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Home My WebLink About0009 DEBBIES LANE - Health f 9 Debbies lane Marstons.Mills A = 011.—,01,2 I I -J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Debbies Lane Property Address James & Kristin Baker Owner Owner's Name / information is Marstons Mills ✓ Ma 02648 1/15/2021 required for every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 5l2 on the computer, Sean M. Jones use only the tab key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Beldan Lane VdQ Company Address Centerville Ma 02632 City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com, SI4522 sean@smjonestitle5.com License Number B. Certification I certify that: 1 am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 16.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 1/15/2021 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts r= Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Debbies Lane Property Address James& Kristin Baker Owner Owner's Name information is required for every Marstons Mills Ma 02648 1/15/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The property located at 9 Debbies Ln Marstons Mills is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and 2 500 gallon precast leach chambers. Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection 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): l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 10 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 9 Debbies Lane Property Address James& Kristin Baker Owner Owner's Name information is required for every Marstons Mills Ma 02648 1/15/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): El Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or 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): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 I f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 9 Debbies Lane Property Address James& Kristin Baker Owner Owners Name information is Marstons Mills Ma 02648 1/15/2021 required for every page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Debbies Lane Property Address James& Kristin Baker Owner Owner's Name information is Marstons Mills Ma 02648 1/15/2021 required for every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Debbies Lane Property Address James &Kristin Baker Owner Owner's Name information is required for every Marstons Mills Ma 02648 1/15/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Debbies Lane Property Address James& Kristin Baker Owner Owner's Name information is required for every Marstons Mills Ma 02648 1/15/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 gpd Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Debbies Lane Property Address James & Kristin Baker Owner Owner's Name information is required for every Marstons Mills Ma 02648 1/15/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ 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 below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 9 Debbies Lane Property Address James& Kristin Baker Owner Owners Name information is required for every Marstons Mills Ma 02648 1/15/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: system repaired 8/9/2005 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2.5 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.): Joints in good condition, no leakage, vented through roof. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,tr 9 Debbies Lane Property Address James& Kristin Baker Owner Owner's Name information is required for every Marstons Mills Ma 02648 1/15/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2 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: 1000 gallons Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle 3 Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and tookmeasurements 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 does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments zu� 9 Debbies Lane Property Address James& Kristin Baker Owner Owner's Name information is required for every Marstons Mills Ma 02648 1/15/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: 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.