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Home My WebLink About0058 EMERALD LANE - Health 58 EMERALD LANE, MARSTONS MILLS -. A=046-046 TOWN OF BARNSTABLE LOCATION C nUM. - LAA!f. SEWAGE VILLAGE MWhrg ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.Oil f 1SW f-XA% f d% 7'i4 Air SEPTIC TANK CAPACITY LEACHING FACILITY.(type) (size) NO.OF BEDROOMS i OWNER 0 PERMIT DATE: COMPLIANCE DATE: ;-,a 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 leachin fac' ' ) Feet FURNISHED BY Z � P4 �6 TOWN OF BARNSTABLE LOCATION LAn SEWAGEQ aI U' 3I 3 VILLAGE ASSESSOR'S MAP&PARCEL • INSTALLER'S NAME&PHONE NO.OU 1 Wtg 0161- Alf SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER CihftHjt PERMIT DATE: JbIdula COMPLIANCE DATE: o A 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 leas ' '' ) Feet FURNISHED BY /h nc 1 bad. 1 Z � Al �� P4 4 93 4r � �1 No. mac/ �� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: • / PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for MispoSal #�pstrm Construction 3pPrmit Application for a Permit to Construct R Q/ A pp ( ) Repair( ) Upgrade Q(,) Abandon( ) ❑Complete System �Indtvtdual Components Location Address or Lot No.�� '` Owner's Name,Address,and Tel.No. Assessor's Map/Parcel — AA GKU c Installer's Name,Address,and Tel No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building S t; Rau No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.require ) 330 gpd Design flow provided ZVI gpd Plan Date Number of sheets p—,�Revision Date Title L �iJ Size of Septic Tank Type of S.A.S. ' Description of Soil ; I dhM loam ?I � Nature of Repai s orAlterations(Answer when applicable) k b 3 jaz MMJAP 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 he v. o tal Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board H Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. E—A� 3 43 Date Issued <3 No. � ./!3 r' „«-�•c�ta Fee icy �, � , THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes ' PUBLIC HEALTH DIVISION - TOWNOF BARNSTABLE, MASSACHUSETTS 01ppYication for Disposal 6pstem Consiruut on Permit Application for a Permit to Construct( ) Repair( ) Upgrade Xr ) Abandon( ) El Complete System Individual Components Location Address or Lot No. / c> d Owner'sjName,Address,and Tel.No. ,,�,Assessor's Map/Parcel �,� - AA wn, � -o..a cap Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Qu.i w -FWI /1, 6� Rk_(i t Ja (L i?)413- Type of Building: , f o r . '1-.'1 {f.-lq� Dwelling No.of Bedrooms Lot Size•- sq.ft. Garbage Grinder( ) — a Other � Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided V. gpd Plan Date q l tl . Numbers o!f sheets ! �p Revision Date Title ��'�+� 6B ., i[ ld� - Mud I 0 tat `x1 /'.- }d; Size of Septic Tank //,A, ,� �} p� ` /� Type of S.A.S. �,•p (X'j {(� { yy,*( <t (� 1 Description of Soil A c,(,t 1\41A �tl I l t .l lei 01, l h( h�)- d Nature of Repairs or Alterations(Answer when applicable) ki ,w wtog 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 ofithe En��onm ntal Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. t� Q Signed Date p - .`Application'Approved by 7 £ 'Date Application Disapproved by Date .� 8 for the.following reasons fit, - - �`�is ra 6 ,l Permit No. Date Issued ----------------- _ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO/CERTIFY,that the On-site Sewage Disposal"system Constructed( ) Repaired( ) Upgraded(V Abandoned( )by iA h�1 Y(([w1 1�1� at Z r W MW 1AK.0 has been constructed in accordance with the provisions Lt,�orf Title 5 and the for Disposal System Construction Permit No. ��dated ,/O/ b / Installer (,,) ,((, V fib �C. 0 DesignerrjIfifner `1" #bedrooms /' Approved design/flow '$fI gpd C} - � The issuance of this permit shall not be construed as a guarantee that the system w'1 l-f •ct'il as designe t. Date 10 Inspector e�( Aj Q .. t� n No r�' , Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Disposal *pstrm Construction Vermit Permission is hereby granted to Construct( ) Repair( ) Upgrade Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions-or special conditions. Provided:Construction must be completed within three years of the date of this permit. _ Date 16 Approved by Town of Barnstable Regulatory Services itwnxsrnata, Richard V.Sciili,.Inierlm Director' Public`Health.Division °�En,int' Thomas McKean,Director 200 Main Street,Hyannis.,MA 02601 Office;, 508-862-4644 Fax: ',508-790-6304 Installer&Designer Certification Form �,,+ Date: �0 t Sewage Permit#.L / �� Assessor's Map\Parxel 'G-t fit) —6 :.t.fq Designer. Qv -n �5 e C Co4c't'-40 a �n ��—:gyp. t arc*✓1 cs jh4t Installer: -- Address: 1Z ial, Address: 3q3c . GP_jhdu[e.