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HomeMy WebLinkAbout0099 FLUME AVENUE - Health 99 FLUME A,VE, WARSTONS 1VIILLS A - - TOWN OF BARNSTABLE LO"`. iQi�t - 1 -1 ' IVW►� �V�- SEWAGE # VILLAGE. t f _ASSES OR'S MAP & LOT INc,TALLER'S NAME&PHONE NO. �� k SEPTIC TANK CAPACITY S LEACHING FACILITY: (type) y' 1 � �'� 4�1 - (size) NO.OF BEDROOMS (� BUILDER OR OWNER PERMTTDATE: 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 y'n1 Pe . . q Fin,-�- � .. _ V � � C ,1 _ � f .. .,. � ` a . 3 _� ,k; , A B �� . � I°I .g •a 31 �19 � 3 ; , as ace Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 Flume Ave. Property Address Martiny Owner Owner's Name / information is required for every Marstons Mills ✓ Ma 02648 02/21/2020 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information S/*'lLf3 p �9 on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. dw_ � 74 Beldan Lane VV Company Address Centerville Ma 02632 City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com, SI4522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑. Conditionally Passes 3. ❑ Needs Further.Evaluation by the Local Ap Ing Authority 4. ❑ Fails 02/21/2020 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original.form should be sent to the system owner and copies sent to . the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5inso.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u / 99 Flume Ave. Property Address Martiny Owner Owner's Name information is required for every Marstons Mills Ma 02648 02/21/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The property located at 99 Flume Ave Marstons Mills is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and 4 Infiltrators. The system was found.to be in proper working condition at the time of inspection. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes","no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts d - Title 5 Official Inspection Form '- �g Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Flume Ave. Property Address Martiny Owner Owner's Name information is required for every Marstons Mills Ma 02648 02/21/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: El Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: l5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Flume Ave. Property Address Martiny Owner Owner's Name information is required for every Marstons Mills Ma 02648 02/21/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and.the SAS is less than.1.00 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or El ® clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters ❑ ® due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Flume Ave. Property Address Martiny Owner Owner's Name information is required for every Marstons Mills Ma 02648 02/21/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1_of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd 10,000 gpd. ❑. ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 C Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 Flume Ave. Property Address Martiny Owner Owner's Name information is Marstons Mills Ma 02648 02/21/2020 required for every it page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® El Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example,a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at.issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Flume Ave. Property Address Martiny Owner Owner's Name information is required for every Marstons Mills Ma 02648 02/21/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number.of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection. ❑ Yes ®- No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Property has irrigation system Sump;pump? ❑ Yes ® No Last date of occupancy: currentDate l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Focn:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 Flume Ave. V P rope rty Address Martiny Owner Owner's Name information is required for every Marstons Mills Ma 02648 02/21/2020 page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Every 2 years per owner Wass stem pumped as art of the inspection?Y p p p p ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5in.sp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 i Commonwealth of Massachusetts +d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Flume Ave. Property Address Martiny Owner Owner's Name information is required for every Marstons Mills Ma 02648 02/21/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Original system 2000 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 1.5 Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints in good condition, no leakage, vented through roof. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Flume Ave. V Property Address Martiny Owner Owner's Name information is required for every Marstons Mills Ma 02648 02/21/2020 page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 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: 1500 gallons Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 71' Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 10 How were dimensions determined? Opened covers and took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance.water level was even with outlet, tank was not leaking and was structurally sound. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•.Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �4 Subsurface Sewage.Disposal.System Form - Not for.Voluntary.Assessments i 4 99 Flume Ave. V P rope rtyAddress Martiny Owner Owner's Name information is required for every Marstons Mills Ma 02648 02/21/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet i Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑.polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of Scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form �o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 Flume.Ave. Property Address Martiny Owner Owner's Name information is required for every Marstons Mills Ma 02648 02/21/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Oil Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was level and in good condition with no rot. Water level was even with outlet invert with no signs.of past backup. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•.Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form .i Subsurface Sewage Disposal System Form -Not for.Vol untary.Assessments u 99 Flume Ave. Property Address Martiny Owner Owner's Name information is required for every Marstons Mills Ma 02648 02/21/2020 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order. ❑ Yes . ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: El leaching pits number:. ® leaching chambers number: 4Infiltrators El Teaching galleries number: ❑ leaching trenches number, length: Teaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 f Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form - Not for Voluntary Assessments 99 Flume Ave. Property Address Martiny Owner Owner's Name information is required for every Marstons Mills Ma 02648 02/21/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching facility was video inspected and found with 3" standing water and no signs of past hydraulic overloading. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 99 Flume Ave. Property Address Martiny Owner Owner's Name information is required for every Marstons Mills Ma 02648 02/21/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy ;locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 18 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 Flume Ave. Property Address Martiny Owner Owner's Name information is required for every Marstons Mills Ma 02648 02/21/2020 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to of least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately i Pc � .0 G 0 T a3 22 C3 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Flume Ave. u Property Address Martiny Owner Owner's Name information is required for every Marstons Mills Ma 02648 02/21/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: pate ❑ 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 inust describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 Flume Ave. Property Address Martiny Owner Owner's Name information is required for every Marstons Mills Ma 02648 02/21/2020 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 ' J COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 99 Flume Avenue Marston Mills. MA 02648 Owner's Name: Robert Bownes stop j6h �jb/ Owner's Address: P.O..Box 1046 Osterville, MA 02655 Date of Inspection: August 9. 2005 Name of Inspector: (Please Print) James M. Ford s' Company Name: James M.Ford Mailing Address: P.O.Box 49 c:x Osterville.MA 02655-0049 Telephone Number: (508)862-9400 "'1 CERTIFICATION STATEMENT f } I certify that I have personally inspected the sewage disposal system at this address and that the infoTnation reported;9 below is true,accurate and complete as of the time of the inspection. The inspection was performed based onmy rn training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs p4rther Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: August 13, 2005 The system inspector shall sub 4a 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. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page.l Page 2 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) j Property Address: 99 Flume Avenue Marstons Mills. MA Owner: Robert Bownes Date of Inspection: Au¢ust 9. 2005 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 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 99 Flume Avenue Marstons Mills, MA Owner: Robert Bownes Date of Inspection: August 9, 2005 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. 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 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,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) ilk Property Address: 99 Flume Avenue Marstons Mills. MA Owner: Robert Bownes Date of Inspection: .4uzust 9. 2005 D. System Failure Criteria applicable to all systems: You must indicate either"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''/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public 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 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,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)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 System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. 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) 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 99 Flume Avenue Marstons Mills. MA Owner: Robert Bownes Date of Inspection: August 9, 2005 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks ? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS,located on site? ✓ _ Were the septic tank manholes uncovered,.opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ _ 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(3)(b)]. 5 f Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 99 Flume Avenue Marstons Mills. MA Owner: Robert Bownes Date of Inspection: August 9. 2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): pd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: The septic tank was pumped after the inspection for maintenance Was system pumped as part of the inspection(yes or no): 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) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Date of installation unknown Were sewage odors detected when arriving at the site(yes or no): No 6 Page!of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 99 Flume Avenue Marston Mills MA Owner: Robert Bownes Date of Inspection: August 9. 