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Home My WebLink About0031 JASPER ROAD - Health �1Jasper.Road Marstons Mills P A = 047 032 FIJI - - u5€t ' -- _ _ h, a - r . . - � ' Flan'is For* QNR RF .. . ... ... . : Thies " MUR`l'GAG� 1NSI'.l�C'i'ION Han)c Use only FI.OUIJ:ZONE- G` THE 0133AMW MP&SUMMMM ON TM5 VEROM DY AN INSTRUldSURVEY, • l - ` KEG ISTRY -OWNER h�'Nl�'TN_.�..�'YD:LI�S.�M�4ST�R?-0 _- REP: f�RT__Ll ► ____-. DUYER: 1A�JL r11�`11 AM IT'�2Q��_'._------ PLAN-'REF• 30751 1 _ _ SCAL,E:l"=. .3(1 )Y CRIMPY •rp !v�z1o_�G.l?r�l��Gl�'n�fi.�Ar 3 ��NKEE 5�3��FEY uovw�,u rH an d Xo cress c� c»_TTIAT-T1IL BUILDING PAin ON THIS PLAN`IS LOCATED ON.-'Cti9.G.ROUNf.) As A. CONSULTANTS ANU Tita 'ITS POSITION DOES _' CONFORM-:.- . ItfAtTNpw..• u 40B (SUITE I) '-. ZONING LAW GETBAM-.It1:QU1RFMF.NTS OF-THE No: '. F. BAMV5 AIBLZ_M . AND 'PRAT INlltJSTRY ROAD . Nl)T - . LIL wrrfllN THE-SPECIAL FLOOD'HAZAR_D. :" `8 d1ARcTOt�S..MIUS. MA 02fi4ti" `'`' 5 Z-11OWN ON THE N.U.D. MAP MATED�1.�� A'al TEL '.428-0055 j n i i -P?i ned d 250001 0015 C F•A)L 420-5353 THIS PLAN NOT MADE FROM AN_'I:vS?RUt�ENT �UiIYEY : WPM'I'RU97PT-�--'-�� NOT TO BE USED fOR FENCES• BUILDING PTRMITS 1.7C. 33248 'AS r 2 4-5 REC`IVED OCT 2 7 2004 DATE 10121104 TOWN OF BARNSTABLE 11 LTH DEPT. PROPERTY ADDRESS31 aazpea Road 17a2Ztonz (7-i.PJZ t NaZZ 02648 On the above date, tho4eptic system at the address above was Inspected. This system consists of the following: 1.- 1-1000 ga.2.2on eept.ic tank. 2., 1- Dz ita igut.ion 9ox., 3.! 2-1000 gai2on paecazt ieach.ing p.ita 60X10' Based on inspection, I certify the following conditions: 4.- 7h.iz .ins a t.it.2e -.ive zept.ic zyztem (78 code) 5., The zept.ie ayztem .iz .in RaoPea moak.ing oadea at the pzezent Lime'. SIGNATURE Name: Robert A. Paolini Company: Joseph P. Macomber & Son Inc . Address: `` P. O. Box 66 'Centerville; Mass 62632 phone: 508-775-333&or 508-775-6412 JOSEPH P. MACOMBER & SON, INC.. Tanks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775.333.8 775.6412 • COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF'EwmarNMU NTAL AFFAIRS DEPARTMENT OF I+rNVIRONMENUL?ROTICTION Y f a TITLE 5 OFFICIAL INSPECTION FORM—.NOT;FORVOLUNTA:RY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART•A CERTIFICATION Property Address;31 aa�/rea /toad fla2.ston,3 (�.i.U.6 (7a owner'sName: S e ca 2crcg Owner's Address: -3 am e Date of Inspection: 1014104 Name of Inspector: (please print)i2o 24 !?Ao.Q_ia Company Name: a- a r-o m.&.e�i .. Mailing.Address: Cen eay.c Z 1 a.66,.02632 Telephone Number. 5 0 8-7 7 :3 3 3 8 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the-information reported below is true.,accurate and complete as of the time of the inspection.The inspection-was performed based on my training and experience in-the proper function and maintenance of on 4ite sewage disposal systems.I am a DEP approved system inspector pursuant tbo-section.15r340.of-Title 5(31.6 CMR-18:000). The system: XXX Passes -Conditionally Passes Nee Further Evaluation.by the Local Approving.Authority AF ' Inspector's Signature: Dater 0 The system inspector shall submit a copy of this inspection report to the.Approving,Authority.(Board of Health or DEP)within 30 days of completing this inspection.If the system:is a.shared system or has a design flow of 10,000 gp I or greater, the inspector and the system owiner.s}ia11 suTitnit the report to the appropriate regional,offiee of the DEP.The original should be sent tothe system ov�mei and copies settto the buyer,if applicable,and the approving authority. Motes and Comments " ****This*report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. .r:,,;.C T......o,r+inn FnTm 6/15/2000 page I Page 2 of 11 OFFICIAL INSPE,CTION:F0RM—NOT:FOR VOLUNTARY ASSESSMPNTS SUBSURFACE SEWAGE DISPOSAL SYST M INSPECTION FOR ' PART'A CERTIFICATION(continued) Property Address:31 laz/2eic /toad Ma zzt onz Ma Owner: She.iia 2"ing Date of Inspection: 1014104 Inspection Summary: Chjeek A;S;C;D or.E/A.4W A►Y�S. omplete all of Section.D A. System Passes: Al() I have not found any information which indicates`thaf any of the failure criteria described in 310 CMR 15.303.or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: _7h¢ A,pii_n .Su,hiv_m .i_/. ,in n,,7e) w oaking nnr/vn. . rzY Y � ./2/rPAP_ai. fimo B. System Conditionally Passes: NO One or more system components.as described in the"ConditionalPass"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. ICI Answer yes,no or not.determined(Y,N "not in the for the following statements.If not determined please explain. N0. • The septic tank is metal.and.over20 years old*or the septic-tank(whetherrmetal.oriot)iszstructumlly unsound,exhibits substantial.infiltration or exfiltration.or tank failure is-:in�inerkt; System.will pass inspection if.the existing tank is replaced with'a complying septic tank.as-approved by the-Board of Health. •A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available.. ' ND explain: NO. Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled.or uneven distribution box.System will pass inspection-.if(with approval of Board of Health): broken.pipe(s).are replaced. . obsttvctidn it removed' distribution box is leveled or;replaced ND explain: Nc) The system required pumping.-More than 4 tunes a year due to broken or obstructed pipe(s):The system will pass inspection if(with approval of the Board of Health): broken pipes)are replaced obstruction is removed r ND explain: ';Z ' Page 3 of l l O1 ICIAL INSPECTION FORMNOT,'OR V4DLUNFA RY ASSES•SM ENTS Si1BgtWArCE SFwAGE DISPOSAL' SYSTEM INSPtCTIdN FORM PART:A . . 'CER.THICA'HON'(6ontinued)• : Property Address:31 7az/?e z Road Ra/tz-one Owner:S h Date of Inspection: e C. Further Evaluation-is.Required by the Board of Health: NO Conditions.exist which require further..evaluaticmby.the,Board:oPHealth;in•order,to:detenrtine ifthesystem. is failing to protect public.health,.safety or the environment. 1. System will;pass unless Board•of.Health determineskin aecordance with 310.CMR 15:303(1)(b)that the system is•not functioning in.a•mattner which:will•protect public health,safety•arr¢•the..envir-onment: No Cesspool or privy is.within,50 feet of amrface water No 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),dktermines.that the system is functioning in a mariner that protects thepublic health,safety and environment: No The system has a septic tahk and soil absorption system.