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HomeMy WebLinkAbout0574 FLINT STREET - Health 574 FLINT STREET,MARSTONS MILLS I �l a� �r� TOWN OF BARNS'TABLE SEWAGE # ASSESSOR'S 1b"&LOT XNSTALjI ER'S NAME&PHONE NO. II SEPTIC TANK'CAPACrrY LEACHNG FACILITY: (tM) r t (size) - 1 NO.OF'BEDROOms 3 BUILDER OR OWNER PERMITOA,TL;: _C.O..MPLIWICE DATE. M. �...,.., Separation Distance Betweep the: Maximum Adjusted Groundwater Table to the Bottom of leaching Facility' Fee Private Water Supply Well and Leaching Facility (IF any evens gist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(if any wetlands exist wit.hi¢t 00 feet .f leas hing lariGty) t^ee Furbblshed by. e C,* l -c O - " G C ' i SOWN OF ARNSTABLE / �� V LOCA aTON � 1 SEWAGE # vn.LAGE I �,�,�Sfy .� Id G- SESSOR'S MAP &LOT��' r GS-q INSTALLER'S NAME&PHONE_NO. ``\\ SEPTIC TANK CAPACITY 16001 ,l LEACHING FACILITY:(type) (size) /00o NO.OF BEDROOMS_ BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 131 pcck y. D aA � pis of„E'�wti Town of Barnstable Public Health Division oii BARMASSBLE$ 200 Main Street �p t679. 0 RFD MP+p` Hyannis,MA 02601 Y BOWES I lei Ives 1 02 1A $ O5.32 7007 302� 2021 3429 7861 0004606238 FEB 25 2009 _ _ _ _ _ _ _ _ _ N MAILED FROM ZIP CODE 02601 - - 1 Andrew Hughes I 574 Flint St. ?Id h'Orb- Marston Mills,MA 9-26frl- A, t7fi�F O RETURN TO SENDER UNCI-A CMa O I f3G�4$'§il'G'S.'U Fcf.1U'G. MC 02601'-='o:'Glt3 Cat�. /�- _ r -� � ---"-- ����,y,,� r, ..� - -- - - — -- .+�.x�exk� _. .�...,.. �.r -..y r°$. .rla..:Jr-.�.�..�p.• r"7�/'='.r r DELIVERYSENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON i ■ Complete items 1,2,and 3.Also complete A. Signature I item 4 if Restricted Delivery is desired. ❑Agent X I ■ Print your name and address on the reverse ❑Addressee i so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery I ■ Attach this card to the back of,the mailpiece, r or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: I If YES,enter delivery address below: ❑No Awwx,-, "Ly,"&N I i i S7 4 I I IZ(1�'T U 0.1 \LL S ��► 3. Service Type I ❑Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise i 1 ❑Insured Mail ❑C.O.D. s I 4. Restitcted Delivery?(Extra Fee) ❑Yes 1 1 2. Article Number — (Transfer from service label)I 7 0 0 7 3020 0 0 01 - - 2 9 7 8 61 PS Form 3811,February 2004 Domestic Return Receipt - _ - --� 102595 oz-M tsao 4 pKE Town of Barnstable Barnstable �O r0� Regulatory Services Department "lA"'edCeC ► yy BAR s-rani�e,�;I "Ass' J° 1639 Public Health Division O ' ��� AlF0"'� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.NkKean,CHO 7007 3020 00013429 7861 February 25, 2009 Andrew Hughes 574 Flint St. Marstons Mills, MA 02648 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned,by you,located at 57.4 Flint,St. Marstons Mills was inspected on February,-13,.2009 by.Jaime Cabot, R.S. Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint received by the Town of Barnstable Health Department. .The following violations of the State Sanitary Code were observed: 105 CMR 410.602 —Maintenance of Areas Free from Garbage and Rubbish: Property was in unsanitary condition garbage and rubbish was on the deck and in the yard. 105 CMR 410.482- Smoke Detectors: Smoke and Carbon Monoxide Detectors not provided in the dwelling. 105CMR 410.500- Owner's Responsibility to Maintain Structural Elements: Large holes were present in the living room and bedroom walls. 105 CMR 410.351- Owner's Installation and Maintenance Responsibilities: Outlet and switch plates missing. 105 CMR 410 480,(A) Locks Kitchen door frame'damaged and door is not secure. The.following-violations of the Town of Barnstable Code were observed: i 1§ 70-4- Certificate of Registration. Rental property is not registered with health department. You are directed to correct the Smoke Detector Violations within twenty-four hours (24) hours of your receipt of this notice by installing smoke detectors in accordance with Mass Fire Codes. You are directed to correct all other violations present within thirty (30) Days of your receipt of this notice by repairing the holes in the walls, installing outlet and switch covers; repairing the damaged door frame and registering the property as a rental property with the Town of Barnstable Health Department. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have a y questions regarding the above violations, please contact the Town Health Division an ask to speak with the inspector who performed the inspection. E12- RD WF YHE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Citi Residential Lending CO tL Postage $ Certified Fee P tmark O Return Receipt Fee Here p (Endorsement Required) - Restricted Delivery Fee (Endorsement Required) ru O Total Postage&Fees m f- Sent To ti3OnP ` '., . O -- -------------------- or PO,Apt.No.;S 7 y FC/,v-7 --PO Box No. , /. City,S e, IP+4 MLAtz-S-ro^ Certified Mail Provides: s A mailing receipt e A unique identifier for your mailpiece F a A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mails or Priority Mall®. ® Certified Mail is not available for any class of international mail. o 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 38111 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. e 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°. ® If a postmark on the Certif led 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 1 y Barnstable �oFjHETowz Town of Barnstable P fl9-Am�iaca C'dy r;k� � Regulatory Services Department hARNSTA61 E y ,6�9. Public Health Division MAss. �Alfi MP Y A' 200 Main.Street, Hyannis MA 02601 .2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO 7007 3020 00013429 7861 February 25, 2009 Andrew Hughes 574 Flint St. Marstons Mills, MA 02648 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned:by you located at 574 Flint St. Marstons Mills was inspected on February 13, 2009 by Jaime Cabot, R.S. Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint received by the Town of Barnstable Health.Department. The following violations of the State Sanitary Code were observed: 105 CMR 410.602 —Maintenance of Areas Free from Garbage and Rubbish: Property was in unsanitary condition-garbage and rubbish was on the deck and in the yard. 105 CMR 410.482-Smoke Detectors:' -Smoke and Carbon Monoxide Detectors not provided in the,dwelling. 105CMR 410.500- Owner's Responsibility to Maintain Structural Elements: Large holes were present in the living room and bedroom walls. 105'CMR 410.351- Owner's Installation and Maintenance Responsibilities: Outlet and switch plates missing. 105 CMR 410.480 (A)—Locks: Kitchen door frame damaged and door is not secure. The following violations of the Town of Barnstable Code were observed: 1704 -Certificate of Registration.. Rental property is not registered with health department. You are directed to correct the Smoke Detector Violations within twenty-four hours (24) hours of your receipt of this notice by installing smoke detectors in accordance with Mass Fire Codes. You are directed to correct all other violations present within thirty (30) Days.of your receipt of this notice by repairing the holes in the walls, installing outlet and switch covers, repairing the damaged door frame and registering the property as a rental property with the Town of Barnstable Health Department. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have y questions regarding the above violations, please contact,the Town Health Division an ask to speak with the inspector who performed the inspection. PER,-ORD F HE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Citi Residential Lending FORM 30«C&W H013BS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN DEPARTMENT A 0z G ADDRESS �j\� GSM sey`0 �J 65``./ V��Jj//� Vz fir® S / 14 TELEPHONE ` / Address S-TbNS '� I �'Lkkwt O _ Occupant"N?.nL� V &OONn Floor Apartmen o. No. of Occupants Z No.of Habitable Rooms No. Sleeping Rooms z -- No. dwelling or rooming units — No.Stories Name and address of owner �+�_�i� 95- Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish 2 17 A ¢�QtjI StA Containers: Drainage ,-+ i, A Infestation Rats or other: Lam, STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: I/L\A^ Roof V?Ch AA,4, CA\ Gutters, Drains: Walls: Foundation: Z16 Yk Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: e 2 Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: (A-) Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: L1 V I U �;-6Q' PLUMBING: Supply Line: (�. ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 l Bedroom 2 p Bedroom 3 r Bedroom 4 -t Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin, Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: Ti General Building Posted 21 M O S Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) i "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIE F PE AY." INSPECTO A /Z•-C , TITLE �A IfAL:1 ps c'Coe- A.M. DATE D TIME ' f y 0 A.M. c THE NEXT SCHEDULED REINSPECTION P.M. w ' 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. -(C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure.to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or'dwelling unit in violation of the Massachusetts Department of Public __Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. Barnstable Assessing Search -Results Page 1 of 2 2009 Assessed Values: DEUTSCHE BANK NAT'L TRUST CO TRS C/O CITI RESIDENTIAL LENDING INC 574 FLINT STREET Appraised Value Assessed Value Map/Parcel/Parcel Extension Building Value: $ 150,500 $ 150,500 102 / 054/ Extra Features: $ 2,700 $ 2,700 Outbuildings: $ 0 $ 0 Mailing Address Land Value: $ 151,800 $ 151,800 DEUTSCHE BANK NAT'L TRUST CO TRS C/O CITI RESIDENTIAL Totals $ 305,000 $ 305,000 LENDING INC 10801 6TH ST-SUITE 130 Residential Exemption Received= $100,964 RANCHO CUCAMONGA, CA. 91730 2009 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation:) Community Preservation Act Tax $ 42.24 Fire District Rates Town Residenti Barnstable FD - All Classes $2.37 $6.90 C.O.M.M. - All Classes $1.08 Town Commen C.O.M.M. FD Tax (Residential) $ 329.40 Cotuit FD - All Classes $1.43 $6.12 Hyannis - Residential $1.78 Town Tax (Residential) $ 1,407.85 Hyannis - Commercial $2.77 W Barnstable - All Classes $2.11 Community Pres Total: $ 1,779.49 i i i http://www.town.barnstable.ma.us/assessing/2009/displayparce109map.asp?mappar=102054 2/13/2009 TOWN OF BARNSTABLE BAR-W Ordinance or Regulation WARNING NOTICE Name of Offender/Mans ger IJA404-n V440M z ��Cf Address of Offender )CC/y MV/MB Reg.# Village/State/Zip _ Business Name �am/Q, on Z/IS (40120 2001 Business Address Signature of Enforcing Officer Village/State/Zip L_ Location of Offense Enforcing Dept/Division P '!'ALIIA J7q(tvU%Ti�,A,, C vi. Offense— L//U L4 11.0 A.' I?EC4 Facts (/A...- OLIO �7k1x-�.j,-Tvft;iz_ LVP� &-I This will serve only as a warning. At this time no legal action has been taken. It is , the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. I WHITE-OFFENDER CANARY-ORD./REG-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W `;71 r� Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Z 41G J . Address of Offender a 1 `1 'L/-V -1 MV/MB Reg.# Village/State/Zip + G61 Business Name am/pm), on ll/; �0-1 20 '1 Business Address Sig ature of Enforcing Officer Village/State/Zip . . ;Location of Offense Enforcing Dept/Division �•`1�F,M V•.'ir �'.? -d�,'r�y Lr "b �i ��"aj L+��wl�!{ ,i/,V A.. �5 J A Offense A14""1 '0 4k 4S 1 /. a.✓ Gs Z, • r1tR Facts Jam .. 1.. ?� - '.r v•,}; 71 UN . 1 !� <.� r+<= _ ,��. €�t. .1 .t -# (" This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE 1 l! LOCATION ,��J��CI�P/�s SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL/�mZ-'G2!�;_y INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY _ SST 1DmG LEACHING FACILITY:(type)% /pFG�S � (size) 9%,C 372 NO.OF BEDROOMS OWNER N^ PERMIT DATE: COMPLIANCE DATE: ,� 0 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet i FURNISHED BY Av A 3e:2,5-VC S� I� 3 � M i No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes aAppItratton for tg o5 6pgtem Cow6tructtou Vermtt Application for a Permit to Construct( ) Repair 4. Upgrade( ) Abandon( ) ❑ Complete System ❑Inddividual Components Location Address or Lot No. �y ��/f�� / Owner' Name,Address,and Tel.No. Assessor's Map/Parcel / F a L/�fC14— `J�(� �3 I L111J.4"nI (��/!/9/- lam. Installer's Name,Address,and Tel.No. Deg ner's ame - ddress and Tel.No. Type of Building: Dwelling No.of Bedrooms - Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building //�/"i� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) � � gpd Design flow providedU gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank j� C�C� Type of S.A.S. ;51epb'�� Description of Soil b„ 9 01/fTS' o: Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees toensure' the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions ofTitle 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board�off9ee�lth. Signed G LG✓�✓ �� Date Application Approved by Date Application Disapproved by: Date for the following reasons R Permit No. Z®Ocj e/�' Date Issued � *f• n No. 266 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓� y , ! Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE MAS SACHUSETTS, .�. 01ppYication for Xhoog Y *pttem �tCon�truction Permit Application for a Permit to Construct O Repair Upgrade O Abandon O ❑ stem Complete Sy stem y El individual Components Location Address or Lot No. �y�L / Owner's Name,Address,and Tel.No. QL(,�J � Assessor's Map/Parcel 6 � Installer's Name,Address,and Tel.Nok� `4*?7) LwV6 De ' ner's Jjame ddress and Tel.No do Type of Building: y.. Dwelling No.of Bedrooms' -- Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building //�/�j� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided U u gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank /"' - IL, 0C_ Type of S.A.S. Description of Soil �zz__02 blfl�_5 Nature of Repairs or Alterations(Answer when applicable) f Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in .. � accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date (� Application Approved by dZ•S Z, Date 4 Application Disapproved by: Date for the following reasons i r Permit No. Zepoq qs— Date Issued �— Z F zoa THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewa e DisposafSystem Constructed ( ) Repaired Upgraded ( ) Abandoned( )by a�j/l/a'71 at ./�,c , has been constructed in accordance with the provisions of it le 5 and the or Disposal System Construction Permit No. .J 010 y— /y�' dated S�JZb�2q�y Installer. Designer t`,l C #bedrooms 3 Approved design flow, 3—go gpd The issuance of this perm 'shall not be construed as a guarantee that the system will-functibnl as design d. �r Date ����/U Inspector No. ZK/ i ------------Fee'THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS Di5po5al *p5tem Congtruction Permit. Permission is hereby granted to Construct ( )_ Repair (v_�Upgrade ( ) Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Coonst tion must be completed within three years of the date of this p alt. Date J -- U0 z � �l/ � Approved by � a �� �.S. TOWN OF BARNSTABLE j LOCAI;ION � f!/7�5 SEWAGE#c7-7,� -5- VILLAGE��i5, ,9 /�i /��c ASSESSOR'S MAP&PARCEL,��� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type)�� �fVr WPS (size) Z%;C 3?2 tj D NO.OF BEDROOMS OWNER M PERMIT DATE: / ���� COMPLIANCE DATE: Separation Distance.Between__the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching:facility). feet FURNISHED BY ,s A 1.3D L �. 