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Home My WebLink About0184 FLUME AVENUE - Health K' 1 1 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 184 Flume Ave ty Property Address f..a Ken Jenkins Owner Owner's Name information is ✓ a.?t MA 02648 11-24-15 required for every Marstons Mills page. Cityrrown State Zip Code Date of Inspection rw.,y Inspection results must be submitted on this form. Inspection forms may not be altered in at* way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority. 11-24-15 spector'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. cc �v t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System• #1.f a Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r<e 184 Flume Ave M Property Address Ken Jenkins Owner Owner's Name information is required for every Marstons Mills MA 02648 11-24-15 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: - ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. .. Check the box for"yes", "no"or"not determined (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ' t• ❑ Y ❑ N ❑ ND (Explain below): F t5ins-3M3 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 184 Flume Ave Property Address Ken Jenkins Owner Owner's Name information is required for every Marstons Mills MA 02648 11-24-15 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with.Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipes) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑,ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Hea16 determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 , Commonwealth of Massachusetts , W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 184 Flume Ave Property Address Ken Jenkins Owner Owner's Name information is required for every Marstons Mills MA 02648 11-24-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: . . • ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS'is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No f ❑ ® . 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 l ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 184 Flume Ave Property Address Ken Jenkins Owner Owner's Name information is required for every Marstons Mills MA 02648 11-24-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) , Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped:_. ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 184 Flume Ave Property Address Ken Jenkins Owner Owner's Name information is required for every Marstons Mills MA 02648 11-24-15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No , ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not ' available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up?, ? ® ❑ 'Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑" Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions;'depth of liquid,depth of'sludge and depth of scum? v ® ❑ 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 i - been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ' ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions:' Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t, r t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments, . 184 Flume Ave Property Address Ken Jenkins Owner Owner's Name information is required for every Marstons Mills MA 02648 11-24-15 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 11-2015 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.20.3): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 184 Flume Ave Property Address Ken Jenkins Owner Owner's Name information is required for every Marstons Mills MA 02648 11-24-15 page. Cfty(Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped 11-2015 Was system pumped as part of the inspection? ❑ Yes ® No if yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance 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): a t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ; ' a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 184 Flume Ave Property Address Ken Jenkins Owner Owner's Name information is required for every Marstons Mills MA 02648 11-24-15. page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1999 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condtion. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal Sludge depth: 6" t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection . Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments + SVO,� 184 Flume Ave Property Address Ken Jenkins w Owner Owner's Name information is required for every Marstons Mills MA 02648 11-24-15 . page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) " Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness . . 0 Distance from top of scum to top of outlet tee or baffle 611. Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,'evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: r ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum.to top of outlet tee or baffle k Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•W13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form F Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 184 Flume Ave Property Address Ken Jenkins Owner Owner's Name information is required for every Marstons Mills MA 02648 11-24-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, in and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: i Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - 184 Flume Ave t, Property Address Ken Jenkins Owner Owner's Name information is required for every Marstons Mills MA 02648 11-24-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) , Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from chambers. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: 0 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. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ti 184 Flume Ave Property Address Ken Jenkins Owner Owner's Name information is required for every Marstons Mills MA 02648 11-24-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type. , ❑ leaching pits number: ® leaching chambers number: 3-Cultec 330's ❑ 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.): Chambers in good working order with no sign of back-up into d-box or surrounding stone. 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 t5ins-W13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 184 Flume Ave Property Address Ken Jenkins Owner Owner's Name information is required for every Marstons Mills MA 02648 11-24-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil,,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): e S t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection.Form m o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments., 184 Flume Ave Property Address Ken Jenkins Owner Owner's Name information is required for every Marstons Mills MA 02648 11-24-15 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) , Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately {n'GC V r a " t5ins-3/13, Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 184 Flume Ave Property Address Ken Jenkins Owner Owner's Name information is required for every Marstons Mills MA 02648 11-24-15 page. City/Town - State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 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: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: r ® Checked with local excavators, installers- (attach documentation) ❑ - Accessed USGS database- explain: i h ground water elevation: You must describe how you established the high d y 9 9 Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 184 Flume Ave Property Address Ken Jenkins Owner Owner's Name information is required for every Marstons Mills MA 02648 11-24-15 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 013- 1� TOWN OF BARNSTABLE ,'LOCATION �d 7L / i�14 M.e 4 y/'. SEWAGE # C,2, + �. VILLAGE Al c.