septic system in accordance with 310 CMR Environmental Protection
Standards.
The design was done by Ronald J. Cadillac dated May 23rd, 2013 and provides
for a disposal construction permit. (see Enclosed Septic Contract). Cape wide
applied for the permit on June 5t"and has started construction yesterday June 16t"
at 46 Cedar Tree Neck Road in Marstons Mills.Ma 02648
Any further correspondence can be sent directly to our mailing address :
P.O.Box 416 Marstons Mills, Ma. 02648 or Home: 46 Cedar Tree Neck Road
Marstons Mills 02648.
Thank
Hoba rna Coo
46 Ceda ee Neck Roa
Marstons Mills,Ma. 02648
508-420-6880
From: Janine Govoni janine@capewideenterprises.com (f
Subject: Deposit Receipt 24673 from Capewide Enterprises,LLC
Date: June 4,2014 at 3:29 PM
To: Hobycook@gmail.com
Cc: MacMyrna@gmail.com
----- --- — _ -_-_—.__--------------------------------------------------------------------------------- ------- .......
Thank you!
Janine Govoni
Executive Administrative Assistant
Capewide Enterprises,LLC
(508)477-8877 x11
Cap wide rmterprises.LLC �+y`��y
LP.Dui wamheT&Sun 11®�I V i c e
153 CamioNcial Street
Ntasbpee,IAA 02644
Date Invoice No,
�� eil4T?014' .',,Ifi 3
Name
I laby&44yma Cook
46 Cadar Tree.Nick Road,
Dkf mluns Millis,MA 0264H
Job No. Terms
4043 due as agreed
i
Quantity D esarotlon !fate Antotartt
L T he V Seplic Syitem Uppadc aL 4fi Cedar,TmL Neck Rd,lbtarstans C50D..4I0 4 SQD.04
Mills I.p,.ff comiract relied tW-(L4) �
Signing.Depusil S4,500-1110
i
i
I
I
i -
i
I
i
i
i
I
i
Thank}asv Sur y-murfiusinessl
Total
All payments-ate due at liens afTmtilr7.
5a,54f�.110
A liic fee charge of3%per munlh will be charued to anyouisslandial;ha:lances that are runt paid
in full a,crunlino the puytncnllerm.above. Paymen Credluts 44,500,410
The cuYAortwr is responsible fur any legal.an"r colle.-liun fees,
A 9251XI iirc will he rhareed Gsr hnimeml check%.
Cash,check,mime}under and cxdWdebit cards an.acceplod. Iitl9SALCL°U'UG' OM
knune>k Fax-* £dnsil Web Me
1.5MA7744P7 1-368-477-497 7arvir.XgCapenidi!EniLLprises.coin 3��ti�v.Ca�ewnd LnCerrrises.cwn
From: Steve Goulet steve@capewideenterprises.com
Subject: irrigat on
Date: June 17,2014 at 8:17 AM
To: HobyCook hcook@zbrafish.com, HobyCook@gmail.com, Myrna Cook macmyrna@gmail.com
. --- -----. _ .. ....._.__
Hi Hoby & Myrna,
We had both crews at your house yesterday and again today. The irrigation was impacted as we
expected —seems like we hit every line we could have. I am assuming that Briggs will be
repairing? Could you contact them and give the Richard Capen's cell number [508-367-1802] (he
is one of the owners at Capewide and has been on-site during the installation) He has worked
with Briggs before and can coordinate the repair for you.
Not a problem with the credit card—those things happen in today's world of fraud. Everything
going very well so far with the installation.
Please respond so that I know you received this message.
Thanks,
Steve
Steve Goulet On-Site Consultant
Capewide Enterprises LLC 153 Commercial Street Mashpee MA 02649
508.477.8877 office 508.360.4994 mobile 508.477.4977 fax
-------------------------------------
wgN.CapewideEnterprises.com
Twitter•Facebook
From: Mail Delivery Subsystem mailer-daemon@googlemail.com
Subject: Delivery Status Notification(Failure)
Date: June 3,2014 at 9:27 AM
To: MacMyrna@gmail.com
Delivery to the following recipient failed permanently:
macmyrna@zbratish.com
Technical details of permanent failure:
Google tried to deliver your message,but it was rejected by the server for the recipient domain zbrafish.com by serverl.inboundmx.com.
[216.82.253.99].
The error that the other server returned was:
550 Invalid recipient<macmyrna@zbrafish.com>(#5.1.1)
-----Original message-----
DKIM-Signature:v=1;a=rsa-sha256;c=relaxed/relaxed;
d=gmail.com;s=20120113;
h=from:content-type:su bject:date:refe re nces:to:message-id
:mime-version;
bh=Ho6Td1 LZx+7VCYg8DU3E3X+uUuB4zopVXsOcCFd/aEO=;
b=bktOcX7ZOwYGkhEjb5B6PgxQxVM1 XzgeBcAQNipKWnbyPlJwhP+/bP6Et98bmD1 i+K
Q K213G VuAZ+gjV2541 h/6teLZkBD76Vtkz DW ptnzl BvztG YCw+DNarPaZjQiQ U9 EFt2 K
Z77RJeYgoDs9MTJOgMDbMioy0al4A28xXV5aYKV5w8G1GOfHioql53tcc9M1 nzPA/LZO
cOCgZbfxMRiLgWQSDo9xX18R8nemSYpaRz8HjpaKH9XHGE7vOwpxzxtNKWg+GVgXfzHQ
GMiG0+0OT4Y13Z16G1 ZRGo+tXQWveNwVJnFIHrE3NUEAy3igFwSQfprnxNNO73xUoC/A
armg==
X-Received:by 10.224.130.196 with SMTP id u4mr62829830gas.13.1401802024255;
Tue,03 Jun 2014 06:27:04-0700(PDT)
Return-Path:<macmyrna@gmail.com>
Received:from macookmb.home(pool-71-178-47-172.washdc.fios.verizon.net.[71.178.47.172])
by mx.google.com with ESMTPSA id 6sm26681035gam.44.2014.06.03.06.26.51
for<multiple recipients>
(version=TLSvl cipher=ECDHE-RSA-RC4-SHA bits=128/128);
Tue,03 Jun 2014 06:27:00-0700(PDT)
From:MACMyrna<macmyrna@gmail.com>
Content-Type:multipart/alternative;bound ary="Apple-Mail=_8CC44C01-2F5D-4DED-9ED4-55DECF34A6AD"
Subject:Fwd:46 Cedar Tree Neck Road
Date:Tue,3 Jun 2014 09:26:50-0400
References:<000001 cf7ea3$Of3ed9e0$2dbc8da0$@capewideenterprises.com>
To:Hoby Cook<hcook@zbrafish.com>,
macmyrna@zbrafish.com
Message-Id:<7F009434-4FD8-46B5-A072-72AB35195615@gmail.com>
Mime-Version:1.0(Mac OS X Mail 7.3\(1878.2\))
X-Mailer:Apple Mail(2.1878.2)
Begin forwarded message:
I `
From:"Steve Goulet"<steve@capewideenterprises.com> �.