2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 13" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain'- If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: _ 1590 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 10" Distance from top of scum to top of outlet tee or baffle: 5" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert, evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert There did not appear to be any signs of leakage The tank was,Dumped after the inspection for maintenance GREASE TRAP: None (locate on site plan) Depth below grade: 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 99 Flume Avenue Marstons Mills. MA Owner: Robert Bownes Date of Inspection: August 9, 2005 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of const_-uction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was level. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 r Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 99 Flume Avenue Marstons Mills. MA Owner: Robert Bownes Date of Inspection: August 9. 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: 4 infiltrators w/stone 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.): The infiltrators were clean. There did not appear to be any si ns of failure The bottom to grade was 5 A video camera was used for the inspection. CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 r Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 99 Flume Avenue Marston Mills. MA Owner: Robert Bownes Date of Inspection: August 9. 2005 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. 5 A �Crp�T Q C � 3 A B a 31 1/9 3 as a� 10 r Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 99 Flume Avenue Marstons Mills, MA Owner: Robert Bownes Date of Inspection: August 9. 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 20+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps the maps were showing approximately 20'+/ to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied,relating to the system, the inspection and/or this report. 11 i,, N UF BARNSTABLE 'LOCATION 99 Flume Ave SEWAGE # -Vr-LAGEMarstons Mills,Mass. ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.JP.Macomber Jr SEPTIC TANK CAPACITY 1 5000. + Box LEACHING FACILITY: (type)4—Infiltrators (size) NO. OF BEDROOMS 4 BUILDER OR OWNER Karen Costegan INSPECTION PERMITDATE: COMPLIANCE DATE: 3/2 9/0 3 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 fee of leachi g 5fli ) Feet Furnished b \ �9 • tr t � rrZ- t DATE ;-__ 3/29/03- PROPERTY ADDRESS:99 Flume Ave - Marstons-Mills _--- -- - Mass. ------------------------ cr,'T 11&4. On the above date, I inspected the septic system at the above re�sg�,����® This system consists of the following: 1 . 1 -1500 gallon septic tank. 2 . 1 -Distribution box. APR 2 7 2003 3 . 4-infiltrators in series. TOWN OF BARNSTABLE Based on my inspection, I certify the following conditions: HEALTH DEPT. 4 . This is a title five septic syst9m. ( 78 Code) 5 . The septic system is in proper working order at the present time. 6. Pumped septic tank at time of inspection.Heavy scum & solids layers were present. ( Garbage Disposal is present) 7 . Infiltraors are presently dry. Surrounding stones are dry and clean. SIGNATUR Name : - J ._ P . -Macomber-jr • Company ;,�ogg�h ��_ m�€r &_ Son, Inc. address :__@ . _6r ............ __�.e-nS rYLLLP,_Ja-_22-632- 0066 Phone : --508- 775_ 3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY IOSEPH P. MACOMBER & SON, INC. Tanks•Cesspools•Leachflelds Pumped & Installed Town Sewer Connections P.0 Box 66 Centerville, MA 02632.0066 715.3338 775.6412 i COMMONWEALTH OF MASSACHUSETTS fD EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ij TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address,99 Flume Ave Marstons Mills,Mass, Owner's NameKaren Coste an Owner's Address:104 Gazab—o—C—Ircie Reading,Mass , 001188667. Date of Inspection:3 29 03 Name of Inspector: (please print)Joseph P.Macomber Jr. Company Name: J_P_Macomber & Son Inc. Mailing Address: Rnx 66 rentervi11P, MaGG 02632 Telephone Number:502-775_3332 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 the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: The system inspector shall s mit 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. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page I Page 2 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 99 Flume Ave Marstons Mi s ass. Owner: Karen osLegan Date of Inspection: 3 29 0 lnspcctl wary; Check A,B,C,D or E/ALWAYS complete all of Section D Syste sses: have not found an information hich indicates that any of the failure criteria described in 310 CMR 15.303 or to 3T MR 15.304 exist. Any failure criteria not evaluated are indicated below, Comments: s stem is in proper working order at the B. System Conditionally Passes: /Y6 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 as by the Board b Health, will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. ,4JO The septic tank is metal and over 20 years old' or the septic ta y nk(whether metal or not)is structurall unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the exis14 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: !12 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)arc replaced obstruction is removed distribution box is leveled or replaced ND explain: aThe 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: 2 Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS S'UBSUR.FACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Proper ) Address99 Flume Ave