>MA dz641y �tl ©z(o1(9 On ,. �? i'✓!r✓tt5C4� 1vas issued a permit to install a (date) (installer) , septic system at tEv VVt Q,2� (C�}- f IA.ed on a design drawn by (address), z— any .teer+%�t� NG,-ZkS k1( dated,' r7 Zs - e (designer) rtify that the septic system referenced above was installed substantially according to the des ga; which may include minor approved changes such as lateral relocation of the distribution box and/or-septic-tank, Strip out (if required) was inspected and the soils were found satisfactory. 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. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the.system referenced above was constructed in with the teens f the IAA approval,letters(if applicable) ut>�wus tJtc�N"f� (Installer's Signature) o �•01SSER� (Designer's Signature) (Affix Designe ere) PLEASE RETURN TO BARNSTABLE PUBLIC REAL`TIFI DTt719I0N. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FO)WM AND AS BUILT CARD ARE RECEIVED BY THE BARNS ABLE PUBLIC' EALTH DIYISIUN: THANK YOU. Wscp vDasigner Certification Forni Rev 3-1413.doe Engineers note:This certification is limited to an as-built inspection of system components as installed prior to backfitl.The engineer did not supervise construction of the system.The installer assumes responsib+Tiq for all matorials,workmanship,backtilling to specified glades with proper compaction and setting risetskovers as shovm on the design plan. TOWN OF BARNSTABLE LOCATION �r�ld SEWAGE VILLAGE ASSESSOR'S MAP&PARCEL . INSTALLER'S NAME&PHONE NO.OU Jhh�— / �Q 't'� �"�4�1Lair SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS OWNER C0 C A V r& PERMIT DATE: U 14 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 Wetlardd and Leaching Facility(If any wetlands exist within 300 feet of leachin fac' ' ) sow Feet FURNISHED BY 1 Z ' 1 46� 6�. � �I Town of Barnstable 1�>r Inspectional Services Department r BMA MASS. � ' Public Health Division 9 ABS. 1679. 1� 0 " 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 7947 September 9, 2020 CAPRA, CONSTANCE R 58 EMERALD LANE MARSTONS MILLS, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 58 Emerald Lane, Marstons Mills, MA was inspected on 08/19/2020 by Frank Nunes III, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PREPR OF THE OARD OF HEALTH t omas cKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\58 Emerald lane Marstons Mills.doc it Town of Barnstable + BARNWABM Inspectional Services Department i°rfa►u►'�a Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS 6)A 1 YEAR DEADLINE CRITERIA Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc I Commonwealth of Massachusetts (o-ate Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 58 Emerald Ln. Property Address Capra Owner Owner's Name information is required for every Marstons Mills MA 02648 8/19/20 page. Cityr town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. Inspector Information Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town - State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 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 8/19/20 Inspebtofs 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 c , Commonwealth of Massachusetts ,F Title 5 Official Inspection Form 1' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Emerald Ln. Property Address Capra Owner Owner's Name information is required for every Marstons Mills MA 02648 8/19/20 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: 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u� 58 Emerald Ln. Property Address Capra Owner Owner's Name information is required for every Marstons Mills MA 02648 8/19/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ 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 he system is failing to protect public health safe or the environment. t Y 9 p P � safety 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 Commonwealth of Massachusetts ,,o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 58 Emerald Ln. Property Address Capra Owner Owner's Name information is required for every Marstons Mills MA 02648 8/19/20 page. Cityrrown 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 ® El clogged 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 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,. 