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Home My WebLink About0358 FLINT STREET - Health 358 Flint Street r A= 101 — 121 Marstons Mills I TOWN OF BARNSTABLE LOCATION S 1—L1 i— SEWAGE# —It VILLAGE 4`J 8 M(' ASSESSOR'S MAP&PARCEL 10 — i,%o--r INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY � �J -� L� o•l i�-P LEACHING FACILITY:(type)• (size) 1A NO.OF BEDROOMS OWNER <Vt L �f PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater.Table to the Bottom of Leaching Facility 13 Feet Private Water Supply Well and Leaching Facility:(If any wells exist on site or within 200 feet of leaching facility) Pt Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY lr D1 1 �'9F-lit S� 4s WAMAV GO f Pa t+c'l Bur piyl�f►►e�i amd g i�c�► ¢Eao� east 4 onsaar ajr ► m vPfaY) &ire c£�et�andandlead�ag.�aa'1�(i�t+i�r wctiands exist,. �vitt 380 fiect� eacl tul ^ i V r e � 64 r � r Town of Barnstable Inspectional Services Department 'ST"'13`F- - Public Health Division i639 � 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 9927 November 30, 2020 WATSON, SERENA 83 RENDEZVOUS LANE BARNSTABLE, MA 02630 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 358 Flint Street, Marstons Mills (System 2, Cottage), was inspected on 10/21/2020 by Shawn McElroy, 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: 0 Single Cesspool. You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. ,REI &9McKean, THE BOARD OF HEALTH - Th mas R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\358 Flint Street System 2 of 2 Cottage Marstons Mills.doc Town of Barnstable NS�M 039. ,.� Inspectional Services Department Ajfp MA'S 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 ONE (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). T 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 Commonwealth of Massachusetts 1 D r-/(9- 1 Te °^ 3 Title 5 official Inspection Form i Subsurface Sewage Disposal System Form -Not for,Voluntary Assessments 358 Flint St (System 2 of 2 Cottage) Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. Inspector Information S� r�oa5 Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address East Falmouth MA 02536 City/Town State Zip Code 508-495-0905 S13971 Telephone Number License Number B. Certification I certify that:) am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);I have personally inspected the sewage disposal system at theproperty 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 Evaluatiori,by the Local Approving Authority 4. ® Fails 10-21-2020 Inspecto 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 ' f^� P Title 5 Official Inspection Form , b) Subsurface Sewage Disposal System Form=Not for Voluntary Assessments 358 Flint St (System 2 of 2 Cottage) j Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 page. City/Town State Zip Code Date of Inspection A , C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes:• ,y ❑ 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.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Fill Title 5 Official Inspection Form bl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 358 Flint St (System 2 of 2 Cottage) } 1._Jug Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 page. City/Town 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 "the system is failing to protect public heaith,'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 !N Commonwealth of Massachusetts .�A iw Title 5 official. Inspection Form ibi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 358 Flint St (System 2 of 2 Cottage) Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 page. City/Town w `"` 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. I :,❑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. r c.•Other: n 4) System Failure Criteria Applicable to All Systems: You must indicate",Yes or"No"to each of the following for all inspections: Yes No 1 , , � t 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 Commonwealth of Massachusetts , Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,. 358 Flint St (System 2 of 2 Cottage) Property Address Conrad Watson Owner Owner's Name information is Marstons Mills MA 02648 10-21-2020 required for every State Zip Code Date of Inspection page. City/Town• p p 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 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. ❑ Z '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 cam' Commonwealth of Massachusetts ,w Title 5 Official -inspection Form �iF�l Subsurface Sewage Disposal System Form ':Not for Voluntary Assessments „4>' 358 Flint St (System 2 of 2 Cottage) Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 page. City/Town 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 I 1 ❑ ® 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? N ' ❑ 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? ®- Wasthe 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: z ❑ ® 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 4AiN Commonwealth of Massachusetts Ia w Title 5 Official inspection Form hi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. 