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HomeMy WebLinkAbout0092 GOOSEBERRY LANE - Health 92 GOOSEBERRY LANE, _ . 102071 �I i 1 TOWN OF BARNSTABLE LOCATION GpoS-e-Jerry L l iq SEWAGE# VILLAGE t)I6r-SkMS (ni IIS ASSESSOR'S MAP&PARCEL /0 2 _ 7 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 5 0 C) LEACHING FACILITY-(type) Lea Ch i n y C i ambers(size) NO.OF BEDROOMS 3 I' OWNER 0 r o v �G17LS PERMIT DATE: sl)r I'L C,ZZ— COMPLIANCE DATE: d Separation Distance Between the: Q(ci n S 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 Le ching Facility(If any wetlands exist within 300 feet of leach' facility) Feet FURNISHED B ' 9 z Gao s,,- beryl /11CrSlzrS /�'►i 1/S s/zo zz G,a (aD—3q, Etc- -3i cG -S,,' Z3 r 2eco- C H CS-53` r CT-q7;;�" C��'-33 ` of - , S � �3 k- r ' 13L- 33 N �- ' u No. / / Feed /�� 1[/ THE COMMONWEALTH OF MASSACHUSETTS Entered incom titer:PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpfitation for Misposal 6pstem Construrtion 3permit Application for a Permit to Construct( ) Repair(i<Upgrade( ) Abandon( ) [e'Lomplete System ❑Individual Components Location Address or Lot No. �Z 606Seb nr y ak-p— Owner's Name,Address,and Tel.No. 50 3-33a - 66ff 7 Assessor's Ma /Parcel162 h1Gr S s m ,"V ri:2-4 y I h�Cihi g P / 2 - -7/ 2 J'C(err fajL? /rIq/Sto�S fi? //S Installer's Name,Address,and Tel.No. SOS.SYa^l070 b Designer's Name,Addr ss,and Tel.No. S-p�_��j�-7733 L'L'��u��- S& a r i 4w S h o ed e. L mba-h Im Po e<x 3&Y lU �ft��riu� ✓I D257y Type of Building: 61 Dwelling No.of Bedrooms Lot Size /0 75- sq.ft. Garbage Grinder( ) Other Type of Building 1?e S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) .�Q gpd Design flow provided 3q 2 , Z SS gpd Plan Date Number of sheets Z Revision Date Title Size of Septic Tank Type of S.A.S. p��rin 1ltCGI:l�t C' /r �$ Description of Soil j o aon 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 gie Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o Health. Si Date 3/c4 J2 Application Approved by Date // _w 2Z Application Disapproved by Date for the following reasons Permit No. — j y b Date Issued /1 Zp Z Z i No. ' r Fee THE COMMONWE OF MASSACHUSETTS Entered incom}uter: Ye `'PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS r ' application for 3dermit ; Application for a Permit to Construct( ) Repair(vy"Upgrade( ) Abandon( ) EaComplete System ❑Individual Components N:1 -In Location Address or Lot No. _2 16G6.Sc{�p��y Lu Owner's Name,Address,and Tel.No. 50 3_33a - 66,1 7 0 Assessor's Map/Parcel k a/ s-Fr.�s a7� !r � �'�fo-C y r7 //ul/9 /j61)1 S (- ,- /n / rlX� fi� -- Installer's Name,Address,and Tel.No. 54)S-Sy JC�, Designer's Name,Address,and Tel.No. 14k� Site Qnd f s—"P ,G L4L, Tj= LG01dars- OU_44..Qz6_Pj=_. JOi_, /0 9 -7733 Type of Building: 0 2 53(� Dwelling No.of Bedrooms Lot Size f��T 5: sq.ft. Garbage Grinder( ) Other Type of Building o�, , ,Q n,�, Q No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) _� ✓, gpd Design flow provided . �/-� 2!�;7 gpd Plan Date �_ Number of sheets 7 Revision Date Title Size of Septic Tank ,t Type of S.A.S. Description of Soil /�r Nature of Repairs or Alterations(Answer when applicable) " �! (/yj _ � �, �/"/.» 'S 04-21,l 'A,' o _ 14- 2�0 lf, 0 ;j,;4,ij-j Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign Date Application Approved by Date Application Disapproved by Date for the following reasons J Permit No. �,� 7 -- 1 (.� %� Date Issued 1 � -'-------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by 4 i 14 at ) has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.7071' )C44 dated Installer A�- I.0 C� � �z� a !. (i;m I��vvt qbesigner �1+���/J t#bedrooms Approved design flow :;,TJ 7 . gpd � The issuance of this permit shall not be construed as a guarantee that the system will ct�ion as'designed. Date _S'I J t�� i ? Inspector ,l 1 ,.n,v J, •No.Znz I Fee J�pm r THE COMMONWEALTH OF MASSACHUSETTS ;PUBLIC'- HEALTH-D-IVISION BARNS_TABLE..MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ,/) Upgrade( ) Abandon( ) System located at q 6✓,i c92 1,T��� and as described in.the above Application for Disposal System Construction Permit. The applicant recognized 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 1 I �� Approved by Town of Barnstable Inspectional Services Public Health Division Thomas McKean,]Director z6ss • po x" 200 Main Street, Hyannis,MA 62601 i Office: 50M624644 Fax: 508.79"304 Date: Cn quo;;L- Sewage Permit# 2o22-M- Assessor's Map/Parcel lag Y71 Installer&Designer Certification Form Designer: ZE-W ors.- �e- C[C.Cufy C ey, A� Las#slier•. ,�k' S��-P o�d�,p� j ,Address: } 3Q( d6q Addresst CuesfiLr , c ts5 `f �►s+ , . mark;rraa z s3 i �Am fi• �ferf"rs�n I On .S1J �i?d 2 �}d-1-< v''j C: n�I� r(- was issued a permit to install a We) (installer) . septic system at }2 " oo s Am m3 based on a design drawn by i (ad ) -0 CGnG `�Ci' zyLeuF dated " Is/ , (die.) I cent" that the septic certify that p system referenced above was installed substantially according-to the design, which may include mirror approved changes such as lateral-relocation of the distribution box and/or septic tank. Stripout(if required)was inspected and the soils,were .found satisfactory. i I"certify that the septic system referenced above was installed with major changes (i.e. greater than 1.0' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to hallow. Stripout(if required)was inspected and the soils were found.satisfictory,. I certify that"the system referenced above was constructed' with the terms of the I/A approval letters(if applicable). a � JOHN yGN LANDERS•CAHLEY (Installer's Si dVIL No.35101 • FF�,�jONS�E����F; si a gnat ( Des Here) PLEASE RE TO.BAkNSTABLE PUBLIC HEALl Dt'MTON CERTII�'ICATE OF COMPLIANCE WELL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC.HEALTH DIVISION THANK YOU. q:\officohnns\deWgmnwbficatonfomidw Town of Barnstable Health Inspector oF1HE Tp� Office Hours . do Regulatory Services 8:30—00 Thomas F.Geiler,Director 1:00—2:00 * saxtvsTna[.E. 9� ; 1e� Public Health Division ArE p►��A Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: '; ,9 O-te-Q— Address: q Z i r iJMap I0 - Parcel 0-7 Name: SR4LPhone #: 7 3 -7 2a. How many bedrooms exist at your property now? 2b. Are you planning to add any bedrooms? If yes, how many? 2c. How many bedrooms total are proposed at this property (including the amnesty unit)? 2d. Please include a copy of the floor plans for the entire property- showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or NO If the dwelling is connected to public sewer,skip questions#4 through#9 below. 4. Location of dwelling is NSIDE or OUTSIDE a Zone of Contribution to public supply wells? 5. Is the dwelling connected to an ONSITE WELL . or to PUBL WA )R? 6. Is a disposal works construction permit on file? YES or NO 6a. If yes,how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? ' YES or NO 8. Is there an engineered septic system plan on file at the Health Division? YES =or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years'' YES Nr _NO - ------------------------------------------------------------------------------------------ -------= ------------- FOR OFFICE USE ONLY '" The Public Health Division has no objection to bedrooms at this pro erty. t Special Conditions: �'� a,os� 3 tie �,af-s AA*701.�,,J, r i M Signed: Date: Q;/health/wpfiles/amnestyapp TOWN OF BARNSTABLE' LOCA'.TION 2Agon SEWAGE # ? =:Y.tIii:AGE_ - . /'JI /�S ASSESSOR'S MAP&LOT .�INSTAI,LER'S NAME&PHONE NO.