58 Emerald Ln. Property Address Capra Owner Owner's Name information is required for every Marstons Mills MA 02648 8/19/20 page. Citylrown 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 El El 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 (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 58 Emerald Ln. Property Address Capra Owner Owner's Name information is required for every Marstons Mills MA 02648 8/19/20 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Emerald Ln. Property Address Capra Owner Owner's Name information is required for every Marstons Mills MA 02648 8/19/20 page. City/Town 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 Description: Number of current residents: 1 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 Seasonaluse? ' ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Occupied 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 •� 58 Emerald Ln. Property Address Capra Owner Owner's Name information is required for every Marstons Mills MA 02648 8/19/20 page. Cityrrown 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: 2018 per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts i� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Emerald Ln. Property Address Capra Owner Owners Name information is required for every Marstons Mills MA 02648 8/19/20 page. City/Town 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: Original septic tank, new d-box and leach pit 1996 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts r= Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ". 58 Emerald Ln. Property Address Capra Owner Owner's Name information is required for every Marstons Mills MA 02648 8/19/20 page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) Tank was backed up at time of inspection If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000g Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 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? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 58 Emerald Ln. Property Address Capra Owner Owner's Name information is required for every Marstons Mills MA 02648 8/19/20 page. Cityrrown 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Emerald Ln. Property Address Capra Owner Owner's Name information is required for every Marstons Mills MA 02648 8/19/20 page. City/Town 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 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was backed up at time of inspection t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts �s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �o 58 Emerald Ln. Property Address Capra Owner Owner's Name information is required for every Marstons Mills MA 02648 8/19/20 page. Citylrown 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: 1 ❑ leaching chambers number: ❑ 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 Commonwealth of Massachusetts ,F Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •� 58 Emerald Ln. Property Address Capra Owner Owner's Name information is required for every Marstons Mills MA 02648 8/19/20 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.): Pit is in hydraulic failure with effluent pushing out of the cover 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 r Commonwealth of Massachusetts �. ,io Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Emerald Ln. Property Address Capra Owner Owner's Name information is required for every Marstons Mills MA 02648 8/19/20 page. Citylrown 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 58 Emerald Ln. Property Address Capra Owner Owner's Name information is required for every Marstons Mills MA 02648 8/19120 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 JL C� f� t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts �. Ip Title 5 Official Inspection Form „e�a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Emerald Ln. Property Address Capra Owner Owner's Name information is required for every Marstons Mills MA 02648 8/19/20 page. City/Town 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: TOPO mapping shows the site at 90'msl and nearby surface water at 43'msl You must describe how you established the high ground water elevation: See above 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 Commonwealth of Massachusetts �e ,ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 58 Emerald Ln. Property Address Capra Owner Owner's Name . information is required for every Marstons Mills MA 02648 8/19/20 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 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 LPIT SHED o° LOT 417 S.TANK 20,798 SFf PROPOSED DECK' GARAGE EXIST.