HomeMy WebLinkAbout0195 FLUME AVENUE - Health - - 195 FLUME MARSTONS MILLS
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COMMONWEALTH OF MASSACHUSETTS
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TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION b�
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Property Address: #195 Flume Avenue
Marstons Mills,MA
Owner's Name: Carolyn Schreiner&Margaret Carra
Owner's Address: 195 Flume Avenue
Marstons Mills,MA 02648
Date of Inspection: 01/18/08 e
Name of Inspector: (please print) Mr.Carmen E.Shay
Company Name: Shav Environmental Services,Inc. �+`� z7
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Mailing Address: 185 Ashumet Road u
Mashpee,MA 02649
Telephone Number: (508)-548-0796 ea
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the inf rmation 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:
XX Passes r w �
Conditionally Passes 9.a: dog<r0,e r,
urther Evaluation by the Local Approving Authority,°}r � %'` " ����y
Inspector's Signature: Date: 01/18/08 F 11u.
The system inspector shall submit a copy of this inspection re ort to the Approving Authority(Board ofaTh�d�t� '
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of00QC •��
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
No evidence of hydraulic failure observed in SAS. D-Box level equal with outlet invert
****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 1
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: #195 Flume Aveue
Marstons Mills,MA
Owner: Carolyn Schreiner& Marearet Carra
Date of Inspection: 01/18/08
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
XX_ 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:
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Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: #195 Flume Aveue
Marstons Mills,MA
Owner: Carolyn Schreiner& MarEaret Carra
Date of Inspection: 01/18/08
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 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 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:
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: #195 Flume Aveue
Marstons Mills,MA
Owner: Carolyn Schreiner&Margaret Carra
Date of Inspection: 01/18/08
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
XX Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
XX Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
XX Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
XX Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow
XX Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
XX Any portion of the SAS,cesspool or privy is below high ground water elevation.
XX Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
XX Any portion of a cesspool or privy is within a Zone 1 of a public well.
XX Any portion of a cesspool or privy is within 50 feet of a private water supply well.
XX 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 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 II of a public water supply well
i
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.
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Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: #195 Flume Aveue
Marstons Mills,MA
Owner: Carolyn Schreiner&Margaret Carra
Date of Inspection: 01/18/08
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
XX Pumping information was provided by the owner,occupant,or Board of Health
XX Were any of the system components pumped out in the previous two weeks
XX Has the system received normal flows in the previous two week period'?
XX Have large volumes of water been introduced to the system recently or as part of this inspection ?
XX _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
XX _ Was the facility or dwelling inspected for signs of sewage back up?
XX _ Was the site inspected for signs of break out
XX _ Were all system components,excluding the SAS, located on site'?
XX _ 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?
XX _ 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
XX _ Existing information.For example,a plan at the Board of Health.
XX _ 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)]
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: #195 Flume Aveue
Marstons Mills,MA
Owner.: Carolyn Schreiner&Margaret Carra
Date of Inspection: 01/18/08
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): No [if yes separate inspection required]
Laundry system inspected(yes or no):
Seasonal use: (yes or no): no
Water meter readings, if available(last 2 years usage(gpd)):
Last date of occupancy: Currently occupied
COMMERCIAL/INDUSTRIAL
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):_
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: Pumped every two years since constructed and at time of installation
Was system pumped as part of the inspection(yes or no): Yes
If yes,volume pumped:_1500_gallons--How was quantity pumped determined? pumper volume
Reason for pumping: Maintenance
TYPE OF SYSTEM
XX 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:
February 15,2000- per Owner Records&BOH Records
Were sewage odors detected when arriving at the site(yes or no): 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: #195 Flume Aveue
Marstons Mills,MA
Owner: Carolyn Schreiner&Margaret Carra
Date of Inspection: 01/18/08
BUILDING SEWER(locate on site plan)
Depth below grade: 36"
Materials of construction: XX cast iron _XX 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: XX (locate on site plan)
Depth below grade: 12"
Material of construction: XX 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: 5' deep x 5'wide by 10' long (1500 gallon)
Sludge depth: 4.75'
Distance from top of sludge to bottom of outlet tee or baffle: 3.00'
Scum thickness: 5"Scum Laver Noted
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 12"
How were dimensions determined: Measured
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Structural integrity of tank was ok. No evidence of cracks, leaks,or water infiltration/exfiltration. 4" PVC inlet Tee present
and in good condition. Outlet Tee also in good condition. Liquid level equal with outlet invert.