358 Flint St (System 2 of 2 Cottage) Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 page. City/Town State Zip Code Date of Inspection D. System Information s 1. Residential'Flow Conditions: Number of bedrooms(design): N/A Number of bedrooms (actual): 3 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): N/A Description: Number of current residents: 0 6 ' 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 El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usa e d Well water 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 2020Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts "' *' '• -. q3 Title 5 Official Inspection Form r� Y w_ i h► Subsurface Sewage Disposal System Form -"Not for Voluntary Assessments ` 358 Flint St (System 2 of 2 Cottage) Property Address " Conrad Watson Owner Owner's Name information is required for every Marstons Mills ' MA 02648 10-21-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) f - 2. Commercial/Industrial Flow Conditions: Typeof 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? r ❑ 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: N/A 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 f Tile 5 official Inspection Form hI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 358 Flint St (System 2 of 2 Cottage) Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 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: 1970's Were sewage odors detected when arriving at the site? ❑, Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 20"feet Material of construction: °v ® cast iron ❑ 40 PVC ® other(explain): Orangeburg Distance from private water supply well or suction line: 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 - - - �w Title 5 Official Inspection Fora ! hl Subsurface Sewage,Disposal System Form -Not for Voluntary Assessments 358 Flint St (System 2 of 2 Cottage) ' Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 ` page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): ' Depth below grade: N/A feet Material of construction: t ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is'metal, list age: r., `'' years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: " Sludge depth: Distance from top of sludge to bottom of outleftee 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 fw; Title 5 Official inspection Form A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments U Z., 358 Flint St (System 2 of 2 Cottage) Property Address Conrad Watson _ Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 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.7/2 61201 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 I Commonwealth of Massachusetts ,w Title 5 Official Inspection, Form, �Vi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .b>" 358 Flint St (System 2 of 2 Cottage) Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills - MA 02648 10-21-2020 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): i Depth of liquid-level above outlet invert N/A 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.): r s a } t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts / Title 5 Official Inspection Form m Subsurface Sewage.Disposal System Form_-Not for Voluntary Assessments,, 358 Flint St (System 2 of 2 Cottage) Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020. page. City/Town 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: ❑ 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 c � Commonwealth of Massachusetts 3 Title 5 Official Inspection Form i�► Subsurface Sewage Disposal System Form -'Not for Voluntary Assessments { N. 358 Flint St (System 2 of 2 Cottage) - Property Address Conrad Watson Owner Owner's Name information is Ma'rstons Mills MA 02648 10-21-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) f t, Comments (note condition of soil, signs of hydraulic failure, level•pf ponding, damp soil, condition of vegetation, etc.): 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 4, ' ' 1 Depth-top"of liquid to inlet invert ' • 30" Depth of solids layer 6" Depth of scum layer 0 Dimensions of cesspool 6x6 Materials of construction Block Indication of groundwater inflow ❑ Yes ® No Comments (note condition of soil, signs of hydraulic failure,.level of ponding, condition of vegetation, etc.): Single block cesspool has signs of back-up with stain lines above inlet invert. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Tide 5 Official Inspection Form of Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 358 Flint St (System 2 of 2 Cottage) Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) r 13. Privy (locate on site plan): 'Materials of construction: ° Dimensions 4. 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 = ' ,w; Title 5 Official Inspection Form r'i Subsurface Sewage Disposal System Form -Not for Vol unta 'Assessments •: r >�' 358 Flint St (System 2 of 2 Cottage) Property Address Conrad Watson Owner Owner's Name information is Marstons Mills MA 02648 10-21-2020 required for every page. City/Town ' State Zip Code Date of Inspection D. System Information (cont.) t = 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 Ilk P, >f. T OD r 1 e t5insp.doc-rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts .� Tole 5 Official Inspection Forint 14 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 358 Flint St (System 2 of 2 Cottage) Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 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: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: • Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.dcc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 � ` :� Commonwealth of Massachusetts 4. 0: Title 5 Official Inspection Form , I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r ,' 358 Flint St (System 2 of 2 Cottage) Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills x MA 02648 10-21-2020 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 ated 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:-4 I, •. • ' 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 nn � No.