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VILLAGE In - 111 1 L L_SS ASSESSOR'S MAP&LOT
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LEACHING FACILITY.(type) (size)
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BUILDER OR OWNER A A '49 Y
PERMIT DATE: C-944PMANCE 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
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- COMMONWEALTH OF MASSACHUSETTS
W Title 5 Official Inspection Form
W Not for Voluntary Assessments
1M Sye��
Subsurface Sewage Disposal System Form
Inspection results must be submitted on this form. Inspection forms may not be altered in any way.
A. General Information
1. Property Information:
135 FLUME AVENUE — MARSTONS MILLS, MA 02648
Property Address
HALLIDAY, JOHN
Owner's Name
135 FLUME AVENUE
Owner's Address
MARSTONS MILLS MA 02648
City/Town State Zip Code
J U LY 12, 2006
Date
2. Inspector:
JAMES D. SEARS
Name of Inspector
A & B CANCO
Company Name
350 MAIN STREET
Company Address
WEST YARMOUTH MA 02673
City/Town State Zip Code
508-775-2800
Telephone 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 DEPapproved =, -
system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System: I _
® Passes ® Conditionally Passes Fails
Needs Further Evaluation by t Local Approving Authority �? y
ector'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.
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page I of 16
COMMONWEALTH OF MASSACHUSETTS
a E Title 5 Official Inspection Form
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Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
D. Certification (cont.)
135 FLUME AVENUE
Owner's Address
MARSTONS MILLS MA 02648
City/Town State Zip Code
HALLIDAY, JOHN
Owner's Name
7-12-06
Date of inspection
Inspection Summary: Check A, B, C, D or E/always complete all of Section D
A) System Passes: (
® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B) System Conditionally Passes: NIA
® 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:
Title 5 Official Inspection Form:Subsurface Sewage Disposal System .
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COMMONWEALTH OF MASSACHUSETTS
Title 5 Official Inspection Form
9 d
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
B. Certification (cont.)
135 FLUME AVENUE
Owner's Address
MARSTONS MILLS MA 02648
City/Town State Zip Code
HALLIDAY, JOHN
Owner's Name
7-12-06
Date of inspection
B) System Conditionally Passes (cont.):
® Observation of sewage backup or break out or high static water level in the distribution box due to
broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass
inspection if(with approval of Board of Health):
broken pipe(s)are replaced
® 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:
C) Further Evaluation is Required by the Board of Health: N/A
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
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
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 3 of 16
COMMONWEALTH OF MASSACHUSETTS
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
Be Certification (cont.)
135 FLUME AVENUE
Owner's Address
MARSTONS MILLS MA 02648
City/Town State Zip Code
HASSIDAY, JOHN
Owner's Name
7-12-06
Date of inspection
C) Further evaluation is required by the Board of Health (cont.): N/A
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
indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less that 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
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COMMONWEALTH OF MASSACHUSETTS
Title 5 Official Inspection Form
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Not for Voluntary Assessments
Sre Subsurface Sewage Disposal System Form
B. Certification (cont.)
135 FLUME AVENUE
Owner's Address
MARSTONS MILLS MA 02648
City/Town State Zip Code
HALLIDAY, JOHN
Owner's Name
7-12-06
Date of inspection
D) System Failure Criteria Applicable to All Systems: N/A
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 pit 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 surface water elevation.
® N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary
to a surface water supply.
® N/A Any portion of a cesspool or privy is within a Zone 1 of a public well.
® NIA Any portion of a cesspool or privy is within 50 feet of a private water supply well.
® N/A 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.
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.
"Title 5 Official Inspection Form:Subsurface Sewage.Disposal System
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COMMONWEALTH OF MASSACHUSETTS
w Title 5 Official Inspection Form
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Al ye V�
Subsurface Sewage Disposal System Form
B. Certification (cont.)
135 FLUME AVENUE
Property Address
MARSTONS MILL MA 02648
City/Town State Zip Code
HALLIDAY, JOHN
Owner's Name
JULY 7, 2006
Date of inspection
E) N/A 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.
