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0199 CEDAR TREE NECK ROAD - Health
199 Cedar Tree Neck Road. .,NS . S Marstons Mills P — —` A 076 026 i Commonwealth of Massachusetts � Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 199 Cedar Tree Neck Rd Property Address Robert Bothwell Owner Owner's Flame information is required for Marston Miffs MA 02648 2-7-08 every page. City/Town State Tip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way. Q M A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Shawn Mcelroy Enterprises Company Name 29 Atwater Or Company Address E.Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification �a I certifythat I have T personalty inspected the sewage disposal system at this address and th�"t he 2 information reported below is true,accurate and cons `"po complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and m�ai.ntenance-of on site sewage disposal systems. I am a lgEP approved system inspector pursuant t064ction 1.5,340bof Title 5(310 CMR 16.000).The system: W: ® Passes Q Conditionally Passes ❑ Fails - - ❑ Needs Further Evaluation by the Local Approving Authority 2-7-08 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. t5insp-08✓06 R-Se 5 f?=W Inspectim Form:Subsurface Sewage Disposal System-Page 1 of 15 US Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 199 Cedar Tree Neck Rd Property Address Robert Bothwell Owner Owner's Name information is required for Marstons Mills MA 02648 2-7-08 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: System is in good working order with no sign of back-up. 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 t5insp-08M6 Title 5 Official inspection Foam:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 199 Cedar Tree Neck Rd Property Address Robert Bothwell Owner Owner's Name information is required for Marston Mills MA 02648 2-7-08 every page. City/Town State Zip Code Date of Inspection B. Certification (coat.) B) System Conditionally Passes(cont.): ❑ 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: 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. t5insp•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 199 Cedar Tree Neck Rd Property Address Robert Bothwell Owner Owner's Name information is required for Marston Mills MA 02648 2-7-08 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cunt.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 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 El ® 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 ❑ ® 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 ❑ N' tributary to a surface water supply. t5insp-08/06 Trite 5 Off hrispechm Form:Subsurface Sewage Disposal Systern-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 199 Cedar Tree Neck Rd Property Address Robert Bothwell Owner Owner's Name information is required for Marston Mills MA 02648 2-7-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria east 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. t5insp•MOB Tine 5 Official trgxKton Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts _ Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments „ 199 Cedar Tree Neck Rd Property Address Robert Bothwell Owner Owner's Name information is required for Marston Mills MA 02648 2-7-08 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 or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example,a plan at the Board of Health. ® ❑ Determined in the field(f any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] t5insp•08106 Title 5 Ofliciat kmpechm Forth:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts _ Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 199 Cedar Tree Neck Rd Property Address Robert Bothwell Owner Owner's Name requiratifo Marston Mills MA 02648 2-7-08 required for every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 1-08 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatsipersonsisq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5insp•08106 Title 5 Offieiar lids pectiorr Focrcr:Subsutfac;e Sewage Disposal System•Page 7 of 15 I—— Commonwealth of Massachusetts F Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �., 199 Cedar Tree Neck Rd Property Address Robert Bothwell Owner Owners Name information is required for Marstons Mills MA 02648 2-7-08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) General Information Pumping Records: Source of information: Not since new. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped detemtiined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool E ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Altemative 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): Pump chamber. Approximate age of all components, date installed(rf known)and source of information: 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp•08/06 Title 5 Qf ciat';Inspec400:Forrn Subsurface Swage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 199 Cedar Tree Neck Rd Property Address Robert Bothwell Owner Owner's Name information is required for Marston Mills MA 02648 2-7-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Building Sewer(locate on site plan): Depth below grade: 81" 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.): Good condition. Septic Tank(locate on site plan): Depth below grade: 74" 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: 1500 Gal Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 0 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 16" How were dimensions determined? Tape t5insp M06 TMe 5 OffctaY Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 199 Cedar Tree Neck Rd Property Address Robert Bothwell Owner Owner's Name information is required for Marstons Mills MA 02648 2-7-08 every page. City/Town• State Zip Code Date of Inspection D. System Information (cunt.) 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 in good condition with all baffles in place. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete Q metal Q fiberglass Q 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 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): t5insp•08/06 Tdre 5Official Inspection.Foan:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts kiwiTitle 5 Official Inspection Form Subsurface Sewage Disposal:System Form -Not for Voluntary Assessments 199 Cedar Tree Neck Rd Property Address Robert Bothwell Owner Owner's Name information is required for Marston Mills MA 02648 2-7-08 every page. cityrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallon 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 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 i evidence of leakage into or out of box, etc.): Good condition. Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No Alarms in wonting order: ® Yes ❑ No t5insp-08/06 Title 5,Officiat Inspection:Form.Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 199 Cedar Tree Neck Rd Property Address Robert Bothwell Owner Owner's Name information is required for Marston Mills MA 02648 2-7-08 every page. Cityr town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber in good condition with no sign of prior pump failure. Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number. 5-500's ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Leach chambers in good condition and empty at inspection. No visible stain lines. t5insp•06/06 Titre 5 Ofrrctat Iepechm Form:Subsurface Sewage Disposal System.Page 12 of 15 Commonwealth of Massachusetts AWM Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 199 Cedar Tree Neck Rd Property Address Robert Bothwell Owner Owner's Name information is required for Marston Mills MA 02648 2-7-08 every page. CitylTown State Zip Code Date of Inspection D. System Information (cunt.