&Z ®� Fee /�y THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppYicatiou for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) VComplete System ❑Individual Components Location Address or Lot No. 0,n�9- Owner's Name,Address and Tel.No.924-y4e q- j5V)S Assessor's Map/Parcel/e M't56m&JA&& dory"a Ir A V-VI n NI i&1;,4 Installer's Name Address,and Tel.No.508 t4.Z�f-Bg;Cv Designer' Name,Address,and Tel.No._S0,9- 362`q5Y/ ( rJo ,�r�c �l3 lic�6�y t 1n�';,,j.T»e. �3gMaim 3d-. D 'd ,p7S" Type of Building: 3_W,,l Dwelling No.of Bedrooms -;— Lot Size 3 7 090 -� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �C6r0 gpd Design flow provided gpd Plan Date 3,tea! Number of sheets Revision Date Title �L. & M'4_ 4, 4'3b� 8in�J gep jNA!!$L►�� Size of Septic Tank -1116 Type of S.A.S.5%$979eX 6"eaMLIS Description of Soil a Nature of Repairs or Alterations(Answer when applicable) to442 ,< d1di�• L , S _ I , Id le44td) 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 Environment o e an of to place the system in operation until a Certificate of Compliance has been issued by this Board o ealth. Si/gne Date Application Approved by / Date Application Disapproved by Date for the following reasons Permit No. &Z I_ ®(2 Date Issued � lli �/ Now/.�� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Misposal 6pstem Construction permit ~Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) 0 Complete System ❑Individual Components Location Address or Lot No.3s%, 171, Owner's Name,Address,and Tel.No.'22 v IYO 9• 17;V)s &ItAtSlr_ rao �C+1 c► C'�rr� �-f5�irin V;1541-4 j Assessor's Map/Parcel/o/ 103 Pta,,r TAA_o ,fit. L�FraJ�rra`t� �'�!.✓ Installer's Name,Address,and Tel.No.,5og- 14,*�'t -59;K, Designer's Name,Address,and Tel.No. 51049 34%t`415 y1 l3or �a .-Qov 5�t-'tar..(-tcm, c L! x �;ft r c. Type of Building: 3 0, Dwelling No.of Bedrooms V /Lot Size sq.ft. Garbage Grinder( ) -Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 640 gpd Design flow provided bj,9 gpd `Plan Date ��.�tt. 3, r / Number of sheets `` Revision Date 6 14 17107-1 Title .0 p. 4_3 :S 1'•'� �- ,31'ae v o , Size of Septic Tank,�7.,fA0/5aa4_afa Type of S.A.S.,S'-'�lXrer�� xc , �t .s f?, C.J< 1 ,�3cv Description of Soil; /( r Nature of Repairs or Alterations(Answer when applicable) ,[~.� ¢ F !at c,t. p ✓�r� e as r E- �f, 'CA �V.r I", Tip GL !��'r�l�iCr�✓,h�a.�ir^t, a lkiy _ . q16 L�lle1 (_��'!.A#,Gt.�-�.1a.y rM�-" �.A''..�i� L 'Sti I raZ•�� t r� .J�s,,�d l•.�!•t 2Jf"X_ t1'-1�a,tn..%✓`A'7 �7:i S�v,n. +l�-is�t rr.,�1 t,q�.�L,4I L1✓ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described�ori-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental•Cdde and•not to place the,system in operation until a Certificate of Compliance has been issued by this B� Health.,-,---,- Signed /,.r / C -•' a== Date Application Approved by _.,.._ Date , T r ! Application Disapproved by ,"� Date for the following-reasons , Permit No. &7j'"" eq t 2. "-Date Issued e /Ali/ ;?O. ----------- =- - ----------- ----- ------ - -------- _ - --- ------- ---=-- ---= ------------------------------ -- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS �. Certificate of Compliance THIS IS TO CERTIFY,,that the On-site Sewage Disposal system Constructed( ) Repaired(^ ) Upgraded Abandoned( )by T 1l k1/l- at 9,58 Fj;et k "mot, M4AA�K,t_t fr'r1�A.�(C), has been constructed in accordance with the provisions of Title 5 and the for DisposalSystem Construction Permit No l 1'� OM,dated f 1 /�� R ' nstr a ler t7Y' �A�Irt to r l s Cot-iP.rr'i. �►1 Designer t ,t,.t�, �,ec.A .fit .,n p. a � rc #bedrooms Approved design flow 110014 and The issuance of this,perm/ (i.t shall not be construed as a guarantee that the system will function as designed. Date -7 1 LP 121 Inspector A_k/j,A.r,� (_ _ . TbAZ4 -----. _ _ :. :- - :_ _ _ - -------- - ------------------------------ No. a Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair( ) + Upgrades(/) Abandon S ( ) System located at 15 F!/t'yi t✓ , f"tlGp ra IRf4,�•� ,1 11 t�/�4 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 Approved by v1 , i Town of Barnstable e Inspectional Services Public Health Division Thomas McKean,Director t6J9. prFDW►A'tA 200 Main Street,Hyannis,MA 02601 i Office: 508-8624644 Fax: 508-790-6304 Installer&Designer Certification Form Date: *i J?_J Sewage Permit# QDal-012- Assessor's Map\Parcel ID 2- Designer: LD WN CRP � IN M Y& INC Installer: Address: xPore Address: qT ItJW RAJ yARMouTH pore MA 02,675 HWU0 MIUSt NA was issued a permit to install a On 61 19 - o a.-1 1�.- uf-lyl o� p ' (date) (installer) septic system at 58 FLINT !�[ M.N Vuu W li 1_h based on a design drawn by (address) �ffij tL A,()JkLbr, dated JUNK a� 1_O21 (deggn r) 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. 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 c liance with the to rms of the oval letters(if applicable) c\S��&OF 6 q��cS DANIELA. �N I OJALA CIVIL (Installer's Signature) No.46502 1 � �SS/ONAL EaG (Designer's S gnature)i (Affix Designers 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. WoAdeplAHEALTMSEWER connecASEPTIODesigner Certiflcslion Form Rev&14-13.DOC f Commonwealth of Massachusetts 1� 3 Title 5 Official Inspection Form �rl Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments 358 Flint St (System 1 of 2 Main House) • Property Address Conrad Watson Owner Owner's Name , information is required for every Marstons Mills MA 02648 10-21-2020 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspectioni forms may not be altered in any way. Please see completeness checklist at the end of the form. A. Inspector Information 51 l5oaLl Shawn Mcelroy Name of Inspector + Upper Cape Septic Services Company Name P.O. Box 73 Company Address East Falmouth MA 02536 City/Town State Zip Code 508-495-0905 S13971 Telephone