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
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ax COMMONWEALTH OF MASSACHUSETTS
N Title 5 Official Inspection Form
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Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
C. Checklist
135 FLUME AVENUE
Property Address
MARSTONS MILLS MA 02648
City/Town State Zip Code
HALLIDAY, JOHN
Owner's Name
J U LY 12, 2006
Date of inspection
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, including the SAS, located on site?
0 ® 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?
0 ® 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)].
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
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COMMONWEALTH OF MASSACHUSETTS
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Subsurface Sewage Disposal System Form
D. System Information
135 FLUME AVENUE
Property Address
MARSTONS MILLS MA 02648
City/Town State Zip Code
HALLIDAY, JOHN
Owner's Name
JULY 12, 2006
Date of inspection
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: 2
Does residence have a garbage grinder? ® Yes ® No
Is laundry on a separate sewage system?[if yes separate inspection is required] ® Yes ® No
Laundry system inspected? ® Yes ® No
Seasonaluse? ® Yes ® No
Water meter readings, if available(last 2 years usage(gpd)): N/A
Sump pump? Yes ® No
Last date of occupancy: PRESENT
Commercial/Industrial Flow Conditions: N/A
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):
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
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COMMONWEALTH OF MASSACHUSETTS
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Title 5 Official Inspection Form
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Subsurface Sewage Disposal System Form
D. System Information (cont.)
135 FLUME AVENUE
Property Address
MARSTONS MILLS MA 02648
City/Town State Zip Code
HALLIDAY, JOHN
Owner's Name
JULY 12, 2006
Date of inspection
General Information
Pumping Records:
Source of Information: 8/05-OWNER
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)
Tight tank. Attach a copy of the DEP approval.
Other(describe):
1999—PERMIT#98-618
Approximate age of all components, date installed(if known)and source of information:
Were sewage odors detected when arriving at the site? Yes ® No
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 9 of 16
COMMONWEALTH OF MASSACHUSETTS
p Title 5 Official Inspection Form
d
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
D. System Information (cont.)
135 FLUME AVENUE
Property Address
MARSTONS MILLS MA 02648
City/Town State Zip Code
HALLIDAY, JOHN
Owner's Name
J U LY 12, 2006
Date of inspection
Building Sewer(locate on site plan): ✓
Depth below grade: 16"
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.):
Septic Tank(locate on site plan): ✓
Depth below grade: 20"
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-GALLON PRE CAST
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle 28"
Scum Thickness 1"
Distance from top of scum to top of outlet tee or baffle 8"
Distance from bottom of scum to bottom of outlet tee or baffle 17
How were dimensions determined? ASBUILT, TAPE&SLUDGE JUDGE
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 10 of 16
eFE COMMONWEALTH OF MASSACHUSETTS
w Title 5 Official Inspection Form
a
91 ye y�0
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
D. System Information (cont.)
135 FLUME AVENUE
Property Address
MARSTONS MILLS MA 02673
City/Town State Zip Code
HALLIDAY, JOHN
Owner's Name
JULY 12, 2006
Date 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.):
TANK & COVERS AT 20" BELOW GRADE, INLET TEE - OUT TEE.
NO SIGN OF LEAKAGE OR OVER LOADING.
Grease Trap (locate on site plan): N/A
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): N/A
Depth below grade:
Material of construction:
® concrete ® metal ® fiberglass ® polyethylene ® other(explain)
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 11 of 16
COMMONWEALTH OF MASSACHUSETTS
N Title 5 Official Inspection Form
d
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
D. System Information (cost.)
135 FLUME AVENUE
Property Address
MARSTONS MILLS MA 02648
City/Town State Zip Code
HALLIDAY, JOHN
Owner's Name
JULY 12, 2006
Date of inspection
Tight or Holding Tank (cont.) N/A
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 a 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.):
D-BOX IS 16"MT-30" BELOW GRADE, ONE LINE IN — ONE LINE OUT.
BOX IS CLEAN & SOLID. NO SIGN OF OVER LOADING OR SOLID CARRY OVER.
Pump Chamber(locate on site plan): N/A
Pumps in working order: ® Yes ® No
Alarms in working order: ® Yes No
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 12 of 16
COMMONWEALTH OF MASSACHUSETTS
a Title 5 Official Inspection Fora
d
Not for Voluntary Assessments
spa Subsurface Sewage Disposal System Form
De System Information (cont.)