GREASE TRAP:_(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: #195 Flume Aveue
Marstons Mills,MA
Owner: Carolyn Schreiner&Margaret Carra
Date of Inspection: 01/18/08
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/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: Present (if present must be opened)(locate on site 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.): No cracks noted—one outlet to trench. Top of D-box is 3 feet deep.
PUMP CHAMBER: (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_)-
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: #195 Flume Aveue
Marstons Mills,MA
Owner: Carolyn Schreiner&Margaret Carra
Date of Inspection: 01/18/08
SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:_
leaching chambers,number:
leaching galleries,number:
XX leaching trenches,number, length: 1 Trenchs—one 12' wide by 35 feet long,2' deep. Cultec 330
Infiltrators.
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.):NO evidence of hydraulic failure and ponding. SAS is 3.0 feet to top. No liquid observed in the SAS.
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 or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.):
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: #195 Flume Aveue
Marstons Mills,MA
Owner: Carolyn Schreiner& Marzaret Carra
Date of Inspection: 01/18/08
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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Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: #195 Flume Aveue
Marstons Mills,MA
Owner: Carolyn Schreiner& Margaret Carra
Date of Inspection: 01/18/08
SITE EXAM
Slope
Surface water -None
Check cellar -Yes
Shallow wells—None
Estimated depth to ground water 12+ 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:
XX 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)
XX Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Refer to plan on file by Dated 2-11-00
I
TOWN OF BARNSTABLE
LOCATIONS �'�('flQ A�eA>� SEWAGE #
V,y
VILLAGE E+_.. 1 t 1 S ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO 39 6 �-
SEPTIC TANK CAPACITY IS OC
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LEACHING FACILITY: (type) ���1( �S )L A (size)
NO.OF BEDROOMS _�aC 3'lji7A
BUILDER OR OWNER C-C� w fl
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) `� A Feet
Edge of Wetland and Leaahing Facility(If an a ds exist
within 300 feet of le Ching facility) JJ I Feet
Furnished by '
1 k + 1
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TOWN OF BARNSTABLE G
LOCATION LyT L SEWAGE # 79--
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VILLAGE �9izs�aa73 �'�� ASSESSOR'S MAP & LOT a6
INSTALLER'S NAME&PHONE NO. TR/ � ^,.+o //11o•v-*�c�,-�/ 5 -�y 7�-
SEP'ITC TANK CAPACITY ��� f �.>.►
LEACHING FACMI TY: (type) (size) / i� 3 i
NO.OF BEDROOMS !7�
BUILDER OR OWNER 13./ ys•'� v�`">�`"
PERMITDATE: /i'�u� COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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No. Fee—1—�-
7 a 13 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZippYication for
Mto Sal *proem Construction Permit
Application for a Permit to Construct(1/)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot Nr/K Flume Ave Owner's Name,Address and Tel.No.
Assessor'sMap/Parcel Marstons Mills Bayside building Co. Inc.
Map 61 Pcl P.O. Box 95 Centerville 771-1040
Installer's Name,Address,and Tel.No. 0 13. 6 Pf Designer's Name,Address and Tel.No.
��i e����/Nv Baxter & Nye Inc.
812 Main Street Osterville 428-913
Type of Building:
Dwelling No.of Bedrooms 7 Lot Size a7 311 sq.ft. Garbage Grinder(1g
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures G /,/
Design Flow �a U gallons per day. Calculated daily flow T 7 d gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank ! Type of S.A.S.
Description of Soil
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 issued b this Board of Health.
Signed Date Z ii ,'-9
Application Approved by Date -3.9 _qT
Application Disapproved for the folio ing reasons
Permit No. 79 6;- Date Issued
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Ham 1���, TOWN OF BARNSTABLE
LOCATION wT // �Gutic� >9 SEWAGE #
VILLAGE 'a�j7°'`�S y"-�t ASSESSOR'S MAP & LOT O6
INSTALLER'S NAME&PHONE NO. ��'�" ^'..o �/✓a�- `�-nJ a-7�r7 f
SEPTIC TANK CAPACITY /s�o `�•-�
�1
LEACHING FACILITY: (type) o S (size) /Z 3 i
I
NO.OF BEDROOMS
BUILDER OR OWNER 13,9 ys•�� c Ui crn :.✓�
i PERMPTDATE: ��i'�uy COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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----_----------
No. / 4��1� Fee ®4ff-1
q a 1 3 THE COMMONWEALTH',.OF,MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTH DIVISION -TOWN OF;BARNSTABLES MASSACHUSETTS
Y' ;a ' for ? ogaY *pgtem Cou5tructiott,��ern -it�_
Application for a Permit?/Ca
ermit taConstruct( V)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No/K Flume Ave Owner's Name,Address and Tel.No.