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): t5inap-08MB Title 5.Official Inspection Form Subsurface Sewage Disposal System•Page 13 of 15 r. Commonwealth of Massachusetts F ® Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 199 Cedar Tree Neck Rd Property Address Robert Bothwell Owner Owner's Name information is Marstons Mulls MIA 02648 2-7-08 required for every page. Cityrrown state Zip code Date of Inspection D. System Information (cunt_) 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. g-H- YY' Li t5insp-08/06 Title Offhaial.inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,v 199 Cedar Tree Neck Rd Property Address Robert Bothwell Owner Owner's Name information is required for Marstons Mills MA 02648 2-7-08 every page. City/Town State Zip Code Date of Inspection D. System Information (coot.) Site Exam: ❑ Check Slope El Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: 15' 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: USGS maps show groundwater at 15'. t5ins 08106 P' Title 5 Ofiicaar Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 15 Town of Barnstable �p THE Tp� ,Regulatory Services BARNSTABLE, Thomas F. Geiler,Director MASS. 9$ 1639- ,�� Public Health .Division AjEp�.�A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. Town. of Barnstable Of 1N81� Department of Regulatory Services Oh- ' BAnnBrABLK Public Health D1VIS10Iit Datc MASK ,b79, 16$ 100 Main Strcct,Iiyannis MA 02601 tf0 t41K1� Date Scheduled �! �Titne�_ Fee 1'd. Soil Suitability Assessment for Sewage isposal Performed By: SIA IVc Witnessed By: — LOCATION & GENERAL INFORMATION Location Address Owner's Name 1"\` ,5vonS Address Assessor's Map/Parcel: 7(Q Ue ' Engincer'sName NEW CONSTRUCTION REPAIR ✓ Tcicphonc 1! -- Land Use kr'l. -AVI C \ Slopes(%) 3" —3D afo Surface Stones 4t\e-- Distances from: Open Water Body 135 R Possible Wet Area l __ It Drinking Water Well N iN n Drainage Way 300 -F-- R Properly Linc �_R Olhcr SKETCII:(Street name,dimensions of lot,exact locations of test holes&pere tests,locale wetlands in proximity to boles) �I0'f 01 �a y0 1 e� n) h$ oil44 ed r- \'% iJ . ! i ------------------ _____- p� '47oe1 #fo ww 'I 1 o H �e s� Wa N Parent ntatcrial(geologic) Qu�- 5y-\- Depth to Bcdrock- DcpUn to Groundwalcr: Standing Water in(tole: NOr\9-- Weeping from Pit race Estimated Seasonal Iligh Groundwater -7-i - (EL Z -) Pet T o-a Crow4L,4 D DETERMINATION FOR SEASONAL HIGH MATE R TABLE Mcthod Used: Nonp- — SZe a 0U-e— Depth Observed standing in obs.hole: • in. Depth to soil mottles: irr• Depth to weeping from side of obs.hole: in. Groundwalcr Adjustment ft. Index Well I Reading Date: Index Well level Adj.factor Adj.Groundwater Level— PEI RCOLATION TEST Date 1ZLo Time l � Observation Dole a 2 Time at 9" Depth of Perc (1 Time at 6" Start Pre-soak Time© z5 f P Oh$ Timc(9"-6') End Pre-soak o-c- t\V\ i M,-, Rate Min./Inch < Z "o, n i Additional Tcsting Needed( ) �, Y/N t Site Suilabilily Assessnncnl: Site Passed Site railed: t Original: Public tleallh Division Observation Hole Data To Be Completed oil Back----------- V / V ***If percolation test is to be concluded within 100' of Ivetland,you nnlst first notify the Barnstable Conservation Division at least one(1) weelc prior to beginning. Q:I lfiAI,TI I/WP/PERCFOIIM P.I,EP OBS1;ItVA'1'ION I10LL LOG..,. Ucplh hunt t .oil llurizun Suil Te.0110 Soil Color ::oil t)thcr Surfnc�(In.) (USDA) (Mansoll) . MORI r-d Stoics,Duuldcls. U-3 rear FILL- 31-ti3j1 (, p w"Dy o y3- 5-7,1 -Z,, t031-k 9./Z - � Co�4PSE S WWI/ ,1 S&xlzi, DtI P 013SERVXrION MOLL LOG 1191c FF 2- Depth from Soil Ilorizon -Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mullsell) Mottling (Structure,Stones,Duuldcrs. Cumistcnwy,%Grnvcll _ 0-23�r. FILL J 33- Z l3� Loin y Wqg, 51�E sz —tzo" C Sawa z.sy /g — DEEP OBSERVATION HOLE LOG Hole It Dcplh from Soil I lorizon Soil Texture Soil Color Soil . Other Surface(in.) (USDA) (MIIIISCII) Muffling (Structure,Stones,Boulders. Qm111SIs1C11&y mr )__ DLL1' OBSERVATION HOLE LOG 1101c /F Depth from Soil Ilorizun Soil Texture Soil Color Suil Othcr Surface(in.) (USDA) (Mmisell) Willing (Structure,Slows,Buuldcls. CullSls cllc ee GLnvc Flood Insurnnce Rate Man: .��o r•�-+o.. �'S���S w��1t�•�, END y r Above 300 year flood boundary No_ Yes ✓ ?err— Oj�s'1de, a Sao,jr. Within 500 year boundary . No Yes Within 100 year(loud boundary No '� Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed thr0ugll0ut the area proposed for the soil absorption syslcm7 'FES if not,what is the depth of naturally occurring pervious material? Certification I certify that on O (dale)1 have passed the soil eveluntor examination approved by the Department of Cnvironul ntal Protection and flint the above analysis was performed by are consistent with the required training,expel tiso and experience described in 310 CMR 1.5.017. Date IDS— Signature D Z Q:l ICALTI IMWP/f lIMCFORM : 1 AN OKA / �LJ Nab© 5 43 Fee /ao THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS �1Application for Zig ool 6y5tem Con!6truction Permit Application for a Permit to Construct( . )Repair( )Upgrade(., Abandon( ) Rtomplete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. fir. H +�ecii� rk (ai4 ►►sue Assessor's Map/Parcel 1(a Wl% Wyv\ ICZA 0 7ce "o "J o1b, 02 '(Q Installe 's Name,Add�ress,and Tel.No. Designer's Name,Address and Tel.No. �D��IO 71' s- Type of Building: Dwelling No.of Bedrooms Lot Size 0.5 &r&7-fit. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 5 G S gallons per day. Calculated daily flow 5 5® gallons. Plan Date IZIIIAOC Number of sheets Revision Date Title 1Pr9p .0 �lQ rev Size of Septic Tank ISO® (c511M.. Type of S.A.S. WIC4S' tj 56SW b4iu, CI ... Description of Soil 1 ^ � F tL_L_ 3G-4>3 0 LA Igt:t, SAWDq L t*n'1 1 b`tR_ 3/1 h j q I 0-3f�� 43-1'2 BI LANED S corms Mk-4/Z :&7-73" b2 A4tE*c Cam 5&�-) cu 10YKS_-Lk C SAnn z S y 6/T Nature of Repairs or Alterations(Answer when applicable) Qe!5,rr.�c�Z — !�lo i-�c��c., .P�.� -t f ou. •�� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been 'sued A?� Hephh. Signed •�f Date Application Approved by Date Application Disapproved for the following reasons Permit No,.O G 7" 3 3 Date Issued 1A , 2 5� G 1!" Fee�0 0 71-111 4 N , Y THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: w t Yes / PUBLIC HEALTH DIVISION -'TO.WN OF BARN�TABLE., MASSACHUSETTS �101 PpYtcatton for MtqogaY bpgtetn Cvn.5tructton Permit IP Application for a Permit to Construct( )Repair( )Upgrade(✓fAbandon( ) Complete System ❑Individual Components Location Address or Lot No. I99 C e� Tfe� Net k �c� Owner's Name�Addr ss and Tel.No. '3�k^ H + Z eC iri.,, M, Assessor's Map/Parcel S l tQ 44;j s 0 7(p -OZCp -A)AANM m4 0 Z Ll(,e Installer's Name,Add�ress,and Tel.No. Designer's Name,Address and Tel.No. 60/ / /y P.�•�3o>L tns9 ` 7 7�` 05\e-✓'A A o Z4SS 508-.4t$-33c( Type of Building: Dwelling No.of Bedrooms 5 ` Lot SizeU.5AcRGi Wit. Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) s Other Fixtures Design Flow 5(o a gallons per day. Calculated daily flow 5 5 O gallons. Plan Date 17_IISI0S Number of sheets Revision Date Title-5 Art Fk y-, ?(op� e A Ue 9 rJR_ Size of Septic Tank 1 S06 fall Type of S.A.S. I f it 4S' L,I S-SM) (A iu, (6,•.