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HomeMy WebLinkAbout0079 CEDAR TREE NECK ROAD - Health L ar Tree 'Neck loadills P 014 1 11I I �I u Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .gym ,M 79 Cedar Tree Neck Rd Property Address wS=' P+„.z Richard Breene Owner Owner's Name ==1 information is required for every Marstons Mills Ma 02648 5/11Ig 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 forms A. General Information / on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return Name of Inspector key. DiBuono Sewer and Drain Company Name 8 Johns path Company Address S Yarmouth MA 02664 City/Town State Zip Code 508-364-9587 S113522 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 5/12/17 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 0 l/s Commonwealth of Massachusetts - --' W Title 5 Official Inspection Form . a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Cedar Tree Neck Rd Property Address Richard Breene Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/11/12 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 CM 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 1,500 Gallomn septic tank as well as a concrete distribution box and 2 500 Gallon dry wells. Camera inspection to distribution box showed no signs of failure B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old.is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:.Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 79 Cedar Tree Neck Rd Property Address - Richard Breene Owner Owner's Name information is required for every Marstons Mills Ma 0264.8 5/11/12 page. CityrFown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwrealth.oii Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 79.Cedar Tree Neck Rd Property Address Richard Breene Owner Owner's Name , information is required for every Marstons Mills Ma 02648 5/11/12 page. City/Town State Zip Code Date of inspection- B. Certification (cost.) 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 abs61r'ptiiori'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 Y day flow t5ins•3/13 Title 5 Official Inspection form:Subsurface Sewage Disposal System_•Page 4 of 17 commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 79 s„• Cedar Tree Neck Rd Property Address Richard Breene Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/11/12 page. Clty/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No Z. Required pumping more than 4 times.in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the..presence of ammonia nitrogen and nitrate nitrogen is equal to or less.than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd._ ❑ ® The system.fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section`D.- Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in-Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection. Fort Subsurface Sewage Disposal System.Form - Not for Voluntary Assessments .79 Cedar Tree Neck Rd Property Address Richard Breene Owner Owner's Name .information is required for every Marstons Mills Ma 02648 5/11/12 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? t ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? I ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3. DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5.ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Cedar Tree Neck Rd Property Address Richard Breene Owner Owner's Name information is required for every Marstons Mills`" Ma 02648 5/11/12' page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: Vacant Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?'(Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings if available last 2 ears usage 218 Gpd 9 ( Y 9 (gPd))� Detail Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 C omtnonweafth of Ii�assachusetts- R. W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form Not for Voluntary Assessments 79 Cedar Tree Neck Rd - rt Property Address Richard Breene Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/11/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): i General Information Pumping Records: Source of information: None provided 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 F,. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 79 Cedar Tree Neck Rd Property Address _ Richard Breene Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/11/12 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: App 18 Years old Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3 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.): No evidence of leaking Septic Tank (locate on site plan): Depth below grade: 2.