Subject:46 Cedar Tree Neck Road
Date:June 2,2014 at 4:41:41 PM EDT
To:<macmyrna@gmail.com>
Myrna&Hoby,
Attached is.the proposal to repair the septic system at 46 Cedar Tree Neck Road. Sorry for the delay in getting this to you. I wanted to
make sure the owner visited your property to view the site conditions ahead of submitting the quote. We hope to be able to limit the impact
on the grounds by cutting and removing the grass in the area of the trench if possible. We will need to locate the private gas line which
goes to the pool house. Upon completion and inspection,the area of the new leaching field will be covered with loam and seeded.
Should you have any questions on the proposal or the process,please contact me. If you wish to move forward with the repair,we require a
signed contract and the appropriate signing payment of$4,500.00. The project would then be scheduled based on your preference and our
availability.
Regards,
Steve
Rtava r;nnlat On_Rita(`nncukant
1
Capewide Enterprises LLCV 153 Commercial Street Mash pee MA 02649
508.477.8877 office 508.360.4994 mobile 508.477.4977 fax
-------------------------------------
www.Capewide Enterp rises.com
Twitter'Facebook
I
K
From: Myrna Cook macmyrna@gmail.com
Subject: Re:add'I paperwork
Date: June 6,2014 at 1:01 PM
To: Steve Goulet steve@capewideenterp rise s.corn
Ok Steve will take care of this as soon as possible.
Sent from my Phone
On Jun 5,2014,at 12:49 PM,Steve Goulet<steve@capewideenterprises.com>wrote:
Hoby&Myrna,
I was at Barnstable BOH this morning to permit the installation. It seems
that the engineer did not you sign the appropriate paperwork for a plastic
I......L;....l:..IA TL:..:........-11...l......L..•L.....................1....L-..:w....l�..♦L..
c See More
Hoby&Myrna,
I was at Barnstable BOH this morning to permit the installation. It seems
that the engineer did not you sign the appropriate paperwork for a plastic
1�....L:....f:..1.J TL:..:..........II...J..-...1-
<http://www.capewideenterprises.com/>
www.CapewideEnterprises.com
<http://www.twitter.com/CapewideEntrprz>Twitter.
<http://www.facebook.com/pages/Capewide-Enterprises-LLC/243209232398118>
Facebook
sRtnnrfarrl(.nnAtinnc nrlf�
r
I�
<ADS Products 11APRIL2014.pdf>
<ADS owner acknowledgement.pdf>
<Homeowner Certification Form for Alternative Systems_Cook.pdf>
Town of Barnstable �as
Departiment of Regulatory,services
L. f Public Health Division )date 2 Z
rsyp. a� 200 Main Street Hyannis MA 02601
lfC)MAC AAA
S i
Date scheduled
Time Fee Pd. �
Soil Su tabil Assessment for SeI3 Dzs o � -
Performed By: 6 �e�/�� V
Y - �� � t �.4�/�> Witnessed By:
LOCATION&
Location Address CtG/�- Tree / 1 Owner's Name /yo�t�r f i!' /yt
. ✓//�•S 9V S �J`S Address61
Assessor's Map/Parcel: C 7 5 ^Q 7_6 /� �q D
Engineer's Name Z
1 IEW CONSTRUCTION REPAIR V Telephone# So 77 S- q 76 Q
Lund Use r'S/ P/1/hif Slopes(96)
Surface Stones
Distances from: Open Water Body ft Possible Wet-Area
ft Drinking Water Well ft
Drainage Way ft Property Line ft Other
ft
kj'(Ml_TC1_1'(Street name,dimensions of lot,exact locations of test boles&pern tests,locate wetlands jn proximity to holes)
.Lot
r t --for
ro01
_
s Z7- \
a gip,,; em.y
I; 44
N
G 3ee'Igo
� /
✓ /gyp _ v� 6.u"i
Parent material(geologic) �(�j /� Depth to Ovlroelt
Y �7
Deptli to Omuudwater. Standing Walerin Hole: Weeping f-otrl PI P110e
Estimated Seasonal High Groundwater r� /
DE,TE,RMINATION FOR SEASONAL111011 WATER TABLE
Method Used:
Depth Observed standing in obs.hole: la. Depth to soil mottles:
Dcrtb to weeping from side of obs.hole: hl, Groundwater Adjustment
Index Well# Reading Data; index Well level Adj,tttetor_ At�•Urnuudwatcr Level Fa
Observation #2: f
Hole It
Time at g"
Depth of PeroFVa !l Time at G' _
Start Pre-soak Time @ 3 0264: Co �� � Time(9"-6")
Had Pre-soak ` No 7'l/II.,j
Rate Min./Inclt 2�IfNl /N
Site But Assessment; Site Passed v Sitp Palled: Additional Testing Needed(Y/N) /t/
Original: Public Health Division Observation Hole Data To Be Completed on Bacic-----------
4'"If percolation test is to be Conducted within 100' of wetland, you njuSt first notify tile.