__nod��S�n- 7`�S•— SEP`nC TANK CAPACITY izA mG FAcmrrY: (type) 4�G 4t �� /�t (size) ` QF$EDR9AM& :SU ER OR OWNER ,07,44,</6 FRRITTDATE: /"�/`'s 'I COMPLIANCE DAZE: :;. Se aiatioa Distance Between the: Maximum Adjusted Groundwater Table `ltom of Leaching Facility Feet Pvate Water Supply Well and Lear ' g Fatty (If any wells exist on site or within 200 feet of to g fag Feet edge of Wetland and Leachin acility(If any we exist within 300 feet of leac ' facility) Feet fu Li3hed by t ` t: • COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON.M.A 02109 617-292-5500 WILLIAM F.WELD TRUDY Governor Se ARGEO PAUL CELLUCCI DAVID H.S" Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commi PART A CERTIFICATION 92 Gooseberry Lane Property Address: Marstons Mills, MA ' Address of Owner: Louis Cataldo Date of Inspection: /3_— 2- Q r1 (If different) Name of Inspector: Wan E Robinson Sr . I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR.15.000) Company Name: WM E Robinson Septic' service Mailing Address: PO Box 1089 , CentP_rvi 1 1 e.,-MA 02632 Telephone Number( 5 0 8; 7 7 r_R 7 J CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal-system at this address and that the information reported below is true, acci and complete as of the time of inspection. The inspection was performed based on my training:7nee-+ . roper function maintenance of on-site sewage disposal systems. The system: Passes Q / _ Conditionally Passes - �. Needs Further Evaluatiori•By the Local Approving Authority Fails Inspector's Signature: e.4g ► t — Date: Ak The System Inspector shall-submit a copy of this inspection report to the Approving Authority within'thirty(30) days of completing this inspection. If the system is a shared system or has'a design flow of 10,000 gpd or greater, the inspector and the system owner shall su the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AI SYSTEM PASSES: ' I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 1' AAy failure criteria not evaluated are indicated below. COMMENTS: BI S TEM CONDITIONALLY PASSES: _- - One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The systen completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes,no, or not determined (Y, N,or ND). Describe basis of determination in all instances. If"not determined", explain why _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certifical Compliance (attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspec the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic as approved by the Board of Health. (revised 04/25/97) page 1 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -PART A CERTIFICATION (continued) Property Address: 92 Gooseberry Ln, Marstons Mills Owner: �t�d�� Date of Inspection: B)SYSTEM CONDITIONALLY PASSE$ tcontinued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or'due to a,broken, settled or uneven distribution box. The system will pass inspection if(with approval of 0 Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed , distribution box is levelled or replaced The system required pumping more than four times a year due to,broken or obstructed pipe(s). The system will pas! inspection,if(with approval of the Board of Health): < broken pipe(s) are replaced obstruction is removed _ vt URTHER EVALUATION 15 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 prote public health, safety and the environment. 1) SYSTEM WILT, PASS.UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANS WHICH WILL.PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: ^ Cesspool or.privy is within 50 feet of a surface water Cesspoof or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water suF tributary to a surface water supply. i I , _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply wi _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply we _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from private.water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indica the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equi less than 5 ppm. Method used to determine distance (approximation not valid). 3) POTHER , I .. . oY# ,.A };. a A .• s .. i 'F•• sic •`. �+_' • ` • 9 wi A r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A' CERTifICATION (continued) 3perty Address: 92 ,Gooseberry Ln, Ma.rstons Mills vner: Cataldo ite of Inspection: SYSTEM FAILS:. " .0 must indicate ei;r;er "Yes" or "No" as to each of the following: 1-have determined that the system violates one or more of.the following failure criteria as defined in 310 CMR 15-.303. The basis for this determination is identified below. The..Board of Health should be contacted to determine what will be necessary to correct the failure. es No Backup of sewage into facility or system component due•to an overloaded or clogged SAS or cesspool. Discharge'or pbnding of effluent to the surface of the ground or surface waters due to an overloaded or clogged-SAS-or cesspool, Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS-or cesspool. _ Liquid depth in cesspool is less than 6" below invert or available volume.is less than 1/2 day-flow, Required pumping,more than 4.times in.the last year NOT. due to clogged or obstructed pipe(s). Number of-times pumped-_. <: Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation,. _ Any portion of a cesspool or privy is within 100 feet.of a`surface water.supply or tributary td a surfaceMater supply. Any portion of a.cesspool or privy is within a Zone I of a public well. r' _ -Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool of privy is less than'100 feet but greater than•50 feet from a private water supply well with no- acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. j LAR _ SYSTEM'FAILS: ` 'ou-mu indicate.either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large.System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: (es 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) The owner or operator of any,such system shall bring the.system and facility into full compliance with the groundwater treatment program r irements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/3S/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST 'roperty Address: 92 Gooseberry Ln, Marstons Mills owner. Cataldo )ate of Inspection: heck if the following have been done: You must indicate either"Yes" or"No" as to each of the following: Ye ( No i_ _ Pumping information was provided by the owner, occupant,,or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been.introduced into the system recently or / as part of this inspection. V _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back=up. _ The system does not receive non-sanitary or industrial Waite flow. The site was inspected for signs of breakout. _ 1/ All system components, excluding the.Soil Absorption System,.have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected.for condition-of. baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge, depth of scum. / The size and location of the Soil Absorption System on the site has been determined based on: The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of- Sub-Surface Disposal System. Existing information. Ex. Plan at-B.O.H. _ Determined is the field.(if any of the failure.criteria related to Part C is at issue,-approximation of distance 'is unacceptable) [I5.302(3)(b)] (s*vix*d 04/2S/97) page 4 of 10 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 92 Gooseberry Ln, Marstons Mills Owner: Cataldo Date of Inspection: /.'L—g— '7 'f FLOW CONDITIONS RESIDENTIAL: Design flow: Yy0 Q.p.d./bedroom for S.A.S. Number of bedrooms:-3— Number of current residents:!--� Garbage grinder{yes or no):_.&a Laundry connected to system (yes or no):�A Seasonal use (yes or no):A 0 ' Water meter readings, if available (last two(2) year usage(gpd): 1995 — 70,U00gals Sump Pump(yes or no): 1996 - 6 7,0 0 0 ga i s Last date of occupancy: CQMMERCIALAND STRIAL: Type establishment: Design aw:,,gallons/day Grease t p present: (yes or no)_ f Industrial Waste Holding Tank present: (yes or no)____ -- Non-rani ry waste discharged to the Title 5 system: (yes or no)� Water ter readings, if available: Last Lteof occupancy:OTHEescribe) Last d occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information:' - _ _ System pumped as"part of inspection: (yes or no) If yes, volume:pumped:I0*-4 zgallons - - - Reason for pumping: tir _ a TYPE OF JYSTEM ptic tank/distribution box/soil absorption system Single cesspool Overflow cesspool - r Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) -• - VA Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known)and source of information: —it 7, Sewage odors detected when arriving at the site: (yes or no) (roviaed 04/25/97) Gaga S of 10 T SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 92 Gooseberry Ln, Marston Mills Owner: Cataldo Date of Inspection: /;--A 1 '7 a ING SEWER: (Locat on site plan) -Depth low grade: Material of construction: _cast iron 40 PVC _other (explain) Distan from private water supply well or suction line Diam er Com nts: (condition of joints, .