The URL can be used to link to this page

Home My WebLink About0458 FLINT STREET - Health 45-8 Flint Street Marstons Mills A= 101-013 I I h �I No.2-153LY UPC 12934 smead.com • Made In USA r f�llS®NMioYODUCTD! OFIKSR FROCIPM CERTIRED s�uRcu� wwwWFaocanti►owG � i IN W[TRES-5 WHEREOF,lbe. said Alco R, Tom and AUklld s\J, `tm' llAY(! .l:tllxcxJ s'Oal' b.0mv, lllls,-- = YtlIA. Ot m, 201 � _ .rt�tl•�7,'Cris; C0N'TN!0t*1W4A.rl1 OF KA AONt"I'Colllhlyof7,� PfLut�oriet- ciav orlll;ae,20 i 7, b0fole flit,, tlw tlltllool;led oloutry pii}rllc;, .%d-3ollall}' q-Teltl mi Alto A juld proved it) mo 1111-cluoll s�iif�frta�t�t;,��ticl�il=�:of ill t ogiont Whig(c':i>:wk t,'et60.1u'va 1 ppfi'i}'�rl 'h'herw1► . r}dlelf..xavlr,or fel.-drool bearr lyg a��ttl lta a'ft t lnrr r?a();tlt >�'ir Frr'ralr�Pft�7t r�;�a firvAli�a I411�r s�; kmo>• n to arse.who bows the ahim,sPgratfory, or a any own (if Me xPgrlrarm)',it)flit 111 l pusolls whoul l.lfltyws a» i ;ttc�l r boyo, awl.114.11 owkd ACA Lo m e tllxlt (bey stpef•[l)C-fore-going of their OkVA fic"I ttt-1 fold dad. ittiti�9.i l l l l l 1r1��!,. �l!1�'il>l�� t a f '-r. .._'_',Y. dd-: fix, 03-1 a-1 lai 8Vvd, Nfim6lonA N411 I, MA 0264A IlAil.l T 1Bk MISIRY Of DEEDS uluc 3Qs>A- 1- P -4; 1, sir. -ML 2 Y PP- CL7 P5 Q1 0 3 DEED RESTRICTION WHEREW-i, ALF-C ft TESA And AUBMELLE. J. TESA� both 01,110 Island Lhivv,Midd icmown, Rlwde.Island 02842, owners Qf land %itwited at 4-q Flint SIN-e-tj florimabic ()v11mA&n..qMi4)j Dfloftstable (,Oullty Nin-s-sme-hi-me(M 026.18 (die ProlictlY), 1.110 t)0;11)f; Ki 1'OY11.1 ID M-0 (2) I)V.cds rcuA)ix1td (lie 1 1 mla4lu Counly Rep M.f istry of D-nds In Book 29138, Page 90,and Book 30400t Page 31.1-4 WHEREAS,gis wquired by 11w Town of Banwablo M)ilditig DelwUncnt and BoArd of Honl0k, Ownw 1wrg-by u,6mccii to o msixiction m i tho true 1w of badmoms. which can bu- I.-Ocludod 1;) mly lionle built on 311d.d. lot as a pm-cowfition w obtainfill"3, opprovol or Ow sq)(10 sygkm) Oh (tw pfaptvily In w.11h 310 CUR 15,00 Stato Rmy1roommud Cod.:.,- Tittle V, 9irilrltuii3 l cltltr itl tll for the Sulysurl' 't I acc.A.-spoial of Sa ii(ary. Sep a9t.; WHEREAS, dio Tomi ot.0 BarikARMO 13MI'd Of H0111ib,- im n prcm.ndition to uppmirip, 1110 =pilc V, Minimum Requiremenu for the Submuffm 01sps-al of SnuitOry 80%118.0, i3 M(10. 1.1hig dxm 0.10 98timnem for th.0 mpanklion on the nuinber o.F L-dtooms in my tiouseemis(rucled on 11w to( be Inx on. rewrd xvidi t.c. 13arnscablc County kcgi4try of D&eek by r<:C0Tdiq thfil;EkKUWM, NOW THEREPOINA, OwTw-T(N.1cm I icre by advice- the fo I I owing re-sifict[o I I Lu.)t1wif aboovc rdetenewit land in accordance with tlic requircnictit.5 of Ohc-Tom of Dwitstable Bonixt of HcAilh, Which manictionslitul run wilh flio tand fwd be btdivg upon all sup cem-ars in title: 1. .158 Flint Swee, B. rjutable (Mm-.Auras M11.1s), MA 11-poit tb.0 lot ri hmisw milaining no movc than -3 bcdroom.4, Gvww-i owevs that this 813011 tic perimmit dood omt.d.o6on aft.'ccflng t1to Prollefty., 2. At 811cl-1. ti-me as tho Town or llinmsutblv, through tho Wmvd of HQa I/or 13 x. ith onc k if d of MA[er wki Sewa Comi-nimloricm,dircou die comiect[on Of the pfopuly hocin described lo u inuiti6p) mver, 11w; w)r1qAt-1wfl-Q11 of all allernutive (Katnient system, unui-ection to a shared uptic sysunl, or any Other wasteym,ter ni'lluagement opkI0.11 Or IN, IvTn0VLL1 Of 11140 0, kkod In t1w civont that we., foT oww4waj jilk! ocir Ormillcomt .commilit and agree 10 OURtiply M111 s-ocib. o difewltill., Ilicit this Covenant sliall b"Omo au(mvwilicidlY vold Tsl ................................- ........... .............. .......... ....................... ........... .................... ............ ............. r Town of Barnstable Barnstable Regulatory Services Department * g Y P 1 1 mHuneficaclb MA�`£� Public Health Division t6;q. QED"1A`A 200 Main Street, Hyannis MA 02601 200� Office: 508-862-4644 Richard V. Scali,Director FAX: 508-790-6304 Thomas A.Mc ean,CHO CERTIFIED MAIL47015 1730 0001 4987 6414 December 13, 2017 TESA,ALEC R&AUBRIELLE 210 ISLAND DRIVE MIDDLETOWN, RI 02842 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 20 Oyster Place Road, Cotuit, MA was last inspected on 10/13/2014,by Paul Martin, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) Due to the following: • A system component (septic tank) is located beneath the driveway. It has been determined that this is an H-10 and should be replaced with an H-20 which is designed for vehicular traffic. • The leach pit is also partially under the paved driveway. It is not known if it is constructed of heavy duty loading(11-20)which is designed for vehicular traffic; this too should be an H-20 component. f The septic tank issue must be rectified before April26, 2018. The leaching pit may not be constructed of heavy duty loading. When it is unknown whether or not a particular system component which is located beneath a parking area or driveway, is H-10 or H-20 (for example: a leaching pit is located beneath a paved driveway without an accessible steel cover to grade and there are no records on file indicating whether the system component is H-10 or H-20), the system shall also be deemed as a"conditional pass." 9 Othe OF THE BOARD OF HEALTH ea .S. CHO Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mail ing\Conditionally Passes Letters\20 Oyster Place Cotuit Third Notice.doc f Town of Barnstable Barnstable Regulatory Services Department 9`"R M Public Health Division '¢39 A•� 2007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard V.Scali;Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 6414 December 13, 2017 TESA,ALEC R&AUBRIELLE 210 ISLAND DRIVE MIDDLETOWN, RI 02842 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 20 Oyster Place Road, Cotuit, MA was last inspected on 10/13/2014, by Paul Martin, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) Due to the following: • A system component (septic tank) is located beneath the driveway. It has been determined that this is an H-10 and should be replaced with an H-20 which is designed for vehicular traffic. • The leach pit is also partially under the paved driveway. It is not known if it is constructed of heavy duty loading(H-20)which is designed for vehicular traffic; this too should be a H-20 co1I1 ponent. n (, When iis__ 1li``t u nknown whether or not a particular system component whit is located beneath a parking area or driveway, is H-10 or H-20 (for example: a leaching pit is located beneath a paved driveway without an accessible steel cover to grade and there are no records on file indicating whether the system component is H-10 or H-20), the system shall also be deemed as a"conditional pass." �,,,k� receive this not e. i ure o repay G41� esutinasched jary , PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S. CHO • Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\20 Oyster Place Cotuit Third Notice.doc INME Town of Barnstable Barnstable Regulatory Services Department A&AnuificaCfty • awruvsr�ace, O 9$Ar Public Health Division 2007 fDtA°� 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1730 0001 4990 2281 May 10, 2017—SECOND NOTICE TESA, ALEC R&AUBRIELLE 210 ISLAND DRIVE MIDDLETOWN, RI 02842 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 20 Oyster Place Road, Cotuit, MA was last inspected on 10/13/2014, by Paul Martin, a certified septic inspector