Assessor'sMap/Parcel Marstons Mills Bayside building Co. Inc.
Map 61 Pcl 1. 4:L=°} P.O. Box 95 Centerville 771-1040
Installer's Name4edress,and Tel.No. 0 3 d y Designer's Name,Address and Tel.No.
• �� ' Baxter & Nye Inc.
�4 C /T TIFA/NU � - �y7�/ 812 Main Street Oetit+eville 428-913•
Type of Building: ,.w- P
Dwelling /No�of Bedroot is'' ? Lot S,ze F 7 / sq.ft. Garbage Grinder(�q
Oth �13,1i�lding 0 No.of Persons Showers(. ) Cafeteria( )
Other Fixtures
Design Flow �C.f. '" ` ga ions per day. Calculated daily"flow 2 1#IMP gallons.
Plan Date .r; f r t/,, Number of sheets Revision Date
Title
Size of Septic Tankl): r qal-, 1�7nTyp of
Description of Soil 4�l
A Nature of Repairs or Alterations`(Answer whenapplicable) , �♦
,.
V F
Date last insp
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 Cbmpliance has been issued by this Board of Health.
Signed (`_n ✓ r,�z{ .� Date 2 a ao
Application Approved by C Date �� -�4
Application Disapproved for the follo ing reasons
Permit No. 1?9 — l,-r L.W,�— Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( V/)O'Repaired( )Upgraded( )
Abandoned( )by A 'I Y CA TC&/,VQ
at / q5- FL U-6if RVF— /b1- /Y14-t s has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. °_ c r dated
Installer Designer / o A
The issuance of thisyermlt shall not b, y g
construed as a guarantee that the s stem ,.ill function as des ne, �1'
Date rid / / r) Inspector V A �O Y�I
V er —.� ✓j
No. ^ Ll ty " Fee r i
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
;Diq;pog41 *pgtem Con.5tructtou Permit
Permission is hereby granted to Construct(Repair( )Upgrade( )Abandon( )
System located at 0 5.' K OE'j1 E A V6 M. o7 tl-L-s L\,
and as described in the above ApplicatioWfor rDisposal System Constructioh Permit. The applicant recognizes his/,her duty to
comply with Title 5 and the following local provisions or special conditions
Provided:Con*stiucticiwmust-be'completed withinal�eg years of the date of this pe t.
_
Date: � ` ��— �� Approved by � �
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Town UI D1,11.1151i1 fl)JU '
Department of llenitll,Safety,And Environmental Services
Public Health Division Date
�t+e 367 Main Street,I ly 13
02 1 )} 004
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n ,s
� a,tat+� �
MAR[!. Time fee I'd. 0
E1659-- 01 Date Scheduled
S vc J'
'l Suitabilit Assessiueut for Se►vage ,Disi�
Witnessed BY: Vf-w Iw
Performed
LUCA'I`ION & GI,IvI+.1t�1L IN OHMA.I`ION``
Owncr'sNameIndian Lakes Dev. r-
Location Address
Lot 11 Flume Ave AddressP.O. Box 95
M.M, Centerville, Ma. 0263 .
Engineer's Name
Assessor's Mnp/Parcel: Map 61 P c 1 10 (Part) Baxter & Nye Inc.
NEW CONSTRUCTION
x REPAIR Telephone# 428-9131
Land Use �j�iT'�''u'r"y'-- Slopes(/a)
Surface Stones
Distances from: Open Writer I)ody_ Aa n Possible Wet Area�c�o_n Drinking Water Well 5o c7 It
n
Drainage Way —R property Line __;Q n Other
SKETCH:(Street name,dimensions of lo(,cxnct locations of test holes&perc tests,locate wetlands In proximity to holes)
xi hNI \ 1Z
I /0\
'\ L = 9.00' '60.\
8s
'9
LOT
112 �
I .1!�h
27,347 sq.ft.