135 FLUME AVENUE
Property Address
MARSTONS MILLS MA 02648
City/Town State Zip Code
HALLIDAY, JOHN
Owner's Name
J U LY 12, 2006
Date of inspection
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:
® leaching chambers number: 3
® leaching galleries number:
leaching trenches number, length:
® leaching fields number, dimensions:
® overflow cesspool number:
® innovative/alternative system
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc.):
LEACHING IS THREE 500-GALLON DRY WELLS 13' X 32' LEACHING AT 3' WITH
COVER AT 18", LEACHING IS WET. NO SIGN OF OVER LOADING OR SOLID
CARRY OVER.
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 13 of 16
COMMONWEALTH OF MASSACHUSETTS
m Title 5 Official Inspection Form
Not for Voluntary Assessments
Vev`OW
Subsurface Sewage Disposal System Form
D. System Information (cont.)
135 FLUME AVENUE
Property Address
MARSTONS MILLS MA 02648
City/Town State Zip Code
HALLIDAY, JOHN
Owner's Name
JULY 12, 2006
Date of inspection
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): N/A
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, damp soil, condition of vegetation,
etc.):
Privy (locate on site plan): N/A
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc.):
f
COMMONWEALTH OF MASSACHUSETTS
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
D. System Information (cont.)
135 FLUME AVENUE
Property Address
MARSTONS MILLS MA 02648
City/Town State Zip Code
HALLIDAY, JOHN
Owner's Name
J U LY 12, 2006
Date of inspection
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.
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Title?Official Inspection Form:Subsurface Sewage Disposal System
Page I of 16
` COMMONWEALTH OF MASSACHUSETTS
N W Title 5 Official Inspection Form
o
Not for Voluntary Assessments
p1 yev
Subsurface Sewage Disposal System Form
D. System Information (cont.)
135 FLUME AVENUE
Property Address
MARSTONS MILLS MA 02648
City/Town State Zip Code
HALLIDAY, JOHN
Owner's Name
J U LY 12, 2006
Date of inspection
Site Exam:
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to no ground water: 10'
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:
TEST HOLE AT 10' NO WATER.
TEST HOLE AT 4' BELOW BOTTOM OF LEACHING.
BOTTOM OF LEACHING AT 6' BELOW GRADE.
I
I
4 � -MWN OF BARNSTABLE
20CATIOJ /'� !> SEWAGE # Q - 6 f 8
VILLAGE 2w—s /�i/I�.ASSESSOR'S MAP ko—w ' Q
INSTALLER'S NAME&PHONE NO. O.'fcD eZe- 30E r
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type � � �.��OA04 6-Yi��size) f >4 3 Z
NO.OF BEDROOMS
BUILDER OR OWNER i
PERMITDATE:--q avv 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
t
30
-23 2-8
, ���
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48` 30 ' ~
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No. Fee
V -f t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
Zipprtcation four Zi5po5al *potem Construction 3Permit
Application for a Permit to Construct(L-/)Repair( )Upgrade( )Abandon( ) D? omplete System El Individual Components
Location Address or Lot No. 1,1 V to-r I b ,r-LVX A1E Owner's Name,Address and Tel.No. .7.71 _/aVO
�,qAV 13S 4.Alit`S M,15/v� bac
Assessor's Map/Parcel ,O- f V
Installer's Name,Address,and Tel.No. q W—3 Fs Designer's Name,Address and Tel.No. 7 _ !��3
Type of Building:
Dwelling No.of Bedrooms 7 Lot Size X.6 3 a sq.ft. Garbage Grinder(.Al())
Other Type of Buildin_Akz )�/16�s No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow qqo gallons per day. Calculated daily flow 76�0 gallons.
Plan Date 1-7--9 P' Number of sheets Revision Date
Title 40 7 N, EL.U,"E N,E
Size of Septic Tank /Sd--b Type of S.A.S.