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 I c Commonwealth of Massachusetts Title 5 Official Inspection Form 1- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Debbies Lane Property Address James& Kristin Baker Owner Owner's Name information is required for every Marstons Mills Ma 02648 1/15/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No 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 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was video inspected and found level and in good condition with no rot. Water level was even with outlet invert with no signs of past backup. t5insp.doc-rev.7r26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts i= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Debbies Lane Property Address James& Kristin Baker Owner Owner's Name information is required for every Marstons Mills Ma 02648 1/15/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2x500 gal ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 i Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Debbies Lane Property Address James& Kristin Baker Owner Owner's Name information is required for every Marstons Mills Ma 02648 1/15/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System(SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): s.a.s. consists of 2 500 gallon precast leaching chambers in a 25x13x2 trench. Leaching facility was video inspected from vent and was found with 1'standing water and no stain lines higher. 12. 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.): t5insp.doc•rev.7/26/2018 Idle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 I c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Debbies Lane Property Address James& Kristin Baker Owner Owner's Name information is required for every Marstons Mills Ma 02648 1/15/2021 page. City/rown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 I Commonwealth of Massachusetts +� Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 9 Debbies Lane Property Address James & Kristin Baker Owner Owner's Name information is required for every Marstons Mills Ma 02648 1/15/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 2 A no � 2 72 & 3 7�'� 2� � 3 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Debbies Lane Property Address James& Kristin Baker Owner Owner's iName information is required for every Marstons Mills Ma 02648 1/15/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Debbies Lane Property Address James & Kristin Baker Owner Owner's Name information is required for every Marstons Mills Ma 02648 1/15/2021 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Commonwealth of Massachusetts H - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .mom 9 Debbies Lane Property Address " Melissa Hersh Owner Owner's Name / information is ' required for every Marstons Mills V Ma 02648 10-28-15 page. City/Town State Zip Code Date of Inspection Is �:J3 1 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 Matthew F. Gilfoy use the return Name of Inspector key. Excavation Company �y Company Name 14 Teaberry Lane I� Company Address Sandwich Ma. 02644 City/Town State Zip Code (508)477-0653 S113640 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 vv 10-28-15 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t a� �s t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 9 Debbies Lane Property Address Melissa Hersh Owner Owner's Name information is required for every Marstons Mills Ma 02648 10-28-15 page. Citylrown 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 9 Debbies Lane Property Address Melissa Hersh Owner Owner's Name information is required for every Marstons Mills Ma 02648 10-28-15 page. Y P P Cit /Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 Debbies Lane Property Address Melissa Hersh Owner Owner's Name information is required for every Marstons Mills Ma 02648 10-28-15 page. CityTrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool 0 ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 9 Debbies Lane Property Address Melissa Hersh Owner Owner's Name information is required for every Marstcns Mills Ma 02648 10-28-15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 Debbies Lane Property Address Melissa Hersh Owner Owner's Name information is required for every Marstons Mills Ma 02648 10-28-15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 9 Debbies Lane Property Address Melissa Hersh Owner Owner's Name information is required for every Marstons Mills Ma 02648 10-28-15 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage see below 9 ( Y 9 (gPd))� Detail: 2014-55,000gallons 2013-64,000gallons Sump pump? ❑ Yes ® No Last date of occupancy: current 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 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 Debbies Lane Property Address Melissa Hersh Owner Owner's Name information is required for every Marstons Mills Ma 02648 10-28-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: owner- last pumped in the spring of 2014 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 Debbies Lane Property Address Melissa Hersh Owner Owner's Name Information Is required for every Marstons Mills Ma 02648 10-28-15 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: New leaching add to existing tank in 2005 Were sewage odors cetected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2'6" Depth below grade: feet Material of constructicn: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private grater supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): 1'6" Depth below grade: 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: 1000 gallon Sludge depth: 4" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 Debbies Lane Property Address Melissa Hersh Owner Owner's Name information is required for every Marstons Mills Ma 02648 10-28-15 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 32" Scum thickness 2 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 15" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appeared to be in working order with liquid level equal with outlet invert. Tank is not in need of pumping at this time. 