for the State of Massachusetts. iThe inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) Due to the following: • A system component (septic tank) is located beneath the driveway. It has been determined that this is an H-10 and should be replaced with an H-20 which is designed for vehicular traffic. • The leach pit is also partially under the paved driveway. It is not known if it is constructed of heavy duty loading (H-20) which is designed for vehicular traffic; this too should be a H-20 component. When is it unknown whether or not a particular system component which is located beneath a parking area or driveway, is H-10 or H-20 (for example: a leaching pit is located beneath a paved driveway without an accessible steel cover to grade and there are ��— no records-on file indicating whether the system component is H-10 or H-20), the system shall also be deemed as a"conditional pass." Failure to repair/replace the septic system with the deadline period will result in future enforcement action PER ORDER OF T BOARD OF HEALTH cKean S. CHO oar o ea iz Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\20 Oyster Place Cotuit Second Notice.doc r G� Town of Barnstable Barnstable Regulatory Services Department Public H Q D ,� Health Division ib;y. u c�0 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1730 0001 4990 4827 April 25, 2016 Ellen F. Mycock PO Box 955 Cotuit,MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5. The septic system located at 20 Oyster Place Road, Cotuit, MA was last inspected on 10/13/2014,by Paul.Martin, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) Due to the following: , • A system component (septic tank) is located beneath the driveway. It has been determined that this is a H-10 and should be replaced with an H-20 which is designed for vehicular traffic. • The leach pit is also partially under the paved driveway. It is not known if it is constructed of heavy duty loading (H-20) which is designed for vehicular k traffic; this too should be a H-20 component. When is it unknown whether or not a particular system component which is located beneath a parking area or driveway, is H-10 or H-20 (for example: a leaching pit is located beneath a paved driveway without an accessible steel cover to grade and there are no records on file indicating whether the system component is H-10 or H-20), the system shall also be deemed as a"conditional pass" Q:\SEPTIC\Conditionally Passes Ltr\20 Oyster Place Cot Apr2016.doc k� i � n Y Failure to repair/replace the septic system with the deadline period will result in future enforcement action PER ORDER OF THE BOARD OF HEALTH ?ean, R.S. CH Agent of the Board of Health Encl: Public and Environmental Health Program Policies, Procedures, and Guidelines Q:\SEPTIC\Conditionally Passes Ltr\20 Oyster Place Cot Apr2016.doc t �T ram, Town of Barnstable Barnstable � Regulatory Services Department cac j IMMSTABLE, + I y MAW 1639• Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL47015 1730 0001 4987 6209 August 2, 2017—tS�E D TESA, ALEC R&AUBRIE:LLE J 458 FLINT STREET MARSTONS MILLS, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 458 Flint Street, Marstons Mills, MA was inspected on 12/14/2016 by Matthew Gilfoy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Property is limited to three (3) bedrooms. You must remove a bedroom with a building permit, or record a three (3) bedroom deed restriction. 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. G'pJ Q PER ORDER OF THE BOARD OF HEALTH /J9 Tho as McKean, R.S., HO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\458 Flint Street Marstons Mills SECOND NOTICE.doc 4' Town .of Barnstable Barnstable AlFft Regulatory Services Department �caC ity +� BARNSTABM ` , 9 %6 9. ,�� Public Health Division TfD""A�A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2847 8407 January 18, 2017 TESA, ALEC R& AUBRIELLE J 81 ASHURST AVENUE MIDDLETOWN, RI 02842 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 458 Flint Street, Marstons Mills,MA was inspected on 12/14/2016 by Matthew Gilfoy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Property is limited to three (3) bedrooms. You must remove a bedroom with a building permit, or record a three (3) bedroom deed restriction. 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. PER ORDER OF THE BOARD OF HEALTH , ' r • h e f Thomas McKean, R.S., 0 Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\458 Flint Street Marstons Mills.doc Health Master Detail Page 1 of 1 4: Lodged in A5: IQW4\trippv Health Master Detail Friday,May 24 2019 Application Center Parcel Lookup Selection Items Reports Parcel Septic Pere well i Fuel Tank Parcel: 101-013 Location: 458 FLINT STREET,Marstons Mills Owner: MCENROE,TRACY A ..............................................__ Septic 1 1/24/1995 Septic 2 New Septic E ................... ....... .i ........ ......... ..... Permit number: 1995061 Permit type: Select type U Complete system: ❑ Issue date : 1/24/1995 @-� P' Com lete date : 3/31l1995 _ Septic tank size: Type/Size of SAS: ii Installer: Select Installer Card on file: ❑ Innovative Alternative Technology type: I/A service type Select service Select IA type ..__ Variance date : Ma Abandon complete date : Abandon permit number: Repair deadline date : Repair notification date : g Keyword: F Comments: 3 BRS 1000 GAL Delete Septic;' ........_... _ .. ................ .... Inspection 12J14/2016 Inspection 10/29/2014 New Inspection.. .... Number Inspection Date Inspector Result f 12088 12/14/2016 Gilfoyy Matthew B&B Excavation CP(Condltlonal pass) 1 _.._.... .. __.......... l Received Date Comments consulted with TM, changed to "conditional pass" 1 ^� Delete Inspection year to remove extra bedroom with building permit, or deed restriction I 1/17/2017 _.... .......... ........... ................ ........ .. ... ... ...... ....., ...,... .......... .. ........,. ..... ........ ... .. III Save Septic Changes Return to Lookup ( _ .. ........I • http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=101013 5/24/2019 0 CO F F I A '. . 413ra Postage $ ,E Kp0,7 ni _ �'A Certified Fee I ED O Return Receipt Fee mark p (Endorsement Required) + `Here M Restricted Delivery Fee y O (Endorsement Required) v�4 rl p Total Postage&Fees $ ra Sent To r esa �}/ec R A r�b�ie/le T' .� ---------------------�---------------------------------- r, Street,Apt No.; / / .F , or PO Box No. SI AS/I vr-.t f1V�v City Sta�AZl d4 1 -- :rr rr. Certified Mail Provides: o A mailing receipt ® A unique identifier for your mailpiece e A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONL� be combhed with First-Class Mail®or Priority Maile. o Certified Mail is not available for any class of international mail. e NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3911)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking.-If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047. "I SENDER: COMPLETEAWS SECTION1 • ON DELIVERY ■ Complete items 1,-2,am Also complete A. Signat e item 4 if Restricted De^� •`desired. X -4 ❑Agent ■ Print your name and aduts''on the reverse addressee so that we can return the card to you. B. R . by Pdnte ame) C. Da of livery ■ Attach this card to the back,of the mailpiece, A-- or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item 1. ❑ es ,. If YES,enter delivery address below: ❑No �sa,AlC /% Jr 8/ �sal,vrs+ �(v.