✓-57,�ti S �1;/I t' ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY l S O O LEACHING FACILITY: (type) 130 �k�IT^(size) NO.OF BEDROOMS .3 BUILDER OR OWNS PERMITDATE: COMPLIANCE DATE: 1 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility i Feet Private Water Supply Well and Leaching Facility (If any wells exist r 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) 3 Feet Furnished by Styi�',�w� ,� Zap .► P C°lip i& v 1 J TOWN OF BARNSTABLE LOCATION �d 9 F el M.e_ 4 yP SEWAGE # /'Z? VILLAGE Ali.✓SI�ti S' /47;IZS' ASSESSOR'S MAP & LOT +� INSTALLER'S NAME&PHONE NO. fLa. SEPTIC TANK CAPACITY 1 S 0 O LEACHING FACILITY: (type)()3.30 (size) NO.OF BEDROOMS �3 /J BUILDER OR OWNS i -1- Gi PERmrTDATE: COMPLIANCE DATE: qI 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 p, g 0- LM _ S irq K � r � \9 GR'c� - 277 No. � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for �Dizpoml 6pgtem C0115truction vertu Application for a Permit to Construct(,*G)Repair( )Upgrade( )Abandon( ) $[Complete System O Individual Components Location Address or Lot No. L..o Owner's Name,Address and Tel.No. —f01-0 fs{a z/ 10• 41 fLL$ Y3ca.:�•i.cI G41j r r Assessor's Map/Parcel ma &I Pe.l to P:0. ir3c"x t5 I Ce,,ho-ui Ile M4 BZ(o3ZZ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. rAYClggl�t)elz Yna-i" StA Oshroille MA 0Ze6-5!9* Type of Building: ��'&�,_ J3 /� ^�'J7 Dwelling �No.of Bedrooms (tit rce- Lot Size �. . sq.ft. Garbage Grinder(44 Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow e.44AIM at gallons per day. Calculated daily flow 330 gallons. Plan Date `��a�r Number of sheets / Revision Date m" /3./9�9 T Title 6r,A� Plot- P14 % Size of Septic Tank 1_Crc� Type of S.A.S. C`lgi#whcmg Zf_ K 1ZtX1Z1 tic Description of Soil Ptca sre v,--Arn +a, SG;I tow c.". Nature of Repairs or Alterations(Answer when applicable) Date last inspected: pidli / G e-) Agreement: A � 7 /Ze;or 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 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been isspe y lth. Signed Date f J&/ Application Approved by " Date { Application Disapproved for the following reasons Permit No. 7'- Z 7 Date Issued �� — No ?( Z7 l 'ram �•(J . i � ��-- Entered in computer: THE COMMON IN ALTFI OF MASSACHUSETTS p P IBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Yes ZippYtcation for Migogaf 6p! tem C"Mruction Permit Application for a Permit to Construct� )Repair( )Upgrade(' )Abandon( ) X Complete System El Individual Components Location Address or Lot No. 4 o,�" y Fjd„k, /fcr_ Owner's Name,Address and Tel.No. 77/-/Ofo Assessor's Map/Parcel YYIo (�l Pe f ICa P.O. t3f,�_ If$ Cckltrui((e MA 4Z(o3Z.. Installer's Name,Address,and Tel.No. - °°f�/—9-31-9 a Designer's Name,Address and Tel.No. �. ORC0,64ADea sr OSlzruiKe MA OZ&ss Type of Building: Dwelling ) ,No.of Bedrooms' Tln rcc Lot Size sq.ft. Garbage =ender,( 4 Other,X,',_,;L_Type of Building ' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow % o v gallons per day. Calculated daily flow 330 gallons. Plan Date 5/rc�/�� Number of sheets / Revision Date /jTlar /3,/9r19 Title -k al If,t- p/c,•, Size of�S:eptic Tank !SM4D f r Type of S.A.S. CAamhcey ZC:I X(ZtXZ` Description of Soil e�a� / r� �. `soil ►s ti t.1 p ., �Z// ) r 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 5of the Environmental Code and not to place the system in operation until a Certifi- ' Cate of Compliance has been�is ,e yjtt� alth. Signed Date Application Approved by " Date Application Disapproved for the following reasons Permit No. r Z 7 Date Issued ———————————————————————————————— ————— �` /O THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sew�a a Dispos Syst CoUtructed(Repaired ( )Upgraded( ) Abandoned( )by t�xaf-7L1%71�- I��,�'ti? X k� I'\} c) at ` q F L U ME 71✓F_ Al. vr!