Marstnns Mi1Is, MaQQ Owocr: Karen Costegan Date of lospectioo: 3/29/03 C. Further Evaluation is Required by the Board of Health: A0 Conditions exist which require Nnher evaluation by the Board of Health in order to determine if the system is failing to protect public health,.safety or-the environment. I. System will pass unless Board of Health determines In accordance with 310 CMR 15.303(l)(b) that the system is not functioning in a maooer wbich will protect public bealtb,safety and the envlrooment: A)a Cesspool or privy is within 50 feet of a surface water Cesspool or privy is witbin 50 feet of a bordering vegetated wetland or a salt marsh 2. S*N stem 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: /(/D The sysiem has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or rributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The s\.stem has a septic tank and SAS and the SAS is less than 100 feet but/�0 feet or more from a pn�•aie water supple well" Method used to determine distance This system passes if the well water analysis,performed at a DEP certified laboratory, for eoliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nirrogcn and nirrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are rriggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 99 Flume Ave Marstons Mills,Mass. Owner: Karen Costegan Date of Inspection:3/29/03 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ v ackup 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 logged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or l cesspool 44. jr1lo »jdf5 C Ory _ ✓ Liquid depth in4evipeei is less than 6"below invert or available volume is less than 'h day flow Required pumping morSlban 4 times in the last year NOT due to clogged or obstructed pipe(s). Number limes pumped bfAl -oW,y �ny portion of the SAS,cesspool or privy is below high ground water elevation. y portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. — r.I Any portion of a cesspool or privy is within a Zone 1 of a public well. — y portion of a cesspool or privy is within 50 feet of a private water supply well. 3 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 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, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this foam.] —I() (Yes/No)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• 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) 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 11 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. 4 Page 5 of I 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 99 Flume Ave Marstons Mills,Mass. Owner:KarPn C'nst egan Date of Inspection: 1 f 9 g f n'i Check if the following have been done. You must indicate`yes"or"no"as to each of the following: Yes No/ i/ Pumping information was provided by the owner, occupant, or Board of Health Were any of the system components pumped out in the previous two weeks -j/— Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? >� Were all system components,JdLding the SAS, located on site? �_ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of thhee 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: Yes no / _{/ Existing information. For example,a plan at the Board of Health. i/ 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(3)(b)) 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:99 Flume Ave rstons Mills Mass. Owner: Karen Cos egan Date of Inspection: 2 9 0 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): '7� Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): '! XI Number of current residents: n Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system f yes or no):WO [if yes separate inspection required] Laundry system inspected(yes or no):J&S Seasonal use: (yes or no): i S .- Water meter readings, if available(last 2 years usage(gpd))?0 01 =2 0 7, 0 0 0 ga 11 ons=5 6 7. 13 GPD Sump pump(yes or no):46 2002=286, 000 gallons=783. 57 GPD Last date of occupancy: Sprinkler system is present. COMM ERCIALIINDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):,,W Industrial waste holding tank present(yes or no):,4,0 Non-sanitary waste discharged to the Title 5 system(yes or no):/90 Water meter readings, if available: _ Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of informationPum ed tank at time of inspection. Was system pumped as part of the inspection(yes or no): If yes, volume pumped: , 00 gall ns--How was quantity pumped determined? //��'�45.�11'� Reason for pumping:IV TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool XV Overflow cesspool vy �ZDShared system(yes or no)(if yes,attach previous inspection records, if any) / ovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) �L&Tight tank �J Attach a copy of the DEP approval 400ther(describe): Approximate a2e Of all comport t ,date installed (if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 99 Flume Ave Marstons Mi11s,Mass. Owner:Karen Costegan Date of Inspection: 3/2 9/0 3 BUILDING SEWER(locate on site plan) Depth below grade: 00 Materials of construction:_cast iron _Z40 PVC 4c�other(explain): A0 Distance from private water supply well or suction line: 4'1 Comments(on condition of joints,venting, evidence of leakage,etc.): .mint--, appear tight No evidence of leakage Vented through the house vents and candy cane. SEPTIC TANK: Z(locate on site plan) Depth below grade: Material of construction: 1/concrete dp meta l�fiberglass�olyethylene ti bther(explain) ,V6 If tank is metal list age:,120 Is age confirmed by a Certificate of Compliance(yes or no);d (attach a copy of certificate) J Dimensions: AI 9'%44X cj &A«./ Sludge depth: 0 If Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: O Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined P umpe d at