Number License Number B. Certification I certify that:) am a DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CMR 15.000);1 have personally inspected the sewage disposal system at theproperty 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 s 2. ❑. Conditionally Passes , 3. ❑ Needs Further Evaluation bythe Local Approving Authority 4. ❑ Fails 10-21-2020 nspector'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 cam' Commonwealth'of Massachusetts a � Title 5 Official Inspection Form ra► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 358 Flint St (System 1 of 2 Main House) Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary •', i i t Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1 j System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. + 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'approJed 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): Id .n. tj 3 _. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 t Commonwealth of Massachusetts Title 5 Official Inspection Form i�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �`rj• 358 Flint St (System 1 of 2 Main House) Property Address „ Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 page. City/Town 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 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.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection -Form w�,l Subsurface Sewage Disposal System Form m -'No t for Voluntary Assessments >" 358 Flint St (System 1 of 2 Main House) J. Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water 1' ' i . r L ;f ❑ 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"ors"No' to each of the following for all inspections: ►. � . -Yes , No ; r, i r ❑ ® Backup of sewage into facilitypr,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.712 612 01 8' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form w: ibl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 358 Flint St (System 1 of 2 Main House) y T, Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 page. City/Town 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 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: El ® , 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 w�. Title 5 Official Inspection Form, l i�M Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 358 Flint St (System 1 of 2 Main House) Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 page. City/Town - State Zip Code Date of Inspection C. Inspection Summary (cont.) ; If you have answered "yes"to any question in Se6tion'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 i ❑ ® 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? ® 1_ ❑ 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 tfie site inspected for signs of break out? ® . ❑ We're 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? Wasthe 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: t Existing information. For example,-a plan at the® ❑ rm 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 Wi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments, r� k •._ . : 358 Flint St (System 1 of 2 Main House) Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 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 flowbased on 310 CMR 15.203 (for example: 1.10 gpd x#of bedrooms): 330 Description: Number of current residents: 0 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 ears usage d Well water 9 ( Y g (gP ))� Detail: r Sump pump? ❑ Yes ® No Last date of occupancy: 2020 Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts r� Title 5 official, Inspection Form r ` Subsurface Sewage Disposal System Form -Not for-Voluntary Assessments 358 Flint St (System 1 of 2 Main House) Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: t Design flow(based on 316 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: N/A 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 C.'l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �o�" 358 Flint St (System 1 of 2 Main House) `r_ 1 Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 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: 1993 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): , Depth below grade: 20"feet Material of construction: ❑ cast'iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 18 Commonwealth of Massachusetts ,a p, Title 5 ®fficiall-I nspection Form 'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 358 Flint St (System 1 of 2 Main House) Property Address Conrad Watson Owner Owner's Name information is Marstons Mills {y' MA 02648 10-21-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) f 6. Septic Tank(locate on site plan): Depth below grade: - "12" feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: r years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: ; r 1000 gal Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape 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 is in good condition with baffles installed and no sign of leakage. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts _ Fill r3� Title 5 Official Inspection Form rl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 358 Flint St (System 1 of 2 Main House) Property Address Conrad Watson Owner Owner's Name information is required for every MarStons Mills MA 02648 10-21-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): s Depth below grade: feet Material of construction: F ❑ 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 �'�I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 358 Flint St (System 1 of 2 Main House) Property Address Conrad Watson Owner Owner's Name information is Marston- , required for every s Mills I MA 02648 10-21-2020 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: ' 15 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.): Good condition with water at working level and no sign of back-up from field. v t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 I, Commonwealth of Massachusetts w,. Title 5 Official Inspection fo m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments :- •>°` 358 Flint St (System 1 of 2 Main House) Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 page. City/Town 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: 3-Infltrators ❑ 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 ell,:� Commonwealth of Massachusetts ►� Title 5 Official Inspection--Fora' ► Subsurface Sewage Disposal System'Form -Not for•Voluntary Assessments 358 Flint St (System 1 of 2 Main House) Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 � 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.): Infiltrator field in good working order and empty at inspection with no.sign of back-up. 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 Commonwealth of Massachusetts fi� y Title 5 Official inspection form ►x r�l .Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments Fjc; 1._`, 358 Flint St (System 1 of 2 Main House) Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 page. City/Town . 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 y Title 5 Official Inspection Form hI Subsurface Sewage Disposal System'Form =Not-for-Voluntary Assessments s � .2.. 358 Flint St (System 1.of 2 Main House) Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 `' 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 F � F �— wD rr ' t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 I r ` Commonwealth of Massachusetts Title 5 Official Inspection Form ibl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 358 Flint St (System 1 of 2 Main House) Property Address Conrad Watson Owner Owner's Name information is required for every Marstons Mills MA 02648 10-21-2020 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 groundwater: 20' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database - explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts = F' Tide 5 Official Inspection Form hI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 358 Flint St (System 1 of 2 Main House) Property Address Conrad Watson Owner Owner's Name information is Marstons Mills ) s MA 02648 10-21-2020 required for every page. Cityrrown - 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: f " ' 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 .A t . t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 V �,.. TOWN OF BARNSTABLE LOCATION SEWAGE 76 VILLAGE 4v7/&4-- ASSESSOR'S MAP & LOT a/' INSTALLER'S NAME & PHONE NO. /-?CV&7Z�60-77 SEPTIC TANK CAPACITY /UUU LEACHING FACILITY:(type) /A)tl,- �.3 ) (size) NO. OF BEDROOMS PRIVATE WELL PUBLIC WATER BUILDER OR OWNER vJA�FZp�-j DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: ------------ 7 VARIANCE GRANTED: Yes No 4A( �}S No � - w THE COMMONWEALTH OF MASSACHUSETTS ppppMo BOARD OF HEALTH 60rn8teb!®CV=c=m 3 TOWN OF BARNSTABL _��_S� ,� Iir Ilan f ux i n �t1 x C� tt rurtt rani# ' Application is hereby made for a Permit to Construct ( ) or Repair (,ICJ an Individual Sewage Disposal System at: Loca ton- ddr ....................................................Lot No. or .. G `v2/�� .v��saoJ •3 7------ �iac..... ............ Owner 1 Address a •-- U -p'- ..............................G'� G�.r�'JZS`7 i24 �, ................ � Installer Address i d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................. ...S ......_ .....Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria A' Other fixtures ................................. W Design Flow................... .-gallons per person per day. Total daily flow............ Via....................gallons. WSeptic Tank—Liquid capacity/ ...gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..........Z....... Width....... ......... Total Length.%*-'.2-t..?�.5_Total leaching area--------------------sq. ft. Seepage Pit No..................... Diameter................---. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. L...............minutes per inch Depth of Test Pit.................... Depth to ground water-----.-----.-_--.----. Gi, Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water..-----................ M - ------------------------------•------••-----•-•---------------------------------•---••-••---.....-•-........................................................ 0 Description of Soil.............ifl-- ........C,,O'9,fin--. .------�: 'S. O V .-----------------------•------•••---------•-•-...__.....-------•-----•-•--.........-----------------------------------••---•---•-----•-•---- W x ----------------------------------------------------------------------------------------------------------------------------------------------•----------- --•---------------------••--•-----••-----•. U Nature of Repairs or Alterations—Answer w en applicable.-../_'`15 _L-____14? oQ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be n issued y t board of health. Signed ......... ^�/�' � ---------------- ------ ----- ............... Application Approved By �� ------9;1 - --- ................ --------.................................. ........................................-- --...-........ Date Application Disapproved for the following reasons- --------------------------------------------- ---------------------------------- -- --------------------......