Barnstable COusel-vation Division at least one (1) week prior to beginniug-
Q\S EPTY--WER CPO RM.DOC
D I EP.OkBSERVATION HOI.,a, LOG Hole# 1
Depth from Soil Horizon Soil Texture .A) Shcl Color Soil Other
Surface(In.) (USDA) (Munsell
_ ) Mottling (Slnucture,Stones;boulders.
onsistency,qb"Gravel)
Si
Z.? 36 j/ 07- s, io'f,-q, O 518
DI CI>CP OBSERVATION HOU, LOG Hole# 2-
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottlin
g (Structure,Stones,Boulders.
o sisten % ravel
-32
DE, EP OBSERVATION HOLE' LOG Hole#
Depth from j.Soil Horizon Soil Texture ., Soil Color Soil Other
Surface(in-) ; (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,4'n Oravol)
'I-/ /7 _
0
36�-.5'? t �� l /
it-
z -1 mod, 44) S
t
DE EP'OIBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(In.) 1 (USDA) (Munsell) Mottling (Structure,StoneB,Boulders,
Consistency. 6 a
GUM
Flood Insurance hate Map:
Above 500 year flood boundnry No— Yes
'Within 500 year boundary No Yes "
Within 100 year flood boundary No— Yes
Depth of Naturatly Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? Y 6�
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on Mitt. )9 I3(date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
the required gixpertise and ex ence descrWeed in 10 CMR 15.017.
Signature Date
Q:\S-EP-rlC\PP-RCF0RM.D0C
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department of Environmental Protection
One Winter Street, Boston MA 02108 (61 n 292-5500
TRUDY CORE
Secretary
ARGEO PAUL CELLUCCI DAVID B.9MUHS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 46 Cedar Tree Neck Road Name of Owner: John Langston
Marstons Mills, MA Address of Owner:
Date of Inspection: March 8, 2000
Name of Inspector:(Please Print) James M. Ford
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
Company Name: James M. Ford
Mailing Address: P.O. Box 49, Osterville, MA 0265S-M9 Map;
Telephone Number: (508)862-9400 Parcel.
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
✓ Passes
Conditionally Passes
Needs Further Eval 'on By the Local Approving Authority
ails
Inspector's Signature: Date: March 9, 2000
The System Inspector shall submi copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection. The original should be sent to the
system owner and copies sent to the buyer,if applicable,and the approving authority.
NOTES AND CONRAENTS
;y
p 401
T04;,.o. 20�
o
revised 9/2/98 Page Iof11
Printed on Recycled Paper
T
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 46 Cedar Tree Neck Road, Marston Mills, MA
Owner: John Langston
Date of Inspection: March 8, 2000
INSPECTION SUMMARY: Check A, B, C, or D.
A. SYSTEM PASSES:
I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure
criteria not evaluated are indicated below.
COMMENTS:
B. SYSTEM CONDITIONALLY PASSES:
One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon
completion of the replacement or repair,as approved by the Board of Health,will pass.
Indicate yes, no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not.
_ The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or
the septic tank,whether or not metal,is cracked, structurally unsound,shows substantial infiltration or exfiltration,or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health)
broken pipe(s)are replaced
_ obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
revised 9/2/98 Page 2of11
I 1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 46 Cedar Tree Neck Road, Marston Mills, MA
Owner: John Langston
Date of Inspection: March 8, 2000
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public heath, safety and 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 THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND
THE ENVIRONMENT:
The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the
well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm. Method used to determine distance (approximation not valid).
3) OTHER
revised 9/2/98 Page 3of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 46 Cedar Tree Neck Road, Marston Mills, MA
Owner: John Langston
Date of Inspection: March 8, 2000
D. SYSTEM FAILS:
You must indicate either"Yes" or"No"as to each of the following:
I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this
determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged 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 '/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 Soil Absorption System,cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone 1 of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
You must indicate either"Yes"or"No"as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-1WPA)or a mapped Zone H of a public
water supply well
The owner or operator of an such system l in ope shall de the system t accordance with 310 CMR 15.304(2). Please consult the local regional
Y Y upgrade Yeg
office of the Department for further information.
revised 9/2/98 Page 4of11
Y
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION. FORM
PART B
CHECKLIST
Property Address: 46 Cedar Tree Neck Road, Marston Mills, MA
Owner: John Langston
III Date of Inspection: March 8, 2000
I �
Check if the following have been done: You must indicate either"Yes"or"No" as to each of the following:
Yes No
✓ _ Pumping information was provided by the owner,occupant,or Board of Health.
*✓ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow
rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection. (*House was vacant)
✓ _ As built plans have been obtained and examined. Note if they are not available with N/A.
✓ The facility or dwelling was inspected for signs of sewage back-up.
✓ _ The system does not receive non-sanitary or industrial waste flow.
✓ _ The site was inspected for signs of breakout.
✓ _ All system components,excluding the Soil Absorption System,have been located on the site.
✓ _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for conditions of baffles
or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
✓ _ Existing information. For example,Plan at B.O.H.
✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)
[15.302(3)(b)].
✓ _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of
SubSurface Disposal Systems.
revised 9/2/98 Page 5of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 46 Cedar Tree Neck Road, Marston Mills, MA
Owner: John Langston
Date of Inspection: March 8, 2000
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 110 g.p.d./bedroom.
Number of bedrooms(design): n/a Number of bedrooms(actual): 3
Total DESIGN flow n/a
Number of current residents: 0
Garbage grinder(yes or no): Yes
Laundry(separate system)(yes or no): No; If yes,separate inspection required
Laundry,system inspected(yes or no): No
Seasonal use(yes or no): No
Water meter readings, if available(last two year's usage(gpd): 1999-55,000 gals.: 1998-44,000 gals.
Sump Pump(yes or no): No
Last date of occupancy: Unknown
COMMERC MV INDUSTRIAL:
Type of establishment:
Design flow: end(Based on 15.203)
Basis of design flow
Grease trap present: (yes or no)
Industrial Waste Holding Tank present: (yes or no)
Non-sanitary waste discharged to the Title 5 system: (yes or no)
Water meter readings, if available:
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
None on file-per Treatment Plant
System pumped as part of inspection(yes or no): No
If yes,volume pumped: gallons
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)
I/A Technology etc. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components,date installed(if known)and source of information: _Approx. 1985-per as built card.