\-KZ Description of Soil; 11 19 0-3 ` F tl l.. 31 L+4`le2 Staff cones W1K ylZ 57-73'' 6tc.aytM_ CoAf,SE 5r' yb/ tu+ iotiRS/�o C CAfeq, SAS 7. 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 Certifi- cate of Compliance has been 'ssu d by 's B and o H T Signed � � Date � Application Approved by D Date Application Disapproved for the following reasons u Permit Nor 0 Date Issued /- 20 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On ite Sewage Doi posal System Constructed(Repaired ( )Upgraded Abandoned( )by C�'r 0' D r C at 1 qY Ceck<_ Tree k)eJ,C ,Ck1 Mg,tkQ s M,, S has been constructed in 4ccordance with the provisions��of Title 59 an the for Disposal System Construction Permit No CAD 5 —�3c.3dated / � o� 5 . st- Installer 1�,''t'� -or 1 Designer The issuance of this p/ermi/t shall not be construed as a guarantee th tthe syste ��11Z.ncin as designed. Date ? ! /D/ �o Inspecto -�n4 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migogar *pztem Con.5truction Permit Permission is hereby granted to Construct(---)-Repair( )U grade(')Abandon( ) Systemlocated at Iq q (edce-• TrcQ_ Netk �o�� d1�451u�S rh\1 S and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit, Date:_/2A2 0 : Approved by A"i To`vn of Barnstable Regulatory Services a O,� , Thomas F. Geller,Director SIAMPublic Health Division TEo �` Thomas McKean,Director 200 Main Street,Hyannis,ILL 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: zl IZC06)- Designer: — Installer: Address: , 3p Address: � � �y��'" ' MA- ozbss-- On ,J Q ,��� � / ��,,�was issued a permit to install,a (date) (installer) 1 septic system at t I c o4 based on a design drawn by (address) ft -6n5 Kl1 le dated !zhI ;(O� (designer) I certify that-the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distributioi}.box and/or septic tank. _Tk�s Qe,6° ae5 Compl"\cz_ c,,;�ti�T;1 �.0.KA on\y, 1Vo�' L,IEc�•!i c�.� e�houa f ���5;r,� Cl� I certify that the septic system reference a ove was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical.relocation of any component of the septic system)but in accordance with State- & Local Regulations. Plan revision or. certified as-built by designer to follow. Of PFIER_. SIJWVN 733 (Instalr Signature) IV28 (Designer's Signature) (Affix Designer's Stamp Mere) PLEASE RETURN- TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COy17LLANCE NVILL NOT BE :ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE B_ARNSTABLE PUBLIC HEALTH DIVISION• TELANK YOU. Q:Health/Septic/Desiper Ceramcation Form i OATE : 1 /27/03 PROPERTY AOORESS:� 199uCedar Tre��Neck ryRoad F�EC�9���� Marston Mills Mass u �=tu _.. NOV 13 2003 TOWN OFBARNSTABLE HEALTH DEPT. On the above dale, I inspected the 5eni; _ ,ymer, -c the Nov ., address. T;,;S systern consists of ii1 ioliC+',vinq; /000 gcc.t°.nor: septic L«r,..-:. MAP O? 3: 7- 10 )0 gallon_ necaof leachiag pic: PARCEL ' Z Ea sec on my in ;,r.'C?s.,!1, I r;rrtily {tl !Oilo`erinr CCJnC7itlOrl3. L0 � Cg.,.5,00.. waste wutea in 24 " aejow the invent pipe. Cezopoof U LS day and the -teaching pit in dAy, ( atl in <S('.nieZ) K p p r' -- - - - - - - - - - -- -- . NOT CONSETUTEA .,tl A,.t A N?°Y 08 sir A A ti A P?7"Y �.a.....n��r_._....t ��`.+...—�..AwevrM +:+�dbean r...rr.•ecu �� t1� .1Ch=ipnol;.i.@acY�il916f a COI MO WEALTH ® ? L 1 t, �, SSACHUS ITS XECUTTVE Or"I IC +`, OF ENViRON-ME?,tTAL �U FtURS i; C C D E P A.li.'�'iti•S} ?vt:.(�, O P �!;io V I AZ.0.NME;D1` A:1, 'I CJ':t,:x I'i } `d r;A J LE, OFFIC_'IAL INar'I:C:TION FOk i�iOl` 9 OIL. VOLLTIN"I'ARY ASSFSSINI N`I`.S SL1II�atJ:.x ACi`, S��kl":�AL DISPOSMa SYSTE-Ibt FORM =ART A C+:tt•: ACA•s ION Property Address: 199 Cedar Tree Neck Road vwnris N2toL .t l? , S,oI ;1a''rni •4 C3wner's Address: ame Name of Inspector: (t:'lease print) J P- Macomber Jr , Companyr "" fil': joleph Nlaili.r:a Addllres.s:I30 < f)b l e r!t e r vI' I T a Teiephone iNumber,'7:-. CE R . FICA'I I{_)N STATEMENT I Canny that i We persona0y inspected t-he sewage disposal systern at this address and that the information reported. b 10`;1 t5 t'tie, Iccuimc and ;Ghillies?; M of QM Ame Cif the OWN. The lrlspection was performed based on my ,r;rin)llg and experience in the proper ,``unction and maintenance: of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section W40 of Tide 5 (310 CMR 15,000). The system: .r _._.-._ Conditionaily Passcs — Needs Further rvaivation by the L-ocal Approving Authoriry }:ails • I115peCt0r`S Siena tree: y �e:: r: , I G_ � 4 t rC:J' D ate: _ J�j%� 1� :�` 4'. i 'T'he system inspector shall sl(6rnit Copy of this inspection report to the Approving Authority(Board of Health or D1.'P, within 30 dgs ol'CoMpl` ing this inspection. If aic. systei, is a shared system or his a design flow of l0,OL>j gpd or yemer, dw inspector and the system owner shall submit the report to the appropriate regional office of the DER T;le Or 404 should be sent to the gsmm oMier and Copies sent to the buyer, it applicable; and the approving author il"Y. 'votes and Tommems - "*"This *"This report o n : lb , !•' 1 : 1,l C !diSlti?r!s at She ttnli Oi iRSpeCt:Ort and ;,'alder 8rte r41:o(Yptii'Jri`: of U5L tk that aline, :As ,nsp own rims n t a ,ii ns how the sysRin wil1 perforin in the IUti,2re under Me same or differeat,t conditions UI use. T lilt S (ny�>r;a!On 1'OTIn E:/1� �l��l� 7:ic, I F o`- Page 2 of 1 I OFFICIAL,INSPECTION FORM—NOT FOR VOLLT.,,°'_'ARY ASSESSMEiO T S SUBSURFACE SENVAGE DISPOSAA, SYSTEM INSPECTION FL<)IZiti� 1°A:r :i' :k CER DYWA i ION' (continued) Property Address: 119 Leda 'Free Neck: Road Omer: 1 di son Marge -------�— L)ate InsPectlon Surnma, CheA A,B,C D or E i AI-.'S,'Ai'S cornpte u)t of Seat, ID A./Systerli Pass=.S; I havro not found tiny information !�'fijrl r Ou f. fib(—� i indi<<tc�s is t anv o. .he failure critc•riti described in 310 C:4�tR 5103 or n) 3lit 1 NIR 15.Y04 exist. Any failure criteria not evaluated arc indicated below, _comments: B. System C'onditlonaily Pusses: Jyu Cone or inore synen) components as described in the "Conuitional Pass" section need to be replaced or repaired. The sySteni upon Coal}het` f t( �Gfi G. the repiaCCmel)( or repair, n -p s approved by the I3oarri of !calf!,, will pass. Answer yes, no or not dewrmined (Y,N,ND) if) the _ for the following statements. If"not determined" please expow. �'�U_The septic tank: is inetal and over 20 yews old" or the vptie ta,dc(whether meta! or;got) is structurally unsound, exhibits subsianh! ir.;`litraM or exlihadon or tank failure is imminent. System will pass inspection if the existing_ Lank is replaced with a complying septic tank as approved by the Board of!-Health. M metal septic tank will pass inspection if it is swucnitii!f`.''sound, not leaking and if a Cenificaw of ` omphance indWa tine: that the tank is less Van 20 Years old is available, N1) explain: 1149010bsemmbn of wage backup or bwak out or high static water level in the distribution box due to broken or obstioc:ted pipet') or due to a broken, settled or uneven distributhn box. System will pass inspection) it (With apFoK Moard of i-!ea!Q: - - broken pipe(s) ;ire re.plgc:ed _ obst uchon 1 rerno vyj dlstrinu.tion boy: is leveled or replaced \J explain: L� Tl-ie system requRed pumping more than 4 Limes a year due to broken or obsti-wed pipe(s). The system will pass inspection if(with approval of the Hoard of Healu'i): broken pipe(s) are repiacedd ob Ir cdon is removed N-D explain: 2 a6cw U1 I j OFFICIAL INSPECTION FORM - NOT FOR `VC L.'JN'[.'AJ�Yi,SS LSSMLOVTS SUBSURYACE SEWAGE MPOSAL SYSTEM INSPECTION EGA: P AI A R'-'.