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 ;M 9 Debbies Lane Property Address Melissa Hersh' Owner Owner's Name information is required for every Marstons Mills Ma 02648 10-28-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 Alarmi present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts 4 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Debbies Lane Property Address Melissa Hersh Owner Owner's Name information is required for every Marstons Mills Ma 02648 10-28-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): At time of inspection D-box is in working order with no sign of back up or carry over. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 9 Debbies Lane Property Address Melissa Hersh Owner Owner's Name information is required for every Marstons Mills Ma 02648 10-28-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: (2) 500 gallons chambers ❑ 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.): At time of inspection leaching appears to be in working order with no sign of hydraulic failure. Chambers were dry at time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 9 Debbies Lane Property Address Melissa Hersh Owner Owner's Name information is required for every Marstons Mills Ma 02648 10-28-15 page. Cityfrown 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 f Commonwealth of Massachusetts a Title 5 Official inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 Debbies Lane Property Address Melissa Hersh Owner Owner's Name information is required for every Marstons Mills Ma 02648 10-28-15 page. Cityrrown 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 10D.feet. Locate where public water supply enters the building. Check one of the boxes below: Z hand-sketch in the area below ❑ drawing attached separately O O 2 AI- 21, 19Z- ` ,? 4- 0 193- 11: f3Z- 83 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 �M 9 Debbies Lane Property Address Melissa Hersh Owner Owner's Name information is required for every Marstons Mills Ma 02648 10-28-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: No Gw 144" 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: 7-13-05 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: Plan on file with BOH Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3N3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 Debbies Lane Property Address Melissa Hersh Owner Owner's Name information is Marstons Mills Ma 02648 10-28-15 required for every li 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 n Bit 21543 P--, 22 2 -C..r 264 E 1 1-21-2006 a 12 = 31w, DEED RESTRICTION WHEREAS, tr'1-l•SS/� of (owne�name, <iti�S L ,4-/LS7�r�S G i�i l�tl� MA address) is..,the owner of ! '13�i s �"r located (address) a MA (hereinafter referred to as ?f8 3 i e AftV/t_ and being shown on a plan entitled "Subdivision of Land in it f MA, Property of et al, duly recorded in Barnstable County Registry of Deeds in Plan Book_ '�f! ' , Page �� ; Or on Land Court Plan Number /Lj14 WHEREAS, L as the owner of said lot has (owner's name) _agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing 'the`issuance of a building permit for the construction of a single family home on this property, is requiring that the agfeement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deedsby recording this document, deedr n NOW, THEREFORE, 11-k7-q41- does hereby place the (owner's name) following restriction 6-h his above-referenced lava in accordance with his agreement with the.TbmuL.of Rarnstable Board of Health, whieh Festrietion zhaIt run with the land and be binding upon all.successors in title: may have constructed (address) upon the lot a house containing no more than -n++-e�y (3) bedrooms. C c- S;A /Vinr agrees that this shall be permanent deed (owner's n me)� t�s ' restriction affectinci located on Sf MA and . being shown on the plan recorded in Plan Book,0�-7� , Paged _ ? Or on Land Court Plan w�n For title of see the following deed: Book—61KI , Page L$ Or Land Court Certificate of Title Number Executed as a sealed in st ment ' '1 day of' t,NvVt( 41 Owner's signature Owner's signature