/L-L it. �— has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. '— Z 7 dated -5 Installer Designer The issuance of this permit shall not be nstruejd as a guarantee that the syst rill function as desig. d. Date Inspector I Z,/ A_�' 4� # ` ; .A ————————— No. ——————————————————Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS i� ogar gtem Con.5truction Permit Permission is hereby granted to Construct( Repair( )Upgrade( )Abandon( ) System located at / z� r Z G'WE r9✓E In. yN/LC_C. C 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. .r- Provided:Construction us a co �pleted 'thin three years of the date oft ' p rmit. / ✓� /� Date: '`T/ "1 Approved by Tolv11 Ul 11,"11.11SUIVI r n Department of Ilenilh,Safely,and EllVlrollm.entnl Services Public ilealtll J)iVlS1011 ante :7 a.�s—gam 3G7 Main Sin unis�A 0260� 1 ruawMous, 1 sure. Time / fee 1'd._ to r 1• i°J� �� Dale Scheduled �fd MIKt 'l Suitability Assessment f01' Servrrge �Dis�� Sur .Y Witnessed By: Performed By: �(� ►� LOCA'0111ij & GI I114JI A1� l 110 vrc�RN�anic Indian Lakes Dev. r. Location Address Lot 9 Flume Ave AddressP.0. Box 95 . M.M. Centerville, Ma. 0263 Cngineer's Name Assessor's Map/Pafccl: Map 61 P c 1 10 (Part) Baxter & Nye Inc. NEW CONSTRUCTION x REPAIR Telephone# 428-9131 Land Use `' �%�1 �� t' Slopes(%) d 1 Surface Stones cs from: open Water Body i2S� R Pos sible Wet Area 4 _n Drinking Water Well) =R l islnnc y So _It Other R Drainage Way_____to -n Propart Line SKETCH:(Street name,dimensions of tot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) LOT 9 R = 25.00N 2 26,537 sq.ft. L = 31.91 kP IN �r "' 171 N 85-02'10' E �� Parent material(geologic)..0O-f W Depth to Bedrock --_-_—. Ucpllr to Groundwater: Standing Wnlcr in I tole:- - wceping from.Pit face— Estimated Seasonal Iligh Groundwater -_--____-- -_----- Si?ASONAL Melhod Used: _----- ------ la. Ur.iUr to soil mottles: Depth Observed standing in obs.hole: _ .--.-------_-.__-- i ln. (iroundwatcr AdJusUncnl_--------_---,-n• Depth to weeping fiom side Jobs.hole: ---.-•.-_-.__-.— --- incicx Well# •!trading Dale:--_--- Indcx 1Ycii Icvcl A'll•f;'clor- Adj.Groundwater Lcvcl -- — I'I;atL(?f,,1.' "l:ON 1V5 ,:..:<,. .<:<.: jiaie.. llmo Observation ¢�' 2� lime At 9" _ - I laic# -- --- 3��` 'I Iwe at G" -- - Depth of rcrc _ Rn.1 P.e-.n nk'1'Inre HO .,,--.�— _..— 'ibne(9"•�") randrre-sonic --._--- --------- Bale Min./Inch -�- — --_---.----.. __.— � -- ---- Site Suitability Assessment: Site Passed Site Failed: _ - Additional Testing Ncedcd(Y/N). Original: Public licalth Division Observatlon hole Data To Be Cu'llpl'ted on Illicit Copy: Applicant R; fir, DEC1' OBSERVATION HOLE LOG Hole # s Dcplh from Soil I lorizon Soil Tcxlure Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % 1711 d r1 p 0 IM l' t t, to5t4AC� ►d d- �` GoArZs I� '2�(Co f0 o &akw") DEEP OBSERVATION HOLE LOG Holtz# Depth from Soil I lorizon Soil Texlute Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Consistency,Yifffud)- Boulderes. DECp OBSERVATION HOLE LOG ale #: Dcpth from Soil I lorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,,Boulderes. ......................... DEEP OBSERVATION HOLE LOG Hole# Dcplh from Soil Ilorizon soil'rexture Soil Color Soil Olhcr Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. e i Flood Insurance Rate Ma): Above 500 year flood boundary No Yes Within 500 year boundary No '� Yes Within )00 year flood boundary No ✓ Yes Depth of NAturally Occurrin er I aterial Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? pervious material? of natural) �— if not,what is the depth Y occurring Dery S;grtiftcation 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 performed Dy me consistent with the required training,expertise and experience described in 310 CMR 15.017. f-f� 9� C L 'TaWN, ~ f iSTABLE XrOCA.'