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 GI If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W title. 5 Official. Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M -79 Cedar Tree Neck Rd-- Property Address _ Richard Breene Owner Owner's,Name information is required for every Marstons Mills Ma 02648 5/11/12 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 24" _ 3„ Scum thickness Distance from top of scum to top of outlet tee or baffle 42" Distance from bottom of scum to bottom of outlet tee or baffle Sludge stick How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping is recommended every two years 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•3/13. : Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments s 79 Cedar Tree Neck Rd Property Address Richard Breene Owner Owner's Name information is r required for every Marstons Mills M8, 02648 5/11/12 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.): i 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts } - W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 79 Cedar Tree Neck Rd Property Address Richard Breene Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/11/12 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 Level with no signs of push back or carry over Comments (note if-box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System.(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 - i Cornrnonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °°M ,• 79 Cedar Tree Neck Rd Property Address Richard Breene Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/11/12 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition-of vegetation, etc.): No ponding no break out 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 For' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Cedar Tree Neck Rd Property Address Richard Breene Owner I Owner's Name information is required for every Marstons Mills Ma 02648 5/11/12 page. CitylTown 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 p -7 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Cedar Tree Neck Rd Property Address Richard Breene Owner Owner's Name information is required for every Marstons Mills Ma' 02648 5/11/12 page. CityTTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one,of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form ,Not for Voluntary Assessments 79'Cedar Tree Neck Rd Property Address Richard Breene Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/11/12 page. City/Town State Zip Code Date of Inspection D. System Information .(cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar t , ❑ Shallow wells Estimated depth to high ground water: 15+ ft feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked,date of design plan reviewed: 3/23/98 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: Testy hole data on plan Before filing this Inspection Report, please see Report Completeness Checklist on next page.. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.•Page 16 of 17 Assessing As-Built Cards Page 1 of 2 J TOWN OF BARN TABLE LOCATION [ l CGCf/ '?tX C lu. SEWAGE N VILLAGE M IMtI S ASSESSOR'S MAP&LOT OI INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY S�O LEACHING FACT ITY:(type),D— r66 �q b ' (size) INO.O?BEDROOMS 3 BUILDER OR OWNER. �1O�n- PERMUDATE:' COWUANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table able to the Bottom of Leaching Facility Feet Private Water Supply Well and Uaching 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 leash. g facility) Feet . Furnished by T^SpG� r,'(7rrti F'�L A " y s 3a, u • 3 �l� S6� . 9 s http://Nvww.townofbalnstable,us/,,kssessing/ IMdisplay.asp?mappar=075014,&seq=1 5/9/2017 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 79 Cedar Tree Neck Rd Property Address Richard Breene Owner Owner's Name information is required for every Marstons°Mills Ma 02648 5/11/12 page. City/Town 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 • f t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Z6 IhRCEIOT COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION RCECEIVED JAN 0 4 2005 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 79 Cedar Tree Neck Road Marstons Mills. MA 02648 Owner's Name: John&Katherine Marini Owner's Address: 345 Neponset Street Canton, MA 02021 Date of Inspection: December 6, 2004 Name of Inspector: (Please Print) James M. Ford Company Name: James M.Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400 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 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 Needs F er Evaluation by the Local Approving Authority Fails g Inspector's Signature: Date: December 14. 2004 The system inspector sha\submcopy of this inspection report to the Approving Authority(Board of Health or . DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving autho-ity. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page 1. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 79 Cedar Tree Neck Road Marstons Mills. MA Owner: John&Katherine Marini Date of Inspection: December 6, 2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 79 Cedar Tree Neck Road Marston Mills. MA Owner: John&Katherine Marini Date of Inspection: December 6, 2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 79 Cedar Tree Neck Road Marston Mills. MA Owner: John&Katherine Marini Date of Inspection: December 6, 2004 D. System Failure Criteria applicable to all systems: You must indicate either"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 '/2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal 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.] No (Yes/No)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 System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped. Zone 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. 4 f Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 79 Cedar Tree Neck Road Marstons Mills. kM Owner: John&Katherine Marini Date of Inspection: December 6, 2004 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out ✓ _ Were all system components,excluding the SAS,located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ _ 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(3)(b)]. 5 f Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 79 Cedar Tree Neck Road Marstons Mills. MA Owner: John&Katherine Marini Date of Inspection: December 6, 2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): 2004-209.000 Qals.:2003- 122.000 gals. Sump Pump(yes or no): No Last date of occupancy: Weekend use COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): epd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: New system-never pumped(per owner) Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed on 11120198-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 f Page 7 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 79 Cedar Tree Neck Road _ Marston Mills. MA Owner: John&Katherine Marini Date of Inspection: December 6, 2004 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 2' Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain). If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 1" 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: 12" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There did not appear to be any 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(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 79 Cedar Tree Neck Road Marston Mills. MA Owner: John&Katherine Marini Date of Inspection: December 6, 2004 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date.of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ if resent must be opened) locate on i( p p )( site plan) i Depth of liquid level above outlet invert: Even 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.): The D-box was level. No solids were present. 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.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 79 Cedar Tree Neck Road Marstons Mills. MA Owner: John&Katherine Marini Date of Inspection: December 6, 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: 2-500 Qal. drywells w/stone-per as built card 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.): The chambers were dry. There did not appear to be any signs offailure. The bottom of the chambers to grade was 6' CESSPOOLS: None (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 or no): 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.): 9 Page 10 of 11 - OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 79 Cedar Tree Neck Road Marstons Mills. MA Owner: John&Katherine Marini Date of Inspection: December 6, 2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. � a O � B y � � 3� 3a- 3 0 0 t0 aye y 9�° 53 5 gy6 S�6 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 79 Cedar Tree Neck Road Marston Mills. MA Owner: John&Katherine Marini Date of Inspection: December 6, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25 +/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps the maps were showing approximately 25'+/-to ground water at this site According to the design plans on file a test hole was done and no water was observed at 12'. The site is within 300'of a tidal bay and no high ground water adjustment needs to be taken. 