---------------------- ............................................. ................... . .... .................................................... ................................................................. ...... ................ ....... . �--� Date Permit No. ----- ...... -------7 -----_-------_-------- Issued ..---- Date r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Xvv iration for Disvu,ial Works (�nnstrnrwln ramit Application is hereby made for a Permit to Construct ( '�—or Repair ( j an Individual Sewage Disposal System at: ................_.................... ..- --•- - -----------.-..----..........--------- a ---- •----•--------- .... ..........-------•---.................... .... . . . .. . ... ... Loca ion-Address or Lot No. • -� /1 --.........v�—i�S...tJ �-7------ .....................................................t/f �.. .........--- j (/C Owner _ Address, !/ Installer Address Type of Building Size Lot.................... .....Sq. feet aDwelling—No. of Bedrooms........................ ..................Expansion Attic ( ) Garbage Grinder ( ) p� Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QI Other fixtures'.----•------------------------------------------------- --- W Design Flow................. _. 5_._-.gallons per person per day. Total daily flow............. 36...................gallons. WSeptic Tank—Liquid capacity&O...gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..........1...... Width.......7........ Total Length_- .LZ Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter-___-___-__..-_----_ Depth below inlet.................... Total(l'eeaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1...............minutes per inch Depth of Test Pit.................... Depth to ground water.......................... G%I Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------------------------------••------------•-••------•-------------•------•-•----------- -•------•------.--.-------.... ---------- -------- -......... D Description of Soil--------------Q...: ......._l:�r + l_.. �..�S eSo -� /ice' S/J� p x --•--•-----•..... -•---•------.....--••--•-•-------•....--•-----• V .....•-••••••--•--••-•--••-•--•--••••-••-••----•-----------••---------•-------------•----.......-•-•-----•-•-•---•---•------------------------•--•------•--------•-•------------•-....-----•---•--------. W x .�/s�n V Nature of Repairs or Alterations—Answer w en applicable._,._/_______________f_L___f�-1�P (?�_'�--�1/�-....... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the y p Compliance issued y t9hi board of health. Signed .---...-- system In operation until a Certificate o Com lance as e n- � c �.. gDate Application Approved By - --.:/ ..--- .............. .. Dare Application Disapproved for the following reasons- ............................................ --- - ------- -- -------- -- ------------------------------------------------- ---- - ----- - -------------------------------- -- -- ---- -- -- ----------- ---- --- ------------ ------------------------------------------------------------- ----------- -------------------------------------- Date Permit No. ..... ... ...'4...../,-,l......................... Issued ....... ......!��"� �.. --- Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF-BARNSTABLE (ITPrttfirate of Torayliance THIS IS TO CERTIFY, That the.Individual Sewage Disposal System constructed ( ) or Repaired ( ) by......................................................................-.......Gi C�i a LG ..... �.^J ................. ........................................................ Installer at ............................................................. J �5 j c�J7- ... ...... - ,...................5 has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .. ..., �-.. r--_--------_ dated -.��- '',-- -.��__'--- ' --� .. .. —J� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT16E CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.. ?...' �fZZ ---------------.................................. Ins ector .--------_ ... ----------------....................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE.................c Permission is hereby granted................:....•------------------------.-. __ to Construct ( ) or Repair (�1) an Individual Sewage Disposal System atNo.......................................... = r��/�t........................ ......................................................I ltS Street as shown on the application for Disposal Works Construction Per Np � ^°. .. Dated.._u_'" -`''_:F�."".�,'�- p/ DATE............................................................................... Board of Health FORM 36508 HOBBS&WARREN.INC..PUBLISHERS AsBuilt Page 1 of 2 TOWN OF BARNSTABLE LOCATION ��i L�iJi.5` �A.r SEWAGE N .%cY—?a VILLAGE yLl� ,/YI/us ASSESSOR'S MAP & LOT,O/- INSTALLER'S NAME & PHONE NO.,l3UJ�7zJcu%7 C'B�•cST_ -� , SEPTIC TANK CAPACITY LEACHING FACILITY:(type) /o�e� ar2s �•3 j (size) 7y�c3i:�S' NO.OF BEDROOMS PRIVATE WELL PUBLIC WATER BUILDER OR OWNER lJff^j AO DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: ,VARIANCE GRANTED: Yes No �Sr yI` a4 I �S http://issgl2/intranet/propdata/prebuilt.aspx?mappar=101121&seq=1 2/26/2016 Vi. woo 8 9Y 13et'fo NY a N'r 3=j kIGN 2f 3l. -t 14.w J -31 u _ , _ Nm nes . rmtcxectea I � I I • it 'r .. } a71g; fro�ro �.rtv_ sEc1sr`tom i I 6 I WUR 2t.3�i 8:11 2L3G .W61F2L 9v '.b' - - µdv �: YIJbtifiifM.. ,yp{WaK 2..8g8qw o v'lie ®1 I�i i•► ICI �'� i� e Sam i�a 1`i ® 1�1 2w TOM YY 'tii s Ywe e 1 ® ® uw y��''�� w'"4a''• 1M ^0® WrRi Q ! WME ��..,'a,,,e m _ Till l �Ill�f 7I� a' rd d YY� _ INI O R�I� ®_ Y �dk�&I�F,I eel ��... a � � � P�'��iA� ,!d��.�" I��- �'.�� i'�a�15..b5�•,�.r-.��.®®I�® ,;:-L�1�1��I®i_�I� �' � _ Rita FIE,- �57F5, qg�P ® &'dI6Y.