�'It?N ` 7 �G, SE WGL i# .Y A"s5F.5SQIt'S MAP d'i VILL d - INS'TALLEWS fitAi Sz 1?flONE NQ SEVIIC TAIRK.CAPAC ecNO bF'BSIDR00MSL ~ I PR�V%�T➢ A: Cf91 �.I�SdG� 1�R►�E,�...� Sop Between ttaat`` Fit 14la ianumf�djtisZtecl Gtputtciwtttec'l'ttblt3tiqI)OttQl` OfLettt.^hm l��trtl►ty .....�,;; �,.... .�r.,. ., I'alv�4�w o Supolyllagt mitt t,.cs Gwa.8 pacat�ty Ct y �et9s ax st 7czur�6 aia slt�ae uvltti Qif Ott)f 10 hiM fucat`ty) --- I?,ctt��cyf bVet "dad Lcaclttu�y F>ttctttay(IE zany wtland5 e9s4 `; ivatia 17 f� h-o- DO :l 'f; 1.• f �`ti mum 1. THIS PARCEL IS NOT LOCATED IN THE FLOOD PLAIN. ;a. m 336=- \ w \. 2. THERE ARE NO WETLANDS LOCATED WITHIN 100' OF THIS LOCUS. 3.0, .s a.zs, e2s ? . n` , f—Y 5 'cAS"ssi S'Ta " 6 3. REMOVE UNSUITABLE SOILS BENEATH PROPOSED SYSTEM, .BACKFILL O� 216��\ WITH CLEAN GRANULAR MATERIAL FILL TO BE GRADED AS FOLLOWS: NOT 1 o . `r .�i L p `�—1—r"" pp ram^ \S MORE THAN 15% RETAINED ON No. 4 SIEVE, NOT MORE THAN 90% RETAINED ON No. 50 SIEVE, OF FRACTION PASSING No. 4, 10% OR LESS TO PASS No. 100 SIEVE AND 5% OR LESS TO PASS No. 200 SIEVE, SOIL TO BE APPROVED ��, ° l \ \ 00\f cj - - -_ BY ENGINEER FOR COMPLIANCE PRIOR TO PLACING ON SITE. FUS OF 1 4. LOCATION OF UTILITIES NOT SHOWN ON THIS PLAN, AT LEAST 72 HOURS o �f � 1 � PRIOR TO ANY EXCAVATION FOR THIS PROJECT CONTRACTOR SHALL MAKE NO SCALE `� Xx r "`"- -�.. / ' R`,= 2 :00' b THE REQUIRED NOTIFICATION TO DIG SAFE (1-888-344-7233) AND APPROPRIATE _ f 37 sue,, L 3 T.91 WATER DISTRICT TO DE INE UTILITY LOCATIOPJS. f CD �Oi DEB= DATA ! :SHED GRANE N 1 _ r C0.24PACTED FILL � � #2 SINGLE FA?i$lLY— 3, BEDROOMS �6r��h 2-r�i� pE>sr�: psp 5 rq�..ya� f p v'0 GAF-BAGS GRii: jER LOT e® .ca SQ' ISI/�0 tAll FLOW 110 X 3 = 330 G.P.D. �Onl� a 3f01 4/2=sEP;lc TA€-4K 3.30 X 200% _ 660 g :.E EWASHED`SFOP� �-6,5 3 7 s q.f t� Do l✓S_ . 1500 AL. SEP'iI. TANK -- F' 191.0 FaERABIMER R OR, �6i• N0 SCALE r t r1LY: 4='tR�S TO BE SCHEDULE �`.a PV�, PERFORATED V;PTH CAPPED ENDS i ; . USE 1 - "" D'Sll7RiBUTIOs`N LINE IN 3 RECHARtEtR .UI�IITS I CERTIFY THAT THE PROPOSED FOUNDATION lh4 112x G8' 'rA.S6•FD STONE i!RE, iHa 3r1J4's� COMPLIES WITH THE TOWN OF BARNSTABLE SIDELINE AND SETBACK REQU MENTS AND IS NOT LOCATED LEACHING AREA REQUIRED WITHIN THE FL❑❑SIRE AIN 330 G.P.D./.74 = 446 S.F. �.9 ,_ / � C ? �, r 2{°2 2 " 2 _ 152 S.F: .StDE1�YFL► AREA DATE: C5. '� -F- . R.L.S. �,t i A ' %La` `\,4;-~* l2 X 261 _ 312 S.F. OL!} fOtdt ARESTEP fy THIS PLAN I NOT BASED ON AN INSTRUMENT SURVEY AND , 454 S.F. TOTAL PP,0'41DED THE OFFSETS S ULD NOT BE USED TO DETERMINE LOT LINES. "� w ✓, = ' -� 1 = 40' t t SCALE; s i D PIT PERCOLATION RATE 1"IN 2'OR LESS 8/14/98 r r , PLAN SOIL CLASS 1 �(4=��1 ``\", ..,�cv� ^c BAXTER & NYE INC. k LOT 9 FLUME AVENUE #P-s2i 1 �-f; � � 1 COiS LOCATED TO tAfiTEElN ' MARSTONS. MILLS s" � F.G. elr z F.F. ITV. 55.0 PIT #0EHUMUS 62.2' #0 HUMUS 63.5' MAY 13 1999 Rrl 64- I F-r-64' _ MAY 10,1999 REV , ..� _ram•: -2" �` A LOAMY SAND A LOAMY SAND ' LEVEL t r` A, �a n._ :x. ... —6" —6" i2ac = fs GAL. 2' x' ELM B LOAMY SAND B LOAMY SAND sz.a s �61.s s�� Y , —� - _._s rc �r LEACHING cHAt �4s '{ — T HERRING RUN AT 1NDIAN LAKES 1.6 �•�6g,4 � g' —3' PERK TEST 3' PERK TES r lam:=61-z INV.z 61.0 t SUBDIVISION #762 ----s" STON BasE--`'""�� ASSESSORS MAP 61, PARCEL 10 I\r RAtt`. Ell C COARSE C COARSE BOTTOM ELEV. EL =59.0 J. SAND SAND BAXTER & NYE INC. 1oYR.7/6 1oYR.7/6 LAND SURVEYORS, CIVIL ENGINEERS 00 OSTERV��ILIZ MASS. FWMZ NO SCALE —11' NO WATER —11' NO WATER ELEV. = 51.2 ELEV. 52.5' BAYSIDE BUILDING CO. INC. r - ,� #97012TYP