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. 11 i N " .A r� No. ! O v Fee�e�� THE ACOMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Migaal *potent Construction Permit Application for a Permit to o struct X Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. GAIZ eMp,15 A166,LlPtOwner's Name,Address and Tel.Ng. M�i�s e5a10+KAy A4A"1,362 Bot�vAje gr.Assessor's Map/Parcel �) Installer's Name,Address,and Tel. o. Designer's Name Address and Tel.No. �37 AssOC . AOX 3zi O A Type of Building: Dwelling No.of Bedrooms_ 1 Lot Size ��5,3�l) sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 33 Cam—gallons. Plan Date Z3 Number of sheets Revision Date Title PT G Avzs Size of Septic Tank I SDO G pL Type of S.A.S. 2 St3Q l AL hAY 94L1,5 Description of Soil 6 u 22i/� e n G i, 2#r. Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: k The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss d y Bard of a Signed Date /'/ Application Approved by Date 71 Application Disapproved for the following reasons 0 Permit No. Date Issued -3 �` ———————————————— r No. # i ._ a .I. .�'�,I«r�'u#} Fee �} f .. i"THf"COMMONWEALTH OF MASSACHUSETTS Entered in computer: . Yes PUBLIC HEALTH DIVISION - TOWN OF, BARNSTABLE., MASSACHUSETTS ZIppricatibn for Zig;pog;ar bp�tem Con!6trttctt= Permit ; Application for a Permit to o, tract Repair( )Upgrade( )Abandon( ) ElComplete System ElIndividual Components Location Address or Lot No.4W C tF p pp, ? 66 Pga Pt, Owner's Name,Address and Tel.NQ. n,, Assessor's Map/Parcel N t')K� MA�I,36' 6U�(/A1e t y CAVIOU MA 2 )91 gZg-_S s x Installer's Name,Address,and Tel.No. Designer's Name Address and Tel.No.J00 U7CT,3� n 3Zh. 0 t t Type of Building: 5,"' • �;. . �, °'t,s': • p Dwelling No.of Bedrooms_ Lof Size jY 3�0 sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers yp g ( ) Cafeteria( ) Other Fixtures E - Design Flow 9. pe day. Calculated daily flow 331Q gallons. Plan Date 2306AR, TK Numbet of sheets 1-I- ._ Revision Date Title PT •S Size of Septic Tank 1 500 GAS Type of S.A.S. 2 -Sl3n 6AL bAY WWl°L1,5 Description of Soil 9" � T L. 22 Y H, n G 2 . x Nature of Repairs or Alterations(Answer when applicable) fyy ` Y4 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 systetlf in operation until a Certifi° Cate of Compliance has been iss d y AA pard of H a . e Signed I C,-4- Date /1 Z p Application Approved by K- VP Date 9Z Application Disapproved for the following reason i Permit No. ",70 Date Isgued • °' THE COMMONWEALTH OF MASSACHUSETTS, {a BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(w Repaired ( )Upgraded( ) Abandoned( )by at as been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated , Installer Designer v The issuance of thisM shall not be construed as a guarantee that the sys ill fu s esigned. ,�/ , �• Date � Inspector — ----------------------------------- G� = No. /�`�/� Fee THE COMMONWEALTH OF MASSACHUSETTS 'PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Zisspozal 6 stem Construction -,Permit Permission is herebyranted to Construct Re air t g ( p ( )U grade( )Abandon( ) System located at 0(6,+ f�- and as described in the above Application for Dis posal sposal System Construction Permit.The applicant recogn zes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction m t be c ed within three years of the date of t rmi . C Date: Approved by TOWN OF BARN TABLE LOC,,A,U�ON l C�t/ �(e l ICI � ►`�. SEWAGE # VIUAGE ✓�1• IM►I�s ASSESSOR'S MAP & LOT OAS^ O�y INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ,LEACHING FACILITY: (type) o�- St� S�• �r4 ,IIS (size) NO.OF BEDROOMS 3 \_I BUILDER OR OWNER yON/� MAri/1 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 leach g facility) Feet Furnished by��n tY1 FDA A sr • �fOn► \ 1 O � B a 41 44 30 EO 3 -)' S66 y 9 53 TOWN OF BARNSTABLE 1r' LOCATION - SEWAGE# I� VILLAGE ASSESSOR'S MAP & LOT 6 19- INSTALLER'S NAME&PHONE O. fit?1TCACd, '1 - ti l> SEPTIC TANK CAPACITY G®Q LEACHING FACILITY: (type) size) NO.OF BEDROOMS BUILDER OR OWNER 1 ' PERMTTDATE: Dt;& COMPLLANCE DATE: `Separation Distance Between the: ' Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet " dR 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 '� 3zeo" W TOWN OF BARNSTABLE Q LOCATION Al SJ Cgc�w.