-' C EE R T 1F T C ATI.'ON (c o n i i r i u t ri) .Property Address: 199 Cedar Tree Neck Mail -7� U a r S t on Qwo"Wisan Margly Date Of!WMAOM C. FunherEva%doa is Rt,quirvd b)• the Board of H 0(h: ,Q Condidom exit whWh rquye Azour C-alumkh by It Board of Health in order io deier-mine ifthe system w Prote C t P u b I i C "n(.,it!-0);.5;�'t(y c,( t,i e c nv tr o rLn i c n�. I 1- Sy"In "Ill ,an uniess Board of Health deormims in accordance with 310 CAdR 11300 XW) that e "Sam is no' "Ming in a rna nur which will proact publk WHC sak, and the myno"yeat A I 7ATO "CT. esspool 0-F 5('; fee! OF, surfact: nt: L"YOW Or &Y K Whin 50 Cen of h bordering vegetated wetland or a salt marsh 2. Svs:crn. -wiii r2ii unns we B,,d Of f U t g i n a T.a n n c� r)Health Qnd Public Water Supplier, if any) determincs that the rowe" we Bulk health, Safety and environment: Tht systefn has b Septic tan): and soil absorption system (SAS) and the SAS is withk 100 feet Ora surAcc wattr supply Or *,,, to a ,,ace waRr suppo,. The svSfrill has a Septic luk and SAS wo to SAS is within a Zone I ter suppq% Vs("! h,;s a -S,p:ic cank and SAS and the SAS A "100 50 rect Ora riva[t , al�r sup The system his a septic tan}; md SAS and the S..;\S is je�ss� than I P Y ply well. 1� feet b1A 5971ect or more tTorn a "Ape "M-r S-,jPp!y wCW rvi7!hod uscd to dc(emlint distance This sYstcal pa5:;CS if the well water analysis, perfnr-rn.cd at a DEP cenified laboratory, for coilrol-IT, An"N anti YAMNc w9ank compounds indicates Mat on well is free i7OM pollution tron-t that Facility' and me Yese" ofarnmOnh nNmgcn and nimale Mogen is equal to or Uss than 5 W, provided that no War ait"A are %gend A copy of the analysis must be anached to this form. Page 4 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 199 Cedar .Tree Neck Road Marstons Mills Owner.-Edison Marne r^ . Date of Inspection: D. System Failure Criteria applicable to all systems You mig indicate"yes"or"no"to each of the following for g inspections: Yes No ll ckup of sewage into facility or system component due to overloaded or clogged SAS or cesspool pischarge or pond ing ore Muent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool reek& Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or /cesspool 2/✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h•day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped 0 :!ky portion of the SAS,cesspool or privy is below high ground water elevation. ny portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface -Zwater 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�0 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.J 4)6 (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 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. 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 �th system is within 200 feet of a tributary to a surface drinking water supply the system i y s located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 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 page s of I l OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY SUBSURFACE SEWAGE DISPOSAL SYSTEM INSI'ECTTON 'i'Cslt,,1 PART B ` CHECKLIST Property Address: 1 99 Cedar Tree Neck Road mars tons i s Owner: Edison Marne Date of Inspection:10 Check irthe following have been done.You must Indicate"yes"or"no"as to each of the 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 wce;;s ? Has the system received normal flows in the previous two week period? !i' Nave large volumes of water been Introduced to the system recently or as p::n cf tt ;s •.,�:•: Were as built plans of the system obtained and examined?(If they were not av;;i;,;L c ,: ;; :.j Was the faciliry or dwelling Inspected for signs of sewage backup? Z_ Was the site inspected for signs orbreak out? Were all system components,e'Vxcluding the SAS, located on site? Were the septic w1k manholes uncovered,opened,,and the Interior cf tl;c t :;; i;;'>;:c;tc; t;• ;;:- ;;�;, :..•�, of the baffles or tees,material ofeonsavetion,dimensions,depth of i,i;jid,d��;'s a,';!,�r: ;;;,+ �c�::• : ;c�;,; Was the facility owner(and occupants if different from owner)provide,) %;itii iorvi tr,c pro; maintenance of subsurrat a sewage disposal systems? The size and location of the Soll Absorption System (SAS)on the site has been dcwnniro;1 v! o ,: c Ycs no Existing information. For example,a plan bt the Doud of Houlth. Determined In the field(if any orthe failt:ra criteria rcl=:cd to :%%�.-t C is is unacceptable)(310 CMR 15.302(3)(b)) , S � I �r Page 6 of OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:l 99 Cedar Tree Neck Road MarGt•nns Mills Owatr:Edisoa muney Date or lnsprolon: 2 103 FLOW CONDITIONS RESIDENTIAL Number orbcdrooms(design): Number orbedrooms(actual): 5 DESIGN now bued on 310 CMR 5.203 (for example: 110 gpd x 0 of bedrooms): d'a s.�� Number of current residenu: Does residence have a garbage grinder(yes or no): •AIP tea Is laundry on a scpvatt scwagc system yes or no):_• (if yes separate inspection required) Laundry system inspcctcd(ycs Scuonal use:(yes,or no):4.0 Watcrmctcr readings, if available(last 2 years usage(gpd)): 2001=108, 000 ga.22on6-295. 89 SPD Sump pump(Ycs or no):100 ZQ0 ga.P.Ponh_465. 76 lP D Lut date of occupancy: S�a�nk 2e� b ys t em i� /�aesen t. COMM ERCLAUINDUSTRIAL Type of esublishment: A1.4 Design now(butd on 310 CMR I5.203): d Buis of design now(seaWpersonVsgR,cte.): h Grease esp present(yes or no): & industrial waste holding unit present(yes or,no): 4 Non-sWury waste dischuged to the Title S system(yes or no):! Water meter readtngs, if available: .[l¢ ) Last date of occupancylust: 77 OTHER(describe): GENERAL INFORMATION Pumping Records Sourcc•ofinformation: Was system pumped as pan of the inspection(yes or no):.60 If ycs, volume pumped:_.gallons •• How was quantity pumped determined? I9' Rcuon for pumping: 'low TYP OF SYSTEM Scptie UAk ,soil absorption system Single cesspool Overflow cesspool _Q Privy ,§p Shared system(yes or no)(Iryes, attach previous inspection records, if any) ti0lnnovativvAlternstive technology,Atuch a copy of the current operation and maintenance contract(to be obtained bom sy;tem owner) j Tight.tank Atucb a copy of the DEP approval Other(describe): Ap,Aroximate see of all components,date Installed(if own)and source or information: Were sewage odors detected when arriving at the site(yes or no): 44 6 Page 7 of I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropemyAddress:199 Cedar Tree Neck Road Marstons Milrls, Owner. Date of Inspection; 1 0 27 03 BUILDING SEWER(locate on site plan) Depth below grade: ��� 4' 02an e gle2 g 12i l2e Materials ofconstrvctio ticon _Z40PVC✓other(cxplain)&0m ceebflood to eesbirood. Distance from private water supply well or suction line: /S't Comments(on condition of joints, venting, evidence of leakage,etc.): o.in.fA elgggezn tlghl. No P nr-P- . .;&jja&age. The :Austem is vented thaough the nook vents. SEPTIC TANK: Zlocate on site plan) /06 f*44#5 Dr<pth below grade: Materiail of construction: ✓concretcA1.0 meta lA10fiberglassVbpolyethylene Ah?other(explain) If tank is mcul list age:� Is age confirmed by a Certificate of Compliance(yes or no):tDi (attach a copy of ccniftcatc) Dimensions: g`�e'��A tI�ll! l�t 6'�?,iAd Sludge depth�.GLatt._ Distance from toVr sludge to bottom of outlet tee or baffler� 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: How were dimensions determined: &fi5dfe&Ad Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet inven,evidence of.leakage,etc.)