time of inspection, Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Pump the septic tank annually. Garbage disposal is present.Inlet & outlet inverts are present The tank ' is structurally soup an shows no evidence of leakage. T' GREASE TRAK&2!0ocate on site plan) Depth below grade:4J Material of construction;,) concrete, 0Metal/f[berglass4i i)olyethylenell9 other (explain): �i4 Dimensions: I&H Scum thickness: 16W Distance from top of scum to top of outlet tee or baffle: iLl� Distance from bottom of scum to bottom of outlet tee or baffle:4_ Date of last pumping: ,t,0 Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): grease trap ; s not present 7 i Page 8 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 99 Flume Ave Marstons Mills Mass. Owner:Karen Costegan Date of Inspection: 3 f 2 9/0 3 TIGHT or HOLDING TAN tank must b �( a pumped at time of tnspectton)(locate on site plan) Depth below grade: ,0 / Material of construction:4.9,f concrete metal,(/.9 fiberglasst4/ polyethylene i3O other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Z,* Alarm level: —424 Alarm in working order(yes or no)A Date of last pumping: Comments(condition of alarm and float switches, etc.): Tight or holding tanks are not present. DISTRIBUTION BOX:Z(if present must be o ened locate on site Ian P )( plan) Depth of liquid level above outlet invert:,_ Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box,etc.): Distribution box has one lateral.No evidence of solids carry over.No evidence of leakage into or out of the box PUMP CHAMBERdW&(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): Pump chamber is not present 8 Page 9 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:99 Flume Ave Marstons Mills,Mass. Owner: xaren Costeaan Date of Inspection: .112()/p 3 SOIL ABSORPTION SYSTEM (SAS):Zlocate on site plan,excavation not required) 4-infiltrators- in series. If SAS not located explain why: Located: See page 10 Type . P leaching pits, number:Q leaching chambers, number: �.rJ .�TrvsTry ,Vd leaching galleries,number: o .UD leaching trenches,number, length: Q kld leaching fields,number, dimensions: O �lJU overflow cesspool, number:4 -- / innovative/alternative system Type/name of technology:%J 2r,-- �, <—�� � 7 Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Loamy sand -to medium fine sand.No signs of hydraulic failure ar pondina. Soils are dry Vege a ion 1 rg— presently dry. CESSPOOLS64AI(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: C� Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum laver: Dimensions of cesspool: i Materials of construction: Indication of groundwater inflow(yes or no): ti Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Cesspools are not presen . 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.): Privy is not present. 9 Page 10 of 1 I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 99 Flume Ave Marstons Mills , ass. Owner: Karen Costeaan Date of Inspection: 3 /2 9 f Q 3 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. O \ , 1 10 Page 1 l of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 99 Flume Ave Marstons Mills Owner: Karen Cnstegan Date of Inspection:i/2 9 /o SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 4 0 ' feet Please indicate(check)all methods used to determine the high ground water elevation: No Obtained from system design plans on record-If checked,date of design plan reviewed: NA Observed site(abutting property/observation hole within 150 feet of SAS) _UQ_Checked with local Board of Health-explain: NA YES Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain:http: //town.barns table.ma. us. You must describe how you established the high ground water elevation: sed: GahretY & Miller Mod 1 . 12 /16/ 4 Ground water elevations above sea level. >ed: USGS:Qhsprvatinn well data lug 199 ;ed: USC-q-Tpc-hniral hill1 zt-in q2-(L00 1 Plat-a #9 Anneal range-, of cirnunrl water ,vN vi vruun c1rT-1 99' - I-Infiltrators ;eet Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the bottom, i of the leaching pit and the adjusted groundwater table is feet. 11 ` •r"�+'{T^ATT"^Tr!.1I�JT•I.1T/TTRi7R.lT.1lt1T•.!tRTJTRRI.T Tt�L 1�l�.t�l.l1 T1.9TT^4�R" ..t• .� 1 TOWN OF Barnstable BOARD OF HEALTH SUII,SURFACR SFWACF DISPOSAL SYSTF,M INSPECTION FORM - PART D •- CERTIFICATION •T'•t^T••.•;•.�Q.I.I.^-�1T.1S►..1•...lSl T1r1�TTI71TT:"!•1.^'ItT.�iRI1�r1TRAA�T•101��� ,� -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 99 Flume Ave Marstons Mills,Mass. ' ASSESSORS MAP , BLOCK AND PARCEL # OVA OWNER' s NAMEKaren Coste'c{an PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Son Inca'.` COMPANY ADDRESSBox 66 Centerville Mass. 02632 Stravt To►m or City Stat• LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 -1 578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete as of the time of -inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check o•ne : /System PASSED The inspection sihich I have conducted has not found any information which indicates that the system fails to adequately protect public health or Lhe. environment as defined in 310 CMR 15 , 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which I have con acted has found that the system fails to Protect the E"ilblic health and the environment in accordance with Title 5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date ne copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the I30ARD OF HEALTII. If the inspection FAILED, the owner or""operator shall upgrade ' the eyetem within one year of the date of the inspection , unless allowed or required otherwise as provided in 3.10 CMR 16 , 305 . partd . doc 1 TOWN OF BARNSTABLE ON LOCATIOI"•1 �°riu 1. 