�►-�u�- � N1rd dlfi�vn �� °agya- 3. Service Type t -ertified Mail® ❑Priority Mail Express"' ❑Registered PRetum Receipt for Merchandise ❑ Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes I f` 7012 1010 0000 2847 84E791 -�PS Form 3811,July 2013 Domestic Return Receipt I UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Perini Aln G-10 Sender: Please print your name, address, and ZIP+40'n thlsbg"l o 0. o c Jr� Town of Barnstable Health Division 200 Main Street Hyannis,MA 02601 I I I I � I t ti Town of Barnstable Barnstable Regulatory Services Department ' ,Uftw1caC j BARNSTAHM 9 , MASS . Public Health Division m TFON � 200 Main Street, Hyannis MA 02601 2007 i Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2847 8407 January 18, 2017 TESA, ALEC R& AUBRIELLE J 81 ASHURST AVENUE MIDDLETOWN, RI 02842 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 458 Flint Street, Marstons Mills,MA was inspected on 12/14/2016 by Matthew,Gilfoy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Property is limited to three (3) bedrooms. You must remove a bedroom with a building permit, or record a three (3) bedroom deed restriction. 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. . PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., 0 Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\458 Flint Street Marstons Mills.doc { �1HE ram, Town of Barnstable MAS& Regulatory Services Department QED M{il�' Public Health Division 200 Main Street,Hyannis MA'02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 63 2007 Rev. 5111116 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 ONE (1)YEAR DEADLINE CRITERIA. ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool 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) o Leaching pit or cesspool with high liquid level, <12" below inlet(per Town Code §360-9.1) ❑Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER 4e� 4v �d6ov mjJr4 (OAd(47',),, P�4 f f erop c, bed roum w, Repair deadline: .e(W- e -e �e t�r� Cl WSEPTIODEADLINES TO REPAIR F ILED SYSTEMS.doc Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments O� 3> ,M 458 Flint Street Property Address a-* Alec Tesa Owner Owner's Name information is required for every Marstons Mills ✓ Ma 02648 12-14-16 page. City/Town State Zip Code Date of Inspection W rti7 CTI Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information pg filling out forms ��- f a U on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew Gllfoy use the return Name of Inspector key. B&B Excavation � Company Name 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113640 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ❑ Fails ® Needs Further Evaluation by the Local Approving Authority 12-14-16 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 �� V6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. City/fown State Zip Code Date of Inspection B. Certification (cont.) Inspection.Summary: Check A,B,C,D or E/always complete all.of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ® Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 0 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: The septic system at 458 Flint Street in Marstons Mills was in good working order at the time of inspection but is a 3 bedroom system and a 4 bedroom dwelling. (per notes in Board of Health file- 3 bedrooms in a State Zone redlines reviewed 4-4-16) D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (Actual) _4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage See below 9 ( Y 9 (gpd))� Detail: 2015-6,000gallons 2014- 15,000gallons Sump pump? ❑ Yes ® No Last date of occupancy: CurrentDate Commercial/Industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of,design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 I Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancyfuse: Date Other(describe below): General Information Pumping Records: Source of information: Date of last pump unknown Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1995 per COC Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 2 feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town feet Comments(on condition)of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 1'2" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000gallons Sludge depth: 7 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29 Scum thickness 5 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 13" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank is in need of pumping at this time and should be pumped every two years for maintenance. Grease Trap (locate on site plan): Depth below grade: NAfeet Material of construction: ❑ concrete ❑,metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments gO 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): D-box was in working order at time of inspection. 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.): NA * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: (1) &W H-20 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching was in working order at time of inspection. Pit had 1' of standing water with no higher stain lines visible. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)-. Privy (locate on site plan): P ) Materials of construction: NA Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W 'Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 458 Flint Street (Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Limck 2, AAF m ''281" Front : - '' 83v R. Flint Street. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 i Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >10'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: A previous inspection report on file with BOH ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: A previous inspection report showed a hand augured hole 4.5' below bottom of SAS. An adjustment of 4' was used showing the leaching is not in high ground water. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 � y ' r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments y ,M 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed E System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 {Q�vi d Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary AssessmentsN 458 Flint Street b ^M t�41 Property Address M Alec Tesa C# Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. City/Town State Zip Code Date of Inspection h„� I-e'i Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew Gilfoy use the return Name of Inspector key. B&B Excavation kCompany Name 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113640 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 12-14-16 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 458 Flint Street 'M Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Revised per town decision 6-16-17. Dwelling was deed restricted to 3 bedrooms. See attached paper work. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ brokenpipe(s)are replaced Y N ND (Explain below): P ❑ ❑ ❑ ( P ) ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well*". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 458 Flint Street M Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. Citylfown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 458 Flint Street M i Property Address I Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? Y ❑ ® Have large volumes of water been introduced to the system recently-or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (Actual) _3 (DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No iinformation in this report.) 'Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d See below 9 ( Y 9 (gP ))� Detail: 2015-6,000gallons 2014- 15,000gallons Sump pump? ❑ Yes ® No Last date of occupancy: CurrentDate Commercial/industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): Gallons per day(gpd) (Basis of design flow(seats/persons/sq.ft., etc.).- Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 17 A Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Date of last pump unknown Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date install if known) pp g p installed ( own) and source of information: 1995 per COC i Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 2 feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line. Town feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1 2 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000gallons Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 I ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29 Scum thickness 5" 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 13" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank is in need of pumping at this time and should be pumped every two years for maintenance. Grease Trap(locate on site plan): Depth below grade: NA feet (Material of construction: �❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 458 Flint Street "M Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 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 in working order at time of inspection. 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.): NA * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: (1) 6'x6'H-20 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching was in working order at time of inspection. Pit had 1' of standing water with no higher stain lines visible. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Deck jj[l— ' 81- jx1�' 'f Front _ " 7' L 3-9 Flint Street t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 I I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 458 Flint Street Propeaty Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >10' 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: A previous inspection report on file with BOH ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: A previous inspection report showed a hand augured hole 4.5' below bottom of SAS. An adjustment of 4'was used showing the leaching is not in high ground water. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 458 Flint Street Property Address Alec Tesa Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-14-16 page. City/Town State Zip Code Date of inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 e i r ►�+ Barnstable 10 '. 0 a�rrlstble egulatoty Services .Department UARNl3TA�L8 � .. 9 % Public ReaIth Division �b 2007 20:01vlain Street,Hyannis lU1A 0260`1 Once:, a08 8624,644. Ri6grrd V.S'cali,Director FAX 308 790=6309 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 000028478407 January 18, 20.17 TESA,-ALEC,R&AU:MMLLE J' 81;ASHU 9 - AVENUE' MIDDLZyT4 N Pd. 02842 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE.5 The septic system.located at 458 Fti rt Street, Marstons Mills,,MA.was inspected;on 12/14 ',016 by Matthew Gilfoy,certified Title V Septic Inspector for the State of Massachusetts: The inspection of the septic system showed that the system "eonditionaliy Pa$ses" under xhe;guidelines of 199.5 TITLE:V (3-10 CMR.15.0,)due to the following: • Property . :Iimtted to three(3)bed ms:You must remove a bedroom with; bu>Ildn°g perm><t, or record a.three(3),1.edroa-m deed restriction: You are,ordered to repair or�-replace the septic system wi in.one(1)year from the date you receive thi-s"notifioatiot. Failure to repairlreplace the.septic system within the deadline:period;will tesalt i fixture enforcement action; PER OER OF RD THE BOARD OF HEALTH Thomas McKean,R.S.., O Agent of'the:Board of Health Qal$EPTIC1Lettcrs Septic ffi tion Failures ar Future Lv1C45$F.lmh`Strect Mi<rsions Mills d c i M—C Sib 54 9. px*1-2. 4;25�!1.. I i 1 F,'.yTitT,CTI.ON ` -14H.C3EM', ALE IRa TESA and AUB ICLLE I TESAF ("Owner") boll) of 210 Islandbti e,,_Middletown, Rhode Island 42892,owticrs of land sittmited at 458 Flint Slt-et, liartastat Mc( tnT1►lori;r M ts;), Darnstablo County,k1txsctt chusetts 026,18 (1ho Propotty), and W.1138 set fortll III PAM (2) DVCdS Ml'OXled t110 lktM.s1t*lv Cotinly Registry of Deeds its Book 9138;Pap 96,and 1 oDk 304001 Pagb 31 WHEREAS,as myulratl by the Town of Barnstable.MAIding Deiwwham and BoAL f of NmlIwIk, Own.cr lwrciay ugrom ica o reslxioli a its to tho number of bt;droonis wbioh errs be mcludod lit uilt on said* lot as a pre-cowlition to obuthtlog opproveil or 11 sol)(k sym*J11-01) (Ito prapotty In compliat e. with 310 CM11 15.00 itato Prtulramn'01 tul Chcle,Title V,Minimiun Re-qukttuenis for(lie Si.Rbsurlac:c Mpml of Saiftry Sewage; WITEREAS, tlto 7'4wn of Barikstablo 13c,ot+d of ficnith, its a pteconditlon to upnrovine the Sgt1c syatoin in+"otti p lance with MO t`ME1, 15.2f1 , 4Kai ° lfnrrlrt n�lTr»ial f�'cxlu, ']'iUu V, Mirllinum Regttirommits for the Submutfact l�isnt Hl of Saflitary Scwogo, b:t ciubinu tlTat klic ogtw000t for oh-P rc.RtrlcHatt on (he nwnber of'bedrooms In my house mistruct.ed Olt ilia lot be put on reconi xvith tJyo Barnstable County Registry of Daedtt by m-cording this doctuelmnt, NOW THBRE V I , c1wmr<cltat;q hcrcby lalrtt:e the.follow in res rietiati o»tlrc r,tkVtC reretellml !anal in mcordan co with tlto rcgla mnlctAs o.f -he Tom of Damstable Beflixt of 1-1c4h,whi0i rew�ttictift sitnll riin W11111 the imid fuid.bc biding upon all succ vssdrs in title. i, (MuttitM M1.1.Is). hilt It;tw eousirmtol upon t4o'lot t, house colil'u ing no more that! 3 hcdro(mm, Gwnw €1gmes that tills shall be perjrutnent deed restric(ion ofrcofing the Property, At$l1►1:).time fis tho Town of].3ttmstulk, ilinnigh.tho Ward ofHealtit. ►titcVor Board of WACkhr total Seine!•t'on)-i ksi{}Hera,dlrcm.t o colmectlon dilic Propttrty hoi in det;crilbtd to o intutic;ip) s*xvcsr, ilic aouslruciion of all alternative wms(t:)(or treatnicnt sy:,ttean, coamcdon to a sharer.! Septic system, or way Other waste rater matitagerttent option for ilia ivai )vet (W tritTostel, wid i» thv ovo1]t that we., foT vW10ve9, mid ottr Orstitecs, covemmnt mid agrea lo omq)ly M11) siml.i a dire:ctlim., that this Coventuit shall bocomc otrtumtiticidly void, l Bk 30561 I?g133 t 29575 IN WITKESS WHEREOF,the said Ake R. Tom and Aubricl ;i�. 'I'M ltAw afilAml 1hoir signotlafcl3,mioden final;below,11119,_1 �ciJA t'J lM,hfirl CRU a I,'Cr,s, COMMONWEALTH OF MOSA0104TIS' Cotin�v of , C}it llil - it—day kif June, �t 1, 1. 1"art jilt,1110 t111dctl+itril��€�ll�ry j�tlt►11c, lal �itit?' 1ij;[1P•i1 %!i r lt' 'ik.`l'r�a s1t�19 A:t�tJ i��lc;1,'Tt' ,auld proved in ini0.1hruubh mitisfgwlot y evid-Mto of Wit itka0ion,Living(thick wtlWhowr oppi o):Q rfr'wir's br'Ot W 0djelf sla k rrfiedor-ral �ut��r�.+Na?.rataf�u�'Jr�aly�aei l�l��rr��a�F to��1a�lra�ta+ttf�f Eli1r��r 1�ta,,rlr�wt'cr��ra+aalAPrt�P1 aar�a�ri�rlt$Jn ff1la�,ti�� known fa ante.who bh7ws the crhow,4igmefory, or a tray own p1cr,Somol AtJowled8o i�rlhc tdFjW(v of the. Algolotm)"to ho tha`.Pen.