Sewage odors detected when arriving at the site: (yes or no) No
revised 9/2/98 Page 6of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION
C ON FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 46 Cedar Tree Neck Road, Marston Mills, MA
Owner: John Langston
Date of Inspection: March 8, 2000
BUILDING SEWER: _
(Locate on site plan)
Depth below grade:
Material of construction: _cast iron _40 PVC _other(explain)
Distance from private water supply well or suction line
Diameter
Comments: (condition of joints, venting,evidence of leakage,etc.)
SEPTIC TANK: ✓
(locate on site plan)
Depth below grade: 14"
Material of construction: ✓concrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal, list age_ Is age.confirmed by Certificate of Compliance_(Yes/No)
Dimensions: 1500 gal.
Sludge depth: 3"
Distance from top of sludge to bottom of outlet tee or baffle: 29"
Scum thickness: 5"
Distance from top of scum to top of outlet tee or baffle: 9"
Distance from bottom of scum to bottom of outlet tee or baffle: 10"
How dimensions were determined: Measuring stick
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.) The baffles were present. The liquid level was even with the outlet invert. There were no signs of leakage.
GREASE TRAP: None
(locate on site plan)
Depth below grade:
Material of construction: concrete _metal _Fiberglass _Polyethylene _other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage,etc.)
revised 9/2/98 Page 7of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 46 Cedar Tree Neck Rand, Marston Mills, MA
Owner: John Langston
Date of Inspection: March 8, 2000
TIGHT OR HOLDING TANK: None (Tank must be pumped prior to,or at time,of inspection)
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm present:
Alarm level: Alarm in working order: Yes_ No
Date of previous pumping:
Comments:
(condition of inlet tee,condition of alarm and float switches, etc.)
DISTRIBUTION BOX: ✓
(locate on site plan)
Depth of liquid level above outlet invert: —
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) The box was located, but not
du.e up.
PUMP CHAMBER: None
(locate on site plan)
Pumps in working order: (Yes or No)
Alarms in working order: (Yes or No)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
revised 9/2/98 Page 8ofit
f
is
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 46 Cedar Tree Neck Road, Marston Mills, MA
Owner: John Langston
Date of Inspection: March 8, 2000
SOIL ABSORPTION SYSTEM(SAS): ✓'
(locate on site plan, if possible;excavation not required, location may be approximated by non-intrusive methods)
If not located,explain:
Type:
leaching pits, number: 1-6'x 6'
leaching chambers, number:
leaching galleries,number:
leaching trenches,number, length:
leaching fields,number,dimensions:
overflow cesspool, number:
Alterative system:
Name of Technology:
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.)
7hepit was dry. There were no sirens of failure. The bottom to grade was 11'. Recommend installing risers.
CESSPOOLS: None
(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(cesspool must be pumped as part of inspection).
Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.)
PRIVY: None
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.)
revised 9/2/98 Page 9of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 46 Cedar Tree Neck Road, Marston Mills, AM
Owner: John Langston
Date of Inspection: March 8, 2000
Map:
Parcel:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
(f1G�
3
A
-rW' O d
3 a �
y
A l - 35'
61 . 30
Aa-
A3- ay
r33- 3
Ay- 33
revised 9/2/98 Page 10ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 46 Cedar Tree Neck Road,Marstons Mills, MA
Owner: John Langston
Date of Inspection: March 8, 2000
NRCS Report name
Soil Type
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Groundwater Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
✓ Observed Site(Abutting property,observation hole,basement sump etc.)
Determined from local conditions
Checked with local Board of Health
Checked FEMA Maps
Checked pumping records
Check local excavators, installers
✓ Used USGS Data
Describe how you established the High Groundwater Elevation. @Lust be completed)
Hand augered down in the middle of the pit to 16', and no rater was observed. Using the Cape Cod Commission Technical
Bulletin, the high groundwater adjustment for this site(MIW 29, Zone C, 2100)was 4.7'.
i
This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty
or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,
written or implied, relating to the system, the inspection and/or this report.
revised 9/2/98 Page 11of11
TOWN OF BARNSTABLE
�fX wTICN�� G9r -� Ar—car` R-d SEWAGE #
rr LAGE M. mAs ASSESSOR'S MAP & LOT
i
I14STALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) 1�T (size) (.X(p
NO. OF BEDROOMS 3 11
BUILDER OR OWNER 5Oh6 1,4AGST0^
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
aAcj�
A
0 Al , 3S"
Aa- a-7
i0.'S- �H,
a3- s3
33
i
L-A.5CAT10N �� SEWAGE PERMIT NO.
Y:ILLAGE
INSTALLER'S NAME i ADDRESS
"ll U I L D E R OR OWN ER
DATE PERMIT ISSUED /o-��---
DATE COMPLIANCE ISSUED
�i
1
'� Z eel 1:a Ile
)OTo.. q,00a � Fm:$ . .......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
------- . ./....................OF......�q 5-T J-- ..................................................
ApplirFation for Disposal Works Tnnstrnrtinn Frrmit,
Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal
System at:
..lam... c � x �k. �- C0f><c,. .. 1 ., ----------------
Location-Address /��/ � or Lot Nay A y
_ ------------•--••----•---------- ...A2.----J.. I.V. ---•- d(d�ll,�S._.....LFi1l�iu�.
...... ` .... EE ...______ 4. .�
r�er Addre�s
al.. 004;6i,r.�P?n-•---------------•------ ............. ......1Q'..11.S-------•__-_____-___----------•--•-
Installer Address
QType of Building Size Lot___if.7t.12t!;.......Sq. feet
V Dwelling No. of Bedrooms._____ _Expansion Attic Garbage Grinder
p4 Other—Type of Building ............................. No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------------------------------------------•-•-----••-------- - -
W Design Flow.........11�!___________________________gallons per person per day. Total daily flow-.-....__..7-3.......................gallons.
WSeptic Tank—Liquid capacity_/12�v.gallons Length_-_-tJ___._-__ Width----!-_-_...... Diameter---------------- Depth................
x Disposal Trench'—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed bY---------------------------•---•-•--•-•----•--------•-•-..------- •----- �te--•----------•••-•-•-------•-----------
,aa Test Pit No. I..... ......minutes per inch Depth of Test Pit------.Jg_e 7__. Depth to ground water.--?......:..........