— 1s Ltd�� SEWAGE'# VILLAGE -Q�n_�r- -�Q ASSESSOR'S MAP & LOT— INSTALLER'S INSTALLER'S NAME&PHONE NO. JAL V SEPTIC TANK CAPACITY Goc LEACHING FACII.TIY: (type) a-S0 h!n2 e�Asize) NO. OF BEDROOMS 3 BUILDER OR OWNER Zl 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 U 3,1 3 1' b° 31 ,3 Yj _ i i i i Sher,). +�ONg -.-^*• 1 m' RI A Soils: PROFILE OF p faerc Test /� d =WAGE DISPOSAL SYSTEM G feren ci es: � NOT TO SCALE Assessors Ma 75 Test Date: 26/NOV/97 EL=43 P Board of Health �rry Dunning - Parcel 14 Engineer: Edward L.,Pesce •� + • EL=39.5 Deed Book 55401330 Representing' Pesce £,pgineering •< , Plan Book 251 /48 Pt? Box 321 ,, .: / Osterville MA ` • 4" SCH. 40 PV 2" LAYER OF Excavator J. P, Macomber f'. ,,,�-Concrete Riser EL=39.5' STONEI 2" WASHED Zone RF f,f - 4" SCH: 40 PVC Aquifer Protection District A , w SLOPE :02 {1/4" PER FT.) 7E.rr` PIT 10" FLOW LINE EL=36.1 FEMA Zones C & All ,° Horizon Texture Color y EL-38' Community Panel Number 0 35.2` EL=37.6' TMIN. 48" 14" 6 ° 250001 OOfiB Or an:c Leave " g ,� ..i T L=37.3 $ I//may/,/V��/// .... .. .. ....,.. .. .. .. •: D7�� D }.:�?:se.�:4. ..5.'.. .•3.•t. .' ':.. •'.t.'...t,'ti.i5 Loom Sand v EL=36.4' • :�,. ,.._• Y � .� 10' min t 10.5' EL=36.6' • OWNER. 5" ................ ................... 38.8' Distribution -6 John S. Marini FOUNDATION SEP77C TANK Box EL=34.1 367 Bolivar Street 1,500 GALLONS (H-10) 25' B Loamy Sand 16YR 6/6 r- (H-10) " Canton, MA 02021 27" • .......... .......... 36.9' z 2 — 500 GAL DRYWELLS 3/4" To 1-1/2 Med Sand WASHED STONE C 2.5Y 7/4 c� N 2" LAYER OF �`O. 118"-1/2" WASHED 1441 No Water 27.2' STONE 3/4" TO 1-1/2" Percolation Rate. < 5 min/in WASHED STONE 12" MIN Design Calculations: Septic Tank: 4 24" o o � EL=34.i ' 4' Design Flow (no garbage disposal): s'-2" 3 Bedrooms X (110 GPO) X 2009 = _660 GPD rn 13'-2" �j 42 CBID 7BM El.: 43.11' Use 1,500 GAL (H-10) Septic Tank SEcorofC8/DH Md �,• ` �orjI EL=27.2 Bottom of Test Hole 4/ Leaching Facilities: 41 °'� a�' DRYWELL END VIEW ` �`` wrTj� Design Flow For Leaching: O� w .hQt 1 / 0 /t"'.S' 3 Bedrooms X (110 GPD) = 330 GPD e yy a'\ C4` 116 0/_ Use 2-500 GAL Drywelis (w/4' crushed stone Sidewalk 2(25' + 13.2')(2')(.74GPD/SF) = 113.1 GPD. Jf �a \ \ 6• A Bottom: (13.2)(25)(.74 GPD/SF) = 2.14.2 GPD Top of Coastal Bonk (by slope definition) - '.` 357.3 GPD > 330 GPD 45 Top of' Cocsfal Bank (as flagged) € `< GENERAL NOTES 42� �i/ k . a 'i 1, ` 1.) PLAN REFERENCE PB 251148. � � � \ � �• � // ///� `� f ; {; 2.) THIS PLAN IS FOR THE INSTALLATION OF A, NEW SEPTIC SYSTEM AND NOT IS TO BE USED FOR SURVEYING OR ZONING PURPOSES. vL Qc 3.) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. , BARNSTABLE j\ TITLE 'S AND THE TOWN OF RULES AND REGULATIONS " THE SUBSURFACE DISPOSAL OF SEWAGE. / /2`� '"``= ��//� �� P1-11 4.) ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN / — O✓ / / / / / 12" OF FINISHED GRADE. of LOT 2 5.) EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE SAME, CBI °h UNLESS NOTED BY FINAL CONTOURS. �, lea— �, �- / / / / /� �r / / fnd �; d 6.) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF 10 / / / o i= ,; ,`„" WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR :WITHIN 10' OF DRIVES OR PARKING AREAS..H-20 LOADING SHALL BE USED / \\ �`' L wag / ,'j s:'eurz// / / / /,f / /j/// �// / / / // / t , _ °'•- i UNDER OR WITHIN 10 OF DRIVES OR PARKING UNLESS'NOTED. t / / 7 7. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE Cam, ropos49 Wall ✓/ %./ ,r• _ MORTERED IN PLACE. d = / / � / /� •� � � ..._ ,, : • /�`�� — � / � / / / / / l . � / ///%/ // // / �, / / // / / ..' � . , 8.) ALL PIPE TO BE 4" SCH 40 PIPE. • / %"C��/� �// /// �j�/ / / '� - / /// •' 1. �°' - ,�. Rrzs �..� PLAN. SHOWING PROPOSED ' // -� / //// •�' � \'`• N ,/ � // %, , — rsr �, ROAo Z SEP TlC SYSTEM //% Mo � / ./•� • ,•�' pi Fc1 0 R' T n 50 Buffer 3�.J\ , / (IN,/\ /� ) ' CEDAR TREE NECK ROAD /h /2 ti BARNSTABL (Marstons mills), MASS i S , 1// / // / f�' ' "Approximate Mean ° ; h� � � � / f/f.�!�/ ' • Low Water (--1.,3' MSL) V_ „ — , f o �-- �!/ / , �o� LOCUS Rs DA TE: March 23, 1998 Scale; 1 30 // � / ,<° • o ^NECK RD f.� (�•,`\ Coastal Bank Lo6afion l �o f�.V (by Slope Definition) '-/ '// / `r�,/ o ���s �'i�'� Pesce Engineering & Associates CapsSury O ;�' NORTH \\ r"%� -.� PO Box 321 PO Box 718 BAY - Osterville, MA 02655 Hyannis MA 02601 0718 j�. c e �� LOCATION MAC' ` (1»=2000'f) (508) 428-3730 (508) 790-7902 (508) 790-7905 fax 30 0 15 30 60 120 Field: RRL RJM Date: NOV 98 Approximate Mean 1 00d Calc./Design: ELP Draft: RRL Review: �ELP u. ... .• .-�, , 4... ez.w, High Water (1.3' MSL) SHEET � OF File: C213P10 s ,