- Pump .septic tank annuadd Inie.t & outlet tees ale .in dace a . The tank i.a auc uaa y zound and b aw.. no evidence o leakage. Liquid level- at the outlet Zhve2t .ia, 5.1' GREASE TRAP:nQ(locate on site Depth below grade:na. Material of consnction: concrete,Vdmetal,eAfiberglas&VIyolyethylenc4Aother (explain): na Dimensions: na Scum thickness:na Distance from top of scum to top of outlet fee or baffle:)na Distance from bottom of scum to bottom of outlet tee or baffle na Date of last pumping:na Commenu(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Grease trap not present 7 Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM.INFORMATION(continued) Property Address: 199 Cedar Tree Neck Road Magg ons Mills owner: Edison marne Date of Inspection:10 27 03 TIGHT or HOLDING TANKQV/d-(tank must be pumped at time of inspection)(locate on site plan) Depth below grade:_,dA Material of construct,&concrete k&lmetal�fiberglass di polyethylene dg other(explain): Dimensions: Capacity: allons Design Flow: allons/day Alarm present(yes or no): Alarm level:_,4>A Alarm in working order(yes or no): Date of last pumping: AIJ� Comments(condition of alarm and float switches,etc.): 7iahl of 4o d.ing .tankz ate no /2/tesen DISTRIBUTION BOXt&c(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:V/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.): t2 "iiziguiion lox .ih not paehen PUMP CHAMBER"4e4locate on site plan) Pumps in working order(yes or no): 0/1 Alarms in working order(yes or no): /1� Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Pump chamgea 7h hot /aeben { 8 Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION(continued) Property Address:1 99 Cedar Tree Neck Road Owner: Edison Marnev Date of Inspectioul 0/2 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) 2-6'XIO' cg ,3aoo.PA ezn-rl 1-1000 gn00nn PonrAing �nif If SAS not located explain why:. /nrnied. -SOD Qngo ZO Typ leaching pits,number: leaching chambers,number: 0 leaching galleries,number: 11, ;hes,achingtren number, length: leaching folds,number,dimensions: T� overflow cesspool,number: �L ,0 innovative/alternative system Type/name of technology✓/��� �!/t(/ C2� vo'e Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Loamy •sand t No a.i nb o h d2auiic a.c u2e ore pon iris . So.iiz a4e dau. Vegetation .is noimaie4ent. CESSPOOLS: y (cesspool must pumped s part of inspection)(locate on site plan) Number-and configuration: Depth-top of liquid to ihlff invert: /_ Depth of solids layer: Depth of scum laver: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no):,T Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Same as agove _ PRIVY4"(locate on site plan) Materials of construction: Dimensions: Depth of solids: Olt Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): p a ivu .ins not ,n4e sent< 9 Page 10 of I I .. OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued)" Property Add ress:199 Cedar Tree Neck , Marstons Mills Owcer:Edison marnev Date of lnspectioo: 10/27/03 SKETCH OF SEWAGE DISPOSAL SYSTEM, Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmuks. Locale all wells within 100 feet. Locate where public water supply enters the building, :vl i 0 11S 9 14. Sl t 1 t 1 y . t � µ .latnoy otul ttwoo'Abdm is}tM oll9nd "ryrn #It0011 .001 uMIM 1111M tt• •Wo1 •r»wvw•o �o tri•wou•1 ►�uur�►� 1u+u•w��d oMt tn�t la of tip a0npul _ I 10 Page I I of l l . OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C s� SYSTEM INFORMATION (continued). Property Address:1 99 Cedar Tree Neck Road Marstons Mills Owner: Edi Gon Ma_rney Date of lospectioo: 10.127/( -3 SITE EXAM Slope Surface water Check cellar Shallow wells 1 Estimated depth to ground water ''Meet Please indicate(check)all methods used to determine the high ground water elevation: l/U:Obcaincd from system design plans on record • lfchecked,date ofdesign plan reviewed:10127103 yFS Observed site(abusing property/observation hole within 150 feet or SAS) NO` Checked with local Board of Health-explain: N,4 qLL Checked with local excavators, install rs•(a h docwn,Cntation) y,�Accessed USGS dauabase•cxplain�t R // own. (iaan.bZal ge. ma. ub. You must describe how you established the hl nun water a evatiti 11.3ed: Gah2et & (l —0.Qea Nodei. 1211"4 �2oun� wa�e4 eie-vations alove •sea -geveg. llsed: fISCS_:0&.6e1tva .con we data—. jaa, e Uzed: USaS Tnchn.ccat? gulletin watea a eva .conb. Leaching Pit l4 �cct Groundwater.p cet Below Bottom of Pit High Groundwater Adjustrtient 1.8 ft per Frim p pter Method . Therefore,the vertical separation distance between the bonom �- of the leaching pit and the adjusted groundwater table is feet. 11 r+n 19�nITR�Tr- +n:wn•nmr�-T.n rwtrwwl5�.++wrrwo.T.w.n�e��u l+��wn TOWN OF BARNSTABLE BOARD OF HEALTH SUBSURFACE SEHA09 I)ISrWAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION l . •••Tf1•T•••••t�T.11it�TT1\w.111'R.1r1T1►IA//A'IT'rl1 r'IIRIR'171'1��1'T�r/�.�T\ L —. -TYPO 01 PRINT CLEARLY- PI?OPERTY INSPECTED STREET ADDRESS 199 Cedar Tree Neck Road ASSESSORS MAP, BLOCK AND PARCEL # 076-026 OWNER' s NAME Edison Marney PART D - CERTIFICATION NAME OF INSPECTORJ_oseph P.Macomber Jr. COMPANY NAME J P Macomber & Son Ind. COMPANY ADDRESSBox 66 Centerville Mass . 02632 Street Tom or City state r,P COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 -1 578 CCRTIFICATION STATEMENT - 0r I certify that I have personally inspected the sewage disposa`1 system Rt this address and that the i►�for►nation reported is true , accurate , and omplete as of the time ofinspection . The inspection was performed and any ecoinmendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site selvage disposal systems , Chec one : System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or' Lhe environment as defined in 310 CMR 16 - 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , System FAILED* The inspection whicli I have con cted has found that the system fails to Protect the F-)tiblic health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signaturearm Date Dire copy of this c rt.ification must be provided to the OWNER, the BUYER -here aPplioable ) and the BOARD OF HEAL1'll, * If the inspection FAILED, the owner orlhoparator shall u within one year of the date of the inspection, unless allowed dortrequiredm otherwise as provided in 3.10 ChIR 16 , 306 . partd . doc • 1 I ! 1 DATE: 3/28/00 ----------- 199 Prince Ave PROPERTY ADDRESS:_199 Cedar _Tree Neck Road Marstons MIlls,Mass. b' v ------------------------ 02648 ------------------------ On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 1 -1000 gallon septic atnk. 2 . 2-6 ' x10 ' block cesspools. �� �. 3 . 1 -1000 gallon precast leaching pit. Based on my inspection, I certify the following conditions: 4 . This is. a title Five Septic System. ( 78 Code ) 5. The septic system is in proper working;-order at the present time. 6 . Pumped septic tank and 1st cesspool at the time of inspection. Heavy scum and solids existed in the septic tank. Pumped 1st cesspool. . Solids had passed ove to this cesspool. 2nd cesspool and leaching pit - /J- are presently dry.Replaced brokenSIGNATURE:s J. '- cast iron ring & cover. Name:_J_�_ Macomber Jr-_----- Company: Joseph_P. Macomber-& Son , Inc . Address: sox 66 Centerville , Ma . 