(SA•S).:and the SAS is within 100 feet of a surface-water supply or-.tributary to asurface water-supply. No The system-has•a.sepfic tank and SAS and the,,SAS is-w•ithin a Zone 1 of a-•publie watensupply. N a The system has aseptic tank and.W:and-the SAS is within,30 feet of a private water.supply wel N o The system has a septic tank and SAS and the-SAS is less than 100 feet.but 50 feet or.1hore froni a private water supply well" Method used to determine distance- v.Lz ua. **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from-pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to.or.less than 5.ppm,provided that no other failure criteria are triggered.'A copy of the analysis must be attached to this form. 3, Other; Page 4 of 11 OFFICIAL INSPECTION FORM NOT TOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTMCATION(continued) Property Address: 31 7a-a/2ea Road Ma2zs ones Owner:She-iia Gl.¢.ina Date of Inspection: i o A4%5 4'" D. System Failure Criteria applicable to all systems:. You must.indicate"yes".or"no"to.each.ofthe:followitig,for all-inspections: Yes No _ . Back-up-of sewAgo:into--fat Ility:or system:component.due-lo.overloaded.or clogged-SA-S.or cesspool X Discharge:or ponding of effluent to the.stirface of thogmund 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 thank"below invert or.available volume is less than'Wday flow X Required pumping more-than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of.the SAS,cesspool or privy is below High ground water elevation. X Ariy,portion of cesspool or privy is within 100 feet of a surface water supply.or tributary to a surface water supply. X Any portion.:ofe cesspool ror.privy is within a:Zone!1,of apublic.well.. X Any portion of a cesspool or privy is 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 5,0 feet from a.private water supply well with no acceptable water quality analysis...[This.system.passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic.compounds indicates:that the well Is.free from pollutiow:from:lbot.facflity and:thg presence of ammonia nitrogen and nitrate nitrogen is equal to or less than.5-ppm,provided that no other failure criteria are•triggered..A copy of the analysis aiust be attached.to this form.] NO (Yes/No)The system fails.I have determined that:one or.more-of:theabove.failure_criteria exist as described in 310 CMR 15.303,therefore the syster...fails.The system owner.should contact the Board of Health-to determine what will be-necessary to correct the failure. E. Large-Systems: To be considered a large system the.systt in must.serve.a:faeility with a design flow of 10j000 gpd to i5p0. gPd• , You must indicate either"yes"or 'no"to each of the following: (The following criteria apply to large systems in addition to the criteria.above) yes no , _ X 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 _ 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 If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner-or operator of any large system considered a significant threat under Section E or failed under Section D'shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIA3r INSPECTION-FORM'—NOT FOR VOLUNTARY ASSESSMENTS ✓� WBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART 8 -CHECKLIST Property Address3 9 .Jaz pee Road ' Ma2z;�on-6 . Nliiz (?a Owner:Shp-iia 6J2.cn a Date of Inspectiod: A Q/4/0 4 Check if the following have been done You must indicate"yes"or"nd"as--to each.of the following: Yes No •_ ` _ -�` ' X Pumping information was provided-by the Owner,occupant,or Board.of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? _. 1 X Have large volumes of water been introduced to the system recently or as-part of 4-inspection? X _ Were as built plans ofthe system obtained and examined?(If they were not available tote is N/A) X Was the facility.or•dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X • _ Were all system components,excluding the SAS;located on site.? X e the se tic tank manholes uncovered;:opened,and the interior of the tank inspected for the condition _ W re p es or tees material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? • of the baffl • X _ Was.the facility'owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS).on the site.has been determined based on: �Is no — — Fxisting information:For example,a plan at the Board uf.Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximetion-of distar is unacceptable)[310 CNM 15.302(3)(b)] S Page 6 of 11 OFFIC�-IAL A.NSPB-C-T-I:O'i::lFORM`*!-NOT FOR VOLUFNTA►RY ASSESSMNTS SU:JPSUIRFACE-SEWAGE- OiSP.;OSAL>SYMM.JNSPECTj4QL. VORM PART.0 SYSTEM INFORKATION Property Address:3 7 l a,�n e 2 Road owner:She.i ea• U z in q Date of Inspection: 10/4 40 4 ' FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): ,< 4 . Number of bedrooms.(actual): 3• DESIGN'flow based& 10 CT&15.203':(for example:A10 gpd z#-bfbedrod sy 4.4 0 Number of current residents: .: 3 Doe&tesidence have a garbage grinder(yes br no):n o Is laundry on a separate sewage.system(yes or.no)n o [if yes aepWte inspection required] Laundry system inspected(yes or no):n b Seasonaluse:(yes orno): ..rzo 2002-66,.000 gaieoIns . P..[7.� 180.,82 Water meter readings,if available(last 2 years usage(gpd)):2 n n 3-A n., n n n aa.P.R o n 3 -P.,D., 16 4.. 3 8 Sump pum (yes or no):n o Last date oYocct pancy: R/i ez ent COItiIMERCIf hF[I+IDUSTRIAL Type of estab=- ft NA Desow. n310 CMR.15.203)% Na pd- Basis.of dUign' low(seats/persons/sgft,etc.): NR Grease trap present(yes or no):N A Industrial waste holding tank present.(yes or no):4L6 Non-sanitary waste discharged to the Title 5 system•(yes or no):Na Water.meter readings,if available: NA Last date of occupancy/use: . N A OTHER(describe):. N4: "NERAL INFORMATION , Pumping Recgrds Sourceofinformation:4/6/2000 ma.in.t tank on.2y Was system pumped as part of the inspection(yes or no): NA If yes,volume pumped:_gallons--How was quantity pumped determined? NA Reason for.pumping:NA TYPE OF..SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool —Privy _Shared system-(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative-technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a.copy.of the DEP.approval I _Other(describe): I Approximate age of all components,date installed(if known)and source of information: gu.t2t 1978 Upgaaded 3123193 Add-it.iona.2 pit:- was added' a .ins ; .tme.