(om w1toae 1.101ti1rs Oro signcd rftyo,anti,mckncrwI4ke-d.[o ime Clot they sIPLii die:fiil'>yping 111sii1w11OW VOIL111A1'flly oftheir okvri E'n ac.l and dued, JI ti� � .;9 fir, •�.�►13# � r i �'tvaulvl_v.Ad�irc5 ; 45.1 Mill strr►N,14fmf1lonii M11-h, MA 01,649 MilABLE U01MY Of DEEDS 1�1t1i �, �4�i�fi, BO�ibtdt I i I i �:- �_+ � ��• ♦ ' ,ate ..� a t � � O •� r. ru -D co Certified Mail Fee + � $ S13S� Extra Services&Fees(check bar,add fee as appropdats)� ❑Return Receipt(hardcopy) $ O ❑Return Receipt(electronic) $ T Postmar ❑Certified Mail Restricted Delivery $ N 0 O ❑Adult Signature Required $ L 1o4 C ❑Adult Signature Restricted Delivery$ -.y O Postage m $ y wt r- Total Postage and Fees p' $ Ln 0 Steee nt end Apt.No.!� l �'MG-------------�------•�e�tJL [. ..... City State ZI ®4 rS �'lS YrIR C�l�f� Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate •Electronic verification of delivery or attempted return receipt for no additional fee,present this , delivery. USPS®-postmarked Certified Mail receipt to the, ■A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service" Restricted delivery service,which provides ' for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders: Adult signature service,which requires the s •You may purchase Certified Mail service with signee to beat least 21 years of age(not .� First-Class Maile,First-Class Package Servicee, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which •Certified Mail service is notavailable for requires the signee to be at least 21 years of agifiede International mail. and provides delivery to the addressee spec , In Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent., with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is Insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark.If you would like a postmark on , ■For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for r the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach.the barcoded portion , of delivery(including the recipient's signature). of this label,.affix it to the.mailpiece,apply r� You can request-a'hardcopy retum receipt or an appropriate-pastaje;and deposit the mailpiece. electronic version.For a hardcopy return receipt, r 7 complete PS Form 3811,DomestiMitum. ; s .Receipt,attach PS Form 3811 to your mailpiece;- 1MP011wrr Save tL1s receipt for your records. 'z.'ri ,�.±ttn.�1 PS Form 3800,4dl 2015(Reverse)PSN 7530-02.0L417 Town of Barnstable Barnstable .�. Regulatory Services Department 1 C j sARNsrAHM I ' "�: ,�� Public Health Division & 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 6209 August 2, 2017— SECOND NOTICE TESA, ALEC R&AUBRIELLE J 458 FLINT STREET MARSTONS MILLS, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 458 Flint Street, Marstons Mills,MA was inspected on 12/14/2016 by Matthew Gilfoy,certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Property is limited to three (3) bedrooms. You must remove a bedroom with a building permit, or record a three (3) bedroom deed restriction. 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. PER ORDER OF THE BOARD OF HEALTH kA Tho as McKean, R.S., HO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mai ling\Conditionally Passes Letters\458 Flint Street Marstons Mills SECOND NOTICE.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 458 Flint Street, Marstons Mills M - 101 P- 13 Property Address Katherine Van Leeuwen Owner Owner's Name information is required for every 458 Flint Street, Marstons Mills MA 02648 October 29, 2014 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: J4 key to move your cursor-do not Troy Williams use the return key. Name of Inspector Troy Williams Septic Inspections —� Company Name 19 Hummel Drive Company Address South Dennis MA 02660 CItyrrown State Zip Code (508)385- 1300 S1682 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority �./ October 29, 2014 Inspector's Signatur Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a desi n flow of 10,000 d or greater, the inspector and the system owner shall submit the cat 9� 9P 9 P Y s report to the appropriate regional office of the DEP. The original should be sent to the system owner �! and copies sent to the buyer, if applicable, and the approving authority. :&A ****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. I II I I � 1 � t5ins•3/13 Tide 5 Official Ins rm o .Subsurface Sewage isposal System•Page 1 of 17 e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "- 458 Flint Street, Marstons Mills M- 101 P- 13 Property Address Katherine Van Leeuwen Owner Owner's Name information is 458 Flint Street, Marstons Mills MA 02648 October 29, 2014 required for every City/Town State Zip Code Date of Inspection page. B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System meets minimum standards set by Massachusetts DEP at the time of inspection only.This inspection is not a guarantee or warranty on the future working conditions of leaching, pipes, components or the future structural integrity of said components and only represents conditions found at the time of inspection only. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 458 Flint Street, Marstons Mills M - 101 P- 13 Property Address Katherine Van Leeuwen Owner Owner's Name information is required for every 458 Flint Street Marstons Mills MA 02648 October 29, 2014 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh i t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 458 Flint Street, Marstons Mills M - 101 P- 13 Property Address Katherine Van Leeuwen Owner Owner's Name information is 458 Flint Street, Marstons Mills MA 02648 October 29, 2014 required for every State Zip Code Date of Inspection page. Cityrrown B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 458 Flint Street, Marstons Mills M - 101 P- 13 Property Address Katherine Van Leeuwen Owner Owner's Name information is required for every 458 Flint Street, Marstons Mills MA 02648 October 29, 2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes'to any question in Section E the system is considered a significant threat, or answered "yes' in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,.' 458 Flint Street, Marstons Mills M- 101 P- 13 Property Address Katherine Van Leeuwen Owner Owner's Name information is required for every 458 Flint Street, Marstons Mills MA 02648 October 29, 2014 page. CityrTown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 458 Flint Street, Marstons Mills M - 101 P- 13 Property Address Katherine Van Leeuwen Owner Owner's Name information is required for every 458 Flint Street Marstons Mills MA 02648 October 29, 2014 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): 13=38,000 gals. 12=32,000 gals. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: vacant 3 monthsDate Commercial/Industrial Flow Conditions: Type of Establishment: N/A Design flow(based on 310 CMR 15.203): N/A Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: N/A t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments `w 458 Flint Street, Marstons Mills M- 101 P- 13 Property Address Katherine Van Leeuwen Owner Owner's Name information is 458 Flint Street, Marstons Mills MA 02648 October 29, 2014 required for every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) N/A Last date of occupancy/use: Date Other(describe below): NIA General Information Pumping Records: Source of information: No pumping info was available. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �~ 458 Flint Street, Marstons Mills M- 101 P- 13 Property Address Katherine Van Leeuwen Owner Owner's Name information is 458 Flint Street, Marstons Mills MA 02648 October 29 2014 required for every , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Tank, d-box and leaching were installed on 4/1/95 per compliance. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1811+ 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.): Flushed lines and found clear at the time of inspection. Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5'X9'X6' 1000 gallon Sludge depth: 4" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 458 Flint Street, Marstons Mills M- 101 P- 13 Property Address Katherine Van Leeuwen Owner Owner's Name information is required for every 458 Flint Street, Marstons Mills MA 02648 October 29, 2014 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 21811 none Scum thickness 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 14" How were dimensions determined? probe/measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Concrete inlet and outlet tees were found present and in working order. No evidence of leakage or damage was found. Tank was not in need of pumping at this time. Grease Trap (locate on site plan): N/A Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last N/A pumping: Date t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 458 Flint Street, Marstons Mills M- 101 P- 13 Property Address Katherine Van Leeuwen Owner Owner's Name information is required for every 458 Flint Street, Marstons Mills MA 02648 October 29, 2014 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tigiht or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): N/A Dimensions: Capacity: N/A gallons Design Flow: N/A _ gallons per day Alarm present: ❑ Yes ❑ No Alarm level: N/A Alarm in working order: ❑ Yes ❑ No Date of last pumping: N/A Date Comments(condition of alarm and float switches, etc.): N/A *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 458 Flint Street, Marstons Mills M- 101 P- 13 Property Address Katherine Van Leeuwen Owner Owner's Name information is required for every 458 Flint Street, Marstons Mills MA 02648 October 29, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert level 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 found level and in working order. 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.): N/A *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 458 Flint Street, Marstons Mills M - 101 P- 13 Property Address Katherine Van Leeuwen Owner Owner's Name information is 458 Flint Street, Marstons Mills MA 02648 October 29 2014 required for every , page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 -6'X6' pit with 2 of stone ❑ leaching chambers number: H-20 grade leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit was found dry with a visible stain line approx. 1'from the bottom. No evidence of hydraulic failure or problems in the past were found at the time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A Materials of construction N/A Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 458 Flint Street, Marstons Mills M - 101 P- 13 Property Address Katherine Van Leeuwen Owner Owner's Name information is required for every 458 Flint Street, Marstons Mills MA 02648 October 29, 2014 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A Privy (locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 458 Flint Street, Marstons Mills M - 101 P- 13 Property Address Katherine Van Leeuwen Owner Owners Name information is required for every 458 Flint Street, Marstons Mills MA 02648 October 29, 2014 page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately L •5;��, B Q t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y< 458 Flint Street, Marstons Mills M - 101 P- 13 �M Vey Property Address Katherine Van Leeuwen Owner Owner's Name information is 458 Flint Street, Marstons Mills MA 02648 October 29, 2014 required for every State Zip Code Date of Inspection page. City/Town D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high round water: 13.0'+ P 9 9 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: SDW 253 Zone B 49.8' 4.0' adjustment You must describe how you established the high ground water elevation: Hand augered 4.5' below bottom of leaching with no water found at a depth of 12.6'. Groundwater adjustment at the time of inspection was 4.0'. Bottom of leaching at 8.1'was found not to be located in the high groundwater elevation at the time of inspection. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'y 458 Flint Street, Marstons Mills M - 101 P- 13 Property Address Katherine Van Leeuwen Owner Owner's Name information is required for every 458 Flint Street, Marstons Mills MA 02648 October 29, 2014 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Town of Barnstable i w i BARN57AHGE, � XAS& Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA*02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5111116 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 r ❑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 = ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool - ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool 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 apipe, relocation of a driveway due to H-1 O'components, etc) ❑ Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §3 60-9.1) - , o Leaching facility with standing.liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER ' l`e ry r v OAcdnc• � J(nf e o bed room w(4� , bjd, , ; 'Repair deadline: k,t( e ram( r f e(dr ] GI QASEPTIMDEADLINES TO REPAIR FAILED SYSTEMS.doc 3 d/-c-m r eJ�y,c-�j f/ TOWN OF BARNSTABLE LOCATION ,� 0ieJ '� SEWAGE # VILLAGE ff) , rn IS, ASSESSOR'S MAP & LOT/,O/ - ca /7 INSTALLER'S NAME & PHONE NO. k) I v,-! C.pL-& SEPTIC TANK CAPACITY j 00(5) 10 �. LEACHING FACILITY:(type) R o (size) 0®� Q �-- NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER .� ��W G�rl-�, L u e e-oo DATE PERMIT ISSUED: ! a 7 ' 9� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No t k 0 ShotJ&- ,��` msmonsM pw; /�/ ....... _�� PARCEL Na_ t3 Fa$...�� .`......�'. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiuit for Uiripwial Wi ork,i C omitrurtinrt ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 4�� .. . .---�J=-.-... !----------- ------------------------------•------------ --- ---..........------------..........---.... , Loc• ion-Address Lot N . ............ .. . __..............-----.... ......................... ........_........_..._.............._.... ......... .......... / � - 4'�( orc1 0 ....... ..... _....... ...... __•_•__•_••___•__._ ..�._. ._._._�. _. ..............•___•__..................�... P........�I �......... Installer Address Type o Building Size Lot__'d2.�_49.QSq. feet U t-t Dwellings No. of Bedrooms ___________________________________-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons------------------_......... Showers ( ) — Cafeteria ( ) d Other fixtures --------------------=------ -------------------------------------------------------- .............. W Design Flow........................................ tallons allons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacit✓ �. Length________________ Width................ Diameter---.---------._- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.......... `........ Total leaching area....................sq. ft. 3 Seepage Pit No... .7�...6.. Diameter.................... Depth below inlet. ?-.............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------- ---------------------•-----------------------------------------_. Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.................... 44 Test Pit No. 2...:............minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q'+ 0 Description of Soil...... ........•---. ..---.... .......... ---------•---------------------------------------•------------------------------------•..•----....... x .............------------------------ -----------------------------------.-----.----------•--------------------------------------------------- ............. -• ....--------- --...... . UW ------------------------------ ---------------------------------------------------------------- ------------- ........... Nature of Repairs or Alterations—Answer when applicable.... _ ..............._ .......... -•--------------------------------- ....... ---------- •.......................... •.--------------------------------- -....................................................................... Agreement. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliant has been is ii d by the board of health. Signed ......... ...................... ..' ...T...:...../....!5.... / Application Approved By . .......... t t�g� � `^G` ...... �� Dare Application Disapproved for the following reasons: ...... . . .. ............... ....................................................................................... ............ ............................................ ..................... ......................................................................................... ........................................ ��— Date ............. ....... .'lam/j �— Permit No. .....:..... .................................................. Issued �..:.-..��.�`. 6 Date 41 —.No........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appfiration fur Ui!ipwial Workii Tomitrurtion V�imff Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Sys IVtem at: �L ..................... ........................J.._........................ ....... ................................................................................................... L or Lot No. ... .. ............ .... ------"-------------------------------------- r �dd, 7 7 'T ��P" ..........4";d............ -------- ........................ �i � �� A1�66.......... Installer i-c Address ell Type of Building Size Lot.A..d'9.6)Sq. feet U 3 Dwelling& No. of Bedrooms- -----------------------------------------Expansion Attic Garbage Grinder 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria 114 Other fixtures --------------------------------------- ............................................................................................................. Design Flow......................................... ,gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacit V- AP---gallons Length________________ Width_______---_--___ Diameter__........_..._. Depth.......-........ Disposal Trench--No. .................... Width............._.___._ Total Length.................... Total leaching area....................sq. ft. Seepage Pit 4.. Diameter-_--_.--__.__.____. Depth below inlet--6---•Length_.__............._. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ %4 Test Pit No. I................minutes per inch Depth of Test Pit______._............ Depth to ground water.._.....__.............. 44 Test Pit No. 2................minutes per inch Depth of Test Pit..__........_____... Depth to ground water..__._.................. 9 1 X.> ------------------------------- --------/...........................................:............................................................. 0 Description of Soil.... .......................................................................................................... �4 U ............................................................................................................................................................ _!V..................... ................... --------- ............................................................................................................................ .................................................... U Nature of Repairs or Alterations—Answer when applicable... .......... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has e issVpd by the board of health. Signed��b7�w........................................................... Dare Application Approved B .___-------- yi� .......... ................................................ Dare Application Disapproved for the following reaf onf: ....................................................................................................................................... ................................................................ ... ................................................................................................................ ........................................ Dare PermitNo. ...... Issued........................................ ............................................................... Date ————————————————--—-- --————————————————---———————--————————————— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gertifiratt of Complianre, THIS IS TO CERTIFY, That,the Individual Sewage Dispos I System consqucted, or Repaired by ........................... L ...................................................................V1*1__6, . .. . ........................................... ----------------------------------------------------------------------------- at ......... ......... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in I , .-.-_ dated the application for Dis"d I Works Construction Permit No. _07*/ ...........osa /_' '... CONSTRUED AS A GUARANTEE THAT THE THE ISSU.ANCE OF THIS CERTIFICATE SHALL NOT B SYSTEM WILL r6NCTION SATISFACTORY. Inspect4,--- ----------------------............................... .............................................._..................._---------- ---------------------------- ------ THE COMMONWEALTH OF MASSACHUSETTS ss BOARD OF HEALTH i. TOWN OF BARNSTABLE FEE.J'1�-..':�e............ ........ Dispnoal Work T inAwtion-Vermit RIVW-k 1911 , . ca-Y�4v�i Permission is hereby granted------ ----------_------ -------------- .......................... to Construct (t'-) or epair -) an Individual Sewage DiSD_0Sa1 System . . .. .................................................... at No.......//-/.. . ............. =......... ------- Street 'bated--- as shown on the application for Disposal Works Construction Permit --------_--- -Z Board of Health ATE---- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS Map Page 1 of 1 Town of Barnstable Geographic Information System New Search I Home I Help Parcel Custom Map I F—Abtter, Map size Zoom out In Viewer Turn map layers on/off b Refresh selecting check boxes below Town Boundaries A ❑ Road Names i� y y / Y ✓` y ''!:'' 'x ❑ Voter Precincts { y . ❑ Multiple Address House Numbers / t. X x ❑ Map&Parcel Numbers , Xi a'..