02632-0066 Phone: 508-775-3338 --------------------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY • III ram" � JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-LeachfleIds Pumped & Installed Town Sewer Connectlons P.O. Box 66 Centerville, MA 02632-0066 775.3338 775-6412 P h 9 �,SS� �` • �e � vtig COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY COX Secretar ARGEO PAUL CELLUCCI DAVID B. STRUH. Governor Comtnissione SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION 199 Prince Ave Property Address: 199 Cedar Tree Neck Road Name of owner Edison Marney Marstons MIlls Mass. Address of Owner: Date of 4rspection: 3/2 A/0 0 Name of Inspector:(Please Print) Joseph P.Macomber Jr. I em a DEP approved system inspector pursuant to Section 15.340 of Tide 5(310 CMR 16.000) company Name: J.P.Macomber & Son Inc. MaTngAddress: Rny 66 rpntervil le,Mass. 02632 Telephone Number: c n o ^ r »o �v--r»T,r 3�-�v 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: 12�/Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails �r Inspector's Signature: Data: The System Inspect hall submit a 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 ofvEnvironmental Protection. The original should'be.sent tov" system owner and copies sent to the buyer,if applicable,and the approving authority. . NOTES AND COMMENTS I revised 9/2/98 Page loriI iJ Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTIDA INSPECTION FORM PART A 199 Prince Ave CERTIFICATION(oontirweO P►,w.tyAdar.aa: 199 Cedar Tree Neck Road Marstons Mills,Mass. owner. Edison r% Data of kup"don: 3 /U OY lKSP£CTION SUMMARY: Check A. B, C, or D: A. SYSTDd PASSES: I have not found any Information which Indicates that any of the failure conditions described In 310 CMR 13.303 exist. Any t4ure criteria not evaluated are Indicated below. COMMENTS: B. SYSTEaA CONDITIONALLY PASSES: _) One or more system components as described In the 'Condltlomd Pass'*action 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 beals of daterrnlnation In all 4stances. 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)Indicsting that the tank was Installed within twenty(20)years prior to the date of the 4upection: or the septic tank, whether or not metal,Is cracked,structurally unsound, shows substantial Infiltration or exffltration, or tank failure Is Imminsnt. The system will pass Inspection If the existing septic tank Is replaced with a complying septic tank u 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 pipe4 9 or due to a broken, settled or uneven distribution box. The system will pass inspection If(whit approval of the Board of Health). broken pips(&)are replaced obstruction Is removed distribution box Is levelled or replaced R - The system squired pumpirig-morn tltart'tour'dmes ti•yeardus to broken or obstructed plpe(s). The strstem wtl V=r-- Inspection if(with approval of the Board of Health): broken pipe(&)are replaced obstruction Is removed revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 199 Prince Ave CERTIFICATION (corrtira,.d) ProwWAddr.aa:199 Cedar Tree Neck Road Marstons Mi11s,Mass. Dwrw: Ed]' sod} Marney Dets of kupectkm: 3/2 8/ 0 0 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 falling to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES W ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH.YVILL.PROTECT THE PUBLIC HEALTHAND SAFETY AND THE BAMONMENT. 4b Cesspool or privy is within 60 feet of surface water Cesspool or privy is within 60 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)DETIERIMINES 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 of 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 tone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS Is within 60 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 60 feet or more from a private wets(supply well,unless a well water analysis for collform bacteria and volatile organic compounds Indicates that the well is free from pollution from that facility and the pr�)encs of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance AW (approximation not valid). 3) OTHER Abf revised 9/2/98 Page 3ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ` CERTIFICATION(eondmied) 199 Prince Ave Property Address: 199 Cedar Tree Neck Road Marstons Mi11s,Mass. owner: Edison Marney Dote of Inspection:3/2 8/0 0 D. SYSTEM FAILS: Yo��must Indicate either"Yes" or 'No" to each of the following: V0 1 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 l/ Backup of•sewage IrttofeciRtlrer-eyetent componertrdaeKo en over(wded orscleggedSA&orcesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. _i✓LN/e Static liquid level in th distributi n bo above outlet invert due to an overloaded or clogged SAS or cesspool. r_ .- Liquid depth in cesspais less than 6" below Invert or available volume is Isas than 1/2 day flow. Required pumping more the 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 then 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" 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 publi 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•le•wit4in 200 feetof-*4ribktor1H0-Q4urfe0edAnkiog-wetM•su'ply• -- the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further inforpstion. rev ' 9 2 98 Page 4orit revised / / f i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST 199 Prince Ave PropedyAddress: 199 Cedar Tree Neck Road Marstons MI11s,Mass. Owner: Edison Marney Data of hmpecdon:3/28/00 Check if the following have been done:You must Indicate either "Yes" or "No" as to each of the following: Yes N Pumping information was provided by the owner, occupant, or Board of Health. ZNone of the systemsomlwaenis haMabeen poa►ped4watJeast 1twoaweWw aad-the'system hasJ;sw1 tceiwwgwaaoi flow rates during that period. Large volumes of water have not been Introduced into the system recently or as part of this inspection. 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,including 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 condition 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 orrthe 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)1 The facility owner.(and-occaLpanuAf difieraW frnoLowner).were4wautdad with Infa&matiorypn the prnnar rnaintnna a^f SubSurface Disposal Systems. I revised 9/2/98 Page 5orii l i • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION 199 Prince Ave Property Address: 199 Cedar Tree Neck Road Marstons Mills,Mass. owner: Edison Marney Dace of km-ctkm: 3/2 8/0 0 FLOW CONDITIONS RESIDENTIAL: Design flow: )V) g.p.d./bedroo Number of bedrooms(desi n Number of bedrooms(actual):j2 Total DESIGN flow br Number of current residents: Garbage grinder)yes or no): ff Laundry(separate system) (yea o If yes, separateJaspection.required Laundry system inspected_(y6 or no) Seasonal use(yes or not: Water meter readings,if available(last two year's usage(gpd): Sump Pump(yes or no): !tX) f y l"/°l�j /� AA w 4= Last date of occupancy:t/.r/X COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: d ( Based on 15.203) Basis of design flow fW Grease trap present:(yes or no) Industrial Waste Holding Tank present: (yes or no) Non-sanitary waste discharged to the Title 6 system:(yes or no)AY Water meter readings,if available: 4-14 Last date of occupancy: Af 14 OTHER:(Describe) Al Last date of occupancy: i GENERAL INFORMATION PUMPING RECORDS and soVEce of information: 7'�v.