- / eam.t - 75 Were sewage odors detected when arriving at the site(yes or no):n o 6 _ Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY A SSESS MENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 7a,3/2 e 2 /2 o a d Plnn.tf_nn_,% N.i_ UN fla Owner;She.i.ea 0/t i.ng - Date of Inspection:10/4/0 4 BUILDING SEWER(locate on site plan) Depth below grade: 2 5 n. Materials of construction:_cast iron X 40 PVC_other(explain i t e PVC (4") Distance from private water supplyy wel or suction line: 7 5' Comments(on condition of joints;venting,evidence of leakage,etc.): po int s *appeaa tight.: No evidence o� leakage., The zy.5tem .iz vented thzough .the houze vent.- ' SEPTIC TANK:.Ye4locate on site plan) 1000 ga.l.l o n Depth below grade: 12" Material of construction: X concrete metal_fiberglass_polyethylene other(explain) If;nk is•metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 8' 6"Long 4 ' 16" 5' 7" fl.i gh Sludge depth: /t a c e Distance from top of sludge to bottom of outlet tee or baffle: t a a c e Scum thickness:t a a c e Distance from top of scum to top of outlet tee or baffle:t a a c e Distance from bottom of scum to bottom of outlet tee or ba —e TTa c e How were dimensions determined; N R Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): '�ump tank even. 2 ,eaaz..Tn2et 9._ oeit.let teen aae .inp.laee.- tank .ins zt zuctuaa.l.lu .3ound.- No z ignz o� .lea age. GREASE TRAP:X(locate on site plan) Depth below grade:&A Material of constriction:_concrete metal_fiberglass_polyethylene_other (explain): 414 Dimensions: N,4 Scum thickness: N Q Distance from top of scum to top of outlet tee or baffle': N R Distance from bottom of scum to bottom of outlet tee orbaffle: NA Date of last pumping: N,4 Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Gnnn.so f_nan IA nnf aap-Ae L, TMA 5 Tvsvn^M;nn Ttnrm Air;i,7nnn 7 Page 8 of I I OFFICIAL IN8PEC'TION FORM—NOT FOR VOLUNTARY ASSESSMENTS .809URFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C' SYSTEM INFORMATION(continued) Property AdFtress: 31 ZgAaalz �? Owner:, . e.iia � TT — Date of Ibspeetion: d. TIGHT or PIOI,DING TANK:NO (tank must be pumped at time of inspettion)(locate on site plan) Depth below gradeNA Materiat of construction: concrete metal fiberglass___polyethylene other(explain). NA Dimensions: •NA " Capacity: •NA gallons Design Flow: NA gallons/day, Alarm present(yes or no): NA Alarm levelYVA Alarm In working-order(yes or no): Date of last pumping: 'NA Comments(condition of alarm and float•switches,etc.): Tig4t o2 hogd.ina tanks aae not R2ezent., DISTRIBUTION BOX: Y e-3(if present must be opebod)(locate on site plan) Depth of liquid level above outlet invert: No Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.) D.i,3ta.iP.ut-ion Sox ha.6 2 eateltaiz.- No evidence o/ zo eid,3 ca2ay Qve2 , No evidence o- Leakage, -in o2 'Out o ox.-PUMP CHAMBERNU (locate on sife.plan) Pump's in working order(yes or.no):NA Alarms in working order(yes or no)/—TA Comments(note condition of pump.chamber,condition of pumps and appurtenances,ett;.): Pump chamge2 .iz no /aaezen r Page 9 of 1 I OFFICIAL INSPECTION FORM-NOT-FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SY•S'I':EM INSPECTION FORM PART=C SYSTEM INFORMATION(continued). Property Address-31 lazpe2 Roacl NalLztonz 01.9.e-6 Na Owner:She-..ea G12.lnq Date of Inspection: 10/4/0 4 SOIL ABSORPTION SYSTEM(SAS): -(locate on site plan,excavation-not-required) Z-1000 a,a.P.Pon Pni ash niYA (6 'X10' �1 If SAS not located explain why: Located .see 2qqa 10 Type X leaching pits,number: z leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative'system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): �1. Innm// ,tn»r/ f•n mnr/i„m nn .No b-Ggnb o/ hyd2aue.cc �aiiulte o2 pon z. g. o.c .s aae d1ty.. 'Vegetation iz noama.e., CESSPOOLSIVO (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: NA Depth-top of liquid to inlet invert: N Depth of solids layer:NA Depth of scum layer: N,4 Dimensions of cesspool: NA Materials of construction: NA Indication of groundwater.inflow(yes or no): NA Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Ce4Al2?o eb ate not /2aeeent PRIVY:NO (locate on site plan) Materials of construction:. NA Dimensions: NA Depth of solids: NA• - Comments(note condition of soil,signs of hydraulic failure,level of*ponding,condition of vegetation,etc.): l,z.iyU .l.b aof z2ge—Apa-L.- 9 Page 10 of 11 OF'FI,IAA INSPECTION FORS*NOTTOI�•'�QI:IJI�TA3ZY ASSESSMENTS S�1,I ACE`SEWAGEMIScP.Q� YS'�?EMINSL 3OMFORM PA SYSTEM x1!�TFORmA TION(;contimed). Property Address: ¢24onh Date of Inspection: SKETCH OF SEWAG�•DISPOSA,L SYSTEM Provide a sketch of the scwaS disposal in 00 feet Locate whereepubls to ic least two uppl Bent rs he building. lding. �r benchmarks.Locate all wells a• +s 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENT FORM S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION PART C SYSTEM INFORMATION(continued) Property Address: 17rt2h on s (7� �� Na Owner: Shea.ea WL::-� Date of inspection-'0 SITE EXAM Slope Surface water Check cellar. Shallow wells Estimated depth to ground waterl0 0 feet aed to determine the high ground water elevation: Please indicate ll methods us (check) . ALQ Obtained from system design plans on record-If checked,date of design plan rgviewed: �-Observed site(abuttingro e /obsery ation hole within 150 feet of SAS) p P•rty Checked with local-Board of Health-ex plain: � Checked:with local excavators,installers-(attach documentation) Accessed USGS database:explain: You must describe how you established the high ground water elevation: used•,Gahert & Miller model 12 1 used•USGS observation w ' ca — — used• 'Techni l bul 1 wa er a eva ions. Leaching 9:, Pit Ceet Groundwater:91 Feet Below Bottom-of Pit High Groundwater Adjustment 1.8 ft per 1gim ptej Method Therefore,the.vertical.separation distance between the bottom of the leaching pit and the adjusted groundwater table is 3 2..8 0 feet: .r•mnn,.-n.,y.r-T'.nr � TURN OF _ [ �2NS7A��1,�.