1 i Town of Barnstable &I Regulatory Services Thomas F. Geiler, Director (� Hvarnat.a. M S& Public Health Division Thomas NIcKean, Director 200 Main Street,Hyannis,MA 02601 Office: 503-362-4644 Fax: 508-790-6304 Installer & Designer Certification Form Dater &01L(A Sewage Permit# / Assessor's Map\Parcel�J Designer: ` 1 ✓` e C Installer: Address: 0 0 X 1V Address: k/2,7 A--A),Q'* S r On 7 Z�6 6*111t,A1_D1f11e,f was issued a permit to install a date) rt/ (installer)(septic system at 5-7 9 N r S-r based on a design drawn by mf_ (address) I � (feo, dated (designer) I certify that the septic system referenced above was installed substantially according to y the design, which may include minor approved changes such as lateral relocation oil,the distribution box an&'or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or anv vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF MqCIO c DAR 1 N M. ✓� (Installer's Signature) �� No. 1140 c�s1Eo MNI1AR\P� �� /0— 7 (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTA E PUBLIC HEALTH DIVISION. CERTIFICATE OF CONIPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form 3-26-41doe I. of sty rp� Town of Barnstable Barnstable kzfkd P Regulatory Services Department Al-AmericaChy RAANnASM 1 Q , Public Health Division m 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 t Thomas A.McKean,CHO CERTIFIED MAIL# 70081830000205008666 5/18/2009 American Home Mortgage Servicing PO Box 631730 Irving TX, 75063 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 574 Flint Street, Marstons Mills MA was last inspected on April 28, 2009 by Shawn McElroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to an overloaded or clogged SAS. • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool You are ordered to repair or replace the septic system within Sixty (60) days 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 ORD OF TH BOARD OF HEALTH a ' cKean, R.S., CHO Agent of the Board of Health f • ) 0— _— Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /a 574 Flint St Property Address Americam Home Mortgage Servicing Owner Owner's Name information is required for Marstons Mills MA 02648 4-28-09 every 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. A. General Information 1. Inspector: SI � Sq�� Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 508-495-0905 S13971 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 to4Sectioil 5.34fl'of Title 5 (310 CMR 15.000).The system: ❑ Q Passes -❑ Conditionally Passes ® Eails i ❑ Needs F rthe Ev ation by the Local Approving Authority CD = ex? � 4-28-09 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and.the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 574 Flint St Property Address Americam Home Mortgage Servicing Owner Owner's Name information is required for Marstons Mills MA 02648 4-28-09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined(Y, N, ND) in the ❑ for the following statements. If"not determined,"please explain. ❑ The septic tank is metal and over 20 years old"or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe'(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced } ❑ obstruction is removed t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 115 I Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 574 Flint St Property Address Americam Home Mortgage Servicing Owner Owner's Name information is required for Marstons Mills MA 02648 4-28-09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 a Commonwealth of Massachusetts . 44 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM 574 Flint St Property Address Americam Home Mortgage Servicing Owner Owner's Name information is required for Marstons Mills MA 02648 4-28-09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _- ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/ day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 574 Flint St Property Address Americam Home Mortgage Servicing Owner Owner's Name information is required for Marstons Mills MA 02648 4-28-09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria 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. t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 r Commonwealth of Massachusetts - Title 5 Official Inspection Form a - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 574 Flint St Property Address Americam Home Mortgage Servicing Owner Owner's Name information is required for Marstons Mills MA 02648 4-28-09 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? Ws the site inspected for signs of break out. i ® ❑ a p 9 ® ❑ 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)] t5lnsp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 574 Flint St Property Address Americam Home Mortgage Servicing Owner Owner's Name information is required for Marstons Mills MA 02648 4-28-09 every page. City/Town State Zip Code Date of Inspection 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 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 213gpd/2yrs Sump pump? ❑ Yes ® No Last date of occupancy: 12-08 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(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: Last date of occupancy/use: Date Other(describe): t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 574 Flint St Property Address ` Americam Home Mortgage Servicing Owner Owner's Name information is required for Marstons Mills MA 02648 4-28-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1986 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GM cv 574 Flint St Property Address Americam Home Mortgage Servicing Owner Owner's Name information is required for Marstons Mills MA 02648 4-28-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 12 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 6 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000 Gal Sludge depth: 16" Distance from top of sludge to bottom of outlet tee or baffle 16" Scum thickness 2" Distance from:top:of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape 15insp official document•03/08 TRIe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 X Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 574 Flint St Property Address Americam Home Mortgage Servicing Owner Owner's Name information is required for Marstons Mills MA 02648 4-28-09 every 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.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site-plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: .Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 574 Flint St Property Address Americam Home Mortgage Servicing Owner Owner's Name information is required for Marstons Mills MA 02648 4-28-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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 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.): Box had clear signs of failure and cracked. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments 574 Flint St Property Address Americam Home Mortgage Servicing Owner Owner's Name information is required for Marstons Mills MA 02648 4-28-09 every page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1-1000 Gal ❑ 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.): Leach pit had clear signs of failure with stains into riser. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth -Not for Voluntary Assessments 574 Flint St Property Address Americam Home Mortgage Servicing Owner Owner's Name information is required for Marstons Mills MA 02648 4-28-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp official document•03JD8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts Title 5 Officia[ Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 574 Flint St Property Address Americam Home Mortgage Servicing Owner Owner's Name information is required for Marstons Mills MA 02648 4-28-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. C D -F-19 `� t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 e Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 574 Flint St Property Address Americam Home Mortgage Servicing Owner Owner's Name information is required for Marstons Mills MA 02648 4-28-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cant.