�. /l�4 System pumped as part of inspection: (yes or no) If yes, volume pumped: 4222 gallons Reason for pumping:_— ,r.y TYPE Of SYSTEM Septic tank/distributioo_b"/soil absorption system Single cesspool x/e Overflow cesspool AO Privy _jL Shared system(yes or no) (if yes, attach previous inspection records,if any) ,t),4 I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank A44 Copy of DEP Approval Other 70 0�MATEAGE all components, date installedlif known)-and source of4pfermation: Sewage odors detected when,arriving at the site:(yes or no) revised 9/2/98 Page 6ofII SUBSURFACE SEWAGE DISPOSAL SYSTFM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 199 Prince Ave Property Address: 199 Cedar Tree Neck Road Marstons Mills,Mass. O1Nf1 : 3/28/00 Date of 4npection: BUILDING SEWER: (Locate on site plan) Depth below grader Material of construction:_zcast Iron_L/40 PVC&other(explain) .t l"4 Distance from private water supply well or suction line /t f- Diameter 011 Comments: (condition of Joints, venting, evidence of leakage,♦tc.l Joints appear tight No ev; denc-P of 1PAkagA SEPTIC TAN K:_O (locate on she plan) Depth below grade'JV Material of construction: �oncret@AAmetals LFiberglass.d6LPolyethylene ddother(explain) '11 If tank Is (natal,list age Jam.. Js.ags.confvmed by Certificate of Compliance_(Yes/No) Dimensions:Yi u&4 'y le �A� �� �✓.(. Sludge depth: 19 Distance from top of sludge dge to bottom of outlet tee or traffle•.1� Scum thlckness: Distance from top of scum to top of outlet tee or baffle: d Distance from bottom of scum to bottor of outlet tee or baffle: + How dimensions were determined:_ I ,-Z orT T. fe aa- 7,i Comments: (recommendation for pumping, condition of Inlet and outlet tees or-baffles,depth of liquid level in relation to outlet Invert,structuroHntegrity, evidence of leakage,.etc.) / PUMP the st-pt-jr- tank ;;nniial1jr r,;;Z:haqQ disposal e tanX 'strticturaliv sound and shows nn Pmj rEanre of 1 eakalgc. .Septic tank gyp y scum & solids layers. GREASMp.. (locate on site plan) Depth below grade: Material of construction:+A/ concreteA�2rnetal4A/ Flbergiass ail Polyethylene4vother(expiain) Dimensions: AIA Scum thickness: Ah4 Distance from top of scum to top of outlet tee or battle: w/d 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.) Grease trap is not present A revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART C SYSTEM INFORMATION(condnuod) 199 Prince Ave PropertyAddress:199 Cedar Tree Neck Road Marstons Mi11s,Mass. Owner: Edison Marney Date of tr►spection: 3/2 8/0 0 TIGHT OR HOLDING TANK;dAd&(Tank must be pumped prior to, or at time of, Inspection) (locate on site plan) Depth below grads:d(d Material of construction:4iAconcrete4gmetal4Fiberglass�,Polyethylene,&other(explain) AI-4 ./A -. . Dimensions: 49 Capacity: Alf! gallons Design flow: A, 14 gallons/day Alarm present__ Alarm level: Av'4 Alarm in working order:Yes.fd No&j Date of previous pumping: le4 _ Comments: (condition of Inlet is*, condition of alarm and float switches,etc.) Tight Or HO di ncr tanks arp nnf ragant DISTRIBUTION BOX:&&Ve. (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if level and distribution is equal, evidenoe of solids carryover, evidence of leakage Into or out of box, etc.) - - DistrihL inn hox is not precap+- . - PUMP CHAMBER:,(, (locate on site plan) Pumps in working order:(Yes or No)�.Q„ Alarms In working order(Yes or No)-A& Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) ump chamber is not rPGPnt revised 9/2/98 Page IofII SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART C ► 199 Prince Ave SYSTEM INFORMATION(cwK1Ia►: ed) Prop-tyAddress: 199 Cedar Tree Neck Road Marstons Mills,Masss. Owner: Edison Marney Data of kWgN dQn:3/2 8/0 0 SOIL ABSORPTION SYSTEM(SAS) (locate on site plan,If possible:excavation not required,location may be approximated by non4ntrualve methods) If not located, explain: Type: ' leaching pits, number:,,y� leaching chambers,number: t/ leeching galleries,number: leaching trenches,number,length: teaching fields, number, di men Ions: overflow cesspool,number. Alternative system: a 1Ve ( 78 Code Name of Technology: Comments: (note condition of soil, signs of hydraulic fallurs,level of pondln damp,soU, conditi n f ve etatlo eta.) Flo signs o1 ri uraulic al ure or pori 1ng-So11S arP dry_ VPgatatinn is nnrmnl CESSPOOLS: (locate on she plan) 1 2 Number and configuration: Depth-top of Uquid to Inlet Invert: Dry Depth of soUds layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: Inflow(cesspool must be pumped as part of Inspection) No signs o wa ter intrusion, Comments: (note condition of toll, signs of hydrsuUc fallure..level of pend(ng,condidon of-vegetation, etc.) Same as above PRIVY: (locate on site plan) Materials of construe qn: . Dimoltalonat '0 / Depth of soilds: Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation;eta.) P'rivy is not pFeseat. revised 9/2/98 Paet9ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C • SYSTEM INFORMATION(c*n*w* ) 199 Prince Ave Prcp--tyAd&—; 199 Cedar Tree Neck Road Marstons Mi11s,Mass. OWTW: Edison Marney Dou of 4uPecsl4m:3/2 8/0 0 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at lust two permanent reference landmarks or benchmarks locate all wills within 100' (Locate where public water supply comes Into house) I 1 1. 1. 1 a . r�. revised 9/2/98 Fagg 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM • PART C ► SYSTEM INFORMATION(conttnied) 199 Prince Ave ProWtyAddrass: 199 Cedar Tree Neck Road Marstons Mills,Mass. Owrw: Edison Marne Dou of kupection: y 3/28/00 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Obssrvation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells r 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, basemeat sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps _zchecked pumping records ,,--"Chocked local excavators,Installers _Used USGS Date �I Describe how you established the High Groundwater Elevation. IMust be completed) Used water contours Map. Gahrety & Miller Model 12/16/94 revised 9/2/98 page it or it >•nx+lrr..—n.T�r—arlrrnn•n*en�-rert ranrn.rr.•n+w�nr+�*Rnm nrrw�++�r+urta�+ •T•�sr���rr.1r—:..t-.r.. 1UHN OFBarnstable BOARD OF HEALTH } SUI)SUI(FA CF SF.HAG<': DISPOSAL SYSTEM - _.M IN9PRCTION FORM PART D • CERTIFICATION I ^•T]•1�T•'. ::f�T,11T.�T..TTM11•TI'R.'1SITRTIfT./lTHT:T—{'IT,11TR't RRfrTT.R.�t/.�.�Rt'A�7 fwl. :Tt1•TT•R+1r•�...1 -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED 199 Prince Ave STREET ADDRESS 199 Cedar Tree Neck Road Marstons Mills,Mass. ' ASSESSORS MAP, BLOCK AND PARCEL 0 076-026 OWNER' s NAME Edison Marney PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber �& Soff''fnc. COMPANY ADDRESS Box 66 Centerville,Mass. 02632 . Street Town or City- state LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 j 790- 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Chec one : iV System PASSED j The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or- the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection w)lic)I I have con\-d-octed has found that the system fails to protect the public health and the environment in accordance with Title 6 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Si nature 14V1 IA41 4�,414412jll Date - :)ne copy of this cer .ification must be provided to the OWNER, the BUYER where applicable) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or.."operator shall u d within one year of the date of the inspection, unless allowed ort required he m otherwise as provided in 3.10 CmR 16 . 305 . partd.doc LOCATION l 9�edla.l� 7ree he e Kd SEWAGE # VILLAGE 44/'51 T�S /"l d/1.r -ASSESSOR'S MAP&c LOT INSTALLER'S NAME&PHONE NO. ,J SEPTIC TANK CAPACITY ISO --aH`c f SO `Gcvu C LEACHING FACILITY: (type) C vs (size) Jc_ 5d0 s NO.OF BEDROOMS 5- BUILDER OR OWNER PERMITDATE: trOMPLIANCE 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 f leaching facility) ._.