Description of Soil AS PF—P f L°gN
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 Enviro ental Code and not to place the system in operation until a Certifi-
cate of Compliance has been ' ue, hi oard Of Ith.
c
Sign d i Date
Application Approved-by Date
Application Disapproved or the following reasons low
Permit No. Date Issued
---------------
THE COMMONWEALTH OF MASSACHUSETTS 6p BARNSTABLE, MASSACHUSETTS I v e
(Certificate of Compliance bwD
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed Repaired( )Upgraded( )
Abandoned( )by af— NCI&I®
at &Pr 16 F41JAE IgVE /y105741J5 WIL4S as constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer 4Designer
The issuance of this permit sh t b ed as a guarantee that the sys e ' 1 function as d ' n .
Date Inspector
No. r Fee
.-qI��
THE COMMONWEALTH OF MASSACHUSETTS Er'tered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
4 R r
ZippYtcatton for Ot4pogaf *potem �lConmruction Perm ;
Application for a Permit to Construct(t/)Repair( )Upgrade( )Abandon( ) Ly'Complete System ❑Individual Components
Location Address or Lot No. A,;V 07 6 a 00C NE Owner's Name,Address and Tel.No.
Vs M -M L G.S 7.W C —/(BYO
Assessor's Map/Pazcel� 013 / �O' t U
6
Installer's Name,Address,and Tel.No.' C�,��'— �/5 Designer's Name,Address and Tel.3 o. 7�d - 9131
el
~ Type of Building:
Dwelling No.of Bedrooms q Lot Size 3 sq.ft. Garbage Grinder(A10)
Other Type of Buildin f 46wlk. No.of Persons Showers( ) Cafeteria( )
Other Fixtures ',. ,:
Design Flow yqO gallons per day. Calculated daily flow ��� gallons.
Plan Date S-t T 9 F Number of sheets / Revision Date
Title L07 /6 rLU019 f}VF—
Size of Septic Tank Ste' Type of S.A.S.
Description of Soil `s � � �LA!✓ I
Nature of Repairs or Alterations(Answer when applicable)
r
�. 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 Envir ental Code and not to place the system in operation until a.Certifi-
cate of Compliance has bee ue b hi oard Qf lth. a / _y
Sign d Date `
Application Approved by W '� Date
,Application Disapproved for the following reasons /
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
' BARNS3ABLE; MASSACHUSETTS
Certificate of Compliance (I
.THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed Repaired( )Upgraded'( )
Abandoned( )byD �I6/90
at L(J'j /6 '�U�'1 /9 t/E /yt YZSTOr/5 ,dl/L[S as constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer `. Designer
The issuance of this permit sha�rl�not b construed as a guarantee that the syste i 1 function as dd gned&4��
Date , Inspector
----A�— ---------------------------
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Migaal 5tem Congtructton Permit
Permission is hereby granted to Construct( ")Repair( )Upgrade( )Abandon( )
System located at G4T 16 TL.UMM AIE yl.. ,p/LL 5
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: Construction must be completed within three years of the date of this permit.
Date: Approved by
No. Fee---y -----
BOARD OF HEALTH
TOWN OF BARNSTABLE
Application- or lVell Con5truction3permit
Application is hereby made for a permit to Construct (Alter or Repair ( )an M* dividual Well at:
010
L t* Address Assessors Map and Parcel
Owne 4 Address
-----------/N
Installer Driller Address
Type of 54ding,
Other - Type of Building No. of
Type of Well
Purpose of Well-----
Agreement:
The undersigned agrees to install the aforidescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to
place the well in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed-
dat.
Application Approved By
date
Application Disapproved for the following reasons:
date
Permit No. V1j 100 aL--13 Issued L11101c)
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS TO CERTIFY, Tat the Individual Well Constructed Altered or Repaired
by �A/
— L ....l.da'ie.
a
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. Dated 06--------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
fr
DATE Inspector
No.W 00-a--O Fee----_ -r-------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Yic�tion r eri ton5tructioriPermit: , . t Application is hereby made for a permit to Construct (%Alter'( ), or Repair ( .)an individual Well at:
r` Location — Address Assessors Map and Parcel
Owner. Address
---------/�a. , /�i��5�D,�t '-- ���5
- - - - --- -
Installer — Driller Address —
Type of Building
welling
Othe�ve of Building = -_ ,` . ' t No". af Persons
l � I �
- e
Type of Well - �—� 2/�N - Capacity —
Purpose of Well---
Agreement:
The undersigned agrees to install the afo'redescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health'Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Certificate .of Compliance,has been issued by the Board of Health.