Owner's signature COMMONWEALTH OF MASSACHUSETTS ss Then personally appeared the above-named Q known to me to be the person who executed the foregoing instrumeJ nd 9 9 acknowled ed the same to be free act and-deed, before me, Notary 46 IS Publi BARNSTABLE COUNTY " REGISTRY OF DEEDS `j"' A TRUE COPY,ATTEST :MSi c�..T ., B Xp res: I"W R MUDp HEGIRWA (date) deed BARNSTABLE REGISTRY OF DEEDS rvew o �tGe , co Al liq lt 4e �� TOWN OF BARNSTABLE LOCATION 7 Oeik S5 ! A SEWAGE # Vrf LAGE ,�°+ � �� ASSESSOR'S MAP & LOT 011-al INSTALLER'S NAME&PHONE NO. X d SEPTIC TANK CAPACITY / LEACHING FACILITY: (type) (size) n, NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: d S— COMPLIANCE DATE: /v d 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 N k ry ►may - _ � >>. No. t7C�c� ee 0 0 .0 0 Entered in computer: THE COMMONWEALTH OF MASSACHUSTTS Yes PUBLIC HEALTHDIVISION - TOWN OF BARNSTABLEa MASSACHUSETTS 01poYication for Migonl Opztem Construction Permit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No.4 2 0—0 8 9 0 9 Debbies Ln, Marstons Mills Melissa Hersh Assessor'sMap/Parcel 11 /12 9 Debbies Ln, Marstons Mills Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No.3 6 4—0 8 9 4 Wm E Robinson Sr Septic Eco—Tech PO Box 1089, Centerville 43 Triangle Cir, Sandwich Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(nc) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date. Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Install a new Title 5 leach system to plans of Eco—Tech, ETE-2096. 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 issued by this Bfiwd ofoHealth. ,. Si e Date V Application Approved b Date ` l6 Application Disapproved for the following reasons Permit No. �C�O S 3 Date Issued IL5 \�✓.��'9i^�,� ,to } � 00.00 No. a�05 Fe THE COMMONWEALTH OF MASSACHUSE +TS Entered in computer: ✓ y. � .M Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication.. for Miopozal 6pelem Con!5truction Permit ` App ation for a Permit to Construct( )Repair( 4 Upgrade( )Abandon( ) 13 Complete System O Individual Components Aocation Address or Lot No. Owner's Name,Address and Tel.No. — 9 Debbies Ln, Marstons Mills Melissa- Hersh Assessor'sMap/Parcel 11 /1 2 9 Debbies Ln, Marstons .Mills Installer's Name Address,and Tel.No. 775-8776 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4 Wm 2 Robinson Sr Septic Eco-Tech PO Box 1089, Centerville 43 Triangle Cir, Sandwich Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( go Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow --gallons. Plan_ Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alteratigns(Answer wher�ap�licable� Install a new Title 5 leach system o p ans o co- ec , #ETE-2096. Date last inspected: hr „- 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 issued b this art of l alth. a ;+ Sig + Date Application Approved by _ �- Date l5 Application Disapproved for the following reasons Permit No. @CDO 'S 30 Date Issued THE COMMONWEALTH OF MASSACHUSETTS Hersh BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed ( )Repaired ( Upgraded Abando ed( l r b Wm f Robinson Sr Septic Service Debbies Lane, as ons MI s at has been constructed 'n accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. o2ouY- 3 L dated Installer Designer The issuance of this permits he as a guarantee that the sy em ill fu lion&n�e Date VQ 5 Inspector Hersh THE COMMONWEALTH OF MASSACHUSETTS $ PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS =igpoga1 *pg;tem (Con! truction Permit Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( ) System located at 9 Debbies Lane, Marstons Mills and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructs n must be completed within three years of the d e of this per �i �l Date: Approved by Town of Barnstable Regulatory Services P� BARNSTABLE, + Thomas F. Geiler,Director 9g,A 6'9. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Designer: Eco-Tech Installer• Wm E Robinson Sr Septic Address: 43 Triangle Circle Address: PO Box 1089 Sandwich Centerville On Uj� Wm E Robinson Sr SeptiVvas issued a permit to install a ate (installer) septic system at 9 Debbies Ln, Marstons Mills based on a design drawn by (address) Eco-Tech dated 07-13-05 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. tH OF lygssgc DAVID y�N D. a (installer's Signature) COUGHANOWR N t No. 1093 GIsTF��O SgNtTAR1 4 (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form "4 II 5/25/01 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, �� i Co�� D ,hereby certify that the engineered plan signed by me dated-7113 0 concerning the property located at W l e5 Lv1 �al�5f y I �c7 meets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) ` D B) G.W.Elevation 44'0 +adjustment for high G.W. 3 DIFFERENCE BETWEEN A and B SIGNED : �' Cam`�`' r`�� DATE: NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:pero6kmp LOCATION 6/6�3 ZAA6 EWAGE PERMIT(164Z, N0. ,P, .