`venting; evidence of leakage, etc.) SEPTIC TANK:? (locate on Bite plan) Depth below grade: " Material of construction: , oncrete _metal Fiberglass _Polyethylene —other(explain) if tank is metal, list age_ is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: ^t Sludge depth: 12 - Distance from top of sludge to bottom of outlet tee or baffle:•g Scum thickness: M I Distance from top of scum to top of outlet tee or baffle:_ %V Distance from bottom of scum to bottom of outlet tee or baffle:_ How dimensions were determined: 4 10 •2`3—T1'+�^ Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leak ge, etc.) 16 D--0 1747 .4. . GREAS TRAP: (locate site plan) , Depth be ow grade: Material f construction: concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensi ns: Scum t ckness. Dista a from top of scum to top of outlet tee or baffle: Dis ce from bottom of scum to bottom of outlet tee or baffle: -Date o last pumping Com s: (recomm ndation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relationto outlet invert,structural integrity evidence of leakage, etc. tzavimod 04/25/97) Page 6 of 10 r l - : SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) -Property Address: 92 Gooseberry Iq , Marstons .Mills .Owner. Cataldo Date of Inspectign: fi TI OR HOLDING TANK: (Tank must be pumped prior to,or at time, of inspection) (locate n site plan) Depth„bel grade: Material of nstruction: _concrete—metal__Fiberglass _Polyethylene _other(explain) Dimensio s: Capacity gallons Desig ow, gallons/day Alarm ' el: Alarm in working order_ Yes; _ No Date of p vious pumping: Comment (condition f inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: - (locam on site plan) Depth of liquid level above outlet invert: Comments: -` (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUM CHAMBER_ (locate n site plan),. - - - Pumps working order: (Yes or No) Alarm working order(Yes or No) C.omme s: (note ition of pump chamber.condition'of pumps and appbrtenance`ss,:etc:) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued ) Property Address: 92 Gooseberry Ln°, Marstons - Mills— Owner: Cataldo Date of Inspection: / 2 �9 7/ SOIL ABSORPTION SYSTEM (SAS)`✓ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)' If not determined to be present, explain: T r YPe' leaching pits, number: µ w leaching chambers, number: leaching galleries, number: - leaching trenches,number,length:y r5 leaching fields, number, dimensions: overflow cesspool, number: ` Alternative system: r Name of Technology: Comments: - (note condition of soil, signs of hydraulic failure,r level of ding,condition of vegetation, etc.) • f CE POOLS: _ (loca eon site plan) Num r and configuration: Depth top of liquid to inlet invert: Depth of solids layer: r Depth of scum layer: a Dimei sions of cesspool: - Mater Is of construction: - - lndi ion of groundwater: inflow (cesspool must be pumped as part of inspection) Comjcdition s: ` (note of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc:) ` PRIVY '0 on site plan) a rials of construction: Dimensions: Dep of solids Co nts: (not condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (swiaad 04/25/97) Page a of 10 I SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 92 Gooseberry Ln, Marst_ons Mills Owner: Cataldo Date.of Inspection: ) •� 3-— Q 7 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (locate where public water supply comes into house) 3 G I 014 � o ' k (revised 04/2S/97) Psge 9 of to SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM'INFORMATION (continued) Property Address: 92 Gooseberry Ln, Marstons Mills f Owner: Gataldo Date of Inspection: Depth to Groundwater A Feet Please indicate all the methods used to determine High Groundwater Elevation: { Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established.the High Groundwater Elevation. Must be completed? �e.�a1 l�tsls ) 4 ► ., 9 *7 4 (revised 04/25/97) Paso 10 of 10 Gy PART C SYSTEM INFORMATION(continued) Property Address: 92 GOOSEBERRY LANE MARSTONS MILLS, MA 02648 M102 P071 L49 F Name of Owner STEVE FANGEL Date of Inspection: 8R100 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within I (Locate where public water supply comes into house) .1 4c B O oi� 9e Yct,.rh QQ L /�3? AC c 37 revised 9n= Page 10 of 11 I ! I I I ! --l-1111 i i f � CIO _ _ ►� I I �___ _ ! _�� �` �_ __ ! ' i � Ii � ii i i i _, � � k I f I I ) I I ► E I � ► � � � � I I i I r �i�I_ i ii I i ' ! ' � ! I I 1I . _ i i � I _ r i � � � � i 1 I ! lI � � - i ! I � I _1 _ I ._ � � _-�- �-�-- I I ! - k I I i ` -- _4 f _ __�____. i i i � I - I � - - I_ I _ I ► l ! !( S _� ! � { - � - _- i .._._.... I l _ _ 1 i �� I L 1 I - - I I I ( - .I - - TT /1 I ! I I I r I - 1 moo it tilt I I F 7 + 1 I f1 i • . .:_.___�. _ � _� _ _ I �_ � I 1 � - i _ � 1 f - I � I _ � , l - .� ; � , I _ - � _ .- _� _ - i ' .� . _. � � I _ . - -- � . I 1 I I � I i I � � , i � �- - -- �! � f � I I i i � ! ! I l _I _ i I I ( I ( - � 1 i I ! I ' 1 i � I Ii �-� � _ ! I1 ! ! iI I ii , I ! i , � � � P. 1 COMMUNICATION RESULT REPORT ( MAY. 3.2006 9:42AM ) TTI BARNSTABLE BOARD OF HEALTH .FILE MODE OPTION ADDRESS (GROUP) RESULT PAGE ---------------------------------------------------------------------------------------------------- 416 MEMORY TX ECNMC DEV OK P. 2/2 ---------------------------------------------------------------------------------------------------- REASON FOR ERROR E-1) HANG UP OR LINE FAIL E-2) BUSY E-3) NO ANSWER E-4) NO FACSIMILE CONNECTION 'own of Barnstable Regulatory Services s Thomm F.Qeiler,Director Public Health Division Thomas McKean,Director 200 Main Street, His,MA 02601 DATIZ: NUMBER OF PAGES TO FOLLOW: / . TO-; lvx� PHONE; PHONE: 08)962.4644 FAX PHONE: FAX pHONT: (sob)790-6344 , ce, f RECEIVfED S E P 2 2 2000 COMMONWEALTH OF MASACHUSETTS TOWN OF BARNSTABLE EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS HEALTH DEPT. DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 92 GOOSEBERRY LANE MARSTONS MILLS, MA 02648 M102 P071 L49 Name of Owner STEVE FANGEL Address of Owner: 92 GOOSEBERRY LANE MARSTONS MILLS,MA 02648 Date of Inspection: 917/00 Name of Inspector: JOHN GRACI /am a DEP approved system inspector pursuant to Secdon 15.340 of Tide 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636 Telephone Number: 608-664-6813 FAX 608-664-7270 CERTIFICATION STATEMENT 4 v: I certify that I have personally inspected the:sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date:9/11/00 The System Inspector shall subm' a copy of this Inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the Inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS "The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life" THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING THE EVERY TWO YEARS'PTO PROLONG THE SYSTEM'S USEFULL LIFE. a; S E P 2 2 2000 . TOWtiOFBARNST H`..AL:?i DEPT. revised 9/2/98 Page 1 of 11 t t l r f f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 92 GOOSEBERRY LANE MARSTONS MILLS, MA 02648 M102 P071 L49 Name of Owner STEVE FANGEL Date of Inspection: 917100 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If'not determined",explain why not. n1a The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was Installed within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not metal,is cracked,structurally unsound,shows substantial Infiltration or exriltration,or tank failure is imminent.The system will pass inspection if the existing septic tank Is replaced with a complying septic tank as approved by the Board of Health. n/A Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _broken pipe(s)are replaced _obstruction is removed _distribution box is levelled or replaced n1a The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if (with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 92 GOOSEBERRY LANE MARSTONS MILLS, MA 02648 M102 P071 L49 Name of Owner STEVE FANGEL Date of Inspection: 917/00 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: 5 Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS.UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water 1. _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS Is within 50 feet of a private water supply well, r _ The system has a septic tank and soil absorption system and the SAS Is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that.the well is free from pollution m that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance n&(approximation not valid). 