�/.\: ,..x. `.. ': ✓._..:.:.� ® Parcels 4 Set Scale 1" = 300 Aerial Photos v� I MAP DISCLAIMER ❑ FEMA Flood Zones - ..e.__._ ". _. ._ a Ive July Copyright 2005-200 Town of Barnstable.MA All rights reserved.Send uestions or coas/Lpslo,Cel$city Zone BarnstableMA v1.2.5533[Production] ®AE-100 year flood ®AO-100 year flood 0.2%Annual Chance Flood LS Open Water ® Neighboring Towns ❑ water ❑ Streams ❑ Jetties in \ V ❑ Edge of water http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=101013 4/14/2016 Health Master Detail Page 1 of 1 Legged In As: TOWN\health Health Master Detail Thursday,April 14 2016 _ Application Center Parcel Lookup Selection Items Parcel Septic Perc Well I Fuel Tank Parcel: 101-013 Location:458 FLINT STREET,MARSTONS MILLS Owner:TESA,ALEC R&AUBRIELLE 3 Septic 1,1/24/1995 New Septic Permit number: 1995061 Permit type: Select type v Complete system: ❑ Issue date :�1/24—/1995 Complete date : 3/31/1995 µ L._..�._m � � Septic tank size: F 1 Type/Size of SAS: Installer Select Installer _ Q, Card on file: ❑ I/A service type: Select serviceRl Innovative/Alternative Technology type: Select IA type Variance date : —I- " Abandon complete date : Abandon permit number: Repair d7F45� Repair notification date : Keyword:GAL j Delete Septic Inspection 10/ a Inspection... Number Inspection Date Inspector _ Result PM10/29/2014 Williams,Troy P(Pass) Q Received Date Comments 11/19/2014 �� Delete Insp 11 e 11 ction Save Septic Changes ) I Return to Lookup ' http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=101013 4/14/2016 I d 'i y ,.._ Parcel, ,01-013 Locations:'458 LINT SIRE T, Marstons,mills MUNR E, *[RACYA � 5...-.... eptic 1, 1J2.4J199S { �,rtt�2 e*�Faept3C.,. i Permit number:j1? 061 Permit type: Select type V Complete system: El Issue date : 112411995 Complete date : 3131l1995 Septic tank size: Type/Size of SAS: 1.. .... Installer: Select Installers Card on file: [_.) I/A service type: Select service Innovative Alternative Technola t e: Select A type Abandon complete date: p Abandon permit number:Variance date Re air deadtine date p Repairnoti6cation date : Keyword: Comments: 38RS 102 GAL DeleteSeptic Inspection 12/1.4/201.6 I€15 aect�on 1 j29/2f 14 Ne lrIr sP c1F .. d Number ILnspection Date Inspector w Result 12088 12;1412016 Gilfoy, Matthew B&B Excavation jv CP?R(CP/Repaired} v , ww . �. __.. _ _. .._. ._.... F r Received Date Comments i € Deed.rest,riction-in-file -consulted with TM, changed) Delete Inspection P r to 'conditional pass" 1 year to remove`extra bedroom with building permit, or.deed,restr ct_on� i 1/1T2017 I _.........._ ___ _____.„ .... .......ti .._._..._...M Save Septic Changes Return to Lookup Thursday,Jun 06,2019 09:47 AM ' i N SITE PLAN N SCALE: 1 "=20' (;E N E RAL NOTES BENCH MARK FIRST FLOOR AT - REAR SLIDER THRESHHOLD ELEV.=100.00' (ASSUMED) 1. ADDRESS: #485 FLINT STREET 2. AI]SESSORS NUMBER: 101-051 3. D VELOPER'S LOT: 3 Shubael 70' 4 TOPOGRAPHICO�4 THE INFORMAND TION WAS COMPILED FROM AN Pond Co 5. TOWN WATER IS PROVIDED TO SITE & SURROUNDING PROPERTIES. 6. R7ERENCE PLAN: PLAN BOOK 282 PAGE 12 = 12' I.P. nd 98 �L i N Rf=FERENCE PLAN: "CERTIFIED PLOT PLAN, LOCATION: MARSTONS MILLS, SCALE 1"=40' DATE: 8/5/76" 1' BAXTER & NYE INC. PETITIONER: JOHN BALONER. ,16•?S' 12' ed TS TREE T 7. NO WETLANDS ARE LOCATED WITHIN 200 FEET OF SAS. '�/' SITE ge of 8. NC POTABLE WELLS ARE LOCATED WITHIN 150 FEET OF SAS. Paver" ZR 9. SOIL INFORMATION OBTAINED FROM APPLICATION FOR DISPOSAL 71' WORKS CONSTRUCTION PERMIT. Irnouth Rd. 65goo' A--114.' Marstons Mills » a LOCUS NO SCALE o v lu e k A o° , m o a X 95.39' . CONSTRUCTION NOTES $ v 1. Contractor is responsible for Digsafe notification $ LOT 3 and protection of all underground utilities and pipes. a 2. The septic tank and distribution box ;,hall be set AREA = 21,910t SQ.FT, level on 6 of 3/4"-11/2" stone. 3. Backfill should be clean sand or grov;al with no 78' stones over 3" in size. No 4 4. This system is subject to inspection (luring installation e by Glen E. Harrington, R.S. / �NG 5. The contractor shall install this systera in accordance with Title V of the Massachusetts Environmental Code NG and the Regulations of the Town of Darnstable. rn Er~`►o0.00. 6. Provide an Acme Precast H-10 5—hole D—Box and o o, 06 cenar 2 H-10 500 gal: chambers or equal. x g 7. No vehicle or heavy machinery shall ('rive over the U e septic system unless noted as H-20 septic components. mDECK 8. Install gas baffle or equal on septic tank outlet tee end. 9. All existing inverts and site conditions shall be verified by contractor. x 99. a' 10. Existing leach pit to be pumped and backfilled. 11. THIS PLAN SHALL BE USED FOR THE SEPTIC INSTALLATION ONLY. 98.44 .M. n 0 01 W 9 49, N �C I. tn N Design Calculations S Ql 98.36' J LL. .. Number of Bedrooms: 3 EXISTING to Garbage Gender: NO, GRINDER NOT ALLOWED WITH THIS DESIGN O 90.30, x Le aching Capacity Required: 3,30 Gal. Da Y %7 ® Leaching Area Required: 3 0 Gu!.-�f0.74 Gal. S .Ft. =446 S .F'. q ) q 9,6 x Proposea Leaching Structure: -'25 X i5'Vi X D Leaching irencn Leaching Area Provided: 477 Sq.Ft. X 39' Proposed leaching Capacity: 353 gpd > 330 gpd. req,d. X 94.74' W x 6' , 1-20'awl.ACCESS MANHOLE 13 r 5- OBSERVATION HOLE ° a, Date of Excavation: FEBRUARY 27, 1976 a, a, 1-25'L X 13'W X 2.0' D WITNES:,ED BY:_ Paul C. Murray — MPI (ASSUMED)PERK RATE: LESS THAN2 S o leaching trench using ' 0 4C= C3 342 H-10 500 gal. chambers with0 ® 244 of stone on sides & ends. Test Hole SEffTBWAC No. 1STEEL REINFORCED PRECAST CON;RETE EP SOILS ELEV. PLAN VIEW20 gal, chambers END-SECTION 13s.o4' ° 97.00'wood— H-10 500 GALLON CHAMBER .. 6., loam NOT To SCALE #20 BLACK OAK ROAD 24' subsoil 101-093 U�Z ACME PRECAST OR EQUAL #50 SAMOSET ROAD yellow.and 101-115 not vow 84" 90.0• `AOFMgs PROPOSED SEPTIC SYSTEM UPGRADE PREPARED FOR whitesan LEGEND N - KEVIN SMOLLER m �XISTING LEACHING PIT o. H R Q co. FOR PROPERTY LOCATED AT Ito be pumped & filled) o. 70 485 FLINT STREET e ARE.TO BE 4 DIA. SCHEDULE 40 P.V.C. NOTE: ALL PIPES F • Q� G'/ 'Iv *NOTE: INSTALL GAS BAFFLE OR EQUAL ON SEPTIC TANK OUTLET TEE. O a EXISTING 1,000 GAL. LS,9 / ST �P� BARNSTABLE (MARSTONS MILLS), MA H-10 SEPTIC TANK TA R 10' min. from house to septic tank DENOTES EXISTING Septk tank coven must be Finishe.•i grade over system-2% slope away X 104.46 PREPARED BY: Existing Dwelling within 6'of finished grade SPOT GRADE irst fl. elev.-10 a.aa 5 HOLE GLEN E. HARRINGTON, R.S. EVS71 DE DIST. BOX Existing Grods Elev..95-97't 95 EXISTING CONTOUR g L E DA ROSE Lk NE E ' D-Box cover must be Mtn. 2•-t/8•-1/2• 1 ehamber oowr must be 2•min. FULL S 0.02' within 6•of lehed grade double shed stone ldthin 8• shed grade •max. MARSTONS MILLS M A 02648 S- Levsl for 2' .-93.5't " APPROX. LOCATION CELLAR is EXISTING 25' 5�.01 EXISTING WATER LINE 1 1000 GAL. M .00' ,d SEPTIC TANK c PI 13' En CA H-10 m °��' C o= 24•w+ q.tt APPROX.renc ev.x= 00 �� STING LOCATION LINE TEL: 508-428-3862 GAS B s N, M 1 25' o FAX: 508-428-3862 EACH TRENCH 6•t � L OBSERVATION f 6'OF 3/4•-11/2•STONE > ` ' " Approx. SCALE: 1 "=20' DRAWN BY: GEH JUNE 8, 2005 o s — E s rox. Bottom of Test Hole elev.=85.:0' HOLE SYSTEM PROFILE 6. OF 3/4•-11/2• STONE FILE: SMOLLEREGAN SHEET 1 OF 1 Not to scale s DATUM: ASSUMED HV lV 1Z:01 90(8.9- [ 10Vd L 1100H N'V0]d n0HS-M ,, r_