O\o.LSvn r
5
15B 7 2'
Pnrcnt material(geologic) a"TwA 414
Ucplh to Dc(imck
t +
Ucplh to Groundwater Standing Wnler in I Isle: %Ycehg from Pit 1'nce_._�—_-- i
Estimated Scasortal 11igh Groundwalcr —•_ —.----------••—
U1;'I:`><±;It111ItN��'I'I.U.1V X oR sEA80NAL H1t3I �'Y.i1.'1'ER I'A.13I.�1
Method Used: _ �` ate"_._ t2 r' In. I c tth to soil mottles: __._In.
Ucplh Observed shading in oils.hoic: —_.._._�_ t I -- n.
Dcplh to weeping front sid^of obs.ho(c:
_ in. (itc�wulwnter Adjustment _ ___-_,__ u
Indc.e Wcll Nybw`L�Rrad!itg Datc �g lodcx 14'ell Icvcl , A+Ij.Gsclor_t,O Adj.Ciroandwalcr I,cecl Il[o
— ---r -- r—...— -----._.r...
I'I�,IPC(3I,&'I"1. 1`1 ')'I�, .I, :;,..<:''�iaie�4 13 I Itnc_�a_ A-,
Observation Z I irate al 9"
Itole ----
r' n T Irate at Ci' --
1.)cplh of I've
Hrn.�rw-•oak'I'Inq R0 V u A,6 "C)_SLL>•v lime(9"-6-)
I:nJ rre-sunk sSrLnn e
t ,
' 1 nJ 2m "N
Rate Min./Inch
Site Suitability Assessment: Site Passcd site I'ailcJ Additional Testhrg Ncedcd(Y/N)
Original: Public Health Division gbsel-vatiou hole Data ro Ile completed on prick-----�
Copy: Applicant
�•�, r� #,� . to ^.
bEEI' OBSERVATION HOLE LOG:,* Hole# I
Depth from Soil Ilorizon Soil'1'exture Soil Color Soil Other
-- - _ Surface(in,) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes.
%Oravell
k Consistency.
tJ fl vo^J s
r
�! rr La S,Q03 10 2 5G(o v a
^ r
e 0A✓U,%� 10 � &�LL
to /v (�,aAVa a e
DEEP.OBSERVATION )MOLE LOG ::: - Hole#
Depth from Soil I lorizon Soil Texture Soil Color Soil
Other
(USDA) (Munsell) Mottling (Structure,Stones,Doulderes.
Surface(in.)
DEEP GIUSE'AVATION DOLE LOG
Hole#
l Other
Soil
Surface(In.) (USDA) ( )
Depth from Soil I lorizon Soil Texture Soil Color
Mottling (Structure,Stones,Doulderes.
DEEP OBSERVATION IiOLE LOG Soil Other
# other
Depth from Soil Ilorizon soil'rexlure Soil
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,loulderes.
e
Mood Insurance Rate Man:
Above 500 year flood boundary No— Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No Yes
Depth Naturally Occurrine herViOU 81tr is
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?
�ertlflcatlon
1 certify that on AAA _ (date)I have passed the soil evaluator examination approved by the
d that the above analysis was perfo ed.by mee consistent with
Department of Environmental Protection an
the required training, expertise and experience described in 31.0 CMR 15.017. V��% CJ�c -
1
L = 9 00 1'\
T E R S t STAR1 .1 :ND, a 2 n�,A�-r t -y
NOTM 4 TOTAL LINTS
1, THIS PARCEL IS NOT LOCATED IN THE FLOOD PLAIN. fr�J1
2. THERE ARE NO WETLANDS LOCATED WITHIN 100 OF THIS LOCUS. a 7.5'6.256.z56.2514.e,
3. REMOVE UNSUITABLE SOILS BENEATH PROPOSED SYSTEM, BACKFILL 1-1.5' WASIt:•D STONE
N11 ' ,
WITH CLEAN GRANULAR MATERIAL FILL TO BE GRADED AS FOLLOWS: NOT
MORE THAN 15% RETAINED ON No. 4 SIEVE, NOT MORE THAN 90% RETAINED t \ l�
ON No. 50 SIEVE, OF FRACTION PASSING No. 4, 10% OR LESS TO PASS No. - <•' =i R_5 5, rod �� � ��
100 SIEVE AND 5% OR LESS TO PASS No. 200 SIEVE, SOIL TO BE APPROVED
BY ENGINEER FOR COMPLIANCE PRIOR TO PLACING ON SITE. ' �
LC
4. LOCATION OF UTILITIES NOT SHOWN ON THIS PLAN, AT LEAST 72 HOURS FIM OF I� �, /
PRIOR TO ANY EXCAVATION FOR THIS PROJECT CONTRACTOR SHALL MAKE No scnLe ��`•— \=� ��
�• i i \ >
THE REQUIRED NOTIFICATION TO DIG SAFE (1-888-344-7233) AND APPROPRIATE #2 % \, �61 A
WATER DISTRICT TO DETERMINE UTILITY LOCATIONS. �,i#� \\60- `
LOB' 10 f \> , \ SS)4
DN DATAy / \/
SINGLE FAMILY-7 4 BEDROOMS ' 1z"i!A cc�+i'Acr� FILL - r�� ��� -
--- - --- AsrcN� dltMo
NO GARBAGE GRINDER
^! Y OW = 11O X 4 - 440 G.P.D. 3/4" ro t t/2 9
D L FL -
SE PC TANK 44 X 200% = 880 t !nASr1tT) sTCN; ��' \/`A
USE 1500 GAL. SEPTIC TANK J'� I!