3) OTHER n/a revised 9/2/98 Page 3 of 11 ',:SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 92 GOOSEBERRY LANE MARSTONS MILLS, MA 02648 M102 P071 L49 Name of Owner STEVE FANGEL Date of Inspection: 917100 D. SYSTEM FAILS: You must indicate either"Yes"or'No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. - X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet Invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool Is less than 6"below Invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nla. - X Any portion of the Soil Absorption System;cesspool or privy Is below the high groundwater elevation. - X Any portion of a cesspool or privy,is within 100 feet of a surface water supply or tributary to a surface water supply. - X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy iv within 50 feet of a private water supply well, - X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or'No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system Is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No - X the system is within 400 feet of a surface drinking water supply - X the system is within 200 feet of a tributary to a surface drinking water supply - X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system In accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 92 GOOSEBERRY LANE MARSTONS MILLS, MA 02648 M102 P071 L49 Name of Owner: STEVE FANGEL Date of Inspection: 9/7/00 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X _ Pumping information was provided by the.owner,occupant,or Board of Health. X _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not.been introduced Into the system recently or as part of this Inspection. X _ As built plans have been obtained and examined.Note if they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. X _ All system components,excluding the Soil Absorption System,have been located on the site. X _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X _ Existing information,For example,Plan at B4O,H, X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)J X _ The facility owner(and occupants,If different from owner)were provided with information on the proper maintenance of Subsurface Disposal Systems. f revised 9/2198 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 92 GOOSEBERRY LANE MARSTONS MILLS, MA 02648 M102 P071 L49 Name of Owner STEVE FANGEL Date of Inspection: 9/7/00 FLOW CONDITIONS RFSIDENTIAI: Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 2 Number of bedrooms(actual):n/a Total DESIGN flow: 220 gpd Number of current residents:3 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a C OM M ERC IAL/I N DUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: n/a System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYPE OF SYSTEM X Septic tankidistribution box/soil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system(yes or no)(if yes.attach previous inspection records,if any) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a " APPROXIMATE AGE of all components,dateeiInstalled(if known)and source of Information: NEW LEACH FIELD IN 1997 Sewage odors detected when arriving at the site:(yes or no). NO revised 9/2/98 Page 6 of 11 5; SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 92 GOOSEBERRY LANE MARSTONS MILLS, MA 02648 M102 P071 L49 Name of Owner STEVE FANGEL Date of Inspection: 917/00 BUILDING SEWER:X (Locate on site plan) Depth below grade: 10" Material of construction: _ cast iron X 40 Pvc _ other(explain) Distance from private water supply well or suction line: n/a Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.) TOWN WATER SEPTIC TANK: X (locate on site plan) Depth below grade: 2" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 1000G L 8'6"H 5'7"W 4'10"' Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness: 1" 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: n/a How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS. GREASE TRAP: (locate on site plan) Depth below grade: n1a Material of construction: —concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a Comments: (recommendation for pumping,condition of Inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) nla revised 9/2/98 Page 7 of 11 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 92 GOOSEBERRY LANE MARSTONS MILLS, MA 02648 M102 P071 L49 Name of Owner STEVE FANGEL Date of Inspection: 9/7/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:N/A Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:X (locate on site plan) A, Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage Into or out of box,etc.) THE DISTRIBUTION BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a i +4 revised 9/2198 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 92 GOOSEBERRY LANE MARSTONS MILLS, MA 02648 M102 P071 L49 Name of Owner STEVE FANGEL Date of Inspection: 9/7100 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(1)1000 GAL 6 X 6 leaching chambers,number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number,length: (1)60 leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE NEW LEACH TRENCH APPEARS TO BE FUNCTIONING PROPERLY. THE SYSTEM SHOWS NO SIGNS OF FAILURE.SOIL PROBED DRY. CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of Inspection)NO Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a U.4 PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 9/2198 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 92 GOOSEBERRY LANE MARSTONS MILLS, MA 02648 M102 P071 L49 Name of Owner STEVE FANGEL Date of Inspection: 917100 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within I W(Locate where public water supply comes into house) 1A 1r1c Our B o • LL7—Lk b x4 Tc��rh QA V /AftTV 3-7 Ar- ab1Sy revised 9/2198 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 92 GOOSEBERRY LANE MARSTONS MILLS, MA 02648 M102 P071 L49 Name of Owner STEVE FANGEL Date of Inspection: 9/7/00 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 10 Feet+ Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions Checked with local Board of health _ Checked FEMA Maps Checked pumping records Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-10+FEET revised 9/2/98 Page 11 of 11 TOWN OF BARNSTABLE` LOCATION �o{ CC nSr4 4 R A v 4 SEWAGE # 7 VILLAGE' /'l� / ��s ASSESSOR'S MAP& LOOT r t INSTALLER'S NAME&PHONE NO. `� .S e'= ��"" Cl SEPTIC TANK CAPACITY LEACHING FACILITY: (type) � 6' 4C �� `ti t (size) NO.OF BEDROOMS 3 /, BUILDER OR OWNER�,.0 f'��1' � PERMTTDATE: f/�'. 'I COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table Bottom of Leaching Facility Feet 4t' Private Water Supply Well and Leac ' g Facility (If any wells exist on site or within 200 feet of le ng facility) Feet Edge of Wetland and Leachin acility(If-any wetlands exist within 300 feet of leachi g facility) Feet Furnished by r t�� 6 Z 07 ( r No. t2 Fee$ T� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppricatton for �Dtgogar *p5tem Con!5tructton Permit Application for a Permit to Construct( )Repair(x )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 92 Gooseberry Ln Owner's Name,Address and Tel.No. 4 2 0—5 71 1 Assessor'sMap/Parcel Marstons Mills Louis Cataldo 107- 071 Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. Wm E Robinson Sr Sept Sry PO Box 1089 , Centerville, MA Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(no) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil -,and Nature of Repairs or Alterations(Answer when applicable) Title 5 Leaching trench ( 60 ' ) 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 by this B azd.,df Health. Signed t' DateApplication Approved Approved by r Date Application Disapproved for the following reasons Permit No. Date Issued �, No. Fee � — � y � �THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0[pprtcation for Mtgpoear 6potent Conotructton Vef`ntit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components ti �• Location Address or Lot No. Owner's Name,Address and Tel.No. 4 2 0—5 71 92 Gooseberry Ln Assessor'sMap/Parcel Marstons Mills _-.,Louis Cataldo /0z- o 7 1 Installer's Name,Address,and Tel.No. 7 7 5_8 7 7 6 Designer's Name,Address and Tel.No. Wm E Robinson Sr Sept Sry PO Box 1089, Centerville, MA Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(nq Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures s Design Flow gallons per day. Calculated daily"flow gallons. Plan Date Number of sheets Revision Date Title _ Size of Septic Tank Type of S.A.S. Description of Soil sand Nature of Repairs or Alterations,(Answer when applicable) Title 5 Lear_-fit not trench ( 60 ' ) -4 � 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 by this Bgardof Health. ' -.,- Signed Date /'—,; Application Approved by. ---Date Application Disapproved for the following reasons `6 / ) r Permit No. Date Issued r ——————— ————————— ——— ————— —————— THE COMMONWEALTH OF MASSACHUSETTS #WB•ARNSTABLE, MASSACHUSETTS ' Cataldo Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( ) Repaired (XX)Upgraded( ) Abandoned( )by at 92 Gooseberry Ln Marstons Mills ha been constructed in accordance l" with the provisions of Title 5 and the for Disposal System Construction Permit No. _- ated (~Installer Wm E Robinson Sr Sept Sry Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. -� Date �.m 1 Inspector No. .