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ---•-------•----------------------------------- ----•----------........-••------•---------•-----••--.....................................
- -----------
ODescription of Soil........ 1-�- w x�---•- - -----------------------------•-----•----------------•-•-------- ------------
x
V ..............................................-----------•-•--••------•-••---------•-----•-•-•---------------•-••-------._...---•-------------•---••------•-------•-----------------•---•-•••----••-----
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 TLI'LLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health
O
S- ne _�.. .----•.......................... . ..�
Date
Application Approved BY - .= . . ..........
Da
Application Disapproved for the following reasons:----__•________________________________________________•----__-_-_--_-________-••------------_-._____.....-....-
....................................•-------•-•---••-----••-•------------..._.._....---...-•---.....•-•=--•-•-•---••---•-•----•--------------•--...•---•--------------•---------•••------------••---•---
�{� Date
Permit No:__.. /Qom_ ------------- Issued__•________________-
- -••- Date
No. .H:JL)I_Er Fns.Z ...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
ApplirFation for MipmFai Works Tonotrurtion rrmtit
Application is hereby-made for a Permit to Construct or Repair ( ) an Individual.Sewage Disposal
System at:
_---
Location-Address or Lot No.
Z. i.. ..--- -------------- --------------------------------------•---.....------•---------.........._..---............_------
•
f9er Address
°A 'n --------------------------------------------- ------------------------------------------------------------------------------------•--...----....
Installer Address
Type of Building Size Lot............................Sq. feet
V Dwelling No. of Bedrooms._.._ _ .Expansion Attic Garbage Grinder
aOther—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( )
a' Other fixtures ...................------•..... .
Design Flow.........................................:..gallons per person per day. Total daily flow.....
W ------.../•••-••--•-•-gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter..............`.Depth................
x Disposal Trench—No................. --- Width...:............... Total Length.___...__........._. Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.........._......... Depth below inlet.................... Total leaching area..................sq. ft
Z Other Distribution box ( Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. .1................minutes per inch Depth of Test Pit.................... Depth to ground water-__----____-______-•___.
(i Test Pit No. 2...............,.minutes per inch Depth of Test Pit.................... Depth to ground water___.............._..___.
a •---•-•-----------------------------•-----.....----------------•-••---------•---.....----•--•--•----.........................................................
0 Description.of-Soil.....................................................................-•--------------------••-----•-----•-••----••--•-••-•---------•.................................
M
W
VNature 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
i ned......................
.
- -------------------•--•------------••------- ---- ••-------------------•--
r Date
Application Approved By..........._
----- .---�----=
D aie
Application Disapproved for the following reasons---------------------------------•-----------...-----•---------•--------------..................................
---------•------------•------•-----------•------------------••----------....--•--•---------....._._.......__....._._..._......---•---------•----.......------------------------------------------•-•-----
E 0 Date
Permit No .=I .......f.. ...':":_._..----------. Issued---•---•-------•--. ...............................
.. � Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
a.
. ..........................................OF.....................................................................................
Tntif iratr of Bout haurr
THIS IS TO CERTIFY, That the'Individual Sewage Disposal System constructed (NQ) or Repaired ( )
byc. ..: ......_..-•••-•-•••-•--•-•-•-•--•-•----•-•----••--•---•-••••--•--•---•--•-•--•••-•-•- - ... •-•-•-•-••--
InsUaller A -
lfC T�.
has been installed in accordance with the provisions of TIT 5'of The tate Sanitary Co as. cr' ed in the
application for Disposal Works Construction Permit No-------- _ __-:_` ?.i1 _._ dated__..-_"__ __ � _ _________________
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST E AS A71�0 AN EE THAT THE,
SYSTEM WILL FUN TIO SFACTORY.
DATE..................".t........ .:.-... _=--------•----••---•-•-•---• Inspector...................--•- •--==--•----•----•--•-----...--•--- ................. t
THE, COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
'd ...................OF.......................
No......................... FEE...
to outtl rko Tonstr ion rrutit
Permission is hereby granted......... .Q,I_ . e ________________
to Construct (at 7or:..Repair (_ ) an Indiv1.u Se ra a Dispos ,System
----•••.....••--- -------• -•------•----••-•--- --•--•--•-•-•-•--------------•-•-••----_..
Street
as shown on the application for Disposal Works Construction Permit No. _""! Dated.._.J `'......................
.. .................•--------------------------••-------•-•••-•_..
Board of Health
DATE........................................
.......................................
FORM 1255 A. M. SULKIN, INC., BOSTON
�jt 1,.16.1� tr AMtI.� � 3 �>Z�OM •� ,.i '�Y �:•�
►.1
G TAtJ K a 33D,r I riU % • A-9 5 6.P.G.
u"M_ tool 6A1_. • i ;. :
5P AL
-",-U"VALL l.¢.F�► s l5D b F. ; f �,.i '- :_:.;:,4-
� Irmo SF' .c 2.S • �1S G.P.D. f. i ;- , �-
B�TTt7.vt
SO o
TC?'A L "D E-S1GIJ = 425 G..p n.
-MT,4 L 'OA►L-( F'Lwl/ * 330 dxPD.
f Ptwe-oLdT1oo RATE : Cto 2.M►W*Otz Um..
C.
h r E .,► M� . i qL oo•
no 11s31
a
3 Z fr6 ^ r�•��'i-...�'• �..nog
�••►a J'Pv�.
sys ao��. 4'�PB I;t,-•Y 1►.v. Gp�. 31.10 _
f fox 31.$ ScQnr Iv
,�0• 3 INV. c TA�1K
I o00 ZY.(, lwv. 1'ry i
GAL. 3i.lo �1.30 ,
rlavuvq LsAir-&4 ;
FT
�Nsa WIr"
w,os+•+sD
-sr 064F-- Z3_ G
I _ C-El.c?TIFIt.r.-.._ PL C> r Pt...AW
PtzoF'1L.� i LoCATICI�-J NIARSTONS M��S
U o �c Aga✓- A1.r A S ?1OT LDIZ L`"
NO W^TE gEU 1U•1(.