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers-(attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS mapsshow groundwater at greater than 20'. Town of B i7nstable P# �L -7L— Department of Rekalatory Services • ` Public Health Division. Date 3 6 7 J ems$ 200 Main Strec4 Hyannis MA 02601 RFD µ►`l� I Date Scheduled 5 0 C, Time d � tee Pd. Dv I • , `oil Suitability Assessment for Sewage Di posar Performed By: f W e4l ! Witnessed By: i LOCATION& GENERAL INTOIUYIATION location Address 614 FLI�JT $T(Ll 'j ' Owner's NamePr�5wE IBM" S 10$C)l (Or,' t - 5ut�t 13b t t�1o.5ptils MILL-s Address �►�t;l1D GuGhMD06A CA q(ISO Assessor's Map/P4rcel: (�2/d�� i Engineer's Name (,A-12—"-) �Y . !' (v2— NEW CONSIRU�'i'ON REPAIR I TeleJphone# 2`l 2Z n/ Land Use 1 Leah`'( Slopes(96) ' S•,' Surface Stones Distances from: ripen Water Body > ft Possible Wee Area ?Zaft Drinking Water Weller a2©0 I 1 t)6 ft. Property Lin19 ��� ft other it Drainage Way i SKETCH:(street name,dimensiods%f lot,exact locations of tget holes&pert tests locate wetlands in proximity to holes) _._ ae 1 'I LO1 28 I 7s 5f +� i I AREA = 10'1 W Z I I W > I i I E0. �ee o I I Z_ I W I 1 to LIJ X O wQ W A i 11 ' z `---- ---------------I J L S�ONE DRIVEWAY LL �\ 1 � • _� pi-2 100.00 it I i 1 Parent material(gcdlogtc) f v �4$Yl I Depth to Bedrock ' Depth to Groundwaker. Standing Water in Hole Weeping from Pit Pace - Estimated Seasonal iHigh Groundwater I' Dt';I'ERMIN�j TION FOR SEASONAL HIGH WATER TABLE Method Used ! ln. Depth db�served standingltn obs.hole: n. Depth to soli AdJu lu I in. ©roundwacer AdJudtmcnt Depth tolweeping from side of obs.hole: I _ Adj.factor,,,_ Adj.froundwater LOVel Index Well# Reading Date: Index Well level - I Dale s � 'l;ltttle•_,_.._. PERCOLATION TEST' • Observation - ` I Tinto at 0" N Hole# ' Q Time at 6" Depth of Pere 1 Time(V-6") - Start Pre-soak Time.0 End Pre-soak I Rate MinJlnch Additional Testing Needed(YIN) Site Suitability Assessment: Site Passed Site Failed; Original:.Public Hc4lth Division Observation Hole Data To Be Completed on Back-- -You must ***If ercola ion test is to be conducted within 100' of wetland'beginning first notify the p _- —i 71;iv;ciinn at least one(1)weak prior to DEEP OBSERVATION HOLE LOG Hole# . Soil Other Depth from Soil Horizon Soil Texture Soil Color Mottling Structure,Stones,Boulders. Surface(in.) (USDA) (Mansell) g (Structure, g'o Gravel tU A 13and DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) • �b''- � ��and Cr7 1�Y�- �l� a"—� JP n d' 10AY1 (d 12„6 66" q 2` �� DEEP OBSERVATION HOLE LOG Hole# N Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Gravel DEEP OBSERVATION HOLE LOG Hole# N Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) SDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, ra I Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes _ Within 500 year boundary No Yes Within 100 year flood boundary No k Yes Death of Naturally Occurring Pervious Material Does at'least four feet of naturally occurring per i �ss material exist,in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on i (date)I have passed the soil evaluator examination approved by the Department PLEnvironmental Protection and that the above analysis was performed by me consistent with the required rig expertise a d experience described in 3.10 CMR 15.017. nQ Signature DateiO� '-� " I Q.\SEPTICIPERCFORM.DOC Town of Barnstable Barnstable a pp THE Tpw � ..,..,..:�.... ��W. Regulatory Services Department gCec 1 BARNSI'AULE. . • p g MASS. Public Health Division �pA �ibgq. 10 �,- Tfo""A�a 200 Main Street, Hyannis MA 02601 2007 ,,4.1., ... 1 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO i�,�• � p l''s�' 7007 3020 00013429 7861 � i-- February 25, 2009 Andrew Hughes 574 Flint St. Marstons Mills, MA 02648 --^ NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 574 Flint St. Marstons Mills was inspected -- on February 13, 2009 by Jaime Cabot, R.S. Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint received by the Town of Barnstable Health Department. A, The following violations of the State Sanitary Code were observed: '' 105 CMR 410.602—Maintenance of Areas Free from Garbage and Rubbish: Property was in unsanitary condition garbage and rubbish was on the deck and in the yard. "V. 105 CMR 410.482- Smoke Detectors: Smoke and Carbon Monoxide Detectors not provided in the dwelling. 105CMR 410.500- Owner's Responsibility to Maintain Structural Elements: Large holes were present in the living room and bedroom walls. 105 CMR 410.351- Owner's Installation and Maintenance Responsibilities: Outlet and switch plates missing.. 105 CMR 410.480 (A)—Locks: Kitchen door frame damaged and door is not secure. The following violations of the Town of Barnstable Code were observed: I:al i ��. . 1§ 70-4— Certificate of Registration. Rental property is not registered with health department. You are directed to correct the Smoke Detector Violations within twenty-four hours (24) hours of your receipt of this notice by installing smoke detectors in accordance with Mass Fire Codes. You are directed to correct all other violations present within thirty (30) Days of your receipt of this notice by repairing the holes in the walls, - installing outlet and switch covers, repairing the damaged door frame ands"'' " registering the property as a rental property with the Town of Barnstable Health Department. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH «, Thomas A. McKean, R.S., CHO Director of Public Health �-+ - Town of Barnstable Cc: Cite Residential Lending 77* .i.T i,.HI - ii aenwj�.r.. _ti4.My... C TOWN OF BARNSTABLE J LOCATION 5711 F S� SEWAGE # VILLAGE ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. � SEPTIC TANK CAPACITY ,/� C LEACHING FACILITY: (type) /' IL (size) NO.OF BEDROOMS .3 BUILDER OR OWNER !/��- � ► PERMTIDATE: ,S/ /Cd/Y(' COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �f,w . `` 5 I Aq f % i �NI TROY WILLIAMS SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection (508) 760-1819 40 Old Bass River Road South Dennis,MA 02660 conymmeatm of MOZOChusettS COPY Executive Office of ErnAronmental Affaks Department of • Environmental Protection wml. W*1d �y ' Tndy Co:� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR ✓/9� 3O PART A CERTIFICATION ,¢ j 1,996 Property Address: 5-211 Fl;h¢ s-A . �1�..-s i ti►;t/S Address of Owner. J �(je yr `� Date of Inspection: I /I 8 /9 b (If different) Name of Inspector.—7—,o � yJ, 1 I 1 Company Name,Address aZl Telephone Number.. SG 4LDV c' . _CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection..The inspection was performed based on my training and experience in the proper function and maintenance of o"ite sewage disposal systems. The system: Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,'the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B,C, or D: Al SYSTEM PASSES: _ZI have not found any information which indiates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. 81 SYSTEM CONDITIONALLY PASSES: A114 One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, *passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Desuibe basis of determination in all instances. If'not determined', explain why not) The septic tank is metal, cra&ed, structurally unsound, shows substantial infiltration or exfittration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic lank as approved by the Board of Health. 1 rcv1•cd !/15/951 t ,.+ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: S l y F/I h�- f Owner. Date of Inspection: BI SYSTEM CONDITIONALLY PASSES (continued) — Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed Pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed FURTHER EVALUATIO N IS REQUIRED BY THE BOARD OF HEALTH: f./�i¢ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: 1he Ws'em nas a septic lank ano son absorption system and is within 100 feet to a surface water Supply or tributary tc, a surface water supply. The ss•stem ha, a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The systen, has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water Supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. SYSTEM FAILS: 11/1j9 4 I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. — Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SASS or cesspool - I sed 6/1S/9Si 2 I� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: ,s 7 y )C/;,, a Owner. Date of Inspection: DJ SYSTEM FAILS(continued): Static liquid level in the distribution box above outlet invert due to an overloaded or dogged SAS or cesspool. Liquid depth in cesspool is less than 6' below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to dogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. — Any portion of a cesspool or privy is within a Zone I of.a public well. Any portion of a cesspool or privy is within SO feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,_attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water supply well) i he owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program equirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. :e�ised ei�sivsi 3 SUBSURFACE SEWAGE DISPOSAL SYSTFM INSPECTION FORM PART B CHECKLIST Property Address: S 7 y Owner. Date of Inspection: ��a 18 Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _V_/As built plans have been obtained and examined. Note if they are not available with WA. ZThe facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow ✓ The site was inspected for signs of breakout. ✓All system components, excluding the Soil Absorption System, have been located on the site. ZThe septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. ZThe facility, o­np• (a-d occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. evietd 8/15/951 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: S'741 F/i h 4 Owner. Date of I �Inspection- RESIDENTIAL: FLOW CONDITIONS - Design flow: 3 U allons Number of bedrooms: yumber of current residents: .2 Garbage grinder (yes or no):,L/o _aundry connected to system (yes or no):�G 5 seasonal use (yes or no):�/o Water meter readings, if available:_- r � onoh , ast date of occupancy: COMMERCIAUINDUSTRIAL• „q/may F ype of establishment: Design flow: Qallons/day rease trap present: (yes or no)_ ndustrial Waste Holding Tank present: (yes or no)_ '4on-sanitary waste discharged to the Title S system: (yes or no)_ .eater meter readings, if available: ast date of occupancy: OTHER: (Describe) ast date of occupancy: GENERAL INFORMATION "UMPINGIRECORDS and source of information: Q S 6'✓a,, /c. /C G� U!+/'�^ System pumped as pan of inspection: (yes or no) �/c If yes, volume pumped Qallons Reason for pumping YPE 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) ' Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information 5/23 /e 6 ems - �' ,I I�. ,ewage odors detected when arriving at the site. (yes or no) / C) PV15fd 8/tS/95; P SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 5211 Owner: 4� Date of Inspection: c"� SEPTIC TANK:., (locate on site plan) Depth below grade: /0& material of construction: concrete _metal _FRP _other(explain) Dimensions:_ bow Sludge depth:_ S�r Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:--.22— Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: /1 Comments: recommendation for pumping, condition of inlet and out l t tees or baffles, depth of liquid level in relation to outlet invert, structural ate rity, evidence of leakage, etc.) f��L f t ,� ; 1 I e— rA A C—oh cl r h cv v v fl h o r2 .It e- MV S %k h s oye� GREASE TRAP: /✓�i9 locate on site plan) )epth below grade: 'Aaterial of construction: _concrete _metal _FRP —other(explain) )imensions: Lim thickness: )stance from top of scum to top of outlet tee or baffle: ',!lance from bonom M crtim to hon('!^ 01 ot)!I?! tee or banie. omments. ecommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural uegnty, evidence of leakage. eto . sed 8;1S/9Si 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 57(1 F/i a 4- Owner. Date of Inspection: 6 TIGHT OR HOLDING TANK: N�'9 ,.locate on site plan) Depth below grade: Material of construction: _concrete_metal_FRP_other(explain) Dimensions: apacity: Gal Ions Design flow: aallons/day alarm level: -omments: condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: locate on site plan) Depth of liquid level above outlet invert: C-•.jz omments: tote if level and distribution is equal, e�idence of solids carryover, evidence of leakage into or out of box, etc.) 2 J "-t') /6 U Q h c/A i L. GJ C.r`%_ H UMP CHAMBER: /��.9 locate on site plan) umps in working order:(yes or no) omments: ')ote condition of pump chamber, condition of pumps and appurtenances, etc.) I r wised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner n ta Date of Inspection. SOIL ABSORPTION SYSTEM (SAS):_z (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) f not determined to be present, explain: r ype. leaching pits, number: oL, e— t1— �X 6 u, �(, p;�- w a r s c leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: omments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) U In tt G vi O o t/ CESSPOOLS: zq-114 locate on site plan) 'umber and configuration: ?epth-top of liquid to inlet invert: )epth of solids layer: )epth of scum layer: )imensions of cesspool: -taterials of construction: ,dication of groundwater: inflow (cesspool must be pumped as part of inspection) omments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 'RIVY: P//7 ocate on site plan) Materials of construction: Dimensions: )epth of solids: omments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Prised B/1S/9Si 8 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued Property Address: Y-2 y Owner: - Date of Inspection; SKETCH OF SEWAGE DISPOSAL SYSTEM: indude ties to at least two permanent references landmarks or benchmarks locate all wells within 100' L3� r~ f�` rye 16' �8' 3s � EPTH TO GROUNDWATER epth to groundwater: feet ;adjusted high groundwater level wised 6/15/95) 9 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS John Graci DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION i" Property Address:. 574 FLINT ST. MARSTONS MILLS MAP 102 PAR 054 L 28 41�i4-(� A Name of Owner BRUNEAU Address of Owner: C/O REALTY EXECUTIVES 1680 RT.132 HYANNIS C/O MRS.MOGAN0" Date of Inspection: 10/11/99 Name of Inspector:(Please Print)JOHN GRACI CD to CEO I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) y�20 .j Company Name: n/a ��, �O4m 199'9 Mailing Address: n/a 10, �!F Telephone Number: n/a �. v d ' CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes The Inpection Is based on criteria defined in Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system is Needs Furtheiubmitna E u tion By the Local Approving Authority, performing at the time of the Inspection.My Inspection does Fails not imply any warranty or guarantee of the longgevity of the septic system and any of its components useful life. Inspector's Signature: Date:10/12/99 The System Inspector shal copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 574 FLINT ST.MARSTONS MILLS MAP 102 PAR 054 L 28 Owner: BRUNEAU Date of Inspection:10/11/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: DLa 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. nLa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Wa Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced n/a The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 574 FLINT ST.MARSTONS MILLS MAP 102 PAR 054 L 28 Owner: BRUNEAU Date of Inspection:10/11/99 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nLa_ (approximation not valid). 