[ /� �� -------------�------ -----Fee $50.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Cataldo izpogai *pztem Construction Vermit Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( ) System located at 92 Gooseberry Ln _. .,. Marstons Mills "Tnstall' r : WmE Robinson Sr Sept Sry 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 jbe completed within three years of the date of this rmit. �J Date: L �l Approved by �% r , f NOTICE-: This Form Is To Be Used For the Repair Of Failed Septic Systems- Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I,- William E. Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed by me dated ­7 ,concerning the property located at 92 Gooseberry Ln, Marstons Mills, MA, meets all of the following criteria- * ��re are no wetlands within 100 feet of the proposed leaching facility. * are no private wells within 150 feet of the proposed septic system. * ' ere is no increase in flow and/orxhange in use proposed. *LT ere are no variances requested or needed. * If the proposed leaching facility will be located with 250 feet of any wetlands,the bottom of the proposed leaching facility will ngtbe located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) B)Observed Groundwater Table Evaluation(according to Health Division well map)—9� 1 SIGNED: y DATE LICENSED SEPTIC SYSTEM-INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60 (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). t L � 2- A Z 203 498 867 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use fQr International Mail Seereverse) Sent t Street&Number Post Office,State,&ZIP Code Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee u') Return Receipt Showing to Whom&Date Delivered a� Return Receipt Showing to Whom, a Date,&Addressee's Address 0 TOTAL Postage&Fees Is 7 M Postmark or Date LL V) a i Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the m cc return address of the article,date,detach,and retain the receipt,and mail the article. LO 3. If you want a return receipt,write the certified mail number and your name and address M on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article Q RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the O O addressee,endorse RESTRICTED DELIVERY on the front of the article. M 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. li 6. Save this receipt and present it if you make an inquiry, t o25s5-s7-B-oi 45 U) Town of Barnstable Department of Health, Safety, and Environmental Services BARNSTABM MASS. Public Health Division •s639 Eo39 °r 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A McKean,RS,CHO FAX: 508-790-6304 Director of Public Health October 8, 1997 Louis G. and Nancy L. Cataldo 92 Gooseberry Lane Marstons Mills, MA 02648 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 92 Gooseberry Lane, Marstons Mills was inspected on April 29, 1997 by John Graci, a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: • The leaching pit was full of wastewater effluent to the top, above the effective depth level for leaching. You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within(60) sixty days of receipt of this notice. You are also directed to bring the septic system into compliance within ninety (90) days of receipt of this order letter by installing a replacement leaching facility. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. tDmasA. RDER OF THE BO RD OF HEALTH McKean, R.S., C.H.O. Agent of the Board of Health q\health\dbfiles\title5i.doc Town of Barnstable Department of Health, Safety, and Environmental Services + BARN9TABLE, • public Health Division 9 MA99. i639' �� A'F1639 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health TO: �Snc L• �'atl�0 2 c, DATE: d2�o4°$ ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 92 �p� Z.aw-- was inspected on .0,C)q" 29/0 7 by a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: eve „e lave You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within444)-en days of receipt of this notice. C6� S:/ You are also directed to bring the septic system into compliance within thhAt{3-0}days of receipt of this order letter. /,e e.c( -•�5 �c c l l� You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health q%WmwAnnwuUi.aa Commonwealth of Massachusetts .John Grad Executive Orrice of Environmental Affairs D.E.P. Title V Septic Inspector Department of P.O. Sox 2119 Teaticket, MA 02536 MEnvironmental Protection (508) 564-6813 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION RfcE�vu 92 Gooseberry Lane Marstons Mills Address of Owner: a Property Address: Y MAY Date of Inspection:4122197 (if different) 1 -199,7 ~' Name of Inspector:John Gracl Cataldo OWN�F �+ BARNSTgg(E Company Name,Address and Telephone Number: �Ty�fPT Z t CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ Passes This Inspection Is based on criteria defined In Title V code 310 CMR 15.303.My findings are of how the system is _ Conditionally Passes performing at the time of the Inspection.My Inspection does Needs Furt r E luation By the Local Approving Authority not Imply any warranty or guarantee of the longevity of the X= Fails septic system and any of its components useful life. Inspector's Signature: Date: 4/29197 The System Inspector shall s mit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B,C,or D: AJ SYSTEM PASSES: _I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. BJ SYSTEM CONDITIONALLY PASSES: _One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined", explain why not.) _ The septic tank is metal, cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is Imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11115195) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 92 Gooseberry Lane Marston Mills Owner: cataldo Date of Inspection:4122197 _ Sewage backup or breakout or high static water level observed in the distribution box is due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced —The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public water supply well. . . The system has a 9we#tilc tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm. 3) OTHER D] SYSTEM FAILS: _ I have determined that the system violates one or more of the following failure criteria as defined in 3W CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool. X SAS is in hydraulic failure. (revised 11115195) 2 ill , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 92 Gooseberry Lane Marstons Mills Owner: Cataldo Date of Inspection:4122197 D] SYSTEM FAILS(continued) Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6°below invert or available volume is less than 1/2 day flow. _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria: _ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11115195) 3 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CH ECLIST Property Address: 92 Gooseberry Lane Marston Mills Owner: Cataldo Date of Inspection:4122197 Check if the following have been done: X Pumping information was requested of the owner,occupant, and Board of Health. X None of the system components have been pumped for at least two weeks and the and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. n1aAs built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge, depth of scum. X The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11115195) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 92 Gooseberry Lane Marstons Mills Owner: Cataldo Date of Inspection:412T197 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 gallons Number of bedrooms: 3 Number of current residents: 4 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available: rda Last date of occupancy: nla COMMERCIAL/INDUSTRIAL: Type of establishment: n1a Design flow:o gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present: (yes or no) No Non-sanitary waste discharged to the Title 5 system: (yes or no) No Water meter readings,if available: n1a Last date of occupancy: n1a OTHER:(Describe) n1a Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System was last pumped in 1996 System pumped as part of inspection:(yes or no)No If yes,volume pumped: 9 gallons Reason for pumping: n1a TYPE OF SYSTEM Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes,attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source information: approximately 15 years. Sewage odors detected when arriving at the site:(yes or no) No (revised 11115195) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 92 Gooseberry Lane Marston Mills Owner: Cataldo Date of Inspection:4122197 SEPTIC