�� 4 � &'� EmS �I1�_Nml �i�&�IYYI --- No.ec2t .. WINCHESTER j, i s h i _ s ri •' to. , d.� _ _�J�a]•.l r� _ �s. �L�iilo '-S.d�_.l �rl/� �- /� ��. ...c!.�� i c Tom.: .®1�+ �s7�I ;® � _ — T 1—�. .• e �a• ':a�r7�'1't�r�A I e��ea��:d� � %i'�f1=ar�L:.:�'1C � � � � nl I, �s3md■ -��Il" i - .�6® ia=- .�loi flit ► 3�°- dam- {. a fff4�S:lfL►�ia/ .r- M-A F•I - e � t_ _ �, ■ e_ .. e_. ®.+f+� fi�ih=.:`tom rrle �C _ •. �_ � IP r r eclelJ ®_.rs.`:® g..Je•�rlr �� 1� � .i i � _ �, 1 � `fir+!\ f1C�1® :ai -^`+ •►a ■ << !'s e L. .: :. �Ii"f3a►. ffs _ �' @ �w jI� � +.. + :�a a•w:' ob e JY � "a.�r JJ► .�._ � ri a.e� vim/ -' '1'1•- ,�® 7��: � _ y �. I"� vo wry -• � ®w � 1 `gym.�_•:aF��i 7 e.l_.IJ.•It".. rJ�a.�.IYt ■` f1. =.saC A w.% MTEl1 rvr�n IV i i i I .NO 11,.. . . Idt- it vpr _ yy — � I 5c,S-r T Fib �.At'� I ,1�B�44b�Y_-.rAb i _ i ! i No. �� Fee BOARD OF HEALTH TOWN OF BARNSTABLE ZppYicatiou for lVell Cong1ruction Permit Application is hereby made for a permit to Construct(✓j Alter( ), or Repair( ) > an individual well at: -35$ F/,.T ST. Mujsr-s M � rl�c LocationAd'dress Assessors Map and Parcel Go 0, CI wA(S-Ao,u 3c$ F,/,-.7 S/ /t9Q/S�wS M/`/ � Owner Address _0,Cej nj iS S'Cu.N.,�c�/ /o $ iOe6.,4 J Ala S�',eeA /'-��• O a��/9 Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well 'Ij/ AU L Capacity Purpose of Well Agreement: The undersigned agrees to install the afore described 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 Certifi to of Comp ' nce as been issued by the Board of Health. Signed �,.,� e. ;81i Date ) Application Approved Date Application Disapproved for the following reasons: s-� Date Permit No.�� 2 �� -2 Issued / Date --------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of (Compliance THIS IS TO CERTIFY,that the individual well Constructed(!-}, Altered( ), or Repaired( ) by CN A)l S sca N y e Installer at 7 S� /�U f 8 S M i�(4 A4q has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Frotec 'on Regulation as described in the application for Well Construction Permit NoA,) 0' - -®/`7 Dated )"7 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector r, f t� No, 1 1101�'' Q I Fee ) r BOARD OF HEALTH TOWN OF BARNSTABLE 2pplication jfor Vern Con.5truction Permit Application is hereby made for a permit to Construct( Alter( ), or Repair( an individual well at: T ST. r Location-AAddress Assessors Map and Parcel 0t' , GG UJIA(Sp/�i 353- F-1rtiT,V /tjo /S✓o I Owner ^^ Address (' ►J-CA-,r,J/S �Ccrrv��c/ �J UPI")✓a SE /146q-f'e_e Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well Capacity Purpose of Well Agreement: The undersigned agrees to install the afore described 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 Certific to of Comppl.iiancejlas been issued by the Board of Health. / Signed U u,,,a Date Application Approved B >,1,.._._ , Date Application Disapproved for the following reasons: hh Date Permit No. i,,) V l Issued Date ------------------------- --------_------------------_--------------------------------- ----< BOARD OF HEALTH TOWN OF BARNSTABLE certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed(k), Altered,(."), or Repaired( by C h)ti 15 r'a )J K j P / Installer at 3 S& F-/, r ST /V/G ✓S/U w S M 4 Ma 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, - '17—C/7Dated I l An !I —2 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector ------ - --- --.----- --------------------- --------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE 11� ll ✓^�,.,, Vell Construction Permit No. iA..J ►/"� •'-�/ - Fee Permission is,hereby granted to O erwru/y Installer to Construct( ), Alter( ), or Repair( an individual well at: No. -1, y-- ST R, k Street 1 am, /_ as shown on the application for a Well Construction Permit No.k):�c ''1 Dated k/69/'/ Date Approved r 'AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION �� r Lei 1��t. SEWAGE # 76 VILLAGE ,Wj, .in_144,S ASSESSOR'S MAP & LOT d/- /_,L/ INSTALLER'S NAME & PHONE NO. G9'�7�cu SEPTIC TANK CAPACITY LEACHING FACILITY:(type) /e�c,-�aU, �3 J (size) :Z. 4 3i:7S' NO.OF BEDROOMS—&—PRIVATE WELL PUBLIC ►ATE BUILDER OR OWNER jSLf^j LA0 yJ.4j &.j DATE PERMIT ISSUED: R3' DATE COMPLIANCE ISSUED: ,VARIANCE GRANTED: Yes No~� � � I �S http://issgl2/intranet/propdata/prebuilt.aspx?mappar=101121&seq=1 6/28/2017 I C E G E N SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES P MARKED WITH MAGNETIC TAPE OR �a Poc o COMPARABLE MEANS FOR FUTURE LOCATION. 99- EXISTING CONTOUR BARN PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) 1. DATUM IS NAVD 88 FIRST FLOOR s8.2 ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADES 2" PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS EXISTING X 9-9-1EXIST. SPOT ELEV. FILTER FABRIC OVER STONE ii• a \ 66.0' MINIMUM 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. �� - 99 PROPOSED CONTOUR 75 OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 65.0 o e s S d a NOTE: 2" MIN. WALL 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS 9 PRECAST H-10 BLOCKS OR 8 THICKNESS REQUIRED 4 Q D TO BE AASHO H- H- 0 TANK z PROPOSED SPOT EL. 1 R 25�. J RISERS TYP. PRECAST RISERS 2 4 � LSESCH40 PVC MORTAR ALL J TH1 H-20 , , PIPES LEVEL 1ST 2' COMPONENTS 5. PIPE JOINTS TO BE MADE WATERTIGHT. r 6" MIN. SUMP ° TYP. INV S EL. 61.00 4' Shubael TEST HOLE 12' MIN. INT. DIM. ( )�4D NS ri �S,DES * .-•-•-- 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH Pond 63.6 P �° o �o" 1a" D D 0 0 0 0 O 0. O D` 310 CMR 5. 0* DDDD 1 00 TITLE 5. �Y _2� SLOPE of GROUND THE INSTALLER SHALL VERIFY THE �.