9S F�y'y'6 /'�✓c` SEWAGE # 99 VILLAGE /`� �s yz -z /�/� �� j ASSESSOR'S MAP & LOT 6 INSTALLER'S NAME&PHONE NO. /V�^ -•' "� �'��', g °, -141 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 4 C'u %Z`c.S . 3 2 0 (size) NO. OF BEDROOMS BUILDER OR OWNER 1� ,�5 a SU< PERMIT DATE:, E 12,L 12 0° 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 fee(of leaching facility) Feet Edge of Wetland and Leaching Facility (If any,wetlands exist within 300 feet of leaching facilitiy) Feet Furnished by � i M . �3 _ �.. � . ►�� •- �_ .. ,, i i '�11 tDYVT -", � r '�i 3YFr. .. r a TJ No. �J + Fee THE COMMONWEALTH OF MASSA/'jUSETTS Entered in computer: Ses PUBLIC HEALTH DIVISION -TOWN OF BAR.'TABLES MASSACHUSETTS 0ppYication for Migo5al �pgter Y Construction Permit Application for a Permit to Construct(V)Repair( )Upgrade( )96ndon( ) ❑Complete System El Individual Components Location Address or Lot No. ! Flume Ave Owner's Name,Address and Tel.No. Assessor's Map/Parcel M a r s t o n s Mills f Bayside Building Co. Inc. P.O. Box 95 Centerville 771-1040 Installer's Name,Address,and Tel.No. Q ®, ® / Designer's Name,Address and Tel.No. Baxter & Nye Inc. C.f7-,F21,41.0 3f av gg7y 812 Main Street Osterville 428-91 1 Type of Building: t�/� _ Dwelling No.of Bedrooms Lot Size 7./d sq.ft. Garbage Grinder(111V Other Type of Building - No.of Persons Showers( ) Cafeteria( ) Other Fixtures c Design Flow FIFO gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date z a: Title Size of Septic Tanker Type of S.A.S. Description of Soil Q Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issj1pA4Vhis Bopd 0 Signed Z//dA � Date e L 0 t) Application Approved by Date -n _J_�_ 9� Application Disapproved forte folio ing reasons Permit No. Date Issued TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT.. INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 4 C'u �S 3 (size) /Z 3 NO.OF BEDROOMS 4 BUILDER OR OWNER 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 Iiz C �C r f J ,J S ;.,,«r,na.:, +`'"-- * .� .r•n.n. ram.„ +'a.•'^* ...'.' .;,. U No. & Fee . r 9� THE COMMONWEALTH OF MASSA�HUSETTS Entered in computer: � Yes ' PUBLIC HEALTH DIVISION -TOWN OF, BARNSTABLE, MASSACHUSETTS YCns pozar *p.5te� Con6truction Permit A lication for a Pe ,t to truct Re air U rade Abandon EJ Com lete S stem O Individual om onents PP ( ) P ( )Upgrade( ) ( ) P Y P A Location Address or Lot No. 7q Flume Ave Owner's Name,Address and Tel.No. x Assessor'sMap/Parcel Marstons Mills Bayside Building Co. Inc. P.O. Box 95 Centerville 771-1940 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Baxter & Nye Inc. A4\1 c,47-,z e/,410 3 f g'17Y 812 Main Street Osterville 428-91 1 Type of Building: y �/ a Dwelling No.of Bedrooms 7i - Lot Size 7 / sq. ft. Garbage Grinder(114q Other Type of Building b?y���T 5r4K-A--. No. of Persons Showers( ) Cafeteria( ) Other Fixtures G Design Flow FM gallons per day. Calculated daily flow � yu gallons. °Plan Date Number of sheets Revision Date Title Size of Septic Tank S / Type of S.A.S. Description of Soil 24 Q!t /. Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss his Bo 4i, L, ou Signed0�%f �_ ..�1 Dates / U Application Approved by ,,,,. s:D Date Application Disapproved for the following reasons Permit No. 910?- L! _t l) Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE TIFY, that the On-site Sewage Disposal System Constructed( �)Repaired( )Upgraded( ) Abandoned( )by C pq7F-1/�U It at �q 1�L0/#E f}ll,F Al. tN(L.(--s has been constructed in,accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. - dated Installer Designer . The issuance of this pe}. t^�°h-�a t be construed as a guarantee that the system/w�ill function as desig'ed. Date t/ W Inspector t{ le a l`-I�i�r�/rr-I t t C v •-C�No. Fee In THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTWDIVISION - BARNSTABLE., MASSACHUSETTS i� o aY 6potem Construction Permit Permission is hereby granted to Construct( Repair( )Upgrade( )Abandon( ) - L U�Yl �9t1 /Ll. �lLLs System located at �91• , � �,�, _�_} fib,Stt':pa 1 , x•,�:,c-- and as described in the above Application for 5isposal System Construetioqq Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions.' ' Ik"1 id4_,Consti-uction,m '�t ust be contpletedthin\three years of the date of thi it. Date: t Approved byt��,/����/ '1,01V11 Ot llariliSlaDle [ 1i P �0 �a� a Department of Ilealth,Safely,and fnvironmenlal Services .� tp,," Public Health Vivisiuu Date � 'rye 367 Main Street,1,501111AM 02601 f L RAN ffADIA►ulA _ Time B ,ter Fee Date Scheduled U r ' Suitability Assessinent for Selvage �Disl�osal. Svil S .Y ` I Witnessed By: Performed By: I.UCATIor Nr()ItM�.I`tUIV ' owners Name Indian Lakes Dev. r. Location Address Lot 18 Flume Ave AddressP.O. Box 95 AA -AA. Centerville, Ma. 0263 Engineer's Name Asscssorwap/Parcel: (yap 61 Pcl 10 (Part) Baxter & Nye Inc. NEW CONSTRUCTION X REPAIRTelepnonea 4.28-9131 o P- Surface Stones Land Use ��1 t��t`i'lFI-L-- Slopes(/e) (ye�U R Possible Wet Arcn�d_R Drinking Water Well �n R Distances from: Open Water Body __.___._— d,I �� R 35D R Property Line 3D__R Other A�11- b Drainage Way -- -YtVLI P�bD SKC'I'CII:(Street name,dimensions of lot,exact locatirms of test hoics&pere tests,locate wetlands in proximity to holes) -� 24 1 pRA-tt� ,rr eslwr LOT 18 C(D)24,124 sq.ft. ` a 205.38' Parent nlalerial(geologic) L1 R t W Depth to Dcdrock Depth to Groundwater: Standing Wa(cr ill I1Ole:_ W,,ping from Pit I'nce [stilt,led Seasonal Iligh Grouodwalcr _- ---------- - 1)trj[`VA0f11P4/vj1ON VOR SEWWi'*l.AL1.l (1 `1'V,ATE.li'I't1.13I.,I t,lclhod UScd: --- - ill. Ucp(h to salt mottles: Depot observed slnndiug in Obs.hoic: __-.-- _.---- ln. ws (ilpundtcr Adjustmen It. __-- ----_•__---- • Ucplh to weeping firm side Of obs.hole: _ -. _ -- Ilutcs Well a_._...