TANK: X (locate on site plan) Depth below grade: 2' Material of construction:X concreate_metai_FRP_other(explain) Dimensions: L 9'6'h 5'7'W 4'10" Sludge depth:2' Distance from top of sludge to bottom of outlet tee or baffle: 25' Scum thickness:2' Distance from top of scum to top of outlet tee or baffle:6' Distance form bottom of scum to bottom of outlet tee or baffle: 16' Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) The septic tank and all components are structurally sound.Recommend pumping the system every two years for maintenance. GREASE TRAP:_ (locate on site plan) Depth below grade: n1a Material of construction: _concrete_metal_FRP_other(explain) Dimensions: n1a Scum thickness:La_ Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle: n1a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) nla ti (revised 11115195) ti SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 92 Gooseberry Lane Marstons Mills Owner: Cataldo Date of Inspection:4122197 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: Na Material of construction:_concrete_metal_FRP_other(explain) Dimensions: n1a Capacity: n1a gallons Design flow: Na gallons/day Alarm level: Na Comments: (condition of inlet tee,condition of alarm and float switches,etc.) Na DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: n1a Comments: (note if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box etc.) Na PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) Na (revised 11115195) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 92 Gooseberry Lane Marstons Mills Owner: Cataldo Date of Inspection:4122197 SOIL ABSORPTION SYSTEM(SAS):x (locate on site plan,if possible; excavation not required,but may be approximated by non-intrusive methods) If not determined to be present, explain: n1a Type: leaching pits,number: 1,000 gallon leach pit leaching chambers,number:n1a leaching galleries,number: nla leaching trenches,number,length: nla leaching fields,number,dimensions:n1a overflow cesspool,number:n1a Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) The leach pit is past the effective depth of leaching The sas is in hydraulic failure. CESSPOOLS: (locate on site plan) Number and configuration: n1a Depth-top of liquid to inlet invert: n1a Depth of solids layer: n1a Depth of scum layer: n1a Dimensions of cesspool: nla Materials of construction: n1a Indication of groundwater: nfa inflow(cesspool must be pumped as part of inspection) nla Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) n1a PRIVY:_ (locate on site plan) Materials of construction: n1a Dimensions: n1a Depth of solids: nla Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) nla (revised 11115/95) 8 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 92 Gooseberry Lane Marstons Mills Owner: Cataido Date of Inspection:4122197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' A � AC S1 �A 1a II �c `Y DEPTH TO GROUNDWATER Depth to groundwater:12 feet method of determination or approximation: USGS Maps and Charts (revised 11115195) 9 V PAR Real Estate System - General Property Inquiry Help Parcel Ids 102 071- - Account No: 49673 Parent: Location: GOOSEBERRY LANE MM Neighborhood: 20AC Fire Dist: CO Devel Lot: 49 Lot Sizes . 24 Acres Current Own: CATALDO, LOUIS G & NANCY L State Class: 101 92 GOOSEBERRY LANE yo,,r 4; 07/1 No. Bldgs: I Area: 768 Year Added: MARSTONS MILLS MA 2648 Deed Date: 040190 References 7135/037 January 1st: CATALDO, LOUIS G & NANCY L Deed MMDD: 0490 Deed Refs 7135/037 Comments: Values2 Land: 24800 Buildings: 56000 Extra Features: Road System: 92 Index: 615 (GOOSEBERRY LANE ) Frntg: 106 Index: ) Frntg: Control Info: Last Auto Upd: 050695 Status: C Last TACS Update: 080390 Land Reviewed By: Date: 0000 Bldgs Reviewed By: Date: 0000 Tax Title: Accounts Taken: Account Status: Hold Status: Cancel Press XMT for more data Next screen PAR Act ion Owners Name Road Index Road Name Parcel Number 102 072 3 SENDER: I also wish to receive the ■Complete items 1 and/or 2 for additional services. 3 ■Complete items 3,4a,and 4b. following services(for an 4) ■Print your name and address on the reverse of this form so that we can return this extra fee): .. card to you. ai ■P�h this forth to the front of the mailpiece,or on the back if space does not t. ❑ Addressee's Address Z ■Write'Return Receipt R uested'on the mail piece below the article number. d ■The Return Receipt willow to whom the article was delivered and the date 2. ❑ Restricted Delivery N c delivered. Consult postmaster for fee. 3.Article Addressed to: 4a.Article Number o. � a _ E 4b.Service Type; d c°+ ❑ Registered Certified ❑ Express Mail ❑ Insured c �j ❑ Return Receipt for Merchandise ❑ COD 7.Date of Delivery n � I 5.R ceived By:(Print Name) 8.Add essee's Address(Only if requested W o i cG and fee is paid) t g .Signature: dresse Agent) ~ � X of. - orm 3811 er 1994 i I l i i 102595-97-B-0179 Domestic Return Receipt ®O M o� —r Mai UNITED STATES POSTAL SERVICE as firstirst-C-C &FeesP FM ® Print your name, address, and ZIP Code in this box®q = I I Public i Town of division I Gar-, PO.Box'* t`3f�le llYannis,MassachUsetts 02601 1 I ' COMMONWEALTH OF MASSACHUSETTS r EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS �i DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON. MA 02108 617-292-5500 R'1LLIAM F.R'ELD TRUDY CORE Governor Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION 92 Gooseberry Lane Property Address: Marstons Mills, MA Address of Owner: Louis Cataldo Date of Inspection: /a-- a^ 9 '7 (If different) Name of Inspector: Wm E Robinson Sr 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR..15.000) Company Name: �Im E Robinson Septic Service Mailing Address: PO Box 1089 C _nfervi 1 1 Q , MA 02632 Telephone Number, 5 0 8 ^ 7 7 9—R 7 7 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training a per4eme roper function and maintenance of on-site sewage disposal systems. The system: _,, passes v p— - 0 7/ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails q�7 Inspector's Signature: cf Q i 1 L��...� Date: / / The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. ��TT Any failure criteria not evaluated are indicated below. COMMENTS: B] S TEM 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. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:ltwww.magnet.state.ma.us/dep e'j Printed on Recycled Paper a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 92 Gooseberry Ln, Marstons Mills Owner: Cataldo Date of Inspection: ��_�_ Q) BJ SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C URTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. :1) SYSTEM WILL PASS:,U.NLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL.PROTECT.THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 92 Gooseberry Ln, Marstons Mills Owner: Cataldo Date of Inspection: ? D] SYSTEM FAILS:. Y u must indicate ei:!;er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis -for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LAR E SYSTEM FAILS: You mu t indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program re irements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 92 Gooseberry Ln, Marstons Mills Owner: Cataldo Date of Inspection: - Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following: ,. YV No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or / as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. _V/ _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. / —The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)] (revised 04/25/97) Page 4 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 92 Gooseberry Ln, Marstons Mills Owner: Cataldo Date of Inspection: /a—,;-- $ FLOW CONDITIONS RESIDENTIAL: Design flow:�O_g.p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents: —`� Garbage grinder (yes or no):�$ Laundry connected to system (yes or no): Seasonal use (yes or no):/L't7 1995 - 7 0 0 0 0 a l s Water meter readings, if available (last two (2) year usage (gpd): r g Sump Pump (yes or no): d— 6 1996 — 6 7 , 0 0 0 ga i s Last date of occupancy: a—,;L—Q CON ERCIAUINDUSTRIAL• Type establishment: Design ow: gallons/day Grease t p present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sani ary waste discharged to the Title S system: (yes or no)_ Water ter readings, if available: Last to of occupancy: OTHE : (Describe) Last d f occupancy: GENERAL INFORMATION PUMPING RECORDSr and source of information: System pumped as part of inspection: (yes or no)ye-iO' If yes, volume pumped: 16a4 gallons Reason for pumping: L TYPE OF S STEM eptic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) /` d i (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 92 Gooseberry Ln, Marstons Mills Owner: Cataldo Date of Inspection: B ING SEWER: (Locat on site plan) Depth low grade: Material of construction: _cast iron _40 PVC _other (explain) Distan from private water supply well or suction line Diam ter Comm nts: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site plan) Depth below grade: + Material of construction: _✓concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: w `7 `L Sludge depth: i t Distance from top of sludge to bottom of outlet tee or baffle:.VZ10 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:_ How dimensions were determined: 0 Zz-7,0 "^ Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leak ge, etc.) @-'0 b J ' � 1�` � 7 L`� n ti a.