Signed. �' --�----- --y/�
date
Application Approved:-By ` �N"P
date -----
Application Disapproved for the following reasons: ------------ -- ------ — --
date
Permit No. W °�UU `- -- — Issued--1�U-z------.--
date
TV
Rr
A.
BOARD OF ,HEALTH
TOWN OF BARNSTABLE
Certificate of Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed (.ol), Altered ( ), or Repairedby
( )
x
Installer
at
has been installed in accordance with the provisions of the Town of Barnstable Board,of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. Dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE— - Inspector-----------------_ —_�__—_____
BOARD OF HEALTH
TOWN OF BARNSTABLE
Yell Constructionpermit
No. -�¢ - -i�t1-�=-- Fee— --
Permission is hereby granted / �/
a ..N...�•w.�•9: ,:�yx,u. i .'tlu u H.w.. .wW.....sw
to.,Construct (, Alte ), or Repai�42
;)pan Individual4Weli at'": '" .° ,..._:
t ' -----------------------
! Street
as shown on the application for a Well Construction Permit
No.-- d Zt Q t Q '
. - —�— --_ Dated—
_�-___
— ---------------------------------
o$oard f H
DATE ��� � -.- � .ealth
�dIM.'
F .
Rpr 05 02 09: 143a John 5084209947 ' p. l
J l 16 TOWN OF BARNSTABLE
L)D P,Y 1 LOCATION `
SEWAGE# Q IF b��
V1I,LAGE ASSESSOR'S MAP 0 d
. INSTALLER'S NAME&PHONE NO,
-
SEPTIC TANK CAPACITY!Svc?
LEACHING FACILITY: (typeC3)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMIIDATE
COMPLIANCE DATE:
i
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Welland 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
iFurnished by
r
09z
i
i
Town ul, HIM.list, tt ----------------------
llcltartment of Ileaillr,Safely,anti F,nvit•oltmenlal Services
Public Ileaitll J)iV1S'011 ante �
�,� a 010
367 Main Sir
ec Iy mis U2601�f
! ruartnrAota, I
KAM Time /ham Fee I'd. L00
''` Date Scheduled _^ �---
Svc J' ��`
'l Suitability Assessment fog' Sewage Dispo
t�rl d✓ti> �'
Witnessed By: V��t
Performed By:
LOCATION &'GI,NIFRA � 1NIt0AMA,`V10N
0%vncr'sName Indian. Lakes Dev. r.
Location Address
Lot 16 Flume Ave AddressP.O. Box 95
Mil• Centerville, Ma. 0263
Engineer's Name
Assessor's Mnp/Parcel: Map 61 Pcl 10 (Part) Baxter & Nye Inc.
NEW CONSTRUCTION
X REPAIR TelephoneN 428-9131
�.6'ith�.t f ll1L� Slopes(%)
�j— Surface Stones
Land Use — p�p� R
Distances from: Open Water Body_ 15�n Possible Wet Aren to es_v_ n Drinking Water Wcll
5c> R Other R
Drainage Way `____ —R Property Line —
SKETCH:(Street name,dimensions of lol,exact locations of test holes&pere tests,locale wetlands in proximity to holes)
N76'06'27"E 272.41'
l�
LO
is N
30 16 co
J 4-1 32 S9 ft.
CrA
L = 20.01' S7d•59'47"W
•59'47"E 0" s
z
�Tw/�g4 P�rIJ Dcptll to Bedrock
Parent material(geologic) � _—_ �!
Ucpli to Groundwater: Standing Wntcr in I tole:_ --
`Weeping from Pit I'nce
Esthnitcd Seasonal I ligh Groundwatcr _---_ -------------- —
001INATI.Ojv FOR SIW0NAG1..II6It WAII,.It
Method Uscd: _ ----- — In. Uc-pt.11 to soil mottles:
Depth C)bscrved standing in obs.hole: �.--.---------._.---lu Gunanlrvntcr Adjustment-_—_____..__—.—_--n.