__ .lirading Datc: -_-_ ludcx Well I:vcl _-_—_ Acli.r.v for- Adj.Grotlndtt•alef Lcvel I LIZ�(3L�i'l'r(?N 17.:;S.1,: :<;..::':' Bate::a�. .3_ 'tlre�_to i`_". Observation Tole H - -- Ucpth of Pctc _ A"?)" rime at 0" -- - — So-It p•._rrnnk't'Inrs?L --v--"'rA W ......m'1� '^^ 'lime(9"•C') . Italc.Min./Inch !_ �_ 11� �WtIIJ_��ij....___.---•------•---•----- -..—_..._._____._ Site Suitability Assessment: Site Passed. %_ Site Failed:v— Additional Tcstbtg Nccdcd(Y/N)- Original: Public Health Division Observation Role Data To Be C0111plctcd on Copy. Applicant 1 I)EEI' OBSERVSnATIONI 100E LOG Mule# 1 from Soil Ilorizon il'1•cxturc ,S619 Color Soil Other Depth from Surface (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. e Oravell Il r spa C. to e-66 19 I i t i I c-o AVLS L50 6 I(7 2 6 z -' rt Ig --h CZ ID� lLl1 - D tot® (Qn'w� DEEP OBSERVATION HOLE LOG Hole Depth from Soil I lorizon Soil Texture Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Surface(in.) SA-W A 1 bEEP OBSERVATION HOLE LOG >., Hole# Other Dcplh from Soil Ilorizon Soil Texture Soil Color Soil Mottling (Structure,Stones,Doulderes. Surface(in.) (USDA) ( ) DEEP OBSERVATION HOLE LOG Mole# Dcplh from Soil Ilorizon Soil'fexlure Soil Color Soil Olhcr (USDA) (Munsell) Mottling (Stricture,Stones,Bouldcres. Surface from Flood Insurance Rate M8- Above 500 year flood boundary No_ Yes Within 500 year boundary No f Yes r flood bounds No Within 100 year boundary Yes--- Depth of Naturally Occurring Pervious Material Does at least four.feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? yf If not,what is the depth of naturally occurring pervious material? C'erd Ication V I certify that on t q (date)I have passed the soil evaluator examination approved by the Department of Enviro rnental Protection and that the above analysis was perform d by a consistent with . the required training,expertise and experience described in 310 CMR 15.017.�)� G TOWN OF BARNSTABLE ?(09 S P 2 3 PH 3- 37 rn D 00 DIVISION 0 000 � � 0o'arn Do D � � rnz0 0 ———————— ——— ————————— ———————— —— ————————————————— 91 � 3 i 3 :z _____ _______ ======== ====== ====== I m mD -- - -- - - - 0 A m 11 T O - 3 ^_^ m m 0 70 rn z 0 0 m t 4 TOTAL UNITS, 1 STARTER, 1 END & I 1. THIS PARCEL IS NOT LOCATED IN THE FLOOD PLAIN. 2 INTERMEDIATES ¢2.24 ��` � ' 141.2 2. THERE ARE NO WETLANDS LOCATED WITHIN 100' OF THIS LOCUS. 1-1.5" WASHED.STONE N 3. REMOVE UNSUITABLE SOILS BENEATH PROPOSED SYSTEM, BACKFILL :�.-:.;, ..•t..•:-.,,.,;��,'.;..�:.:; .. •.; PROPOSED 0 22.5� Z WITH CLEAN GRANULAR MATERIAL FILL TO BE. GRADED AS FOLLOWS: NOT 00 ESERVE MORE THAN 15% RETAINED ON No. 4 SIEVE, NOT MORE THAN 90% �' o \�A 60. �], rn ci �i J .� RETAINED ON No. 50 SIEVE, OF FRACTION PASSING No. 4, 10% OR LESS ' ,;4`• :.:;. : ..: 1 O, ,'� rn ` TO PASS No. 100 SIEVE AND 5% OR LESS TO PASS No. 200 SIEVE, SOIL I /LJ/ �,^ i CO DiO `8' TO BE APPROVED BY ENGINEER FOR COMPLIANCE PRIOR TO PLACING ON 6 ti /� i CDrn p -wtdC SITE. 35.0' \ 1 o : o rn 4. LOCATION OF UTILITIES NOT SHOWN ON THIS PLAN, AT LEAST 72 PLAN OF LEACH CHAMBERS HOURS PRIOR TO ANY EXCAVATION FOR THIS PROJECT CONTRACTOR SHALL MAKE THE REQUIRED NOTIFICATION TO DIG SAFE NO SCALE 70 O d (1-888-344-7233) AND APPROPRIATE WATER DISTRICT TO DETERMINE00 UTILITY LOCATIONS. 12' FINISHED GRADE Ln 00* 36"MAX.- 12"MIN. COMPACTED FILL �` 20.00 �'" LOT 19 2"� -- — --- --- ---. - \ PEASTONE M �� f �� ��� � � � �, DESIGN DATA �` ' } � 30i5" as .< a t Q .:. 3/4' TO 1 1/2 " �/ -'��.- tlj`�_ IrI SINGLE FAMILY- 4 BEDROOMS \ : , MI MA s" .a DOUBLE t, S 'I.,, NO GARBAGE GRINDER :._ : DAILY FLOW = 110 X 4 = 440 G.P.D. WASHED STONE Y „«, 01 SEPTIC TANK 440 X 200% = 880 i4 2 i124 s .ft. cC � USE 1500 GAL. SEPTIC TANK- s� Imo= �!4' Q �. , OF SECTION SECTION fC, �01 o CA �S Res, ;c ; OD / 3' NO SCALE z"j i „ c-> t �G �:. " �-- I N • , p'`� STEPHEN ! S86'2854 E _- °' At I yc CULTEC LEACHING CHAMBER DESIGN s; in " I '} f i 205.38/ io' , RECHARGER 330R OR EQUIVALENTw� Q ALL PIPES TO BE SCHEDULE 40 PVC WITH CAPPED ENDS 3F PLAN " ! "'�uCdALE,`ras USE 1 4". DISTRIBUTION LINE-IN 4 RECHARGER UNITS �•`�`�:®® IN A 12'X 35' WASHED STONE TRENCH AS SHOWN P+ I CERTIFY.THAT THE PROPOSED FO ND COMPLIES SCALE; 1 = 40 LEACHING AREA REQUIRED WITH THE TOWN OF BARNSTABLE SIDELINE AND SETBACK �+ 440 G.P.D,/.74 .= 595 S.F. REQUIREMENTS AND OT LOCATED WITHIN THE FLOOD PLAIN. SEPTIC SYSTEM DESIGN 2(35 + 12) X 2 188 S.F. SIDEWALL AREA (12 X 35) = 420 S.F. BOTTOM AREA DATE:-1'�'`�_60_ R.L.S. 608 S.F. TOTAL PROVIDED LOCATION / PERCOLATION RATE 1"IN 2'OR LESS 8/14/98 THIS PLAN IS N T BASED N AN INSTRUMENT SURVEY AND SOIL CLASS 1 THE OFFSETS SH NOT BE USED TO DETERMINE LOT LINES. LOT 18 FLUME AVENUE TEST DOLE MARSTONS MILLS BAXTER & NYE INC. DATE COVERS LOCATED TO WITHIN i -9220 JULY 27, 2000 6" OF F.G. PIT2 ELEV. = 65.3' PIT1ELEV. = 67.3' - _0 HUMUS o HUMUS PLAN. REFERENCE - TOP OF FND F•G.=66't F.c.-65.0' A LOAMY SAND A LOAMY SAND 67.5 LEVEL _ -6" 10YR. 6/4 _ -6" 10YR. 6/4 HERRING RUN AT INDIAN LAKES. B SANDY ;"` B SANDY LOAM 4' INV.= 1500 GAL DIAMETER 2' LOAM SUBDIVISION #762 65.0 INV. = CHING CHAMBERS O -4 1 TEST 64.6 Si TANK ,NV = scwEouLE� a.va LEA ASSESSORS MAP 61, PARCEL 10 - DIST.' - ' ' - 4.5 INv. =64.4 sox .... .INV. =64.2 INV.-63.0 a 10.00'� .............. .....�'-�6" STONE BASE—' `ti: 4 MIN. BOTTOM ELEV. EL =61.0 Cl CSANDE a. Cl CSANDE BAXTER, NYE & HOLMGREN, INC. 10YR.7/6 10YR.7/6 LAND SURVEYORS, CIVIL ENGINEERS ti_ _ OSTERVILLE, MASS. PROFILE C2 COARSE SAND C2 COARSE SAND I,{ 10YR.7/6 " 10YR.7/6 APPLICANT ?r "-11' NO WATER "-11' NO WATER _ NO SCALE ELEV. = 55.3' ELEV. = 57.3' BAYSIDE BUILDING CO. INC. #97012-18 o -T�PM Mo.I I 4'-4" lu j m : m 6 RUBBER x OI Q ROOF 1 I ..\ m� !. —48' Rf5E �. l TRAY CEILING— io !!!ram I n G Ott • i� � 1 � � I � 4C f TV oPEH To- 8'-6° CEILING NG44T in, I BELOW I i CARPET ACCESS P+40NE t2C) CLOSETCID 8-6 N CEILING WGT _ I ilLl L[, __ 2F --B-E DROOI"I #2 3- es c �, M _ - CARPET �- O - th M I /� SB 6/4'x59 3/4 fn i� G� Ca M g ~O - = - 2 Lf7 �-1ALL wox "' n " '- CARPET �i of .