----r WARD OF HEALT11 SWINU'FACF SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION ,.,t:,i-T.;-::•-*.n.-.rrr+:nr.m•nrr,r+sirms+em�+r+'r.-x-rr.urtnrenr+nr- '^Pry . -TYPL OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 31 la,3pezt Road ASSESSORS MAP, B140,CK AND PARCEL, # 047-032 She.i2a Gl/t ing OWNER' s NAME PART D - CERTIFICATION NAME OF INSPECTOR e P ° COMPANY NAME Joseph P.-Macomber & on COMPANY ADDRESS Box 66 Cent To State LIP Town City COMPANY TELEPHONE ( 508 775 3338 FAX ( 508 .) 720 CER'rIFICATION STATEMENT I certify that I have personally inspected the sewage disposa_l system at this address and that the information reported is true , accurate, and omp.lete as of the time of �inspeetion . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my 't'rai.nin.g and experience in the proper function and maintenance of on- site sewage disposal systems , , Check one: XXX System PASSED The inspection which I have conducted has not found any information which indicates that. .the system fails to adequately protect public health or the enviro:ilment as defined in 310 CMR. 15 . 303 , Any failure criteria •not evaluated are as stated in the FAILUIIE CRITERIA section of this form. System FAILED* \\ r The inspection which I have coil acted has found that the system fails t( protect the j-)ublic health and the environment in accordance with Title 5 , 310 CMR 15 , 303 , and as specifically noted on PART -FAILURE CRITERIA of this ins ec i n for Date Inspector Signature' O( n e copy of this certification must -be provided 'to the OWNER, the BUYER where applicable ) and tha. BOARD OF H$ALTJI. * If the inspection FAILED, the owner or operator shall upgrade ' the system within o'ne ,year of the date of the inspection., unless allowed or required otherwise as provided in 3:10 eh1R 16 .3'06 . partd .do, 3z a6� DATE- 12/14/01__-_ PROPERTY ADDRESS:_31- Jasper_Road--------- _-Marstons Mills,Mass_____ . 02648 ------------------------ On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 1 -1000 gallon septic tank. 2. 1 -Distribution box. 3. 2- 1000 gallon precast leaching pits. ( 6 'X,10 ' Based on my Inspection, I certify the following conditions: 4 . This is a title-: five septic system.( 78 Code ) 5. The septic system is in proper wor-king oder at the present time. 6 . Waste water is 14" below invert pipe on #1 #2 pit is dry. It is set up this way.. SIGNATURE: 1` VA Company: Joseph_P. Macomber_& Son , Inc . -- ---- - - .eEIVED Address:_ Box—66------------- p�C 2 0 2001 Centerville , Ma . 02632-0066 I i OWN OF BARNSTABLE �:.^AI TH DEPT. Phone: 508-775-3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY rJOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0 666 . 775-3338 775-6412 S r a� COMMONWEALTH OF MASSAQHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL, INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 31 Jasper Road Marstons,Mi' 3 s,Mass Owner's Name: Kenneth Masterson _ Owner's Address: Same Date of Inspection: 12 14 01 Name of Inspector: (please print) J.P. Macomber Jr. Company Name:Joseph P. Macomber & Son Inc Mailing Address: P=O= Box 66 rpni-prui 1 1 e Mn 02632 Telephone Number: 508-775-3338 CERTIFICATION STATEMENT I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a D E P approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: / Passes _ Conditionally Passes _ Needs Further Evaluation by the Local Approving Authority _ Fails Inspector's Signature: Date: / -/ f'� The system inspector shall kbmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. if the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that y time. This inspection does not address how the system will perform in the future under the same or different condiitions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of 1 1 OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:31 Jasper Road Marstons Mi11s,Mass. Owner: Kenneth Masterson Date of Inspection: 1 2/1 4/01 Inspection mary: Check A,B,C,D or E/ALWAYS complete all of Section D A System Passes: Q have not found an information hick indicates that any of the failure criteria described in 310 CMR 15.303 or in�DZ R 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B. System Conditionally Passes: 42� One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes,no or not determined (Y,N,ND) in the for the following statements. If"not determined"please explain. W4.The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: aThe system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 `-Page 3 of l l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 31 Jasper Road Marstons Mills,Mass_ Owner: Kenneth Masterson Date of Inspection: 1 2/1 4 f Q 1 C. Further Evaluation is Required by the Board of Health: aConditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: k%) Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. k6 The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet t 50 feet or more from a private water supply well`*. Method used to determine distance 4Q40z "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 31 Jasper Road Mars tons Milis,Mass. Owner: Kenneth Masterson Date of Inspection: 12 14 01 D. System Failure Criteria applicable to all systems: You must indicate "yes"or"no"to each of the following for all inspections: Yes N/ackup _ of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or /clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or / cesspool tzAled� 6/?(fd ' � squid depth in 1 is less than 6"below invert or available volume is less than 'i day flow Required pumping more than 4 Mimes in the last year NOT due to clogged or obstructed pipe(s). Number _ Vof times pumped�. Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface — water supply. FAny y portion of a cesspool or privy is within a Zone 1 of a public well. y portion of a cesspool or privy is within 50 feet of a private water supply well.portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) �1 e (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303. therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply _ 0 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—TWA)or a mapped Zone 11 of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a .significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5ofII OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 31 Jasper Road Marstons Mills,Mass. Owner:Kenneth Masterson ° Date of Inspection: 12 1 4 01 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? Xave large volumes of water been introduced to the system recently or as part of this inspection ? Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components, Including the SAS, located on site? Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum ? JZ_ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)] 5 Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 31 Jasper Road Marstons Mil s,Mass. Owner: Kenneth Masterson Date of Inspection: 12/14/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR,15.203 (for example: 110 gpd x#of bedrooms): ! ?/I Number of current residents: Yl Does residence have a garbage grinder(yes or no): 4 Is laundry on a separate sewage system.cyys or no):"' [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no):,LZ Water meter readings, if availlaabble,(last 2 years usage(gpd)):2 0 0 0—4 2, 0 0 0 gal l ons=1 1 5.0 7 GPD Sump pump(yes or no): t4D 2001 -73, 000 gallons=200 GPD Last date of occupancy: COMMERCIAL/MUSTRIAL Type of establishment: " . Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):&14 ��,� Industrial waste holding tank present(yes or no):/y/J Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: ,fJ Last date of occupancy/use: OTHER(describe): _ A� GENERAL INFORMATION Pumping Records ^�LG Source of information: Was system pumped as part of the inspection(yes or no): If yes, volume pumped: 0 _gallons--How was quantity pumped determined? ,�G¢ Reason for pumping: 4_J TYP OF SYSTEM Septic tank,distribution box, soil absorption system iU Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be dobtained from syste owner) li L Tight tank Attach a copy of the DEP approval Other(describe): .U3 Ap' oxi age pff components,date installed(if known)and source of information: Upgraded 3/23/93 Additional pit was adder at this time. Permit#93-135 Were sewage odors detected when arriving at the site(yes or no): ZO 6 C%b Page 7 of 1 I �- OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 31 Jasper Road Marstons Mills,Mass. Owner: Kenneth Masterson Date of Inspection: 12/1 4/01 BUILDING SEWER(locate on site plan) 1J Depth below grade: rJ 1 .� �/ Materials of construction: 4Qcas[ iron _�/40 PVC_Pother explain):/L/� Ale L Distance from private water supply well or suction line: �W, Comments (on condition ofjoints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of leakage. The system is vented through the house vents. SEPTIC TANK: Zlocate on site plan) lVO,15lA440�'i1S Depth below grade: /Z Material of construction: ncrete X.�metal�fiberglass, olyethylene ther(explain) Aj;� If tank is metal list age:A-1P Is age confirmed by a Certificate of Compliance(yes or no-W. 0 (attach a copy of certificate) Dimensions: �/fdLlliCrb v�� Sludge depth:—�� Distance from top 2f,&Iudge to bottom of outlet tee or baffle: 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 were dimensions determined: 1 Comments(on pumping recormtrm:ndations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of.leakage, etc.): Pump septic tank every 2-3 years. Inlet & outlet tees are present.The tank is- structurally sound and shows no evidence of leakage.into or out ,of the box. GREASE TRAW.4: (locate on site plan) Depth below grade:,2/� Material of construction,;[-concret40 metaJ�fiberglass�_ olyethylene4>Lother (explain): W Dimensions: Scum thickness: 60 Distance from top of scum to top of outlet tee or baffle: Distance from bosom of scum to bosom of outlet tee or baffle: Date of last pumping: 41W Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet inven, evidence of leakage, etc.): Grease trap is not present 7 Page 8 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 Jasper Road Mars ons Mi s,Mass. Owner: Kenneth Masterson Date of Inspection: 12/14/01 TIGHT or HOLDING TANK44t/2(tank must be pumped at time of inspect ion)(locate on site plan) Depth below grade: Aly- Material of construction: tO concrete AIA metal 07 fiberglass AL,4 polyethylene I&other(explain): Dimensions: Capacity: oallons Design Flow: oallons/day Alarm present(yes or no): AM Alarm level: -I Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): Tight or holding tanks are not zaresent. DISTRIBUTION BOX: Zif present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Alle Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box, etc.;: Distri_buti_on box has two laterals.No evidence of solids carry near Nn evidence of leakage into or—olit of f-be hnX PUMP CHAMBEPAAZ (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Pump chamber is not present. 8 Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: IL Jasper Road Marstons Millsfmass. Owner: Kenneth Masterson Date of Inspection: 1 2/1 4/n 1 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) 2-1000 gallone If SAS not located explain why: T,nrated - See page ! 0 Type leaching pits,number: ,(,r6 leaching chambers, number: 0 leaching galleries,number: O leaching trenches,number, length: leaching fields,number,dimensions: O overflow cesspool,number: D ,06 innovative/alternative system Type/name of technology:,22,4- Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Lom san No si on ing C)i are drV Vegp t ' S normal CESSPOOLStk�(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: D Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: 101 Dimensions of cesspool: A1 Materials of construction: /()q Indication of groundwater inflow(yes or no):/J),� Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): esspoo s are not present- PRIVY(locate on site plan) Materials of construction: '414 Dimensions: Depth of solids: Continents(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Pr ivy 9 Page 10 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:31 Jasper Road Mars tons Miiis,Mass. Owner: Kenneth Masterson Date of Inspection: 1 2 1 4 01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. .31 12d I o z A i - 2- Zo 47� 3 3- 50' 3- 45; 0 5 0 5- z� 5- 52- ' 10 „ age 1 1 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 Jasper Road Marstons Mi11s,Mass. Owner: Kenneth Masterson Date of Inspection: 12 1 4/01 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water !�feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: _y_e,-Qbserved site(abutting property/observation hole within 150 feet of SAS) _Na Checked with local Board of Health-explain: YES Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain: . You must describe how you established the high ground water elevation: Used; Gahrety & Miller Model September 1994 Ground water level above sea level. USGS;Obsewrvation well data. June 1992 USGS..GrRiind water level January 1992 92-000-1 Plat #2 Ground Leaching Pit 'eet Groundwater9y Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the boao r, 4_ Of the leaching pit and the adjusted groundwater table is 114,0?1 feet. ]1 i �.rAn rn.—n.r►r".'rrarn. mrnmrrf.-Trtr7.rmm.•m'e'srrlTr.l'I'Rmn nr'n,u*7rRT.m 1rT .ram•'.-ram--�"^--..t..�... TOWN OF Barnstable WARD OF HEALTH 0 SUIISUNFACF SEWAGE DISFVSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION up M -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET. ADDRESS31 Jasper Road Marstons Mills,Mass. ' ASSESSORS MAP , BLOCK AND PARCEL # M-11f— ®� OWNER' s NAME Kenneth Masterson PART D - CERTIFICATION NAME OF INSPECTOR Joseph P. Macomber Jr. COMPANY NAME Joseph P . Macomber & S.an Inc COMPANY ADDRESS P.O. Box 66 Centerville Ma 02632 Stravt Town or City State LIP COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 ) 790 _1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Chec one : System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 16 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED The inspection which I have con ilcted has found that the system fails to protect the pttblic health and the environment in accordance with Title 5 , 310 CMR 16 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . 1 - LLll Inspector Signature Date ecopy of this certification must be provided to the OWNER, the BUYER On where applicable ) and the 130ARD OF HEAL711. * If the inspection FAILED, the owner or""o`perator shall up grade system within one year of the date of the inspection , unless allowed or required otherwise as provided in 3.10 CMR 15 . 305 . partd .doc AsBuilt Page 1 of 2 TOWN OF BARNSTA13LE t4 SEWAGES#5 VILLAGE ASSESSOR'S MAP&LOT &PHONE NO. SEPTIC TANK CAPACITY 1606 LEACHING FACII.rPY:(type)- ,) � �l (size) o�00-0 NO.OF BEDROOMS BUILDER OR OWNER /L uz� lt I DATE: �,� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility _ Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachin fac' ty) Feet Furnished 0 / �tJ* 't0 - 3 a i" http://issgl2/intranet/propdata/prebuilt.aspx?mappar=047032&seq=1 3/10/2016 DATE:_ .8/20/96 . PROPERTY ADDRESS: ''31 J-�sber Road D Marstons MillsMass . 02648 On the above date, I inspected the septic system at the above address. This system consists of the following: 1 . 1-1000 'gallon septic tank. 2. 1 -Distribution box. 3 . 271000 gallon leaching pits . Based on my ing action, I certify the following conditions: This is a title five septic system-.. .- ( 78 Code ) ' The Septic system is in proper Working Order At. the present time. No repairs needed at the present time . , 81GNATURF: Name: J. P.Macomber Jr,, Company:_J. P_Macomber & Son-_Inc . ; Address:--B-, _�6_'___,�___,__ Centerville Mass : 02632 Phone:---5Q873338_____-- - I THIS CERTIFICATION- DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. M9ACOMBER & SON, INC. Tanks Cesspool-Leachflelds Pumped & Insti{fed Town Sewer Connections P.O. Box 66' -enterville, MA 02632-0066 775-3338 77"412 Commonwealth of Mossachusetts Executive Office of Environmental Affairs ®epartment of Environmental Protection F.Weld GOVOMW Trudy Cox* Aryeo Paul Celiuccl Sec W7David B.Struhs LL Gowmor Carm�sabrwr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Add.. Robert L. Masterson AddresaofOwner. Date of Inspeation: 8/7/96 (If different) Nameoflnspeotor. Joseph P. Macomber Jr. Company Name,Addresa and Telephone Number. J.P.Macomber & Son Inc . Box 66 Centerville ,Mass . 02632 508-775-3338 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 nay training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _1z Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Sig"ture: Dates 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: J/SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as derined in 310 CUR 15.303. Any failure criteria not evaluated are indicated below. J SYSTEM CONDITIONALLY PASSES: A)i9 One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passea inspection. to yes,po, or not determined(Y,N, or ND). Describe basis of determination in all instances. It"not determined",explain why not) The septic tank is metal, cra:ked, structurally unsound, shows substantial infiltration or exilltration,-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 11/03/95) I One VAnter Street a Boston,Massachusetts 02108 a FAX(617) 556-1049 a Telephone (617)292-SSW �� Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PropertyAddresa: 31 Jasper Road Marstons Mills ,Mass . Owner. Robert L. MAsterson Date of Inspection: 8/796 B) SYSTEM CONDITIONALLY PASSES (continued) 1 /0 Sewage backup or breakout or huh static water level observed in the distribution beat 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 &/G9 The system required pumping more than four tirrti 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 Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: 44� 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: rL_O The system has a septic tank.and soil absorption system and 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 is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 60 feet of a private water supply well. AZ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feat 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. 3) OTHER (revised 11/03/95) 2 4 ^J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PropertyAddreaa: 31 Jasper Road Marstons Mills ,Mass . Owner. Robert L. Masterson Date of Inspection: 8/'7/9 6 DI SYSTEM FAILS: 4rO 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. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. A.L, Discharge or pondiag of effluent to the surface of she 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 cenTooi is leas 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 4!,* Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. _d 1 Any portion of a cesspool or pricy 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. Lo Any portion of a cesspool ur privy is within 50 feet of a private water supply well. A)V 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. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: �V0 The system serves a.facility with a deaign 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 6.00 and 6.00. Please consult the local regional office of the Department for Anther information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropertyAddra.e: 31 Jasper Road Marstons MI11s ,Mass . Owner. Robert L. Masterson. Date of Inspeotlon: 8 7 9 6 e Check if the followinghave been done: ,L Pumping information was requested of the owner, oc*pa t,and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal �g flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ZAs built plans have been obtained and examined. Note if they are not available with N/A ZThe facility or dwelling was inspected for signs of sewage back-up. ZThe system does not receive non-sanitary or industrial waste flow , The site was inspected for signs of breakout. ZA11 system components,&uding the Soil Absorption System, have been located on the site. ZThe septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of bames 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 existing information or 2The roximated by non-intrusive methods. facility owner(and occupants, if different from owner P� � ) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAddicsw 31 Jasper Road Marstons Mills ,Mass . Owner. Robert L. Masterson Date of Inspootiow 8/7/96 FLOW CONDITIONS RESIDENTIAIy Design Slow: `s onj pc-)-dl 5' • Number of bodroo Number of current residents: Garbage grinder(yes or no):_:�V Laundry connected to system(yes or no)>&7� Seasonal use(yes or no): 4-0 Water meter readings, if available: We 11 ` Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment:_ wk Design flow:_A �ons/day Grease trap present: (yes or no). o Industrial Waste Holding Tank present: (yes or no) Non-sanitary waste discharged to the Title 5 system: (,yes or no)aGL6 Water meter readings, if available:_ 1;/4 Last date of occupancy: OTHER. (Describe) AM Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and o of information: Wme System pumped as part of inspection: (yes or no)101 If yes, volume pumped: 44 gallons Reason for pumping: A44 TYPE 0�'SYSTEM _'Septic tank/distribution box/soil absorption system V6 Siagie cesspool /1r'/c9 Overnow cesspool A-D Privy Shared system(yes or no) (if yes, attach previous inspection records, if any) Other(explain) RO AGE of all components, date iaitalled (if known) and source of information: ,law Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95) 6 : . . 8/7/96 _ (O iEPTIC TANK:�ev y, o-V &` a . locate on site plan) depth below grade:_ Material of construction: concrete _metal _FRP _other(explain) )imensions: y A" nMa 'ludge depth-.—��istance from from top of sl �to bottom of outlet tee or baffle:, cum thickness: z2 ✓' istance_from top of scum to top of outlet tee or baffle:,ls2&C istance from bottom of scum to bottom of outlet tee or baffle,_ �j omments: ecommendation for pumping, condition of inlet and outlet tees or baffle. depth of Liquid level in re)at'on to ou let 'nv rt, structural trity, evidence of leakage, etc.) Pump tank. every, 2=3 years-;.;Inlet iC out e� �ee8�- are lace •Liquid level in relation to .Qut t rover is. 1 THe + no si s REASE TRAP. /I&.,ele, ocate on site plan) epth below grade- 'Aaterial of constn!rti6n4)#9zoncrete _metal _FRP _other(explain) imensions f cum thickness: istance from top wi scum to top of outlet tee or bah'le:_AW istance from bottom of cruet in bottom of outlet tee or b hie:_ V-Ai omments: ecommendation for pumping, condi—ri of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural to iity, a idence of leakage, etcJ_ _ evlsed a/ls/9s) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 1 Jasper Road Marstons Mills Property Address: 3 Mass .p Mills , Mass . Robert L. Masterson Date of Inspeotlon: 8/7/9 6 TIGHT OR HOLDING TANK:&'''X 1 (locate on site plan) • Depth below grada:/1JR Material of oonstiuctiow,.Wconcrete_metal_FRP—other(explain) ,f2 Dimensions: Capacity: gallons Design flow: ons/day Alarm level: / f all Comments: (condition of inlet tee,condition of alarm and float switches, etc.) DISTRIBUTION BOX:Y�'S (locate on site plan) Depth of liquid level above outlet invert: if%L- Comments: (note if level and distribute n is ual, evidence of sc ds ov r, evidence of leakage into 0 out of box etc.) D-Box is leve� ; o signs or solids carry over. ko evidence of leakage in or out of the box. No rP=airs nepdp(i at. the =reSPnt time . PUMP CHAMBER.A?eV (locate on site plan) Pumps in working orden(yes or no)-&"!�-- Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) GOsyJll�lL/11�J (revised 11/03/95) 7 �• y' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontlnued) PropertyAddresa: 31 Jasper Road Marstons Mills ,Mass. Owner. Robert L. Masterson Date of Inspection:g/7/9 6 ,D SOIL ABSORPTION SYSTEM (SAS):_ (locate on alto plan,if possible;excavation not required, but may be approximated by non•iatrusive methods) If not determined to be present,explain: Type: leaching pits,number!_g . leaclLia chambers,number leaching trenches,number,length: leaching fields,number, ions— overflow cesspool, 'number: Comments:(note condition of soil,signs of hydraulic failure level of nhw,condition of vegetation, .) sand;Mpdjum No ins of h drau�ic failure •No signs o ` pon tranatat.inn is norm l - 1 -nit is dry one has 1" of water. No repairs n.,'.dod at tho proaont 'Pima CESSPOOLS:, (locate on site plan) Number and configuration:_ ab4 Depth-top of liquid to inlot invert: wi/,) Depth of solids Depth of scum layer. Dimensions of cesspool: Material of construction: N42 Indication of groundwater: AW _ inflow(oesspool must be pumped as part of inspection) A,V Comments:(Acrte condition of iL signs of'hydraulic failure,level of ponding,condition of vegetation,etc.) ..