-S) YILLA6E �I STA LLER'S NAME i ADDRESS B U I L D E R OR OWNER Q DATE PERMIT ISSUED D 0MPLIANCE ISSUED � A E C _ T } . r _f c s �a p THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Diipu,ial lVorkri Tnntrnrtinn Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at .. , ..1 (l n�. l�s Co l t.�......... .k b .. 5.4-a es j� Coca ion-Address or�,ot No.f �M .......Ll-.rl r�...mG .1. +.1! ............ .... oZ�.. S�Q ....St........JGv+rl.G.l_._...!. ...... Owner Address a .............................. --------------- ......... -------------- OF ........... Installer Address Q Type of Building Size Lot.. Q_}. ....Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) PL4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ------------------•---••----•-•. • W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter-----------_-. Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `4 Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water..................... f� Test Pit No. 2................minutes per inch Depth of,Test Pit..................... Depth to ground water......................... ----•-•--•--------------------------------••----.....--•--.........-----•-••-•--•-•------=------••---------•-•-•--.......-•-•••••-•-----••...•--....._...... ODescription of Soil................................................................................................••-•----------•----....-•---•-------•--...-------------•..........•---•- txj ---------------------------------- ._....---------------------------------- -..------------------ -....... .-.------------- •--•---------------- ...... ------------- ------------------ •---------- ..... W U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -------------------------------------------•--•----•----....------------------------.....•...............---....--------------------•------------------------•--------------------------.._.._..-----•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b7eissued by thee�oaard of health.Signed y Date Application Approved BY ._._---•--•------•-----•----••---------------•--- -..---- Date Application Disapproved for the following reasons:................................................................................................................. .....................................••--••--•--....---•------.......----•----.....---..........---...............................-•-•--......---...---•-•---------•-------•.••-•--•--•-•••-----•••.••••. Date Permit No....... .- .-aAs.................... Issued......'' '" .:�..---....------. ---- - Da y _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........O F........................................... Appliration for'-D iipniittl Workii Tonstrnrtion ranfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...-•..................................................••--....-•-•--•••---••---•---••----......-- ••---•-----•-•-•---•-•-•-•--•----•.....--•--.....---._....••------•.......-•-•-----........_...... Location-Address or Lot No. ....... .......................... ........................_. er Address W .._.._..... Installer Address d Type of Building Size Lot...........................Sq. U Dwelling ...........................Expansion Attic ( ) Garbage Grinder feet —{No. of Bedrooms................. aOther—Type of Building ............................ No. of persons........................... Showers ( ) — Cafeteria ( ) a' Other fixtures .................................. d W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........ ........... Diameter.................... Depth below inlet................:... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Perf �r ormed by........... .............................................................. Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... fs, Test Pit No. 2_,............minutes per inchj°Depth of Test Pit.................... Depth to ground water........................ 1�1----•-------------------------------•-----.........-----------......----•-----..........---•••--------•---•--•--••-.....-•••---•-:.....•---...----........O Description of Soil..................................................---------••-----•---••-•-•---------------------------------------., �C U ::.r:<.. ........... -.......------------- W U Nature of Repairs or Alterations—Answer when applicable................................................................................................ -------------------------------------•-•••----•-•--•--••-•-----•-----•------•-•-------•-•-•-.-_....--•-.....----•--•---••••----••----•------------•........--•••-•-•-•••---•--•----------------•------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in " operation until a Certificate of Compliance has be sued by thejjoard of health. ..