-=c�.� e ,� e ✓ ee GREAS TRAP: (locate site plan) Depth be ow grade: Material f construction: _concrete _metal _Fiberglass _Pollyethylene —other(explain) Dimensi ns: Scum t ickness: Dista a from top of scum to top of outlet tee or baffle: Dist ce from bottom of scum to bottom of outlet tee or baffle: Date o last pumping: Comme s: (recomm ndation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 92 Gooseberry Ln, Marstons Mills Owner: Cataldo Date of Inspection: / ;L—Z-- 4 17 TIG OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate n site plan) Depth bel grade: Material of onstruction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensio s Capacity-_gallons Desig low: gallons/day .. Alarm vel: Alarm in working order _Yes; _ No Date of p evious pumping: Comment (condition f inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUM CHAMBER:_ (locate n site plan) Pumps n working order: (Yes or No) Alarm ' working order (Yes or No) Commen s: (note co dition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 92 Gooseberry Ln, Marstons Mills Owner: Cataldo Date of Inspection: J `7 & SOIL ABSORPTION SYSTEM (SAS)._L' (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: G r- leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vege anon, etc.) /� a G Gi/ L Z,- a A_� G /'f ) a 41 ` CE POOLS: _ (loca a on site plan) Num r and configuration: Depth top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dime sions of cesspool: Mater als of construction: Indic tion of groundwater: inflow (cesspool must be pumped as part of inspection) Comm ts: (note c dition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY _ (locat on site plan) M rials of construction: Dimensions: Dep h of solids• Com ents: (not condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page 8 of 10 +f u • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 92 Gooseberry Ln, Marstons Mills Owner: Cataldo Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) d 60 ` r (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 92 Gooseberry Ln, Marstons MIlls Owner: Cataldo Date of Inspection: Depth to Groundwater A I Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record t/Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records v Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) (revived 04/25/97) Page 10 of 10 TOWN OF BARNSTABLE' LOCATION SEWAGE # _9 7 .:YII LAGS 01w, /V� S ASSESSOR'S MAP& LOT ?INSTALLER'S NAME&PHONE S N0. n© ��ti r n— d SEPTIC TANK CAPAM Y rG 6-4 LEACHING FACIUN: (type) (size) :.1Q;:OF BEDROOMS 3 .'HiIIIDER OR OWNER :PERMITDATE://�'.��'"S 7 COMPLIANCE DATE: paiation Distance Between the: Maximum Adjusted Groundwater Table Bottom of Leaching Facility Feet Pf.vate Water Supply Well and Leac ' g Facility (If any wells exist on site or within 200 feet of le ng faFility) Feet P,dge of Wetland and Leachin acility(If any wetlands exist .:within 300 feet of leachi g facility) Feet Furnished by .ti t � f , i L = `€Y 4 L 7 4 X Aa Ir q 4l _. i X � � t . - _ ;� _)-Esc•. �y k �` '� �' �� 6✓ Rom. THE COMMONWEALTH OF MASSACHUSETTS DI/61� BOARD W HEALT- � a� ....�. ... ................ OF'..... . .. . ....4.. ....-.. A liraliou for Disposal Morkg Tonstrur#iun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual �ewage Disposal System t: .................... —..... -.. % .. ...........__.. ocat -Address or Lo N . ..:. . .. 4... :.......... ......................... . . .......... ... °... ...........`............. Owner La�r� Address Installer Address y *) Q Type of Buildi Size Lot./-dI_ z�`G ___..Sq. feet U Dwelling No. of Bedrooms........._._-2, .__..Expansion Attic ( ) Garbage rinder ( ) aOther—Type of Building ............................ No. of persons...... ..................... Showers ( ) — Cafeteria ( ) QOther fixtures ....................................................................................................................................................... Design Flow.....................�._,)......_.. gallons per person per day. Total daily flow...............- J_gallons. WSeptic Tank—Liquid capacity/gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—N Wid h Total Length.........../_� Total leaching area....................sq. ft. Seepage Pit No....... ......... Diameter.. _/YJ...'�.Depth below inlet........6f ......... Total leaching area.J A.2'.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `- Percolation Test Results Performed bY--•-.--=•----------------------- --•- -•-•------•-------•................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit......_.........__.. Depth to ground water_-..-----_-__-_-_-____- f1 Test Pit No. 2................minutes per inch Depth of Test Pit.............._..... Depth to ground water........................ O Description of Soil................... _-- --- �••-•------•-•--•---•-------•-------•----•....-- x v W UNature of Repairs or Alterations—Answer when applicable................................................................................................ ..........................................--.......................................................................... -•-------•-•----•••----•••------••--•---------------•----------•............-•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of h lth. � 4 Signed.- j .� .. .• G ------------- ------------------- Application Approved B ------------------ .---- Application Disapproved for the following reasons:...................... .. ......................•---........_....................Date ---•-•.................••--•---•-----•--•••••---•-------••-•----......._...-••••-•-•••-----•-•-•.........•--••--•••--••-•--•-••-----•••--•--•-•••-•••-••-•--••--•--••-••--••-•-----•--...-----------•--- Date PermitNo......................................................... issued........................................................ Date No.....V Fizz...,,2.................... THE COMMONWEALTH OF MASSACHUSETTS BOARD QF H EAL"TY e. v6 � Applirativit for flliapnfial MurksZonfitrurtion ramit Application is hereby made for a Permit to Construct -( ) or Repair ( ) an Individual Sewage Disposal system t .... ... ... f a.a -, � ... ................... TAddress Lot of No xw .......... ¢� ................ Owner Address ............................................. ......................................... .......... ............................. � . �.._........................ .. .. .. Installer Address Type of Building./ Size Lot../�),. .....Sq. feet Dwelling--I/No. of Bedrooms..................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ....... No. of persons-------------_.............. Showers — Cafeteria Otherfixtures ......................................................------------------------------------------...---------•-------••-----------.-----_----•---------- W Design Flow.......................:.'": ........... gallons per person per day. Total daily flow................ 04 Septic Tank—Liquid capacity/ gallons Length................ Width................ Diameter................ Depth................ xDisposal Trench—N --------------------- Width..........1..4.._ Total Length................... Total leaching area.....................sq. ft. Seepage Pit No........ ......... Diameter' :_ ___ Depth below inlet........ ......... Total leaching area..J.e_:�.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bv......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water_.____-----____-__-..._. r.Lq Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water.____-______-__--------. O Description of Soil------------------ , r; rl:....dr....----•---•---•----•... ------------------------------------------------------------------------------=------------ v •--••---------•---....