3) OTHER nLa revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 574 FLINT ST.MARSTONS MILLS MAP 102 PAR 054 L 28 Owner: BRUNEAU Date of Inspection:10/11/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped nta. X Any,portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any,portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 574 FLINT ST.MARSTONS MILLS MAP 102 PAR 054 L 28 Owner: BRUNEAU Date of Inspection:10111199 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [1 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal Systems. I revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 574 FLINT ST.MARSTONS MILLS MAP 102 PAR 054 L 28 Owner: BRUNEAU Date of Inspection:10/11/99 FLOW CONDITIONS RESIDENTIAL: Design flow:-M g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):3 Total DESIGN flow: = Number of current residents:0 Garbage grinder(yes or no):KQ Laundry(separate system)(yes or no): NQ If yes,separate inspection required Laundry system inspected(yes or no):JW Seasonal use(yes or no):M Water meter readings,if available(last two year's usage(gpd): nLa Sump Pump(yes or no): NO Last date of occupancy: 811/99 COMMERCIALANDUSTRIAL Type of establishment: nLa Design flow: n1a gpd(Based on 15.203) Basis of design flow: nLa Grease trap present:(yes or no):M Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:nLa Last date of occupancy: nLa OTHER: (Describe) Wa Last date of occupancy: Wa GENERAL INFORMATION PUMPING RECORDS and source of information: oLa System pumped as part of inspection:(yes or no):MO If yes,volume pumped nLa_ gallons Reason for pumping: n& TYPE OF SYSTEM XSeptic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: n& APPROXIMATE AGE of all components,date installed(if known)and source of information: 1986 Sewage odors detected when arriving at the site:(yes or no). NQ revised 9098 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 574 FLINT ST.MARSTONS MILLS MAP 102 PAR 054 L 28 Owner: BRUNEAU Date of Inspection:10/11/99 BUILDING SEWER: (Locate on site plan) Depth below grade: 14" Material of construction:_ cast iron _ 40 PVC X other(explain) Distance from private water supply well or suction line: TOWN Diameter: nLa Comments: (condition of joints,venting,evidence of leakage,etc.) nLa SEPTIC TANK: X (locate on site plan) Depth below grade: K Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) BLa If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NQ nLa - Dimensions: L 8'6"H 5'7"W 4'10" Sludge depth: 1"" Distance from top of sludge to bottom of outlet tee or baffle: 3r Scum thickness:4 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: A How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING EVERY TWO YEARS FOR MAINTENANCE GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) Wa Dimensions: Wa Scum thickness: nLa Distance from top of scum to top of outlet tee or baffle:jVA Distance from bottom of scum to bottom of outlet tee or baffle Wa Date of last pumping: Wa Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) Wa revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 674 FLINT ST.MARSTONS MILLS MAP 102 PAR 054 L 28 Owner: BRUNEAU Date of Inspection:10/11/99 TIGHT OR HOLDING TANK: MQ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: nLa Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) riLa Dimensions: n& Capacity: nta gallons Design flow: nia gallons/day Alarm present: XG Alarm level:-nLa- Alarm in working order:Yes_No_: NO Date of previous pumping: nLa Comments: (condition of inlet tee,condition of alarm and float switches,etc.) Wa DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert:LIQUID LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) DISTRIBUTION BOX IS STRUCTURALLY SOUND PUMP CHAMBER: NIQ (locate on site plan) Pumps in working order:(Yes or No): NQ Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) nta I revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 574 FLINT ST.MARSTONS MILLS MAP 102 PAR 054 L 28 Owner: BRUNEAU Date of Inspection:10111/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: nLa Type: leaching pits,number: 1000 GALLON LEACH PIT leaching chambers,number: _nLa leaching galleries,number: _nLa leaching trenches,number,length: nLa leaching fields,number,dimensions: n& overflow cesspool,number: jVA Alternative system: nLa Name of Technology: j3La Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALL SOUND AND FUNTIONING PROPERLY THE PIT HAS NOT HAD MORE THAN 2 5'OF WATER IN IT I CESSPOOLS: _ (locate on site plan) Number and configuration: Wa Depth-top of liquid to inlet invert: Wa Depth of solids layer: Wa Depth of scum layer. n1a Dimensions of cesspool: Wit Materials of construction: Wit Indication of groundwater: n1a inflow(cesspool must be pumped as part of inspection)Wa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Wit PRIVY: _ (locate on site plan) Materials of construction:Wa Dimensions:Wit Depth of solids: nA Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nLa revised 9/2/98 Page 9 of 11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 674 FLINT ST.MARSTONS MILLS MAP 102 PAR 064 L 28 Owner: BRUNEAU Date of Inspection:10/11/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a o ° Q e b AA�1 AB AC I I AD �h EA as revised 9/2198 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 674 FLINT ST.MARSTONS MILLS MAP 102 PAR 064 L 28 Owner: BRUNEAU Date of Inspection:10/11/99 NRCS Report name: nta Soil Type: nLa Typical depth to groundwater: n& USGS Date website visited: n& Observation Wells checked: NAQ Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS revised 912198 Page 11 of 11 LOCATION _ SEWA-,'GE PERMIT NO. VHAAGE _ ^- fz--5 INSTA LLER'S NAME i ADDRESS (� S UILDER "' OR OWNER f � DA T E P ERMIT I S S U E D DAT E COMPLIANCE ISSUED �ZJ Al -� f Y s FE •••• - - _ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH --- .......................................... Appliratiou for Dispaiial Works Tontilrurtiun ramit Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal System at: �C/RJj _,5 fai�57-� ,Gelc e-s e-07— ................__ .........................--...........--•-----•------................. -----------------------**"'*-Addr ss or Lot No. .................... % �4.�� .u.L .7✓I .ems/CL ---•--- - . . ..-•------•----•-----•-•-•...............•......----•.............._........ Owner Address W Installer Address UType of Building Size Lot../ 276......Sq. feet s Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (/� `4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures -----------•... -------•------- - Design Flow......__..__ a`—_____________________gallons per person per day. Total daily flow____ �-� ' � gallons. W --- WSeptic Tank—Liquid capacity/gallons Lengthe-.�&'.". Width._ Diameter_---- __ Depth...,...... x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No------/............. Diameter-----1Q---____ Depth below inlet---- Total leaching area..................sq. ft. Z Other Distribution box (X) Dosing tank ( ) '— Percolation Test Results Performed b .._�G 4�Z--- ���.�!JfE&J✓C Date...., ? a Test Pit No. 1...._.4.�minutes per inch Depth of Test Pit...../2___.______ Depth to ground water—A ....... f= Test Pit No. 2................minutes per inch Depth of Test Pit..... Depth to around�Jwater.....%............ Descriptionof Soil -----------/----- ----------?_.�'..............----•--•----.............................�4 2.L__ l__ !�ii ��� .... .� ... ..._.•.(/...!�•�y ...............°v' !n F�<r �y ______ __________________________� �/� fa .ER W ...........................................................................................(fie:�______. ____...._...._____.___.__....._____....._.._...... 4. �La �.7.. F� V Nature of Repairs or Alterations—Answer when applicable._______________________________________________________________________ �._ ........_..._._.. 6 Agreement: E�Vie; The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in a c -r rr the provisions of n i l.I.L 5 of the State Sanitar C de—The ndersigned further agrees not to pla e e system >< 3 �� operation until a Certificate of Compliance has b is ue board of health. Signed. -- . .• . •............................................ Da Application Approved By........ •--- •---- ..... ...................... ----. A Da Application Disapproved for th following reasons:----•--•••••••---•--•--•--•-----••••--•--•-••-••••••-•-•••••--•-•------------•-••---•-•••....................... ---------------••---......-------•--•-•••---•--•-----•---•-••------•--••-------••-•..._ -- .. Date PermitNo................................................................... Issued Issued--•------------------------------••--------........... Date arr No----------------_------ Fi$.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Glee �t J............OF.... .......... C-' Appliration for Uhip al Workii Tomitrurtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................