� _ L Feet Furnished by �1 c v D ©Sr D � gOi4 0 - Q -pr31 A 6 o(a o � r� ►+a" o 14 TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY TOWN OF BARNSTABLE LOCATION SEWAGE # o2DDS l®�7 VILLAGE . ZV,��I ASSESSOR'S MAP & LOB INSTALLER'S NAME&PHONE NO._/ - SEPTIC TANK CAPACITY Sao s L /Jyo G,cl Choi y.c LEACHING FACU ITY: (type) Oo (size) A2 NO. OF BEDROOMS r BUILDER O OWNER PERMITDATE: f.7 l-aG COMPLIANCE DATE: lJ Separation Distance Between the: Maximum Adjusted Groundwater Table to the 13Qttom of Leaching Facility Feet T,,. Private Water Supply Well and Leaching�Facihty (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) looms Feet Furnished by 5441/1"7 Get pe !112 irmGYc �1d isrr�Gr� rr�-10 i��w � Oy i i I s-i EdisgA. Marney 199 199 Cedar Tree Neck Rdad Mar8tons Mils,Mass. 02648 System consists of. 1 -1000 gallon septic tank. 2-6 'x10 ' block cesspools. 1 -1000 gallon precast leaching pit. 1 0 r� 1 _ i/ l LO CAT IPN SEWAC PERi01T NO. VILLAGE _ ss R o7ss • 6, s Iq�-(1 IOSTA LLER'S CIA ME & A00RESS Y 111 BE OR OVq ER aftu i�'v OA T E PERMIT ISSUED OATE • COMPLIANCE ISSUED - PrG i i � v J. \:Jam. Rte 28 / 0 S CU ohw �:'� �......f rn- OhW ,-�.......... :i N h Roao v Necked Public WaY) Tree , ; e d a r Neck a 0. 4 / L=28 -':::', \ L 75.0 � / Locus Map 4• _14;01 O,y - V 3�1�'� - -- - Scale: 1"=2,000f' ' Owner: ASSESSORS REF. : Map 76 Parcel 26 A John H & Cecilia M Gallagher 16 Whitman Road OVERLAY DISTRICT: / f Needham MA 02462 Deed 188351106 AP - Aquifer Protection District ' t 1 vi ` A \ It f-- --' As Shown on Plan Entitled MN2 "Revised Groundwater Protection \ Overlay Districts" - April, 1993 ZONE: RF TH2 Area (min.) 87,120 SF (RPOD) Zo Proposed:: �_ Existing N �. o _ ��') �o � / Frontage (min) 150' t P(D-0 �~ / Width (min) no TO BE REMOVED \ �5 �0 \ OR ABANDONED` `-'' J NEot olaTO D Setbacks: o, coNc \f�R opE Front 30' \` \. 6�51)MBcFT c amide 15' Q �`\ Existing \� R �0 Rear 15' Garden J 7O Area ,Q \ . 8 �\ Q l` FLOOD ZONE: Spa Bluestone \ Zone A11e111) & C r+ \\ \ Patio ? '� Community Panel No. .. . .. ..... ..... R E Y .......` v c P° 't �' #250001 0018 D \ `\\\ \` SAP sv+l \ ) July 2, 1992 � O v o poSE�EI �� vv vv PR 0 , Flag I \ \ I= m \ z o \\ \\ # 199 h a \\ \ 1 Sty w/f \ z \ \ \\ Dwelling ON T� t) O CT \ el Top of Coastal Bank 0B / (Town Definition) �py . ° /k \ram �..j 15� 1 a'� 01 _10- 777. - - - , i - l7 �. � or \ �M'r1 `N MHW as per ....... Ed9 Plan 75151 (June 15, 1946) - o Legend: , Q Septic Cover p Dill Hole _ _ __ -- ..'..�................ __ 0 CB/DH Concrete Bound _ / .................... Utility Pole - 160E ..................... MLW as per Plan 75/51 ................ Light Post (June 15, 1946) © Gas Gate ......................... -p+- Pool Fence ............................... -ahW- Over Head Wires ..................... .. . .......... -G- Gas Line(as flagged) Ram & Float -w- Approx. Water Line p -E - Approx. Electric Line rince Cove Tidal Vent F F EL. 26t Finish Grade F.G. EL 25 Risers & Cover To Grade F (2 Required) J'Max. Filter 9 i in Compacted Fin Fabric B.F. EL. 183 1 �- 1/6'- 1/2" Pea Stone See Note 3 Owl EL. 27.0 LEACHING - Double Washed EL 171 Propose - - - - - _ -._-.._ ._.._! CHAMBER Stone 0-80x _ H-20 EL. 22,7 H-20 Proposed - -_-- Proposed 1500 Gallon Proposed 1500 Callon Leochin Chambers EL. 16t Septic Tank Pump Chamber Flow E uilizers - H-20 10' H-20 H-20 s eqw e Min. Bed din & "T•s 0. as Per Title _ Encountered Remove & Replace Leach Chamber Cross Section � t .. =t. nC: ^ - -4J ii -t. l ryl �+-'•' All USuilable Soils Within 5'of The Outer Perimeter of The System Not to Scale Developed Profile of Proposed Septic System Not to Scale Groundwater ®EL. 2f Per TOB Groundwater Map 1 2"0 Galy. Pie 24"0�P For Float Support Opening Above For /� cme �Cnver O,",d, ofI." SEPTIC NOTES To D-Box Acc / p PERC TEST: 11,191 1. Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours Pum Power & Float Con trot With Federal, Sfote &Locale Bldg. & Elec. Codes \ y Prior to Any Excavation For This Project the Contractor Shall Make PERFORMED BY SULLIVAN ENGINEERING DESIGN DATA the Required Notification to Dig Safe(1-888-344-7233). 4"0 Fr m ti WITNESSED BY DONALD DESMARAIS,R.S. 2. The Contractor is Required to Secure Appropriate Permits From Town Tank. um 40 PVC Single Family 5 Bedroom Upgrade Prevost Pump DECEMBER 9,2005 g Y- Pg Agencies For Construction Defined by This Plan. Chamber With NO Garbage Grinder �� ' 10' g 3.Where Shown,Install Risers to Within 6 of Finished Grade Daily Flow= 110 x 5=550 GPD Unless Noted Otherwise(5 Required). TEST HOLE - 1 TEST HOLE 1 Septic Tank:550 GPD x 200%= 1100 GPD 4.All Structures Buried Four Feet or More or Subject Pump Chamber Plan View Detail EL.25.0 EL.25.0 p FILL FILL Use 1500 Gallon H-20 Septic Tank to Vehicular Traffic to be H-20 Loading. Not to Scale 36" 22.0 23" 23.1 5. Septic System to be Installed in Accordance With 310 CMR 15.00& 4-0 5ch. 40 PVC Finished 9-M" O LAYER lOYR 3/1 O LAYER ]OYR 3,1 LEACHING AREA 248 CMR 1.00-7.00 Latest Revision and the Town of Barnstable am seoliara crnk cratle cover /0.74=743 SF Required Board of Health Regulations. VERY DARK GRAY VERY DARK GRAY 550 GPD 43" SANDY LOAM 21.4 25" SANDY LOAM 22.9 Sidewall=2(12'+45')2'=228 SF 6.All Piping to S 40 PVC. 7.Inlet Tees Shall11 Extend nd a Minimum of 10" condait Thra Chamber For B 1 LAYER I OYR 4/2 B 1 LAYER 1 OYR�'2 Bottom Area=(12'x 45')=540 SF ,.at cables '. h nllFor Drain I DARK GRAYISH BROWN DARK GRAYISH BROWN 768 SF Total Provided Below the Flow Line. ' To O-Bo, 8.An Outlet Tee With a Gass Baffle Shall Extend 19" Below the Flow Line. Emer mnc stars Min. z' cover 57" SANDY LOAM 20.3 33' SANDY LOAM 22.3 9.Existing Septic System to be Removed,or Alorm Or Ef. 14.0 Mercur Flcat B2 LAYER IOYR 5/6 B2 LAYER lOYR 5,/6 LEACHING CHAMBER DESIGN Pumped and Filled With Clean Material. Switches - J Regd YELLOWISH BROWN Pam On Et 12 9 YELLOWISH Y LOAM All Pipes to be Schedule 40. Use 10.Contractor to Confirm That Proposed System Receives All House Flow. COARSE SANDY LOAM 20 7 P Pump or.El. t?5 am 73" 18.9 52" COARSE SANDY LOAM 5-500 Gal.Leaching Chambers in a 11.Wherever Sewer Lines Must Cross Water Supply Lines,Both Pipes secure Pi a at Ta z•e sad. .o PVC C LAYER 2.SY 6/4 C LAYER 2.5Y 612 Shall be constructed of Class 150 Pressure Pi and Shall be Pressure a am a ham e, Threaded Pipe LIGHT YELLOWISH BROWN LIGHT YELLOWISH Bl'OWN 12'x 45'Washed Stone Field as Shown. Pe MED. SAND Tested to Assure Watertightness. Baltam EL 1,z 120" 15.0 _ _________MED. SAND NO GROUNDWATER ENCOUNTERED - 12.Thrust Blocks Shall be Placed Along the Pressure Line Where Required. 9 PERC TEST 19.3 a" was^ed 1 120"1 <2 MIN/IN 15.0 Stone Min. NO GROUNDWATER ENCOI:NTERED Pump Chamber Section Detail Not to Scale TITLE: Site Plan PREPARED BY.• PREPARED FOR: NOTES: Proposed Se t/c V rade Sullivan Engineering, Inc. CapeSury hn 1.) The property line information shown was p p pgJo H & Cecilia M Gallagher compiled from available record information. PO Box 659 7 Parker Rcod c� t Osterville, MA C2655 Ostervil-e MA 02E5 ' 16 Whitman Road 2.) The topographic information was obtained 199 Cedar Tree Neck Road (508)428-3344 (508)428-3115 fox (508)420-3994 (508)420-3995 fc, Needham MA 02462 from on on the ground survey performed on PSu11PEOool.com copesurv�kapecod.rer or between 31/MAR/04 & 14/SEP/05. v ( ss arnstable Marstons Mills)MI��S) M 3.) The datum used is NGVD '29, a fixed mean Draft: JOD Field: MDH/WHK/JPM p 10 20 40 80 sea level datum. v DATE: SCALE: Comp/Review: PS Comp/Draft: MDH/RRL Dec. 15, 2005 1 "=20' Proji. # 24033 Project # C612