- Signed......... � G , Date Application Approved By.... '-`" i' .� ....o+ .--... ..- ....... Date, , Application Disapproved for the following reasons: ...........................................•---------••---------•--•--••---•------------. ......•--•-•...... ----------•...................•-•--•---•----•-----••----•-------•---•-••-•••----------•--.......------..........----------------------•--•-------•...••-•-----•--------....--••--•••-----••--•--•----•--- r1., Date i PermitNo.........................•--••---- ..................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... (9rdifiratr of f omplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by................ ..... ...._. �C� Installer has been installed In ac""coi�ce with the provisions o p '� 5 of The State Sanitary Code ......as described in the application for Disposal Works Construction Permit No......... __.�. .7 .-.- dated................................................ _. THE ISSUANCE OF THIS CERTIFICATE SHALL N�T BE C ' STRUED A GUARANTEE THAT THE SYSTEM WILE. FUNCTION SATISFACTORY. DATE.....-... .. �.. ---------------------•-----•-•-••-•-• Inspector...... ,GQ!!!!!!.../ •t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No...$y,,, ..........................................OF.... .......................---.................................................. FEE..... '�....... FWT nrk�t,�nn� ua anti# Permission is hereby granted ------------- --- -- ......... ...... to Construct :( ) or Repair ( ) an In eMI ge Disposal System at No.. / - "' �„_ . .,.._.... .......................... - -•-------•--•--------•-----------•--•---------------- as shown of the application for Disposal Works Construction Permit No..................... Dated.......................................... ......:: --------- •- rd of Health DATE .............................................. -FORM 1255 A�M. SULKIN, INC.. BOSTON `- X IN ASSESSORS MAP NO: r No.--W_ __j-A----- „PARCEL NO: Fee-- - ------------- ,...... . .BOARD OF HEALTH .. `'.'.-•'_:,_ .� TOWN OF BARNSTABLE Applica ion r eY on5tructionpermit Ap 1'cation i hereby made f r a perm' to C struct ), Alter ( ), or Repair an Individual Well at: r -- Z- - - ----------------- ------ ------------------ -- ----------------------- ocation — dress Assessors Map and Parcel Owner Address Installer — Driller Addre Type of Building Dwelling----&__/_ &4nlj-------------------------- Other - Type of Building No. of Persons-rso�n�s-- --? ---------------------------- Type of Well Ca acitY-----/ — -------------------------------_-_- Purpose of Well ------------------------------ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation un '1 a Certificat f Co pliance has been issued by the Board of Health. Signed - ------- - - -- - '� 7 ------- _— date Application Approved By-- =- --j -- ---- - -- ---=- ---- -----____--------------- date Application Disapproved for the following reas ns:-----------------------------------------------__________________________________________ OU -- date Permit No. -- - - Issued - - - - -- - - - ------------ ------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TQ CERTIFfY, That the In/div"dual Well Co st ted ( o)f Altered ( ), or Repaired (: bY----------- 11e -----v� 1 r � �----------------------- - - - ------------- Installer at------------------------------------------------------------------------------ has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. --------------------Dated-------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----- -- --__--- - -- - - —-------------- Inspector---- ---- -- — - ----------------------------------- ! 1 1 _ --- •- ____-- -_-_ -----__ No.- ---- ---- - Fee �,-. ---- BOARD'OF HEALTH TOWN OF BARNSTA-BLE Applica ion. or erg on5truct ion Permit Application is hereby made Za permit to Construct (Q ), Alter ( ), or Repairl. �n individual Well at: /Location — Address Assessors Map and Parcel ---------------5:_6 -------------- —— — — — Owner Address Installer.— Driller Address/ Type of Building Dwelling------4 -'��-�Lf � ----------------------- Other -Type of Building---------------------------------- No. of Persons- 3 ------------------------------ Type of Well------"S= = — Capacity---- Purpose of Well--------,A .� --- - --- Agreement: _ .The undersigned agrees to install the aforedescribed individual well. in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate 'f Co pliance has been issued by the Board of Health. 1 Signed`__------- - = - ' � ��' ------- / / date -!!�� --�� J �- - .'