\ DWELL. to PROPOSED PORCH NOTE: SEPTIC LOCATION FROM BOARD OF HEALTH RECORDS .g7 JOB # 04-292 PL 0 T PLAN SHOWING. PROPOSED ADDITIONS TO AN EXISTING DWELLING FOR THE PURPOSE OF OBTAINING A BUILDING PERMIT ONLY LOCATION 58 EMERALD LANE MARSTONS MILLS, MA SCALE 1 " = 30' DATE : OCTOBER 1 , 2004 PREPARED FOR: REFERENCE LOT 417 LCP 30751-I SH 2 WILLIAM CAPRA ASSESSORS MAP 46 PARCEL 46 I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE "7 71MOTHY GROUND AS SHOWN HEREON. r r_I ►� G`LI7 L:> off 505-362-4541 COVELL fax 508 362-9880No.^303J V down cape engineering, inc. z;' +. CIVIL ENGINEERS LAND SURVEYORS DATE RE LAND SiJOR 939 main st yarmouth, ma 02675 TOWN OF BARNSTABLE -LOCATION V � -�(/ �'� SEWAGE# i . �o VILLAGE /L(� 4 IJ,('I& ASSESSO ' MAP&LOTC)Zlo.4d17 NAME&PHONE NO{` / �� i ' f� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size),.)t�4j 60/,S' NO.OF BEDROOM BUILDER ocoWNS &r/`G 119� C PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 If 4602 3�� a� 1� Co c i TOWN OF BARNSTABLE r � � LOCATION Id fa;n,T� SEWAGE # ^* / zJ VILLAGE N Aa<A AA i. I: _ASSESSOR'S MAP&LOT p INSTALLER'S NAME&PHONE NO. dM i 0A10 e. !�,C ,1Qf I c SEPTIC TANK CAPACITY Zo n_ G2 , LEACHING FACILITY: (type) ©o (size) NO.OF BEDROOMS BUILDER OR OWNER y - Q PERMTTDATE: 91 COMPLIANCE DATE; °'"` Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 4 ay 12 / Y7 E y r� BORTOLOTTI CONSTRUCTION,INC. 765 WAKEBY ROAD,MARSTONS MILLS, MA 0 -� i 508-771-9399 508-428-8926 FAX:. 508-428-939'ap. 44� r 1996 _u SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECT ORM �l PA RT A CERTIFICATION �o Property Address: �6na- 7.AS Date of Inspection: Inspector's Name: Owner's Name and Address: ,e` /Afl'q tS' zVi AS, /2;; azp le CERTIFICATION STATEMENT* I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection. The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The System: , Passes Conditionally Passes Needs Further Ev luation By the Local Aproving Authority Fails / Inspector's Signature: The System Inspector shall submit a opy of this inspection report to the Approving authority within thir- ty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUM ARY• A)SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system,upon comple- tion of the replacement or repair, passes inspection. Indicate yes, nor,or not determined(Y,N,OR ND).Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal,cracked, structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): - 1 - i s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A , CERTIFICATION (continued) Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of The Board of Health): Broken pipe(s)are replaced Obstruction is removed. . C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by The Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 Feet of a surface water Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT TILE PUBLIC.HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 Feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. !71 TEM FAILS: have determined that the system violates one or more of the following failure criteria as defined 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. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent 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 clog- ged SAS or cesspool. Liquid depth in cesspool is less than G"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped -2- A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) 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 I of a public well. Any portion of a cesspool or privy is within 50 Feet of a private water supply well. Any portion of a cesspool or privy is less than 100 Feet but greater than 50 Feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following q conditions exist: 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 11 of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. ` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following have been done: _Pumping information was requested of the owner, occupant,and Board of Health. i/ None of the system components have been pumped for atleast two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As-built plans have been obtained and examined. Note if they are not available with N/A. -jZ 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. _KAll system components,excluding the Soil Absorption System,have been located on site. ,The septic tank manholes were uncovered,opened,and the interior of the septic tank was in- spected 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 on the site has been determined based on existing information or approximated by non-intrusive methods. -3- 2 q R SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) _I'he facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL f✓ Design Flow: gallons Number of Bedrooms: o;- Number of Current Residents: :3 Garbage Grinder: Laundry Connected To System: Yes Seasonal Use: /)/O Water Meter Readings,if Table: Last Date of Occupancy: kQlY`en COMMERCIAL/INDUSTRIAL: A 10 Type of Establishment: Design Flow: gallons/day Grease Trap Present: (yes or no) Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings, If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION PUMPING RECORDS and source of mforma 'on: Win d O& `i /V"" S y System Pumped as pail of inspection: If yes,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM: Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy hared System(If yes,attach previous inspection records, if any) Other(explain): L%42N�tr-7- 11,e s ROXIMATE AGE of all components,date installed(if known)and source of information: Sewage odors detected when arriving at ta site: I.A -4- J J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK Depth below grade: — Material of Construction: .101�concrete metal FRP Other (explain) Dimisions:_,?-,S-y[41 y`�L'_Sludge Depth: op a Scum Thickness:Alone— Distance from top of sludge to bottom of outlet tee or baffle: -"*'0#e Distance from bottom of scum.to bottom of outlet tee or baffle: A/01-Te- 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: Depth Below Grade: Material of Construction:_concrete nietal FRP Other (explain) Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or baffle: 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.) TIGHT OR HOLDING TANK:x/( Depth Below Grade: Material of Construction: concrete metal FRP_Otiter(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm Level: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) _ DISTRIBUTION BOX: Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP CHAMBER:,"/ Pump is in working order: Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) -5- c, s I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM (SAS):�� (Locate on site plan, if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: Leaching pits,number: Leaching chambers, number: Leaching galleries,number: Leaching trenches, number, length: Leaching fields, number,dimensions: Overflow cesspool,number: Comments: (note condition of soil, signs of hydraulic failure level of p ndi'ng,condition of vegetation, etc. InO U - CESSPOOLS:ko— Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of Cesspool: Materials of construction: Indication of groundwater: Inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soilk, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) PRIVY: Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) -6 v SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) r SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. O p; Locate-all wells within 100 Feet. IV) i 0 { 6� DEPTH TO GROUNDWATER: i Depth to groundwater: 2 Feet Meth pof Determination or Appr mation: d r o bee S; -7= r . A� No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYicatiou for Mizpaal *potem Cougtructiou 3dermit Application is hereby made for a Permit to Construct( )or Repair( an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Ld -So Smgv-"� LC,V,-e_ 14,01,16 �ff//-z-- P66 Pi Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 33 d gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) .L= S J'f ..6 -�� --i-� 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 t to place the system in operation until a Certifi- cate of Compliance has been issued Bo b lth. Sign Date 7' l_5 7� Application Approved by `-.--Application Disapproved for the following reasons Permit No.�/ L� Date Issued 7 / 13 F e J THE COMMONWEALTH OF MASSACHUSETTS _ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 1 0[pprication for Zigpoga1 *pgtem Congtruction permit Application is hereby made for a Permit to Construct( )or Repair( an On-site Sewage Disposal System at: Location Address or Lot No. Owner's,Name,Address and Tel.No. -so �Em 01,6 �ff kz:-C" Puo pi Z) gyp' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �b��Y✓"�b��S ao /.��`-ram �p Type of Building: �--7 Dwelling No.of Bedrooms J Garbage Grinder( , ). Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow -5 .5- gallons per day. Calculated daily flow 33 d gallons. Plan Date Number of sheets Revision Date Title 41 Description of Soil r l Nature of Repairs or Alterations(Answer when applicable) h/ST r4/ //3o6 a%T d � Date last inspected: i Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal systemr in accordance with the of Title 5 of the Environmental Code and t to place the system in operation until a Certifi- cate of Compliance has been�issu—e-d�b- this Bo eI alth _ SignT Date e7 1- Application Approved by l Application Disapproved for the following reasons r T Permit No. `s Date Issued 7 / -----_--------------—_---- —_------ THE COMMONWEALTH OF MASSACHUSETTS- PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS , Certificate of Compitance // THIS IS TO TIFY,that the a age Disposal System installed( )or repaired/replaced(<on b by A- for 00 to as M le .Q_ •LZ. has been conitructe4 in acf,.ordance with the provisions of Title 5 and the for Disposal System Construction Permit No. yr dated Use of this system is conditioned on compliance with the provisions se ,rth below: No. / / Fee `7 j THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,. MASSACHUSETTS Migpogal *pgtem Congtruction Vermit Permission is hereby'granted t to construct( )repair( a On-site Sewage`S stem located at !M a -e f' /�. --_.Q 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. All construction must b completed within two years of the date below. Date: Approved b PP Y I CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, hereby certify that the application for disposal works ' construction permit signed by me.dated , concerning the .�. property located at_ Egey_� Lr'Lf-C meets all of the following criteria: 4 There are no wetlands within 300 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system. u The observed groundwater table is 14 feet or greater below the bottom of the leaching facility •• There is no increase in flow and/or change in use proposed There are no variances requested or needed. SIGNED: DATE: LICENSED SEPTIC SY TEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. . 1 i b 4 ti pi LO;C A T I,QN SEWAGE PERMIT NO. �, T�� 8 / 7Lr'1}1L1� �1�N2 77' 19- LL VILLAGE INSTA LLER'S NAME ADDRESS B U I'L D E IT OR OWNER V 1Z ICI f,,,on r 1 2 Cvf2 fo DATE PERMIT IS S U E D DATE COMPLIANCE ISSUED �y 1 -71 No. 1 ``t.y: VII Fizz.... :- TH BOARD A7,4 ., OF EAcHTH Ts � , w � ►ti� .........0 F............ .. .......................................................... VVIiration -for i u �t1 aark Cn�n�#r�trtin� Pr�tit *-Jystermn cation is hereby made for a Permit to Construct (� or Repair ( ) an Individual Sewa sposal ........ A.. ....................................... ................................. -------------._.....---------._...-------.....------ ocation-Address or Lot N . Owner Address wa ---•---•--•-•.............. •----------•---------- nn-�.......................... ----------------- s S taller Address ;•\U Type of Building C)Wns Size Lot...944.14 7-_______Sq. feet Dwelling—No. of Bedrooms----------3-----_-------------------------Expansion Attic ( ) Garbage Grinder ( )N� a, Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d11 Other fixtures ...................................................... W Design Flow................S ......................gallons per person per day. Total daily flow............TA O------------------.---gallons. WSeptic Tank A—Liquid -5 capacitylARA.gallons Length------I-------- Width------ ....... Diameter-------r------ Deptli.!------------ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area..-.----__- ___sq. ft. Seepage Pit No-------!------------- Diameter------G_-_____-.-_ Depth below�'nlet..._.4_..__.__.__. TotalIchil area__/A.�_ ----sq. ft. Z Other Distribution box ( ) Dosing tank ( ) .0 ', lk=/$,—-7 7 aPercolation Test Results Performed by-------------------------------------------------------------------------- Date-------------------------------.__-.---. a Test Pit No. 1----------------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--.-._..---_-_-.------ a ------..•.._it -- - - ---•-•. r - Descrt Description o So' ° p d ✓ -------- - — 1.2 3 4____LL _ ____________________________________________________________________________________________________ ---------------- ------------------------------------------------------------ ----------:------------------------------------------------------------------------------------------------------- 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 Article \I of the State Sanitary Code—The undersigned further-agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sined..--- �' ---------_------------ _.------- Application Approved BY 1��'< r -• .................................. Application Disapproved for the following reasons:--••---•-----------------------------------------------------------------------•-••----.__..Date-------------- Date PermitNo.......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS , BOARD 05 HE TH v I'44*1 --------.OF .... J . :... ........................ Applirtttfiun -for IRlymittl Workii Tonti#rur#ion Vanift Application is hereby'made-for a Permit to Construct ( ✓10or Repair ( } an Individual Sewage Disposal System at: ----j='A)Alt /-x_ti•&-............................................. ................................. ----------................•------------------------- _ Location_Address or Lot No. .» Owner Address Installer Address Type of Building 3�d'' Size Lot...�mj-_71_7-------Sq. feet Dwelling—No. of Bedrooms-----------e-------------------------_.....Expansion Attic ( ) Garbage Grinder ( )Iy10 Other—Type of Building _.......................... No. of persons...___-_._--________._-__-__ Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------- - W Design Flow________________`►_.©.....................gallons per person per day. Total daily flow.............10.0......................gallons. 9 Septic Tank 4-Liquid capacity_,0_v.0_.gallons Length------I------- Width-----87—...... Diameter-------j'----- Depth..f---__.----- xDisposal Trench—No. .................... Width-------------------- Total Length-------_.._-------.. Total leaching area--------------------sq. ft. Seepage Pit No-------I------------- Diameter___.__....... Depth below nlet-_-__a_____________ Total lezcliit area..12 c'.q____sq. ft. z Other Distribution box ( ) Dosing tank ( ) ��. A-It 1, Percolation Test Results Performed by-----------------------------------------------•----- ------------- Date.............--------------------------- Pest Pit No. 1----------------minutes per inch Depth of 'Pest Pit____________________ Depth to ground water------- ---------------- w Test Pit No. 2________________minutes per inch Depth of Test Pit-------------------- Depth to ground water.----------------------- � •------------ ------- --------- -- y Description o So -------" -------40-- j yr s ? --.- ----- V • Gh i/ i_.. ----------------------------------------------- :__-._-`---•---------------------•------ W v UNature of Repairs or Alterations—Answer when applicable--------------------------------------------------------------------------------------.--------- ----------------------------------------------=---------- ---------------------=-------------------------------------- ------------------------------=------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions oftArticle XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sied > -------•--••-•-------------•--------------------•-------- % ---- ------ Application Approved BY 44 1 Date Application Disapproved for the following reasons--------------------------------------------------------------------------------------- -- -------------•- -•••••-•--••-•--•-•----•--•-•-------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 'Date Permit No. --------•---•..-•. Issued. Date THE COMMONWEALTH OF MASSACHUSETTS �BOARD (3f HE �T;:�......... ` .........O F. ....... .: ........................ err#ifirtt�r rrf f��1��1itt�rr f THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) bY-----------------------------------------------R ... "A• - -------- ...........................--------................................................... it at........ '- t ?j. :•-••-- t; e-Cry A I. L nt : ----t--`- ' '- I ------ -- has been installed in accordance with the provisions of XI of The State Sanitary Code as Pyibed in the application for Disposal Works Construction Permit No......:......IX-11................ dated__-.7_--__-----------------------_........... THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FU CTION SATISFACTORY. DATE----------_--- •••.............�---�---------- . .. .••--••-•-•• Inspector............ - ------ ......... -------------- THE COMMONWEALTH OF MASSACHU TTS BOARD OF HEALTH No......................... FEE----- •-- Permission is hereby granted---------- __ '" �?---_____________ to Construct ( v) or Repair, ( ) an Individual Sewage Disposal System Ij at No.•---�1•••J--7......-... ...... -----------------;1,7_:_ 11 i L -- ----------------------------------------- .... . as shown on the application for Disposal Works Construction rmit ____-__ Dated---_ .S`.7�� ............. �P ' S• � ------------------------------------ Board of Hel DATE.......------------------------------------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBtLISHERS J y ` 3 A l"'tRR '"�F I 4 F t M.,y..,(, Rf>A ryt '1;711pp PsR t:.,�,�d�> ttr' r c, 'r' ti'° A' X W, 'u'. ? 'k iY } q rt,�:"l. 'Y :.}J�4>7,�` A1� C "t W Iu4 Ar F�"�` kIN Ml la k'Q i- �v1+ A•'Pl'A� �' nfiml �,u J'°'F�'�n` +k¢�.i,q" t 4�4.. syP:l'sr r F ib ln' 't'1j{"K t rl s 1+ +� .,y"a��11 ?nyr h h, t f � 4 C�lf p d( yy t'n 3 k1 ;:,,'r {'r� 4;y 91 •:+ rA C- ; � ;r (nr+,''Jf;;r r. 