_................................................................................ ------•-•--....__.................----- Location-Add r ss or Lot No. .'Y.:.'� v � ............... .��i ' lL`�G�S .G,►' �.�--...... .......... ......... ••. ..... --....--------•---••-----•---•---- Owner ................................Address Installer Address d Type of Building Size Lot__-,J* e_'775....Sq. feet 1 aDwelling—No. of Bedrooms..........�.......•___________--------Expansion Attic ( ) Garbage Grinder (1-k) p, Other—Type of Building ............................ No. of persons..................._........ Showers ( ) — Cafeteria ( ) Q' Other fixtures ...................................................... W Design Flow............ `r.....................gallons per person per day. Total daily flow____ -------- ''' __�- ....gallons. Qi Septic'Tank—Liquid capacity gallons Length�.'- r?'fi '.". Width... _''f=" me Diater-___--"'._. Depth...5... . Disposal Trench—No..................... Width.................... Total Length.............._..... Total leaching area....................sq. ft. Seepage Pit No------I------------- Diameter-___- Depth below inlet....'�t.47 Total leaching area..................sq. ft. Z Other Distribution box (X) Dosing tank ( ) '-' Percolation Test Results Performed b .__ ' `..-__—A. !'/J!L 10 e e. Date_...G......_...... aTest Pit No. I......e.Z.minutes per inch Depth of Test Pit..... ' ....______ Depth to ground water---/ O......_._.. Test Pit No. 2................minutes per inch Depth of Test Pit------I -}______ Depth to ground water_.4........04 -••-••......----•...... �' C r G ¢o D Description of Soil-••---•----•-----_ ....-....;r�� � -� a5a7G __ eT t�a `.� _, -- v -••••-•••••••-•-•••••--••-•--•----•--..,� .... ..................................� .................................. UL •-•----•-•--•------- ---••...-•--•-... --•-•-•---.....•-••--••..... "may tS U Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------- % ,. �_QVI L a Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in ac r cc t . the provisions of TTTL 5 of the State Saint Code—The undersigned further agrees not to place h ystem ink operation until a Certificate of Compliance has b en is ued the board of health. Signed-,.' --------------------------------------- -•-• ......................... Da Application Approved By......... ..... •...................... •-- .:_ �►•• Da Application Disapproved for th following reasons---------------•----------------------------------...-------------------------------------------------------•-- .............................................................-...........................................------------------------------------•-----------------------------------.... Date �� �_. PermitNo-------------- ------------------•--••-•----•-•-- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ' .................0 1 /.......OF v`-a-.�1' C ~— ... .... ........................................ C9rdifiratr of Toutlift aurr THIS IS TO CERTIFY, That the Individual.Sewage Disposal System constructed ( or Repaired ( ) ..... . ....................................... Installer has been installed in accordance with the provisions of f_"L' 5 of The State Sanitary Code as described in the application 'or Disposal Works Construction Permit T r_Y"_...._..-. ............. dated___.__`'f_........'.......`............... THIF(ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTE WILL FUNCTION SATISFACTORY. r° 2 3 � � ••----------.. Inspector----•--•---�-•••-•-•--•-••- DATE....-•...................... ......---•--• ----------------------.......---•-••-------•--•-•----- THE COMMONWEALTH OF MASSACHUSETTS A - BOARD OF HEALTH on .---- >y 1� OF. � N, •-•• ---•--•-•-••---•-- FEk..... ................ .a�r�� ��aa,��ri.mrat rratti� Permission is hereby granted--------------.k-zC.-q------cz ............................................................ to Construct (A>i6 or Repair..( ) an Individual Sewage Disposal System at No...................................L0.1....__-•. '---.. -j.g.'T.....S__'T. i....,A---.�-T©!�----�-.- _�t-=�----------------------•-•--- Street as shown on the application for Disposal Works Construction Permit No..gF'.... SDated________ �.. .............. •......-•--•-•------•-••-••---•-------•...---• . --- -- t/ Boa t calf DATE......... - =2 ..................................... .� FORM 1255 HOBB`S & WARREN, INC.. PUBLISHERS -- fi BENCH MARK LEGEND TOP OF CONCRETE 1 - 87 BULKHEAD CORNER PROPOSED CONTOUR ELEVATION = 88. 45 ® PROPOSED SPOT GRADE- 100. 00 r BARNSTABLE CIS DATUM _ S� I I I1 88 —— 98 —— EXISTING CONTOUR — —_�- + 96.52if 1 r ---- EXISTING SPOT GRADE t' �n s I w . � I LOT 28 1 W— EXISTING WATER SERVICEie I AREA = 10775 S f �-— 1 0 ft j TEST PIT R2 Gad` t `is m� 's3 nQge=:l m ' o. Ljj Li w C 0- I I I \\ LL LL I I \ LOCUS MAP ' N.T.S. I— n o f o f 10 o \88 GENERAL NOTES: ' ► Z Z0) j 1. ALL� I I J LL I BOARD OF G HEALTH TMAND THE DESIGN ENGINEER.IS PLAN MUST BE APPROVED BY THE LOCAL 0) j 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS L I OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE I ( Li j w LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: I l I X a 11 j N - 310 CMR 15.405 (1) (B): f I 1 W Q J n 1) A 2.11 FT. VARIANCE FROM 310 CMR 15.221(7) TO ALLOW LEACHING TO BE LJ p 5.11 FT BELOW GRADE VS REO'D 3 FT. (H20/VENT PROVIDED) l j GAS LINE 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 4- DESIGN ENGINEER. ' �rt---------_— 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 1 --`--- FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN I 1 ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. LL S;ONE I j 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF DRIVEWAY I THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF j \ I HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. I �al 1 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED ��`� ---- —� I TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 9. IT SHALL BE THE RESPONSIBIUTY OF THE CONTRACTOR TO VERIFY ���' THE LOCATION OF ALL UNDERGROUND UTILITIES. PRIOR TO BEGINNING mw Part -I TH-2 CONSTRUCTION. \— S TH-1 10. EXISTING LEACH PIT TO BE PUMPED AND REMOVED FILL WITH CLEAN MED. SAND 87 100. rt _ j 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 13. NO ADDITIONAL PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING 14. ALL PIPING TO BE 4" SCH 40 ® 1/8-/FT (UNLESS SPECIFIED OTHERWISE) OF 9ss-! 15 THE FOR DESIGN USE OF THIS A GARBAGE GR DOES NDERNOT ALLOW �y� A LOCATION OF 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING DAREM. �, EXIST.ST. LEACH PIT 17. PROPERTY IS LOCATED WITHIN ZONE 11 OR NITROGEN SENSITIVE AREA. �No.V1 Nob "' SEE NOTE 1 O � ( )sl T o S 28 0� t PROPOSED SEPTIC SYSTEM UPGRADE PLAN i 574 FLINT STREET, MARSTONS MILLS, MA ` — L MAP. 102 Prepared for: Mike Dedecco SURVEY REFERENCE: t LOT. 054 Engineering by: Surveying by SCALE DRAWN JOB. NO. r PLAN OF LAND BY GERALD A MERCER & CO. "s DEED BOOK #12880 DDARRE M.MEYER,R.S. Bco-Tech mP3ronmeatel 1"=20 DMM DATED: OCTOBER 1957 i BOX 981 DEEDFAGE. #232 EA8T8ANDtMCH,mAa2537 (508) 364-0894 DATE: CHECKED SHEET NO. I 508—W-2922 05/27/09 DMM 1 of 2 NOTE: TO PREVENT BREAKOUT, THE PROPOSED 1 NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:82.39 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TAN K PROPOSED D-BOX PROPOSED S.A.S. T.O.F. EL.=89.39 INSTALL OUTLET AND SETERS 8 COVERS OVER INLET &TO 6" OF FINISH GRADE SET T TO 6"ALL I OF GRADEVER ONE CHAMBER (M N ND SET INSTALL A 4" DIAMETER CTO 3 TION POFTF.G R Of �9SJ9�y F.G. EL.=87.50t F.G. EL.=87.50t F.G. EL: 87.50t F.G. EL: 87.5(MAX.) D � EN M YE ;w"wimmm WA �� go. 1140 L - 10"tP 9" MIN COVER/ L - 34. L = 10'(MAX) INSTALL TWO INSPECTION PORTS (MIN.)OSCH4 (MIN.) COVER • S=i!G (MIN.) TEE ® 5�1x kITAR4"SCH40 PVC 4`SCH40 PVC 4"SCH40 PVC ,�14. a 11.3" TO dJ 2 a INVERT INV.=86.21 4e`uouw INV.=85.96 L£V£L 2 ROWS OF 5 UNITS AT 6.25'/UNIT = 31.25-ROW GAS BAFFLE PR00600XED INV.=82.60 1 ROWS OF 6 UNITS AT 6.25'/UNIT = 37.50'/ROW INV.=82.80 DB-5 INV.