� v <'- — -------------------------------------- Application Approved By � date Application Disapproved for the following reasbnA S:------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- date PermitNo. -- 1/I_� / � ------------------------ Issued---------------------------------------------------------------------------------------- date 4 ~" BOARD OF HEALTH TOWN OF BARNSTABLE THIS IS TO CERTIFY, That the Indio"dual Well Constructed ( �) Altered ( ), or Repaired ( � ------------ by------------ �_,� --- - --1_/I U U�-'�------------------------ - - Installer at-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ---------------------------Dated---------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------------------------------------------------------------------------- Inspector------------------------------------------------------------------------------------ BOARD OF HEALTH TOWN OF BARNSTABLE Yell CongtructionVermit a � No. ----i- V Permission is hereby granted----------- �---------��-_� �------ -'es-_=-`-�--='--'------------------------------------------------------------ CP to Construct ( ), Al er ( or Repair ( .)an Indiv�irdual Well at:No. Yi Street as shown on the application for a Well Construction Permit !,t -------------------------- < `"----------.Y-------------------- --------- No.- — - 2 1 - - Dated 4 1�-rcf� �� % Board of Health DATE-------------- -� : l -------------------------- ENVIROTECH LABORATORIES Mass. Cert. #:MA063 449 Route 130 Sandwich, MA 02563 • (508) 888-6460 CLIENT: Keith & Mellissa Hall LOCATION: 9 Debbies Lane ADDRESS: Marstons Mills, MA 02648 COLLECTED BY: Clifford Well Drilling SAMPLE DATE: 6-2-92 TIME: llam DATE RECEIVED: 6-2-92 SAMPLE ID:ET584 JOB #: WELL DEPTH: 48' RESULTS OF ANALYSIS: Parameter Units Recommended limit Result Coliform bacteria/100 ml (MF Method) 0 0 pH pH units 6.0-8.5 5.61 Conductance umhos/cm 500 117 Sodium mg/L 20.0 14.2 Nitrate-N mg/L 10.0 4.64 Iron mg/L 0.3 <0.05 Manganese mg/L 0.05 Hardness mg/L as CaCO3 500 Sulfate mg/L 250 Potassium mg/L 20.0 Alkalinity mg/L 200 Chloride mg/L 250 Turbidity NTU 5.0 Color APC units 15.0 Background bacteria COMMENT: Low pH indicates high corrosive characteristics. M NO WATER IS SUITABLE FOR DRINKING PURPOSES OR PARAMETERS TESTED. 5X ❑ DATE DATE OF TEST: JUNE 20. 2005 SOIL TEST L O�G - -SOIL EVALUATOR: DAVID D. COU.GHANOWR. RS �WITNESS REQUIREMENT WAIVED - NO VARIANCES SOUGHT. DESIGN ' CALCULATIONS NO GROUNDWATER ENCOUNTERED TEST PIT I PARENT MATERIAL: PROGLACIAL OVTWASH ELEVATION - 64.00 .- PERC AT 84 in 2 MIN/INCH IN C SOILS DESIGN FLOW: 3 BEDROOMS X 110 GPD - 330 GPD SEPTIC TANK: 330 GPD X 2 DAYS - 660 GALLONS DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL 64.00 0-25 FILL CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) 25-27 O WOOD LOAM 10 YR 2/1 NONE FRIABLE DISTRIBUTION BOX: USE 3 OUTLET D-BOX. 27-38 E LOAMY SAND 10 YR 4/I NONE FRIABLE 38-44 A SANDY LOAM 10 YR 3/3 NONE FRIABLE SOIL ABSORBTION SYSTEM: A 24 fi x 12.5 ft x 2 ft LEACHING GALLERY CAN LEACH 44-64 B LOAMY SAND 10 YR 5/6 NONE LOOSE A 6 o t - ( 24 x 12.5 300 s f 58.67 64-I50 C MEDIUM SAND 10 YR 6/4 I .NONE LOOSE A s d w - ( 24 + 24 + 12.5 ' 12.5 ) x 2 - 146 s f Atot - 446 sf StSO Vt 0.74 x 446 - 330.04 GPD 1983 TEST PITS USE A 24 f t x 12.5 ft x 2 ft GALLERY. Vt - 330.04 GPD > 330 GPD REQUIRED JULY 29. 1983 GROUNDWATER ADJUSTMENT RICHARD FAIRSANK. PE RON GIFFORD. B.O.H. EXISTING GROUNDWATER LEVEL 0 in 0 In BASED ON TOWN OF BARBSTABLE TOP TOP a GIS DEPARTMENT RECORDS. SOB INDICATED GW 48.00 500 GALLON DRYWELL SOB 24 in 24 in INDEX WELL SDW-253 LEACHING GALLERY D�IONS AND DETAIL ZONE B READING DATE MAY. zoos CONSTRUCTION ' DETAIL USE M-10 `" T CLEAN CLEAN READING 48.8 INSTALL ONE INSPECTION MEDADJUSTMENT 3.00 �RYWELL UNIT STONE RISER TO WITHIN SIX hS1AEND SAND ADJUSTED GW 51.00 8'-6'x 4'-10-x 2'-9' � INCHES OF FINAL GRADE 2 ft EFF. DEPTH AND INDICATE LOCATION 24.0 ft ON AS-BUILT PLAN lo 144 in 144 in o 0 0 34 NOTES N �pOppOp� In o pgppgaa�qpc::jc �P� 1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN pp4g0 O 4\ 2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. 3.5' 8.5- 8.5- 3) ALL COMPONENTS INSTALLED SHALL MEET -THE MINIMUM REOUIREMENTS 24.0 ft NOT TO 102 in OF MASSACHUSETTS tITLE 5 SEPTIC CODE (310 CMR 15) SCALE 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING .FOR SYSTEM. 5) EXISTING LEACH PIT TO BE PUMPED. COLLAPSED. AND FILLED. OR REMOVED 6) ALL STONE TO BE DOUBLE WASHED AND FREE.•OFARON. FINES AND DUST IN PLACE 7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0! BEFORE-PITCHING DOWN SEWAGE DISPOSAL SYSTEM PLAN 8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE' INSTALLATION OF LOW FLOW FIXTURES -TO SERVE EXISTING DWELLING AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK 9) SYSTEM IS NOT DESIGNED TO WITHSTAND .VEHICULAR 'LOADING. DO NOT MELISSA A. HERSH PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. 10) -INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. 