----------------------------•-•-----•------- . --=----------------------------------------------------------------------------------------------------------------------•----- >. U Nature of Repairs or Alterations—Answer when applicable:__----•---------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions ofArticle XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board,of health. Signed � I� 1 D Application Approved BY - / -' �` , - - - ' Date Application Disapproved for the following -reasons--------------------- ----------------------------------------- .............................................. ----------------------------------------------------------------------------------------•---•------•--------•-----•-•---•--......._.....-•••------•-............•--•--••............................... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL.TIj,_p^ ..... ..... .........OF....... . , ..... ........ Tlertifiratr of TaUmpliatt,re THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed { '� or Repaired ( ) by ------------- --- -------------- ........................... at. . • has been installed in accordanVe with the provisio of Article Xl,o he State Sanitary Code as described in the application for Disposal Works Construction Permit No----__________`T _ --------------- dated... - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. //// DATE........ -�d.. �.................................... Inspector......... 4 ............... ..................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD U,�' HEAL.TH. .�r ...:......Or........ ................ r.+ ' No...... ......... FEE..... .: ......... h Permission is hereby granted = ........................................................;...._ ........................................ to at No.stru r Repair a� i� Individual Se�'a e osal S ste> ��& ( P ) P Y , ? Street . j as shown on the application r Disposal Works onstrUctlon P wit Na.../l ...._.. ted._._.P.. ;. I� ...................... ' Board of'J-lealth' p DATE------------------------------- ------------------------ --------------------- FORM 12.�5 HOBBS & WAftf�jEN, � PUSLISiiERj � r d I 1 .. • I� eta' �__ P 4' - - — - - _ _.. .- -- - _— ,, __._810 :1" 1� I —4• .d. I I '—�'mrrm— .C_.'C7C�-- i � — _ -1•!L- `\\ IN O1 I l �ie+lmt - - sswa --' h rQ q . EM `.3z; J _ 1 .. f . ; y _ t i 1 t ra-lvtaoor�mnace-- • 1 L-� .a f ' �l �-•c-,w ors—c�-.1•.sZy aaw�A r - rmr•. w - olllwa i 4 ` ,(/A'1'Y LN®tbN rvG 4 Y1tir. k I"`"";,•,.,;;.< R; r I t!`lilt bh4't�AVI.`'..rdy� i 1 y r4, � 4 F J/f t OIL h�C N, NCW�VL: i LOT 48 LOT 41 I LOT 67 t1 1 ,,., it tl WAY r <a�s;�i ''e �r,,Mir, ,•°"1d :,'„'Y S 870 E 100j00' . ' \ LOCUS MAP TP2 ; BENCHMARK: I � , 1 1 1 1 z STAKE AND TACK r co �� ``� , • _ . _ 1�`%, HE D ELEV. 92.12 o ---- wG --------- --- ' _ APPROX z LOCATION OF w EXISTING TANK I11 , D—BOX AND Ai LOT 49 EXISTING 3 --- ;' S.A.S. ACCORDING '� Wl TO 0 10,575 S.F. BEDRoom C'0' In CARDHE AS BUILT HOUSE ;1 FIRST % ; L6 LOT 40 W l ~� ELEV. 103.36 DEC w ❑ o ; BASIN 1 c PAVED �, ,#� -- ;, NOTES: Q RIVEWAY J ; , ,' �� 5' Q THE EXISTING SEPTIC SYSTEM COMPONENTS O SHALL BE ABANDONED, PUMPED AND FILLED A ;o;i ; WITH CLEAN INERT MATERIAL OR REMOVED / 1 0 o AND DISPOSED OF AT A SUITABLE .100 ! /� � LOT 66 LANDFILL. w GRAVEL i $�' ;io (� AREA t L 12.5 TP�fill" Ill ' I -' / I° '' 'I FLNCL STRIP SITE PLAN tTILIT _ 89 1 POLE N 87" W 100,00' PREPARED FOR LOT 65 NORALYN HUGHBANKS OF 92 GOOSEBERRY LANE H of ass BARNSTABLE, MA LOT 50 �� �� J. E. LANDERS—C AULEY, P.E. Y 1 CIVIL ENVIRONMENTAL ENGINEERING LOT 39 `i cn P.O. BOX 364 WEST FALMOUTH, MA 02574 No.35101 508 540 - 7733 ph. 0 10' 20' 30' 40' °9p Q 508 540 - 3344 fax ci �_ ASS.#102—71 DATE: 03 05 22 SCALE: 1" = 20' SCALE: 1" = 20' DRAWN BY JDR JOB NO. 3364 1 SHEET: 1 OF 2 USE-- RISERS TO BRING USE RISERS TO BRING USE RISERS TO BRING tF.F. ELEV.=103.36 COVERS TO WITHIN 6" ALL COVERS TO WITHIN 3" COVER TO THIN 6" OF FINIS D GR E 20'MIN. 0 F N SHED GRADEOF FINISHED GRADE. LEV.=94._5_ TO BE USED AS INSPECTION PORTS. 4" CAST IRON OR ELEV.=90.5_91.0 SCHEDULE 40 P.V C. ALL STONE IS 4" CAST IRON OR } DOUBLE WASHED ADIST.=-4�1,4L 4" CAST IRON OR SCHEDULE 40 P.V.C. 12 MIN. 3' LAYER OF SLP.= 0_08 SCHEDULE 40 P.V.C. SIP.-0.005 1/8"-1/z" INVERT DIST.=1.,8' CONCRETE COVER DIST.=11_6 WASHED STONE ELEV.=*92_52 FLOW LINE SIP.=0_02_ - 0"0"0"0"0"0"0 0"0 0"0" 89.5 0"0"0 0 0"0 0"0"o"0"0"0"0� 89 21 INVERT o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ELEV.=_- _ o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10" MIN. 14" 88 96 emt, o_o o_o_o_o_o_o_o_o_o _o 0 o_ o o_ o 0 0_0_ THE PIPE EXITS - 0 -CS 8- 0 8' b - U c 24" LAYER OF THE STRUCTURE FROM UNDER ODUTL�T iw is ELEV.=____ -�- - ®®®® 0 ®®®® o 0 0 0 0 0 0 0 ELEV.=,�$��� ELEV.=88.76 0 0 0 0 0 0 ®®®�®®®®®®® o 0 0 0 0 0 0 . /4" TO 1-1/2" DETERI�NED BY THE LENGTH OF 00000000000 ®®®®®®®®®®® O0O0O0O0O000O0CWASHED STONE THE BASEMENT FLOOR. rs uto nEPTH of LIQUID OUTLET TEE DISTRIBUTION BOX 0 0 0 0 0 0 ®®®®®®®®®®® 0„0„o 0 0„0 0 ELEV. 6.70 THE TANK USED. DEPTH BELOW FLOW LINE (SEE CHART AT RIGHT) 4 FEET.......14 INCHES *INVERT SHALL BE FIELD 5 FEET.......19 INCHES ELEV.= 88.7_0 USE H-20 LOADING VERIFIED PRIOR TO THE 6 FEET........24 INCHES TO BE WET TESTED IF 2 ® 4' 10" x 8.5' LEACHING CHAMBERS PLACEMENT OF ANY SEPTIC 1500 GALLON SEPTIC TANKSEE 310 i5.zz7 C MORE THAN ONE OUTLET. EQUALLY SPACED IN A 12.5' x 25.0' TRENCH 4.0 SYSTEM COMPONENTS. TO BE PLACED ON 6 OF STONE TO BE PLACED ON OF MECHANICALLY COMPACTED SOIL 6" OF STONE OR USE A TANK WITH THREE COVERS. MECHANICALLY COMPACTED SOIL. BOTTOM OF TEST HOLE ELEV=82.7 SOIL TEST DONE BY. J.E. LANDERS-CAULEY P.E. GROUNDWATER IS GREATER THAN 20' BELOW WITNESSED BY: D.DESMARIS THE S.A.S. (BARNSTABLE GIS) PERCOLATION RATE: _5---MIN/INCH P# STRIPOUT ALL UNSUITABLE MATERIAL TEST HOLE 1 DATE: V-Q7L21 ELEV._90_I____ AND REPLACE WITH MATERIAL THAT COMPLIES WITH 'TITLE 5 STANDARDS PROFILE OF DEPTH HORIZON TEXTURE COLOR MOTT. OTHER 12.5' x 25.0' = 312.50 SEWAGE DISPOSAL SYSTEM 12.5'(2)(2) + 25.0'(2)(2) = 150.•00 )NOT TO SCALE 0"-72" FILL(HTM) 462.50 x .74 = 342.25 G.P.D. 72"-82" O/A I CERTIFY THAT I AM CURRENTLY APPROVED BY THE TEST ABORTED DEPARTMENT OF ENVIRONMENTAL PROTECTION PURSUANT MOVED T TEST HO 2 TO 310 CMR 15.017 TO CONDUCT SOIL EVALUATIONS GENERAL NOTES: AND THAT THE ANALYSIS GIVEN HAS BEEN PERFORMED BY ME CONSISTENT "WITH THE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE DESCRIBED IN 310 CMR 15.017. I FURTHER CERTIFY THAT THE RESULTS OF 1. THIS PLAN IS FOR THE REPAIR OF AN EXISTING SEWAGE DISPOSAL SYSTEM. MY SOIL EVALUATION, .AS INDICATED THE ATTACHED SOIL EVALUATION FORM, ARE ACCUU RATE AND IN 2. PLAN REFERENCE Bk 138 Pg 25 LOT 49 BARNSTABLE REG. OF DEEDS. ACCORDANCE WITH 310 CMR 15.000 THROUGH 15.017. 3. THIS PLAN IS FOR THE INSTALLATION /REPAIR OF SEPTIC SYSTEM AND NOT TO BE USED FOR SURVEYING AND ZONING PURPOSES. DESIGN DATA: 4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF ;SEWAGE. NUMBER OF BEDROOMS -3-(TIMEE)_-_ 5. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN TEST HOLE 2 { DATE:09�07�21 ELEV._92___ GARBAGE DISPOSAL NONE (9j_ 6" OF THE FINISHED GRADE. DEPTH HORIZON TEXTURE COLOR MOTT. OTHER 6. EXISTING AND FINAL `GRADES SHALL REMAIN ESSENTIALLY THE ELEV, TOTAL ESTIMATED FLOW Q .__ GPD SAME, UNLESS NOTED BY FINAL CONTOURS. 93.2-91.95 0"-15" FILL (HT ) GAL /BR./DAY X ____ BR. ) 7. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE (UNDER OR 91.95-91.28 15 -23 SAN DY ANDY LOAM �I( A O Ss SEPTIC TANK CAPACITY 15.Q.QSx�L. REQUIRED F M WITHIN 10' OF DRIVES OR PARKING AREAS. H-20 LOADING j sq o� � 1.500 GAL. PROVIDED SHALL BE USED UNDER OR WITHIN 10' OF DRIVES OR PARKING JOHN ACHING AREA REQUIREMENTS AREAS UNLESS NOTED. 91.28-88.87 23"-52" B LOAMY SAND lOYR 5/6 o NDERS•CAULEY 8. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL " CIVIL SIDEWALL AREA 190.0(Z S.F. BE MORTARED IN PLACE. I N0.35101 9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH 88 » » .�9 �Q BOTTOM AREA _ �4_ S.F. DEEDED OR ZONING REGULATIONS. OWNER APPLICANT IS TO .87-86.70 52 -78 Cl SILT LOAM 1OYR 7/1 o OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. sS��NALENG LEACHING CAP.(BOT. & SIDEWALL)_:342.25GAL 10. THE :EXCAVATOR/CONTRACTOR SHALL VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES PRIOR TO ANY EXCAVATION. 86.70-82.70 78"-126" C2 M-C SAND 110YR 6/4 NO H2O RESERVE LEACHING CAPACITY _JA GAL. 11. UNTIL APPROVAL FROM THE BOARD �OF HEALTH IS GRANTED, THIS NO MOTT. PLAN IS SUBJECT TO CHANGE. + APPLICANT: NORALYN HUGHBANKS DATE: 03/05/22 SHEET 2 OF 2 JOB # 3364 E