CULL LZACEMIG CHAMM DMIG
MR OR ZQUN NO SCALE t
ALL PIPES TO BE SCHEDULE 40 PVC`PERFORATED
'rl3TH CAPPED ENDS N 3 11
USE 1 - 4' DISTRIBUTION LING. IN 4 R_CHARGER UNITS I CERTIFY THAT THE PROPOSED FOUNDATION I cy r\ 5 �✓�N
IN A 12'X 35' WASHED STONE TRENCH AS SHO"A 1 COMPLIES WITH THE TOWN OF BARNSTABLE SIDELINE _ _ ! 27,347 SC�.ft.
LEACHING AREA REQUIRED AND SETBACK REQUIREMENTS AND IS NOT LOCATED ` 158.72' �.
440 G.P.D./.74 = 595 S.F. WITHIN THE FLD❑ AIN, ;� 1 2(,35 _ 12) X 2 = 188 S.F. SIDEC101ALL AREA DATE: 3.• 4 --A R.L.S. y � `- ~1V85�`�D 1~Z E OPEN SPACE
{12 X 35) = 420 S.F. BOTTOM AREA 1 i'
THIS PLAN IS qQT BAS ON AN INSTRUMENT SURVEY AND
608 S.F. TOTAL PROVIDED THE OFFSETS SHO OT BE USED TO DETERMINE LOT LINES.
PERCOLATION RATE 1"IN 2'OR LESS 8/14/98 SCALE: 1"= 40' � g�
SOIL CLASS 1 MET HOLE CE D PlDT PLAN
BARTER a NYE iNC. _- �= ,"?_ :a.:._ 1A)CATIO
C04=r,5 LOCATED TO W LOT 11 FLUME AVENUE
.,,„t ,is
_a I..
.,1Tri?t !_ #P-9213 P(S., +i ,�
MARSTONS MILLS
PIT 2-F.F. E�J."_ 54.0 - PIT #1 ELc�/. = 4c,s # '_.._�V. _ 50.0' v . J ,ti DAM
=5'_'= O HUMUS 0 HUMUS � �i��
5 _ A LOAMY SAND LOAMY SAND ' �„ OCT. 12, 1999
A
MY. 'tN0 5a.L 4' � �• ' •"r - B6l0AMY SAND B6LOAMY SAND •,'� ' FUR Ecmamm
4Q.R j i? C TAh C y c?; I EACHiNG CHA;.i2iR$ _2-8" _ i z -4 S
=�c _ -?'Y'c n 11 '1� �-7-=fi_j�[f1!- _ _3_p" PERK iESC __3_fy" pFpK n�T ,o HERRING RUN AT INDIAN LAKES
v ®49.e- = SUBDIVISION 762
a�iM - 'r�N =° '�J` , j -'G ASSESSORS MAP 61, PARCEL 0
Cl COARSE _ Cl COARSE
BO i ACM ELEV. EL =47.0 }: ADJUSTED G.W.•LOT 13 SAND SAND _ �� ' ' BARTER & NYE INC.
ELEV. = 41.3' = 10YR.6/4 10YR.6/4 -� r
c•� _ �}' .SAND SURVEYORS, CIVIL ENGINEERS
OBSERVED WATER _5 C2 COARSE AND �,r, - OSTERVILLE,MASS.
_ C2 COARSE SAND S
I ?
= z - T� ���,
ELEV. 10YR.7 6 10YR..,8.8 7 �6
t / /
NO SCALE -11' -11' �• �.':;,� -� r �Yq,=
BAYSIDE BUILDING CO. INC-
/y5 #97012TYP
•