PIZOPoa:6 F- �D PLAt•.1 Ki= 2Et�1t:E.
Gt,�zTl1=� '�FtAT TN�'FovN��.'c►o►�S��c ,U --
14 1U:mow GcokPL.q6 � W 17►••i T►•a;Z: •$I L E.LI►••iE: LOT $ • •
UI�Gd/tcuTri OF µ� � � t
Aun 7cTL CK: �cQ i 01_-0 po S
�' T LP��1DI to G,
Tow►J 0; T
SXX%S &Z>LE- +
►(�•1-1�84-- �c:l��C`=��:.D 1-A.:-!U ''i u e V�::`/o�S'
TI-Al5 17I..Aa-I I i LIOT L' ASG1D CL-a A&J GST:.�V►l.tC: o h:�.5�..
iwoi; 'ZL1ML:I.JT � TlaL: e,-4cwLD
►•J L Lour l_I Ni=�� L----—--=----- 2,��..J -�I
r
r T7
3 )
O O
o ,
Ali � / � / ► ` - , . � _ ���: :
tUul% P
`�
TAN � 1
74
.�.z
PLAN _ :
` ScALC
.
LOT 8 '
)L POSE' LANDt
is
Fee------------ -------
BOARD OF HEALTH
TOWN OF BARNSTABLE
TippIication-for lVell Con0ructionpermit
Application is hereby made for a permit to Construct ( , Alter ( ), or Re it ( . ) n individual Well at:
- ------------------ —------—------- ----
-------------------------------------------
Location — Address Assessors Map and Parcel
--------------------- --------------------- Y6- Ce c-----� -R -K'ec L( ------------
Owner Address
- _- - -
Installer — Driller Address
Type of Building
Dwelling---------------------------------------------------------
Other - Type of Building No. of Persons--------------------------------------------------------
Type of Well_- _ J C----------------------------------------------- Capacity--------------------------------------------------
-------------------------------
Purpose of Well! r!�� Q�*?__A_ �f-------------------
Agreement:
The undersigned-agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Certificate f Com 'ance has been issued by the Board of Health.
Signed "'
--- -- -- - ---- --- -G Y -
date
Application Approved By-- ----------------_- - — --
date
Application Disapproved for the following reasons:-----------------------------------------------------------------------------
---------------------------------------- ------------------------------------------------------------------------------------------
date
f ��
Permit No.-----#�----�'--- '��-�----------------- Issued--------------- _------ +�-------- 4e,
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS TO CrTIFY, T the Individual Well Constructed ("j, Altered ( ), or Repaired ( )
----------------------_ — —- - —-------------------------------------------------------------- --- -----------------
Instal►er
atl/-------e---"J- ------------------------------------------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit Nar- "-- Dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE---------------------------------------------------------------------------------------- Inspector—----------------------------------------------------------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Yell Con5tructionpermit
--
/ _
No. - --- --- -- Fee-------------------
Permission is hereby granted--N-7-!= �4'�' - ' -------------
to Construct Alter ( ), or Repair ( ) an Indivi ual Well at:
No. -------- -------------------------------------------------------------------------------------------------------
Street
as shown on e a plication for a Well Construction Permit
No.— Dated --G� -` - � --� = - - -
- - -`------------------ ,
DATE-------------------------�`----� -
��. ----------------
Board of Health
�--
No.- --��-- � Fee---��--'7---- ?3
BOARD OF HEALTH
TOWN OF BARNSTABLE
0[pprication-*rVell CootructionPermit
Application is hereby made for a permit to Construct ( �, Alter ( ), or Rep it ( )an individual Well at:
�. '` - e �>' ! -1-r�_ ? �--------------------
Location — Address /Assessors Ma and Parcel
-------------------------------------------------—-----------------------—--------------- ---------------------------------------------------------------------------------------
r )/,� Cc Owner q Address
L/—_•JC�I.�_f-fi r==�-//-----------------------------
Installer — Driller Address
Type of Building
Dwelling---------------------------------------------------------------------
Other - Type of Building----------------------------------- No. of Persons---------------------------------------------------------
Typeof Well ---------------- ------------ Capacity------ -------------------------------------------------
Purpose of Well-ILL
�_<.,_tv=3
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Certificate pf Com 'ance has been issued by the Board of Health.
Signed � ---------------------------------- y------- --- --------
date
Application Approved By - -- - - - � _ -4_-�--�
date
Application Disapproved for the following reasons:-----------------------------------------------------------------------------------------_-_--------
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
�,/ date
Permit No. -- /1/G- � -------- Issued--- - ^------------��--7------------------------------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed (v'), Altered ( ), or Repaired ( )
bY-------- --------------------------------------------------------------------------------------------------------------------------------------------
Installer
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection y
Regulation as described in the application for Well Construction Permit Nc�/-'-'-c�jl�- -Dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-------------------------------------------------------------------------------------- Inspector----------------------------------------------------------------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
lVell Con5truct ion Permit
No. -- ------------- ----- Fee-
Permission
f� SC4 ti.
Permission is hereby granted--�9--'-=-----------`-=`---`'---�=--------------------------------------------------=---------------------------------------------------
to Construct ( -; Alter ( ), or Repair ( ) an Individual Well at:
Street
as shown onn the application for a Well Construction Permit �
60
---4,mt--y-4----------------------------
Board of Health
�' '--- --- t�__-`------��---r� --------------------
DATE----------------------
JOB NO. B14-03 0
LEGEND TEST HOLE 3 TEST HOLE 4 NOTES COOK.DWG
N/F 1. LOCUS IS A.M. 075, PARCEL 028. FB30/7 SB 13/46 y
TH 1 TEST HOLE LOCATION, NUMBER CONDON DEPTH (inches) ELEV.(feet) DEPTH (inches) ELEV.(feet) 2. ELEVATIONS SHOWN ARE APPROXIMATE NAVD88 BASED UPON TOWN GIS. a
�/ WATER LINE MARKINGS REDUCE GRADE TO KEEP COVER TO MAXIMUM OF 3 p 24.0 p 23.7 3. LOCUS IS IN FLOOD ZONE C ON FIRM DATED JULY 2, 1992.