I.)cpth to weeping from si+Ic ofobs.hulc:
lndC.e Well H _ •grading Date:—_____ ludcx 14'cll b vcl ____—_ Adl.f,cior— Adj.Groundwnle.i Level
me-In
Ubsrrvaliun +I 'I ime at 9" _
Ilolc N --
/ � •Clore at G"
sin. r.•..nnk'1'Inr•RO U� `� ���2Q.%f� 'ILne(9"•G•')
I_ud rre-sonk --
lit IIJ 1AA0J /L if _
R.atc.Min./Inch _--�. — — ----_ —-- —_—
Site Suitability AsscssmenC Site Passed __ Site failed:— Additionai'1'csling Ncedcd(Y1N)•_
Original: Public health Division Observation Hole Uala'li o Be Colttpleted Ott HHelt---------
�
Copy: Applicant
`'Di+iCt'=013sCliVA?t CONII,OL` CLOG : Hole# I
w:,r {
Dcplh from Soil I lorizon Soil TcxlurJ w SoihColor Soil other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
%
atM �0 A (..oA+u S 10 105
=�2`r Alb
S�� to 02 �,
DEEP OBSERVATION HOLE
Depth from Soil I lorizon Soil Texture Soil Color Soil Other
(Munsell) Mottling (Structure,Stones,Doulderes.
Surface(in.) (USDA)
r
.i
DEEP O0SCItVATION Out LOCH I4ole#'
- Other
Depth from Soil
Soil I lorizon Soil'fexhire. Soil Color Mottling Structure,Stonei,Doulderes.
Surface(In.)
(USDA) (Munsell) B ( e
j
DEEP OBSERVATION HOLE LOG Ilole#
Depth from Soil Ilorizon Soil'rexlure Soil Color Soil Other
(USDA) (Munsell) Mottling (Structure,Stones,
Surface(in.) Doulderes.
Flood Insurance ate Maa:
Above 500 year flood boundary No— Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No ✓ Yes
peach 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?
If not, what is the depth of naturally occurring pervious material?
S,prflfiCatlOn M
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of Enviro mental Protection and that the above analysis was perfo d b me c n ier�t with
the required training, expertise and experience described in 310 CMR 15.017.
1
NaTm
4 TOTAL UNITS 1 STARTER,1 END, &2 INTERMEDIATES. 7 I
1. THIS PARCEL IS NOT LOCATED IN THE FLOOD PLAIN. 3305 rfP LOT 17 loll 19
2. THERE ARE NO WETLANDS LOCATED WITHIN 100' OF THIS LOCUS. � 8.256:3�4. n
3. REMOVE UNSUITABLE SOILS BENEATH PROPOSED SYSTEM, BACKFILL 1-1.5• WASHED STONE
WITH CLEAN GRANULAR MATERIAL FILL TO BE GRADED AS FOLLOWS: NOT s; N ` `•
MORE THAN 15,% RETAINED ON No. 4 SIEVE, NOT MORE THAN 90% RETAINED 8 `L to \ +27"E U \ ±
ON No. 50 SIEVE, OF FRACTION PASSING No. 4, 10% OR LESS TO PASS No. (' i i N'j6•�6 \ "
100 SIEVE AND 5% OR LESS TO PASS No. 200 SIEVE, SOIL TO BE APPROVED
BY ENGINEER FOR COMPLIANCE PRIOR TO PLACING ON SITE. 35.00
i