�+ MIN. 63.15 TEE 1500 GAL H-10 TEE � O o �00000000< ( ) 62.90 DDDD DDDD S T o SEPTIC TANK o 0 0 D'� o •° � o 0 0 0 D o ®o�� ® ® . F ALL UTILITIES AND ALL D o D D ® ®C� ®®®®®®®®®® D ° D O :C 0 ' DDDDDD LOCATIONS o o > D D D D I D D D° WATERTEST D B X o 0 0 0 0 0 V.I.F. 4' IIQ. LEVEL o o c o 0 o D D D D 7. THIS PLAN IS FOR PROPOSE WORK ONLY A T 000000 , DDoo D K L AND NOT 0 "C GAS BAFFLE •. �_o 0 0 0 0_• D o c D D D O 0 0- N > o 0 000 'o 0 0 o LOCUS UTILITY POLE .. 0 / NESS o D o D FRLE'EL BUILDING SEWER OUTLETS AND ACME OR EQUAL D D D O O � � � � D D D O D D D D aoo�®®®®®®® ®®®®®❑®�®®® . D D D D BE USED FOR LOT LINE STAKING OR ANY OTHER 1 )0000DOD0 .00D00000 , ANY D D D O ELEVATIONS PRIOR TO INSTALLING N , D D D D PURPOSE. D D 61.27 61 .10 D D 59.00 FIRE HYDRANT , .. PORTION OF SEPTIC SYSTEM , ...... .,, .• . ...;. �.. . .,,: .• °°°°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o o' 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING °o°o°o°o°o°o°o°o°o°o°o°D°o°o°o°o°o°o°o°0°0°09 H-20 500 GAL LEACHING CHAMBER BY ACME PRECAST OR (EQUAL.+,ono o.�.n.n.o_o 0 0 0 0 0 o.n_�_D_o_o.o 0 3�4"-1-1�2" DOUBLE WASHED STONE 4' MIN. \� T 5 UNITS RE QUIRED UIRED ALL AROUND PRECAST T O Q 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED o I AR STRUCT URES RES CA WITHOUT INSPECTION BY BOARD OF HEALTH AND 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS S T I L 0 EN ON 0 OUTSIDE OF STONE: 50.5' X 12.83' OBTAINED COMPACTION. (15.221 [2]) b PERMISSIONNED FROM BOARD OF HEALTH. SYSTEM PROFILE 0 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) DIGSAFEHOUSE ACCESS COVERS TO WITHIN 6" OF FIN. GRADE LOCATION (1-888 UNDER33) AND VERIFYING THE LOCUS MAP LOCATION OF ALL `UNDERGROUND ,& OVERHEAD UTILITIES J PRIOR TO COMMENCEMENT OF WORK. 54.0' BOTTOM TH-2 , TOF = 65.3t ( 2•5% SLOPE) ( 2 % SLOPE) ( 1 % SLOPE) NO GROUNDWATER FOIUND SCALE 1 =2000 t 66.0 - H-20 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE \ MINIMUM .75' OF COVER OVER PRECAST H 20 REMOVED BENEATH AROUND A H AND 5 A OU D THE 16 gp , , LEACHINGASSESSORS MAP 101 PARCEL 121 NOTE: 2" MIN. WALL FOUNDATION SEPTIC TANK D BOX 12 POND 46f LEACHING FACILITY. PRECAST H-10 FACILITY THICKNESS REQUIRED TYP.RISERS „ v 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND 4 �bSCH40 PVC \ 2m 6" MIN. SADIM. PIPES LEVEL 1ST 2' REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. BARN CESSPOOL ONLY, SEPTIC SERVICING EXISTING " MIN I60 L C G 1 2 .p DWELLING TO REMAIN. ZONING SUMMARY N162.6' 1a~ \ O , 10~ -10 , F T E 1500 GAL H TEE 62.30 E 62.05 V.1.F. SEPTIC TANK \ o•o 0 0'o i 0 0 0 0 0 0 •, c ZONING DISTRICT: RF I T BOX DISTRICT 4 E •o D o 0 0 O WATERTES D O LI LEVI 0000 Q o 0 BAFFLE•. ^ L GAS B o o n- FOR LEVEL NESS c9 ACME OR EQUAL \Q - F F MN LOT SIZE 87,120 61.1 0S.F. 1 27 T 6 . i5` . . N. LOT FRONTAGE,. 1 O' ••O `� O'•O O O.O+O.O'O O.O.O:D•O O.O VU••G,:OO`•O b .� O O O O D O 0 0 0 0 O O O O O O O O O O O O O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - V O O O O O MN I DDD I FRONT D D D D D 0 0 0 0 0 0 0 0 O ON SETBACK 30 O°O°O°(•�O_.1_9.•1 0000 0 0 0 f`•n_n_O_•1_O.O O i, cS I \ MIN. SIDE SETBACK 15 6" CRUSHED STONE OR MECHANICAL 4 MIN. REAR SETBACK L� K 15 15.221 2 COMPACTION. [ ]) ••\ MAX. BUILDING HEIGHT 30 2.5 1 SLOPE % SLOPE Q o IT H-20 SITE S LOCATED WITHIN THE RESOURCE 13 78 PROTECTION OVERLAY DISTRICT - P D 0 FOUNDATION SE TIC TANK BOX 0 � C� \ SITE IS LOCATED WITHIN THE GROUNDWATER <v EXISTING PROTECTION OVERLAY DISTRICT C3 BUILDING SITE IS LOCATED WITHIN ESTUARINE WATERSHEDS FOR POPPONESSET BAY THREE SYSTEM DESIGN. BAYS, RUSHY MARSH, AND CENTERVILLE RIVER S . O A ALLOWED \NOT L GARBAGE DISPOSER IS , o B EXISTING 3 BEDROOM DWELLING BARN O' e � 8 ••\• BEDROOM DWELLING HOUSE \ EXISTING 3 ED (HOUSE) S 50 BR a�'•• S 3 ELEV. ELEV. \ 5 1 J 1 2 5 2 6 2 S „ 4 _ P A 0 65.5 65 C� 110 GPD 660 GPD _ 0 DESIGN FLOW. 6 BEDROOMS5 3 O � , �, A A USE A 660 GPD DESIGN FLOW , LS ' LS = \ 6 `' \•. SEPTIC TANK: 660 GPD (2) 1,320 ,per I . • „ 10YR 4/2 >, 10YR' 4/2 o / / USE (2) 1500 GAL. SEPTIC TANKS / 12 18 B a LEACHING: / �.�,� ` \ LS` LS SIDES: 2 50.5 + 12.83 2 .74 = 188 GPD PR P SED ' BLty Sa n 10YR 5/6 10YR 5/6 ( ) ( ) 26 63.3 DRI Y o 36 62 BOTTOM 50.5 x 12.83 .74 = 479 GPD \ ( ) EX SON / TOTAL: 901 S.F. 667 GPD TEST HOLE LOGS 0 PROPOSED C C 6 MULTI USE CRAIG J. F RRA S 1 A M OREQUAL) E RI E 3871 LEACHI NG CHAMBERS (ACMEPER C USE 5 500 GAL LE ( � ( BENCHMARK: COURT ENGINEER. STO NE AL AROUN D WIT H 4 S E A S COR. PATIO I T `;per 9 DONALD DESMARAIS =67.0' NAVDB ` WITNESS. MS MS � DATE: 12/9/2020 OD ` / P AT < 2 MIN INCH ERC. RATE / 10YR 7 4 4� Y / 10 R 7 4 O TH1 / O O �L I 192268 I CLASS SOILS P MA . PATIO Q o APPROVED DATE BOARD OF HEALTH + 6 \ o NN 120" 55.5' 132" ' 54 SHEL PROP ED , PARKING r PATIO LOT A / NO GROUNDWATER ENCOUNTERED 1 6• 57,090 f Q 6 EXISTING Q 8 BARNwl" 1 T L Eumm 5 SITE . PLAN FFLR = 68.2 > O F ROP. Q (EXISTING 3 POOL P OP. v B'E�ROOMS a C.t�' ___ Q r p _ PA �uOF cT� PRO . 1 DECK PROP. I/ 6 �., ADDN. #358 FLINT STREET a MARSTONS MILLS MA 4 , � PREPARED R\ FOR F � a 0 I q\\ no G \ \ \ OHE -- 7 o�F - / . KEVIN VILSAINT \OHE OHE / Ca �NOFM PSNOFMq 9 / E OHE OHE { / o'��DANIEL 9cyGs � DANIELA. m OJALA DATE. J U N E 3 2021 A. • o � , u v PROPOSED CI {L E r oJALA S •8 No.46502 40980 -o ADDN. No � \ 0,I iST ESS\ D \ \ VO SfONAL EN ,� , r o i - / Scale: - 20 j. \ q F 0 N0 A44,90 ' G _ � o EL q DANI oy II G A. � DANIELA. 0 10 20 s ' 30 40 50 FEET o OJALA � o OJALA E d \ o No,40980 CIVIL SF�xC No.46502 \ PARKING °F� S\oa q o s P �, - off F 508 36 4� 2 541 q 0 O �. G 1 S T ER �E SURN � _ F fax 508 362-9880 s 0 s N i E O 0 N AL � / I downcape.com a c e own CO Pe i r�d n nee r S / p g n nc / g civ il engineers /. ,= landsurveyors�.,_._�' a �( 3 rt-r�-1 l 939 Main Street ( Rte 6A) I DATE I II DANIEL A OJALA, P.E., P.L.S. YARMDUTHPORT MA 02675 ' LICE #21 -055 k 21-055 III T-I -- I- --I - -