L NEEDED 20 OF FILL MAY NOT EXIST WHERE 4. ALL PIPES TO BE 4 SCH 40, AND PITCHED AT 1 4 PER FOOT. UNLESS NOTED
--UE ESTIMATED LOCATION OD UNDERGROUND ELECTRIC rk� Fill Fill �� ��
� LEACHING IS SITUATED. RAISE CHAMBERS AND D-BOX / ( )
G CAUTION ESTIMATED GAS LINE �`'�,�0,5 IF SAND C LAYER IS HIGHER. 20 A layer 10yr 3/4 20 A layer 10yr 3/4 5. MUNICIPAL WATER IS AVAILABLE. LOTS WITHIN 100' ARE ON TOWN WATER.
sandy loam sandy loam 6. COMPOINENTS TO BE AASHTO H-10, UNLESS NOTED.
9.5 x $,7 EXISTING & PROPOSED ELEVATIONS ('X' MARKS POINT) 36" 36" 7. INLET 'TEE TO PROJECT DOWN 13", OUTLET TEE DOWN 14". �
EXISTING CONTOUR B layer 10yr 5/8 B layer 10yr 5/6 8. IF TWO) OR MORE LINES, WATER TEST D-BOX FOR EQUAL FLOW
sandy loam sandy loam D-BOX; EXIT PIPES TO BE LEVEL FOR FIRST TWO FEET.
g PROPOSED CONTOUR 52 19.7 52 19.4 ,. 2
9. DEPTH OF COMPONENTS NOT TO EXCEED 3 , OR VENTING MUST BE PROVIDED. NOT TO
0 UTILITY POLE (IF SHOWN) COVERS: BUILD UP COVERS TO 6" BELOW GRADE--2 ON TANK, 1 ON D-BOX, 2 ON LEACHING �� SCALE
® EXISTING DRAINAGE CATCH BASIN 22 »n 10. STONE TO BE DOUBLE WASHED 3/4 TO 1 1/2 WITH 2" MIN. 1/8 TO 1/2" PEA STONE ON TOP. LOCATION MAP
BENCH MARK-TOP, BACK, CENTER 19 2 66 C layer 2.5 6/4 C layer 2.5 6 4 11. IF UNSUITABLE SOILS, OR SOILS DIFFERING FROM THE SOIL LOG ARE FOUND,
x FENCE (IF SHOWN, NOT ALL SHOWN) 0.0 SEPTIC TANK= 31.72 NAVD88± y y / y y / CONTACT THE BOARD OF HEALTH, OR R.J. CADILLAC.
med. coarse sand med. coarse sand
0TREE (IF SHOWN, NOT ALL SHOWN) 12. IF AN OVERDIG 15 CALLED FOR BELOW, FILL MATERIAL FOR 5' AROUND AND UNDER LEACHING
28,1 NOTE: 3 DRY WELLS SET 4' APART ��, IS TO BE CLEAN GRANULAR SAND MEETING SPECIFICATIONS OF 310 CMR 15.255(3).
x 4 6 BENCH MARK--TOP SPIKE SET WITH 4' OF STONE ALL AROUND uo ��. TEST HOLE 1
43.4 COULD BE INSTALLED IN THE SAME �3` 13. PUMP AND FILL .ANY EXISTING CESSPOOLS. REMOVE ANY CLOGGED SOIL, BLOCK, AND STONE IN
DOWN 1" = 31.74 NAVD88± LOCATION. (41.5' X 13' X 2' DEEP oo. '� LEACH AREA, AND DISPOSE OF AS DIRECTED BY HEALTH AGENT. DEPTH (inches) ELEV.(feet)
(11 -3" Off Deck corner, 45-6" off Well) =560 IGPD) USE SAME INVERTS. 14. ALL C(ONSTRUCTION TO MEET TITLE 5 AND LOCAL REGULATIONS.
132" no water 13.0 132" no water 12 7 0 24.0
x 23,2 x 2�C2 A layer 10yr 2/1
TEST HOLE DATE: May 8, 2014 lilt sandy loam
PRIVATE LINES & CONNECTIONS: 22 BENCH MARK-TOP REAR CENTER PERFORMED BY: Ron Cadillac, Soil Evaluator B1 layer 10yr 4/6
SEPTIC 'TANK = 31.72 ASSIGNED WITNESSED BY: Donna Miorandi, RS sandy loam
1. UNMARKED GAS SERVICE CROSSES 22
/x x 23.2 18,3 REDUCE GRADE FOR PERC RATE: <2'-00"/inch (C layers) B2 layer 10yr 5/8
PROPOSED SEWER LINE. x 24,5 SOIL SURVEY(1993): Carver loamy coarse sand sandy loam
2. LOCATION OF WATER SERVICE TO `� `� `� 3' MAXIMUM COVER GEOLOGIC MAP 1986 : Mash pee pitted lain deposits 36" 21.0
POOL NOT KNOWN--SLEEVE ANY � x 47,7 ° � �AF.S�?A \T 3 �o N/F OVER LEACHING ( ) P P P P
SEWER WITHIN 10' OF WATER. RUGG
TER DISCONNECTING GARBAGE � x 3 ,o 2'3 ��� Invert 30.30 32--ADS ARC 36HC CHAMBERS �
3. AFTER 26' �`,TH 4
DISPOSAL HAVE PLUMBER CHECK 2 ,4 `> Existing (H-20) C layer 2.5y 6/4
TO MAKE CERTAIN IRRIGATION Use Gas Baffle
26 j Invert 19.74 Top Units=20.1 medium sand
. 2 13 cover
WATER IS NOT CONNECTED TO HOUSE. 28 x 23.0 x 20.8 Proposed 0 Filter Cloth
IF CONNECTED TO HOUSE MAKE SURE �' ,10 Existing S=1"/ft avg. 3 Max.