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McENTEE ' v CIVIL No. 35109 /STE �� OWNER OF RECORD t l lS� CAPRA, CONTANCE R �` 58 EMERALD LANE PARCEL ID: 046-046 MARSTONS MILLS, MA 02648 Engineering by: SCALE DMWN JOB. No. PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. 1"=20' P.T.M. 264-20 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. 58 EMAERALD LANE MARSTONS MILLS MA (508) 477-5313 9/17/20 P.T.M. 1 of 2 Prepared for: Constance Capra, 58 Emaerald Lane, Marstons Mills, MA 02648 NOTE: TO PREVENT BREAKOUT, THE PROPOSED SEPTIC TANK FINISH GRADE SHALL NOT BE <101.00 INSTALL RISERS & COVERS OVER INLET & FOR A DISTANCE OF 15' AROUND THE OUTLET AND SET TO 6" OF FINISH GRADE PROPOSED D-BOX PROPOSED S.A.S. PERIMETER OF THE S.A.S. INSTALL RISER & COVER INSTALL RISER & COVER OVER TWO CHAMBERS AND SET TO 6" OF GRADE SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT T.O.F.=106.3t F.G. EL..=104.8t F.G. EL.=104.5f F.G. EL.=104.0f F.G. EL.=103.8f L = 16' L = 5' 2" LAYER OF 1/8" TO 1/2" S=1% (MIN.) @ S=1% (MIN.) DOUBLE WASHED STONE 4"SCH40 PVC 4"SCH40 PVC APPROVED FILTER FABRIC) s" 10"I as $j.,JR 4" s 2' EFF. aaaa 3/4" TO 1-1/2" DOUBLE EXISTING 48" LIQUID DEPTH aaa WASHED STONE LEVEL 4' 4.8' 4' GAS�BAFFL IINV.=101.37 PROPOSE INV.=101.20 EFFECTIVE WIDTH = 12.8' INV.=102.50t 3 OUTLETS EXISTING H-20 INV.=100.50 EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H-10 RATED NOTES: TOP CONC. ELEV.=101.3t 1)-CONTRACTOR. SHALL VERIFY ALL EXISTING PIPE BREAKOUT ELEV.=101.00 INVERTS, PRIOR TO INSTALLATION. INV. ELEV.=100.50 ease BEeaE 2) D-BOX SHALL BE SET LEVEL AND TRUE TO mw.......MEMO aaaaaaaaaaa GRADE ON A MECHANICALLY COMPACTED SIX BOTTOM ELEV.= 98.50 INCH CRUSHED STONE BASE, AS SPECIFIED 4' 2 x 8.5' = 17' 4' IN 310 CMR 15.221(2). 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25' 3) INSTALL INLET & OUTLET TEES AS REQUIRED. PERVIOUS MATERIAL 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 5' (MIN.) ABOVE G.W. LEACHING SYSTEM SECTION AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. BOTTOM OF TEST PIT, EL.=92.1 SEPTIC SYSTEM PROFILE GENERAL NOTES: DECK 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL GARAGE BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE ,EXISTING / LOCAL RULES AND REGULATIONS. HOUSE(158) 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFIL PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. BACK 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING OF HOUSE FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. DECK - - - 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF A THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. J �37r• C� 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. sCp c�6 ,51' 8. THERE ARE NO WELLS WITHIN 100' OF THE PROPOSED S.A.S. P 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. T 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY ao THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING cv PROPOSED S.A.S. CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND S.A.S. LAYOUT IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. DESIGN CRITERIA SOIL LOG DATE: SEPTEMBER 17, 2020 (REF#TPT-20-188) NUMBER OF BEDROOMS: 3 BEDROOMS SOIL EVALUATOR: PETER McENTEE PE(SE#1542) SOIL TEXTURAL CLASS: CLASS I WITNESS: DAVID STANTON R.S. HEALTH AGENT DESIGN PERCOLATION RATE: <5 MIN/IN ELEV. TP-1 DEPTH ELEV. TP-2 DEPTH DAFLY FLOW: 330 GPD 103.8 A 0" 103.6 A 0" DESIGN FLOW: 330 GPD SANDY LOAM SANDY LOAM 103.4 10YR 4/2 103.1 10YR 4/2 GARBAGE GRINDER: NO B 5 B 6" EXISTING SEPTIC TANK: 1000 GALLON CAPACITY SANDY LOAM SANDY LOAM LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF 101.3 10YR 5/6 30" 100.9 10YR 5/832" C C .74 GPD/SF L PERC DISTRIBUTION BOX: 1 INLET, 4 OUTLETS (MINIMUM) H-20 40"/58" M-C SAND M-C SAND USE 2-500 GALLON LEACHING CHAMBERS IN SERIES 2.5Y 6/6 2.5Y 6/6 SURROUNDED BY 4' DOUBLE WASHED STONE-ALL SIDES 10% GRAVEL 10% GRAVEL SIDEWALL AREA: 2(12.8 + 25.0') x 2' = 151.2 SF BOTTOM AREA: 12.8' x 25.0' = 320.0 SF TOTAL AREA:...................................................................471.2 SF 92.3 138" 92.1 1 138„ DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.6 GPD PERC RATE <2 MIN/IN. "C" HORIZON NO GROUNDWATER ENCOUNTERED Engineering by: SCALE DRAWN JOB. NO. PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. NTS P.T.M. 264-20 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET No. 58 EMAERALD LANE MARSTONS MILLS MA (508) 477-5313 9/17/20 P.T.M. 2 of 2 Prepared for: Constance Capra, 58 Emaerold Lane, 'Marstons Mills, MA 02648 I` .