9 DERBIES LANE MARSTONS MILLS. MA 1 1) SEPTIC TANKS SHALL BE INSTALLED LEVEL .AND;TRUE _TO GRADE ON A LEVEL STABLE BASE THAT HAS .BEEN MECHANICALLY COMPACTED AND ON TO WHICH ECO-TECH ENVIRONMENTAL SIX INCHES OF CRUSHED STONE HAS BEEN,_PLACED TO MINIMIZE UNEVEN SETTLING t 43 TRIANGLE CIRCLE SANDWICH MA 02563 12) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED 1 FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. ETE-2096 JULY 13. 2005 2/2 i PLAN REFERENCE CONTOURS 00 PLAN BOOK 272 PAGE 92 EXISTING - - - - PROPOSEDO �rw o ��c iN ASSESSOR'S MAP: it MINIMAL GRADING °e �� >a �~ oo LOT: 12 0 _ �---LOCUS mNN o N OR`� SPUR LANE 3 w '^ m� �o BENCH MARK s 3 TOP OF DRAIN GRATE A NE `2 _� ELEVATION - 62.02 E LL W z o BARNSTABLE GIS DATUM 'J OPTEAGL EpCZ OF PAVEMENT MA LOCLUS A MAP C -- Z oo N'l� n yw0 e56A A . NOT TO SCALE Q 68 wh ,,nn �^ wcnc9 7p4? r' Q <N V _ 62 64 ` J\ N J Z 3 60 I29.39 «+ 70 0 J N <w W w �GC <5 �_j 5; J �i < j Mi ap J � w v AaA ►velc 2 Z v� - w = o /� m LEGEND � �- Q Q EXISTING 0Y > > 1000 GALLON O (9 ' Z SEPTIC TANK W>- O D-SOX U ~ J !affi x n � TEST PIT Q m �_ V1 N wC1 Z C< Ln o c N r EXISTING W LL I= 24 ft x 125 ft x 2 ft [- LEACH PIT OO Z C)L a ul �s�� LEACI-iNG GALLERY Q� L�GAS TE UTILITY POLEmb $ O U Ow ji p m� w X WATER LINE J DRAIN j '— pJ t0 Q)m p ,g° mW Cn HYDRANT O W t0 o r v--I W r,- mT Z7°G> 00 1983 G a + u°0i M o0 PITS-.® 3 Lo e AREA - 0500 s f •- � � LU v 3 60 EXST^'O FENCE Q Z _� J t (D O Q 45 fi y 3 <Q z SEWAGE DISPOSAL SYSTEM PLAN o �m � � LL 6a -TO SERVE EXISTING DWELLING Z 1 l J O 70 �LtH OFsS 4 , o ,_,_, N o�� D q�y MELISSA A. HERSH < + o �, PLAN �� AVID �, 9 DERBIES LANE MARSTONS MILLS. MA D. Z M b SCALE: I in - 30 ft COUGHANOWR CO-TECH ENVIRONMENTAL I o �No. 1093 E Q = o F �0 43 TRIANGLE CIRCLE SANDWICH MA 0256 LL w SSA(ARRN 508 364-0894 LL S �S ETE-2096 JULY 13. 2005 1/2 THIS PLAN IS TO BE CONSIDERED A DRAFT PLAN UNLESS .IT a v l l i BEARS THE STAMP AND SIGNATURE OF THE DESIGN ENGINEER ORIGINAL PLANS INTENDED FOR SUBMITTAL TO THE BOARD OF HEALTH WILL BE SIGNED N BLUE AND STAMPED'N RED. r. r WVJ _ por � w se, s A P. 1 32- 46 r r • - - - - Seto",�) �LpnJ THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) M DAT A, 1 - ,,. ^'- .__t- - .. .. ' a,w.�-.pr.. 1`�..1,.r —• ..,. � 9+` .4..— i ,.t _ ye-. - sq.. - -..a., 1 s : .,. . .an. y,9,, ,,.#s .:f'.`� .. , .., ,a: .. ,Y. •, W::"-��. Y-_._ :�r `�t�``'J. .�. t — 1" ,+ f r 1., ti`n-,�:�'""`�s�fixr� rr•- c,+: b 'z'" 1! � ^ r 1. �/ r K $." � 1 - •� - ,. • �TION - SEWAGE , . - , ~ {1} • u � � - � � = , - . : � . , • - SEPTIC TANK - Zoe 'D' BOX - >S , - LEACH_1C j - ,. G F :, r: k OP oFS Oj. t 'OF 1 sT 4 (MSL)a s ,WASHED ST.pJVY 44 t � _ _ - / .. } 1 �:: ; is / 1• �\ - , p2�aP IN. • ' ) ,'>7i t • :;�1q1.,` 81 , 83. •/ w�a.'.. a.. OUT• IN• OUT- iN• 5 Y -1?3. C TANK �"/ JELEV: ELEV. ELEV. O ELEV. i. , S V. ELEV, . g 2.0' .•�Z.A r,- �� i,.�-;.r _' _ �p `1: .Q ,+ELEV. f U° _ 1 ems. \" '•!' •�jj' fI n.,,7 , 1 ASHED STONEl� • 4S - .,�,r 1 I i ,• ram$ �dd "„ll 4 �, — L:-_ 3• ,\,�` ddd` '/ .i- r. T HOLE LOG \ - �tc.-14„Go - µ - r .�f.. .. � '�� V, ' ZC�t "7G7C> '�-�• ' r \ \ ;: ,.. I s„ r., By rH � WITNESS : BEDROOM HOBS - DATE / "!s3 DESIGN - t 1 �z a T.H. # 1 T.H. # ZT -� ~� fit )• �.,�:� gq �4' ELEV. a�v ELEV. NO 'DISC OSER V Q -�� `� •�S f'1\ S £ Z--MIN/IN. = DtSPESER �.I �a' Ta .jolt_ PERC RATE +- , 3! t ,� �\�.- -12.5 FLOW RATE 33G tGAt.iDAv I j Z4 r--- , z' �1 t r >_ S', I TANK 4_.° �-- i' ' •t SEPTIC TA -r•:}I g.� , - Q'O_$EPTTC TAIV 1Z ix + E1.--I -�� LEACH FACILITY 4'i1Z C«t.t ��..>=A. ., ct�.��.� r, ? s.a�:� SIDE WALL TC Co =a1��•S fZ:'� 1 = _ G/D ' �.� � �'� i y ` 83•\ i BOTTOM �-� br.S S4 .7 - TOTAL ZLo-1 0 ' __--� tt, tt LEACHING r. t 1'4 USE: �• + ter" i \ o.c� :! f 4�4 Co 3-[7 NU WATER ENCOUNTERED TES: '(UNLESS OTHERWISE NOTED) I^TUM(MSL).+TAKEN FROM__- -=--- - QUADRANGLE MAP !/� 3 r 1UNICIPAL WATER --____tea=-- --•----AVAILABLE ! N T ,PE PITCIi:•V.r'PER FOOT :3\p J O,,.Ns P1. !� tt �'O AR NE ' S _- >ESIGN"LOADING FOR'ALL PRE-CAST UNITS: AA5HO 44 I G`3A A t -i-�� ;} -DISTANCE ASGERTIFIED w 71N,GROUND COVER OVER ALL SEWAGE FACiLI'f1E5:-(1) FT- : `v {-)vf.�• N 1.© �Ia�AL� ' - - SITE - �- PLAN 1PE JOINTS SHALL BE MADE WATER TIGH7 ar,'• �, rlo. 3d 2 " r Z �9 ERAY CERTIFY THAT•THE BUIL 'PE JOINTS S DETAILS TO BE"ACCORDANCE WITH COMM.OF MASS: O xarl S}ioygd p PLAN IS LOCATE HE t�oT. ) - \W1�a1Lt•BY �S 1 ATGS- �� Ate. �F 4„ �, q ;A TAT£•Er4VIfiONMENTAL CODE TITLE 5 - i LOCUS: h � � , ��1 �`� GROUND AS SHO R FIT`iT s*S?s +ao cxt�rwaG w-• s cx � ti. c �� CONFORM.TO T!i LAWS OF THE C►�TtSion� MIL � iS-TABL.0 tIM.A 1a eSw9�-��.l wtT►I:u .P2 t 'mil - TOWN OF _ i� StTs�.c�ATto�.a .las cys- t+��c,�fi3 t_ aT )F.1 R�C,- y� x REG.PROFES C NS ED. TE - � - 4 N � a W TRUCT DA REF: R CQ a en ineeiin ` PREPARED;Fp S wn 4O • C1 ENGINEERS 's✓r F3EZ.TY ST 1+J�+�W tLH=• ev1j.' r e LAND SURVEYORS REG_LAND SURVEYOR ++ �0+ yZ�9b"� - t i BOARD OF.HEALTF! _ SCALE DATE Z�i ' r" MASH PEE. j Yarmoulh k4A - EX.15T)tVG) - 7 a vED DATE.- ---- MA :r i .