vert 30.51
BACKFLOW PREVENTION DEVICE IS 32 9 .2 32,1 , Inn 1500 Gal. � 2 Inspection Ports
2 RECOMMEND A VERTICAL 45'
IN PLACE TO INSURE LAWN CHEM-
ICALS c�� 3 BEND FOR MOST OF THIS SECTION Existing Septic Tank ----------- 0 3/4" no water
CANNOT REACH HOUSE. 2 OF SCH 40 PIPE. 120 14.0
x 33,2 � 3 \� /���--�3,� 23.2 Invert 19.70
.8 32, 1 \ 6 Stone or compact Invert 19.91 18.8
- Proposed '
32, u / 'i -I' ,�'� `� Proposed p 4' 1 6.1 Bottom Level TEST HOLE 2
c� O / , 0,3 INSPECTION SCHEDULE 1 ,
Z,•: lv Q 32,6 31.74 cP \ \ x 24.5 I '-� DEPTH inches
CALL R.J. CADILLAC TO I _ 1- Bottom TH4=12.7
x 23,6 2 24,1 INSPECT PRIOR TO BACKFILL horizontal co 4' p (inches) ELEV.(feet)
CY) . x 3 ,3 G 32.7 ,i ,�°' DESIGN DATA" `° A layer 10yr 3/4
N � .\� / UNMARKED 22.8 I - 11 sand loam
U,• O \a 32 P�' ,' PRIVATE GAS -i' i �} TH 2 LEACH AREA 10
3 9 i CROSSES
C14a- w �32 7 /r � 32,7 i B layer 10yr 5/8
\� Cor 32 7� �� ' ` # 25 5 BEDROOMS:` 5 USE 32 ADS ARC36HC CHAMBERS SET IN sandy loam
50,2 GARBAGE GRINDER: DISCONNECT FOUR ROWS AS SHOWN FOR AN 11 -6
N :. J, _ , , 32lt
3 ✓� x 31.9 �• .:• yo /� 26 BY 40' BY 10 3 4" DEEP LEACH AREA. 22.4
REQUIRED CAPACITY: .5'0 GPD / j
x 44 POOL WATER -G --" \ o ; GJ, EXISTING SEPTIC TANK: 1500 GAL. USE FILTER CLOTH OVER CHAMBERS.
t.10 ERVICE CROSSES �� 9 0, `• ,�, :" � I
x 7 x 33.3 / ? L 30'8---- \0� E`��i EFFECTIVE LEACHING AREA: 768 SF 48"� j
x 8 \\ \G, 31.9 k-'30, ,0 3 4.80 SF/LF- X 5'/UNIT=24 S.F/UNIT
~ ��E,` 32 UNITS X 24 SF/UNIT=768 SF(EFFECTIVE) C layer 2.5y 6/4
O ck- �, LAWN IRRIGATION 29.9 i
5 - e \ �` \S 5 WELL `�E�� DESIGN CAPACITY: 568 GPD medium sand
• :\S \r\9 , - - 32,9 /S ]
3
cu ,1X 7 F) X 74 GP D F
- 0.3
�( 68 S
AV 39,2 3`33 \\ 2,7ix' 1,6 i 28 E'er ��00
0 A i o
- FLOOR PLANS
\�\sed sec . 32 3261 NOT TO SCALE 120" no water 15.1
Grades 33,0 �� 28 6 32.
N/F 3
S rg
� 0,9 /
x 40.6 Ex not shown �\ 29.7 /
CONROY x 40,1 :.::<'' HOUSE here �\ J 211A Nam/
. 34,4 W LOT 8 /
::.:...::::.. "
O
\\ :: ` RQO 40 36,4 � 29,7 / BATH KIT. R6 i
x 32, I / LAUND.
r 12. 27 ACRES / DEN LVRM
"`�NG 4 3x 3 ,7 I I / SI GARAGE
\S :;::• I I STUDIO DEN
:::• ::: I W' I 4L6 / UNHEATED
I
:::•• \ O STORAGE ABOVE DNRM
40,8 i / ` 41.5 \ x 33.2 F- ► 28J O b6//
41,35 �� ,k 4 u i �30,35 RM ELEC.
\ 41.5� �\ \ i 4L6 _ _ __ 30, 29.7 /
1.9 41,7 -'3713 " ,3\/X�30,8
41,8 41,5 1 // FINISHED WALKOUT BASEMENT 1ST FLOOR
42,0 �
40,2 \ 41 7 i � / 31,84 F� �� \\•41 0x 29.2
1,3 .73
2 //
/ /� .7 3
x 3 .7 �41A5 ( � 11F \1 28.7 /// BDRM BATH MASTER BATH
29,01 r 28,1741
00\1 RE 4 \\ \ P 0��6 / BA H
LONG BDRM MASTER
\ / 27.10 OFFICE Eff
a o1 / p P \ \7.20 i NO BDRM
7.37 39,3 141.4 0 41ZD- /40.4 36,2 \ 27.1/ CLOSET
� D j✓6.47
x 40,6 I a � x 37,8 � � FINISHED ATTIC
2N D FLOOR
/40.57
' Cc 1
26,6�
31 N II
x 39.3 /J26 49
i
139,8
39,0
SITE PLAN
� /�r
I j 1 38,94 ,�
x 3/7
- �40
./28.10 FOR
41,7
x 37.4 THIS PLAN IS A VALID COPY ONLY IF IT BEARS
x 39 2 g'45'20" W 37,8 36'S ' _ - ,--�0 68 AN OR ED S A SIGNATURE. HOBART A . H ., 8c MYRNA ALLEN COOK
x 39.5 3�02'96 7,3 _ f�
37.36 3 - - - LOT 8, 46 CEDAR TREE NECK RD. , MARSTONS MILLS, MA
37.4_ �, _ r����jN OF Mgss9c� o \,ZN CF h1gSs9cyG
JAS
w _ - � ROME D G�JAS � o ROME D s� MAY 239 2014 SCALE: 1 "= 20'
- - - " CADILLAC
0 0 __ - CADILLAC
# 1060 #35779
M CK 31E ��GISTER�O l9O�ESS\� 0Q
SANITAR\P�
RONALD J. CADILLAC, PLS, RS, P.C.
PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN
P.O. BOX 258
WEST YARMOUTH, MA 02673
HEALTH AGENT APPROVAL DATE (508) 775-9700
REV. 6/11/14--5 BEDROOMS C 2014 BY R.J. CADILLAC PAGE 1 0F 1