= 82.0 SOIL ABSORPTION SYSTEM (PROFILE) EXISTING 1.000 GALLON SEPTIC TANK INSTALL SANITARY TEE IN 0-BOX RESTORE VEGETATIVE COVER EXISTING SEWER OUTLET BACKFlLL WITH CLEAN PERC SAND �•�-- 75" -� TO TOP OF CHAMBERS NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING �. , .• PIPE INVERTS PRIOR TO CONSTRUCTION 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BREAKOUT=TOP ELEV.=82.39 _1. Igo GRADE ON A MECHANICALL COMPACTED SIX INV. ELEV.= 82.00 : INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.= 81.06 EXISTING SUITABLE go 310 CMR 15.221(2) 2.83' MATERIAL al 3) REPLACE EXISTING 1,000 GALLON SEPTIC 5' MIN. ABOVE BOTTOM OF EFFECTIVE WIDTH 3 x 2.83' = 8.49' 76" I TANK WITH 1500 GALLON SEPTIC TANK T.P. EXCAVATION OR G.W. IF FAILED, DAMAGED, OR UNDERSIZED. (6.56' PROVIDED) USE 3 ROWS OF 4-HIGH CAPACITY PROFILE 4) INSTALL INLET & OUTLET TEES AS REQUIRED ADJ. GROUNDWATER EL.=74.50 = ADS BIODIFFUSER UNITS-NO STONE 5) PLACE SANITARY TEE IN D-BOX. SEPTIC SYSTEM PROFILE TYPICAL SECTION r 16" N.T.S. K*•� 11� DESIGN CRITERIA SOIL LOG P#: 12573 I NUMBER OF BEDROOMS: 3 BEDROOM (PROPERTY IS IN ZONE II) DATE: MAY 27, 2009 34" � SOIL TEXTURAL CLASS: CLASS I SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. SECTION END CAP WITNESS: DAVE STANTON , BARNS. BOH DESIGN PERCOLATION RATE: <2 MIN/IN TP-2 16"" HIGH CAPACITY (H-20) BIODIFFUSER UNIT DAILY FLOW: 330 G.P.D. Elev. TP-1 Depth Elev. Depth 87.5p 0" 87.50 0" DESIGN FLOW: 330 G.P.O. A LOAMY SAND A LOAMY SAND MODEL 16" HICAP GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 86.83 B 10YR 4/2 tOYR 4 2 8' 86.83 B 8" LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT PROPOSED SEPTIC TANK: USE EXISTING 1,000 GALLON CAPACITY SANDY LOAM SANDY LOAM EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY LEACHING AREA REQUIRED: (330) 85.0 30` 85.0 30" SIDE WALL HEIGHT 11.2"= 445.94 S.F. 1OYR 5/8 1OYR 5/8 DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. .74 Gt ° ct OVERALL HEIGHT 16" DISTRIBUTION BOX: 5 OUTLETS (MINIMUM) SANDY LOAM SANDY LOAM , 4640 TRUEMAN BLVD ) tOYR 6/6 toYR s/s OVERALL WIDTH 34' HILLIARD, OH/O 43026 PRIMARY S.A.S. 82.0 C2 66" 82.0 66" CAPACITY 13.6 CF • USE 16 UNITS OF 16" ADS BIODIFFUSER H-20 UNITS-NO STONE C2 (101.7 GAL) ADVANcm DRAINAGE srsTEms. INc. CONSISTING OF 2 ROWS OF 5 UNITS AND 1 ROW OF 6 UNITS MED. SANDVA VA MED.SAND 2.5Y 7/4 V41 PERC ®79.83 2.5Y 7/4 PROPOSED SEPTIC SYSTEM/SITE PLAN BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.70 SF/LF OF BIODUFUSER) 74.50 156" 74.50 156' 574 FLINT STREET, MARSTONS MILLS, MA (BIODIFFUSERS) 16 UNITS x 6.25 LF x 4.70 SF/LF = 470 SF f Prepared for: Mike Dedecco DESIGN FLOW PROVIDED: 0.74(470 GPD/SF) = 347.80 GPD > 330 GPD req d PERC RATE <2 MIN/IN. (-Cl- HORIZON) NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN JOB. NO. DARRENM.MEYER,RS Boo-Tech Environmental NTS D.M.M. • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 POBOX981 (508) 364-0894 to conduct call evaluations and that the above analysis has been performed by me consistent with the DATE CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I have passed the Sail Evol. Exam in October, 1999. EAST SANDHgCH,AfA OZb37 .2RU 05/27/09 D.M.M. 2 of 2 f j REVISIONS: Ai SOIL TEST PIT DATA: INDICATES INDICATES SEPTIC TANK DETAIL. 1000 GAL DISTRIBUTION BOX DETAIL: LEACHING PIT DETAIL. PERC. v OBSERVED NO. DATE �j . NOT TO SCALE NOT TO SCALE NOT TO SCALE -7 �>l TEST GROUNDWATER LOAM 8 SEED NOTES: 1. SEPTIC TANK SHALL BE STEEL 4. INLET AND OUTLET TEES TO BE CAST IRON OR NO. OF OUTLETS: MANHOLE COVER OR MVEMENT BROUGHT, TO FINISH GRADE-4 TP :ff I TP TP # 2 TP REINFORCED CONCRETE. SCHEIM 40 PVC. TEES TO BE CENTERED UNDER NOTES- :�Zp!, !IZ:', ,, If [I ti I W 1 5111 t I I I I I I I I I 2. SEPTIC TANK TO WITHSTAND H-10 LOADING MANHOLE COVER. 7 , . ,-N- ItIkIl � U(11;1 GRD. EL. GRD. EL. GRD. EL 1010- 2 GRD. EL. 1. DIST BOX TO WITHSTAND H.-IO LOADING 2 MIN.OF 1/8" UNLESS UNDER PAVEMENT, DRIVES OR GW. EL. GW. EL. GW. EL. GW. EL. TRAVELED WAYS,WHEREIN H-20 LOADING UNLESS UNDER PAVEMENT, DRIVES OR TO 1/2" 12"MIN. FILL WASHED _j PRECAST TRAVELED WAYS WHEREIN H-20 LOADING STONE SHALL"APPLY. I , DIST I SHALL APPLY. MANHOLE COVER 3. ALL PIPE CONNECTIONS AND CONCRETE I V_ f3 -50 L CONSTRUCTION TO BE WATERTIGHT. BROUGHT TO FINISH GRADE BOX 2. PROVIDE INLET TEE OR BAFFLE WHERE SLOPE OF VC INLET PIPE- D C3 C=l C3 C3 C3 SUE5011- q8.2- INLET PIPE EXCEEDS 0.08 FT/FT OR IN 24' 24" PUMPED SYSTEM. cm rm 1= C= 00 NOTE: 12 MIN. GENERAL NOTES: �00 P� COVER 3. FIRST TWO FEET OF PIPE OUT OF DIST 100-� LEACHING PIT TO co AR sC- I ...!F , -10 LOADING coARsE BOX TO 13E LAID LEVEL. 0 0 CO M C3 a b WITHSTAND H 1. THIS PLAN IS FOR DESIGN AND w UNLESS UNDER r PLAN VIEW A PRECAST PAVEMENT,DRIVE OR CONSTRUCTION OF THESEWAGE F t)�j e r- I Ij le REMOVEABLE-\ DISPOSAL FACILITY ONLY. ;NORMAL WATER LEVEL w 3/4"TO 1-1/2" Q C3 C3 1= = C:3 cz] 00 TRAVELED WAY WHEREIN COVER DOUBLE H-20 LOADING SHALL LEACHING PIT 2- ALL CONSTRUCTION METHODS AND r A NI) S.4-1 l\j D WASHED 0 C= C:3 C3 0 rp APPLY. 7� MATERIALS SHALL CONFORM TO MASS. IA_ STONE ID PROVIDE 9, D.E.G.E. TITLE 5 AND LOCAL BOARD TEE WATERTIGHT ILL (no fines) L) E T OF HEALTH REGULATIONS. JOINTS(typ.) .1 13 C3 C3 M C-1 r__l CJ 0 0 P::CA3T L-ir 3 E E C:t RAvel- PTIC 4'-0"MIN. OUTLET G-R^V6 L NOTE 2 3. ALL PIPES LOCATED UNDER PAVEMENT b- 1� D C3 C:3 =3 C-1 C3 C3 M TANK LIQUID DEPTH TEE INEi� =-4 rz -_ I - a . A ,,, i OR TRAVELED WAY SHALL BE 4"OUTLETA I o4na H UL 4 R EQUAL. -7 A /AWlW 6"MIN. J_j ;? DIA. L __j --BOTTOM ON , BOTTOM ON LEVEL STA OLE BAISE 0. LEVEL STABLE DIA. CROSS-SECTION BASE PLAN VIEW CROSS-SECTION VIEW CROSS SECTION 144 Wk,-f r_f� 187.5 N110 WATE-P, CONSTRUCTION NOTES: DATE' DATE: DATE: DATE: INVERT ELEVATIONS. F6131 28, FEB, 2e", iliac TEST BY: TEST BY: TEST BY: TEST BY: 9 511 W;,C 7 INVERT AT BUILDING MICHNIG WITNESSED BY: WITNESSED BY: WITNESSED BY: WITNESSED BY: INVERT AT SEPTIC TANK00 c�0'75 _Tz,:*A "c INVERT AT SEPTIC TANK(Out) LOT 27 -7 96. 2 PERC. RATE: PERC. RATE: PERC. RATE: PERC. RATE: INVERT AT DIST. BOX00 MIN./lINCH MIN./lINCH MIN./INCH -MIN./INCH INVERT AT DIST. BOX(out) 97, INVERT AT, LEACHING PIT DATUM: , BOTTOM OF LEACHING PIT 510. U.S.G.S. MAXIMUM GROUND I.P. FND. , 00,1 00 OE , VERTICAL DATUM: ASSUMED .5 870 /00.00, 991C71 —----- WATER ELEVATION 7 ­1 OBSERVED GROUNDWATER BENCH MARK USED: ELEVATION LOT 2 8 775 S.F. 0.25 AC. :t z w > a. L DESIGN CRITERIA -3 C-_r> tj N, DESIGN FLOW: CID ro BEDROOMS AT LID G.P.B./D !��G.P.D. Cn J a_ LOT 35 The BSC Group REQUIRED SEPTIC TANK: 98 88 3- 7?�,P f Af G A L. U. SEPTIC TANK PROVIDED: GAL. 0 ca, 10TES ve N SIZE OF LEACHING FACILITY REQUIRED: 1) PROPERTY LINES SHOWN HEREON WEERE CON111PILED DESIIGN PERC. RATE. MNJNCH tfWt, M S P # R6ut FROM A PLAN. RECORDED AT THE' BAR'NSTABLE COUNTY m REG TRY -OF DEEDS IN PLAN BOOK 138 PAGE 2 AND tEi SwDIe_vtlIaqb,MA:, 9 IS 02630�� I)OES NOT REPRESENT ACTUAL SURVEY ON THE� 17 -­31W-Sl _j GROUND. C IZ) mz) PROJECT TITLE: HE GRO 2)THIS TOPOGRAPHIC SURVEY WAS NIADF ON UND 4zll SIZE OF LEACHING FACILITY PROVIDED: BY 'TRANSIT AND STADIAMETHOD, > 60/ 7-,)4 .7 .,f ON HYD. TAG SEWAGE DISPOSAL. m BOLT 4t- 1059 qz� x C;pp SYSTEM DESIGN ' EL 100.00 -74; <PP M -f - 4-k 7*1 79 51 6 Z, 0 LOT . 2 8 HYDRANT W w z 2-T 7 WAT E Rj T !FLINT., STREET GA E T P '#2 I r 4;r Uj MARSTONSVILLS . 10 0*2 L11 N LOCUS PLAN: LAKE rl C c 97x99 UP#3 AROF,�5SSIOIVAL LAND SU)ff VEY OR 0 "I.P. FND. N 870 001 00 m w /00. 00 , w Ir z 0 01 PAEPAk'ED FOR:,' X 61 OC w B m JANE BEATTY - SERVIS _j it 0 w TOP OF I.R FND. P V_ EL. 100. 67 29 0 LOT rABL I W NA 4r r pomp T PROFESSIONA L ENGINEER - CIVIL DA TE DA wA R CH 13, 19, 6 'COMPIDEStGN: CHECK- 0 ' TPC O"D SARmS, 91, DRAWN: PLAN VIEW FIELD: D J B T J Y UNDERGROUND UTILITIES WERE COMPILED FROM AVAILABLE SCALE: 1' = 10' FILE NO RECORD PLANS OF UrILITY COMPANIES ANOPUBLIC AGENCIES SCALE: 1 2,083' AND ARE APPROXIMATE 'ONLY. BEFORE DESIGNAND CONSTRUC­ DWG; NO. 1085 -.-SHEET, 5 10 20 30 FEET TION CALL DIG SAFE 1 - 800 -322 -4844 . 1 -OF ZONE RF JOB NO: 1723iOO ;HT ty�P 7TA G * 1059 0.00