4. LOCATION OF UTILITIES NOT SHOWN ON THIS PLAN, AT LEAST 72 HOURS PLAN OF LFAM CELA]GHM W
PRIOR TO ANY EXCAVATION FOR THIS PROJECT CONTRACTOR SHALL MAKE NO SIn
THE REQUIRED NOTIFICATION TO DIG SAFE (1-888-344-7233) AND APPROPRIATE I { 4•`� ``
WATER DISTRICT TO DETERMINE UTILITY LOCATIONS. 1 I a 1 c 1 (D
1 ,.i''�
i
DE91�1 DCA 12' ` �� .r� `\ CL
FINISHED GRADE
36"MAX.- 12-MIN. \ COMPACTED FILL `� I 1 G1 30,632 s q.f t. ; Z
SINGLE FAMILY- 4 BEDROOMS 1 , � �' 1. T
NO GARBAGE GRINDER 2 PEASTONE Ld
#2
PT
DAILY FLOW = 110 X 4 = 440 G.P.D. 3o.5 O 3/4" Tot 1/2 " O
�a DOUBLE �•� � ,` G�
SEPTIC TANK 440 X 200% = 880
WASHED STONE ' `'' \ \`•+ �/
USE 1=,OO GAL. SEPTIC TANK -
CiJ LMW LAG CHAR D � JgCTiON
Fa=ABGZR 3W R OR ZQUNAImMff NO SCALE � �, \ .v 0-
N�
ALL PIPES TO BE SCHEDULE 40 PVC PERFORATED �. � ---7
WITH CAPPED ENDS _
USE 1 - 4" DISTRIBUTION LINE IN 4 RECHARGER UNITS I CERTIFY THAT THE PROPOSED FOUNDATION
IN A 12'X 35' WASHED STONE TRENCH AS SHOWN COMPLIES WITH THE TOWN OF BARNSTABLE SIDELINE �`� `N0.0A
LEACHING AREA REQUIRED
AND SETBACK REQUIREMENTS AND IS NOT LOCATED
440 G.P.D./.74 = 595 S.F. WITHIN THE FLD PLA
2(35 + 12) X 2 = 188 S.F. SIDEWALL AREA DATE: R.L.S. 6. ,
(12 X 35) TOTAL PROVIDED 4T S.F. BOTTOM AREA
608 S.F. TO THIS PLAN IS NOT BASED ON AN INSTRUMENT SURVEY AND PIAN
THE OFFSETS SHOULD NOT BE USED TO DETERMINE LOT LINES.
PERCOLATION RATE 1"IN 2'OR LESS 8/14/98 SCALE; 1"= 40'
SOIL CLASS 1 TAT �� �»OF MqS CERTI 3 PIDT �PLAN
BAXTER & NYE INC. ya cS9
COVERS LOCATED TO WITHIN #P-9218 STEPHEN LOCATIONy
6" OF F.G. ALL LOT 16 FLUME AVENUE
F.F. ELEV. = 74.0 PIT 1 PIT 2 �; MARSTONS MILLS
F.C. 72't
# ELEV. = 71.0' # ELEV. = 72.0' cn
F.G.- 72't 0 HUMUS 0 HUMUS o ��
\ LEVEL F�-7? A LOAMY SAND A LOAMY SAND �,r�FCISTE? �c��/ AUG•17,1998
INV. = 1500 GAL _ -s" -6" Fsv�i
69.0 INV. - I'll a DtAMETp� 2 " I< B LOAMY SAND B LOAMY SAND 81Or� L.EN
68.8 Sernc TANK INv. T SCHEDULE LEACHING CHAMBERS -2•-8" -2'-B"
8.6 INV. -6$,4 80X DIST. b P.v.c- I Cl COARSE Cl COARSE HERRING RUN AT INDIAN LAKES
...�:.•_.r. INv. -68.2 INV. 68.0 ?is SAND 10YR.6/4 SAND 10YR.6/4
i --�6" STONE BASE—
MIN. — -4' PERK TEST -4' PERK TEST �ar ASSESSORS MAPSUBDIVISION6 , PARCEL
IN. -? � :
BOTTOM ELEV. EL =66.0 %
C2 COARSE C2 COARSE qsomm BAXTER & NYE INC.
SAND SAND A. LAND SURVEYORS CIVIL ENGINEERS
1OYR.7/6 IOYR.7/6 S,xrm
'rO 240" OSTERVILLE,MASS.
NO SCALE -10' NO WATER 1-10' NO WATER "PUCANT,
ELEV. 61.0' ELEV. = 62.0' BAYSIDE BUILDING CO. INC.
� v4�
B •9g #97012TYP