� C m C CZ_ CO C IVELUY I' 3 0 O ?� 104 I A.. f- C� S LL F5 I TUNNEL A +T2 CEILING - - -- TILE — - ® - L J I _ BUREAUI2Q 22 --_ PHONE - O 8'-6° CEILING HG44T I I I � � 8 E DROOM 3 °- V5 606 i L V N lV ! m I HOO E�� 0 m Y I A }, 2'-10" 2'-10' i4 TV s,-o° v m n c St4EET x a c+ A4In u z 7-s. SECOND FLOOR PLAN 4-l0• -w 4' SCALE: VA" - V-0" JOB, 0096 24'-b" DRAWN BT, 1CW DATE,_ 7/115/00 i I . { • t A _'_^'-O' 12'-6' 2�• k II-6• �r_0• 6'_6' I hl to 4'_t0" 6'-8' q_p• q_p• r�� I STiEP i / DECK i _ x lu tom! e Vy�' ? WALK-OIIT ✓ GAN TILE VEP. �L•• I ' j FLGl'7i< JOISTST . a;i ' aI li - °' ry DGC 2g5q BREAKFAST ��� I D-C 2g2g L lu 2q 3/A'Ix2q O' 20'-tY m u x 2q 3/-0'z5q 3/-0' 4X6 ! uu iv I 6 c ry C� POST TV I I BULK PNONE HEAD WBx2A STEEL BEAM ! U m w FW5H ABOVE TRAY CEILING 2� m I 4x4 , ._o{ PKT (.-_..DC� 24''9 R _ Posy, f"I'ASTER_ Lu 12g 3/A x2-1 B�A' ! < F!�c cmv Lf i cn II ® ! B E D R OOI"I I PCG �Z !. ' ..Q -Io; DINING I ff _ .. .I� CARPET 10 FS 30Fi FS B08 a'I �\ }� ' I I29 �, Y. =Jli�! SKYLITE SKYLITE �?' IIIK I � C H E N -4" 3'-B� (i'\ 4'-A kPJC1V t AY'7V E I 2 jk -�C__ - -. i--- - -- - -- --- - --!_ - OAK I I OAK ^ ry; LIN. 4� ile N Uai T 14" COL. �'I© - 2 ® O ✓W6 ' (� � �/L� -IC" 1-8' I I DW .0 ® I 1 5_b• _ or lu w N tS�® T I ® IlLPAINTI � 2Q = 29 F/LJ 15, WIDE � m. I 2 7 1/2 WAL DN mi IIY � I P BATS � _36' NIGH o TILE f oFRR ,FAMLdJYR I , I TILE �\ DCC 235gi 3 C t V n �T- c G.O.42 �HIGKLET I 6g 3/A'x5q 3 � I :o \ DN _I GATNEDERAL inq.l ® O I.2� :9 I (( �)�• `v .a cO Lo // Co � N G SILL HGHT. FAN I I I L I I � Co C 78" A.F.F. ' ^"A LA- OAK v �PO� T - 14 COL. <-WALL PADDED OUT A" I a- PCG z oI @ I UPI FOR PLUMBING CHA5E F- I LU il 2q 31A'3 U m EE��,! o I m V ® PNONE I L a Z -- �� FOYER Q =a w 1 (2) q l/A" LVL'S FLUSH Ili Q in � J I 7'-10" UNDER BEARING WALL ABOVE to -_- -_ Ili J 0 0 W I 6 OAK w 2 f O F F 1\ A ° Q 3Q OWDEko oAK I� Q CL ROOD"I o x m TILE I O W m I o! Q n iV r m DGC 2135 m iV II m UU v1v ` m 13/A'x35 3/ I (� U O x m m 3 I O �Il I z 9 4� I I.- L] v o V J[ rc GARAGED I= A._I. A'-7" I Q v 6 FU m m m F I R S T FLOOR F L N m e m Q T cx 11 BEET m 1 O D m In SCALE tY4" V_p'I a m N I m ! n 5-6" 5'-6' 4'-I" 3'_5• V-0. g'-5. A'_7• T_q. q'-O" 7r_q• -O' S'-6' 7'-b' Iq'-O' f- �' 003G 24'-6" DRAWN BY, KW DATE, Ina/OD e 1 _ v 4 TOTAL UNITS, 1 STARTER, I END & 42 \ �\\ l� \ \ 1. THIS PARCEL IS NOT LOCATED IN THE FLOOD PLAIN. 2 INTERMEDIATES .24 ' 141.2 2. THERE ARE NO WETLANDS LOCATED WITHIN 100' OF THIS LOCUS. , 1-1.5" WASHED STONE N 61 3. REMOVE UNSUITABLE SOILS BENEATH PROPOSED SYSTEM,. BACKFILL ? O P OPOSED � 22.53 Z ..,:1. WITH CLEAN GRANULAR MATERIAL FILL TO BE GRADED AS FOLLOWS: NOT ESERVE MORE THAN 15% RETAINED ON No. 4 SIEVE, NOT MORE THAN 90% ~' o ` > 60' RETAINED ON No. 50 SIEVE, OF FRACTION PASSING No. 4, 10% OR LESS e;. \ O• j �,�� �--yam rn _ TO PASS No. 100 SIEVE AND 5% OR LESS TO PASS No. 200 SIEVE, SOIL \ dj/ �- �. CID I -0 \ `$' w� TO BE APPROVED BY ENGINEER FOR COMPLIANCE PRIOR TO PLACING ON I. d SITE. 35.0' " v�BG/� O ` m 4. LOCATION OF UTILITIES NOT SHOWN ON THIS PLAN, AT LEAST 72 PLAN OF LEACH CHAMBM �,�'o- y 40' -� HOURS PRIOR TO ANY EXCAVATION FOR THIS PROJECT CONTRACTOR SHALL MAKE THE REQUIRED NOTIFICATION TO DIG SAFE NO SCALE10, 1-888-344-7233 AND APPROPRIATE WATER DISTRICT TO DETERMINE �'I \ �/ a� '. 01 UTILITY LOCATIONS) 12' x mil pp FlNISHED GRADE . COMPACTED FILL CO Mta I Ii t w t y al 36"MAX.- 12"MIN 2 00 LOT 19 2=� — --- — — -- q— PEASTONE M � � 'Ijt• S;' 14R r ,z `\\`` DESIGN DATA14 a :. 3/4' TO 1 1/2 J \ SINGLE FAMILY— 4 BEDROOMS 30.5" O NO GARBAGE GRINDER a DOUBLE pp WASHED STONEI LOT IV cr DAILY FLOW = 110 X 4 = 440 G.P.D. 4�,��� _� SEPTIC TANK 440 X 200% = 880 c0 \I�= 2�;124 sq.ft. USE 1500 GAL. SEPTIC TANK SECTION I t j` O �y OF �Y1 i k d :y�4\ i O - �� i NO SCALE o� STEPHEN �c 1 S86°228'54"E I 205. ' I%a CULTEC LEACHING CHAMBER DESIGN 38 A Ll J �aE yy .✓ I.5- 16 YY 1,J3- RECHARGER 330R OR EQUIVALENT �:. "•''_ tr♦'y.�:�- ;� 1 � � _ ��F�c ctSTER"c`��'� ALL PIPES TO BE SCHEDULE 40 PVC WITH CAPPED ENDS: USE 1 - 4" DISTRIBUTION LINE IN 4 RECHARGER UNITS �'�` •®� � IN A 12'X 35' WASHED STONE TRENCH AS SHOWN I CERTIFY THAT THE PROPOSED FO ND COMPLIES , I cE SCALE; 1 — 40 LEACHING AREA REQUIRED WITH THE TOWN OF BARNSTABLE SIDELINE AND SETBACK 440 G.P.D./.74 = 595 S.F. REQUIREMENTS AND OT LOCATED WITHIN THE FLOOD PLAIN. SEPTIC SYSTEM DESIGN 2(35 + 12) X 2 = 188 S.F. SIDEWALL AREA (12 X 35) = 420 S.F. BOTTOM AREA DATE:�_�'�_ '_ R.L.S. 608 S.F. TOTAL PROVIDED LOCATION PERCOLATION RATE 1"IN 2'OR LESS 8/14/98 THIS PLAN IS N T BASED N AN INSTRUMENT SURVEY AND SOIL CLASS 1 THE OFFSETS SH NOT BE USED TO DETERMINE LOT LINES. LOT 18 FLUME AVENUE TEST HOLEMARSTONS MILLS BAXTER do NYE INC. DATE COVERS LOCATED TO WITHIN #P-9220 JULY 27, 2000 6" OF F.G. PIT i�7 ELEV. = 65.3' PIT ELEV. T 67:3' F.G.= 66't - - 0 HUMUS 02HUMUS - PLAN REFERENCE 0 W_ TOP OF FND F•G=66't F.G.=65.0' A LOAMY SAND A LOAMY SAND 67.5 LEVEL _ -6" 10YR. %4 _ -6" 10YR. 6/4 HERRING RUN AT INDIAN LAKES mZ c m^ INV. = 1500 GAL 2' •" B SANDY LOA ;t B SANDY LOAM y� `• 4-DIAMETER 'h —1'-6" —1'-6" SUBDIVISION #762 r {n 65.0 Inv64 8 SEPTIC TANK INV. SCHEDuLE 40 P V C i FL LEACHING CHAMBERS ASSESSORS MAP 61, PARCEL 10 DIST. ...- -4' PERC TEST 4.5 INV. =64.4 eox � p� INV.=64.2 IHv. =63.0 MZ N 10.00' . ........... ... -6" STONE BASE- O MIN. v` D O . BOTTOM ELEV. EL = Cl COARSE Cl COARSE BARTER, =61.0 SAND SAND NYE & HOLMGREN, IN m !OYR.7/6 10YR.7/6 LAND SURVEYORS, CIVIL ENGINEE S _ " _ OSTERVILLE, MASS. ` C2 COARSE SAND C2 COARSE SAND PROFILE 10YR.7/6 `r 1OYR.7/6 APPLICANT NO SCALE -11' NO WATER -11' NO WATER ELEV. = 55.3' ELEV. = 57.3' BAYSIDE BUILDING CO. INC. #97012-18 1