(G vYy (locate,on site plan) , Materials of construction: Dimensions:_ Depth of solids: Co U (note condition of soil,signs of hydraulic failurs,level of ponding,condition of vegetation;etc.) (revised 11/03/.95)• g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ,FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE L:SPOSAL SYSTEM: include ties to at least two permanent references landmarks. or benchmarks locate all wells within 100 ' ' Well Water I r - • ` � G a sh h y DEPTH TO GROUNDWATER depth to groundwate m th;od of- d P I - mihajtion or o f,�:si-1�r ;:nPw 7 Px�c�i,`�n Xo' .stater encountered at 121 THE COMMONWEALTH OF MASSACHUSETTS �- BOARD OF HEALTH l : TOWN OF BARNSTABLE No. .�. ............. FEE....$...3. t 2112 �t5�1US�tl �Dl'jt� �IIII!3tt'lIi'�i�tt �Pxlttit Permission is hereby granted-........`.'.�.�,•.':`.`�tr:O:'t'.:E r Jr . to Construct ( ) or Repair (Y ) an Individual Sewrtge Disposal System at No..-......�- L?c•r-,Ryas.?....:'. ... ............ .. ... . )) 7...................... . ........ . 5trl'l't 7- as shown on the appli ation f r Disposal Works Construction r 't No. .,, l.... .... � .%�. ��,j-•_�, ' .! ./ Board of fie Ith DATE......... ...... `.,i... ........:............... FORM 38508 HOBBS 6 WARREN.INC..PUBLISHERS ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gertifirutlo of &mplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( XX) b ......................................................... y ...J...I'...i:a...o..... e.r.... i'................................................................................................................................... at ...'11.... as.T)e..r'...B�oal.�....14ar. -o.-. :' ]__ls........................................................................::............................................................... has been installed in accordance with the provisions of TITLE >f_Toe St te-1r"nmental Code as described in the application for Disposal Works Construction Permit No. .. .� „. dated THE ISSUANCE Of THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARAN ECTHAT THE SYSTEM WILL FUN,�T)ON S �ISFACTORY. �•-�� _ v4 " 1 `- DATE ..... ................. JL W � U) bey 3r�1 THE COMMONWEALTH OF MASSACHUSETTS° DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. June 8, 1995 Acting Director of the i�Zion of Water Pollution Control RA{}'!I 1-R:r't�•*T�1TR. iTR RiS'flJ�'RT•1TR.1•CIT:.'}1T'.T�TTi�T•TR.11TlT.i'CST�iJTTR 9'CZ T}rT9"11'^.TI�'R1'•...T+.T-•'F TOWN OF Barnstable BOARD OF HEALTH SUIISUItFACR SUAGF DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION •••rr•t^T•._:: —r.tr..^.--nr.r..R•r..rr+r�s.—errrn�-r—r:t�:-+=re-nmr^�-+nrnesav rsremrnsirv-ecss nTT'^7'rr+*rs�trrn•T•.vnrrr•rr•�r•—.• -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS _ 31 Jasper Roach Msrstnns Mi 1 l s _Maas _ � ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME _Robert L. *Nasterson PART D - CERTIFICATION r NAME OF INSPECTOR Joseph P.MAcomber .Jr. . COMPANY NAME J.P.Macomber & Sdfi' Inc. COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Street Town or City State ZIP COMPANY TELEPHONE ( ) 7� - �� FAX ( 790 ) 1578 A CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate, and complete as of the time o,f -inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one: XXXXxxxxX Systeui PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 , 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have conducted has found that the system fails to Protect the public li�ealth and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date 8/20/96 , One copy of this certification must be provided to the OWNER the BUYER ( where applicable ) and the DOARD OF HEAL1'Ii. * If the inspection FAILED, the owner or" perator shall u d within one year of the date of the inspection, unless allowed ort required he m otherwise as provided in 310 ChJR 16 . 305 . TOWN OF BARNSTABLE qq Gs��RVVAGE # VILLAGE &9 �4 I- ASSESSOR'S MAP & LOT 4NSTA r ER *T ME&PHONE NO. d o'r SEPTIC TANK CAPACITY /000 17 LEACHING FACILITY: (type)o ` (size) NO.OF BEDROOMS s BUILDER OR OWNER A �DATE: � 94 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachin fac' ty) Feet Furnished 4 CC) Y J_f`gyp f TOWN OF BARNSTABLE OCA7 ON E ��✓�°" SEWAGE # VILLAGE ZY9 �� / ASSESSOR'S MAP & LOT_ °` INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 6te -1 LEACHING FACILITY: (typel,"h (size) dJ NO. OF BEDROOMS BUILDER OR OWNER / ✓G�1000 ``�� PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 f of leaching facility) Feet Edge of Weti d d n Facility(If wetlands exist within 3 o cility) Feet Furnishe by ' D i Z 2- 2.b` 7' 3 3 5 r 3- �5 � 5- 12 TOWN OR BARNSTABLE 6 `c, LOCATION M- r ad SEWAGE # VILLAGE �� /an_t `h,/�. ASSESSOR'S MAP & LOTlrJ`L1 r INSTALLER'S NAME PHONE NO.J',,/7 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) p,T (size) af NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER O OWNERfA r6eao) PV DATE PERMITIS�UED: zo Z13 DATE COMPLIANCE ISSUED: VARIANCE SGRANTED-' Yes No ,L .:- p y i new No....- / Fxs�...30.-00.... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH APPROVED ®arnstable Conservation Department TOWN OF BARNSTABLE Appliratinn for Di►ipniul Works Tomitrnrtin Vrntt Date— Application is hereby made for a Permit to Construct ( ) or Repair �X` an Individual Sewage Disposal System at: 3.1...Jas.er....?Oaa...lians.cm.s---Mills-•.............. Masterson Location-Address or Lot No. ......................-.......................................................................... ----•-•---------------•--•---•••-••-••-•-•.....----•-•--•-•-••---..........--•--•---.............. O ener Address a ---- ----=----•---.-...-----•--._.-..-.......•Installer .. Address ^.. .P Macomber Jr. � Type of Building3________________E�Expansion Attic Size Lot_.__.__.___�............_S ( )q. feet r Dwelling X No. of Bedrooms-------------- p• ( ) Garbage Grinder aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ---------------------------------------------------------------------------------------- -------•------•-----•-•----•--•-•-•--•--••--•-...._......---• W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width.......---_---.- Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------- --------•------•---•-••---•-------•-•-----•--•-••-•-•--•-•------- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---•---------------------------------------•--•-•--------------•-•-•----...-•-•-•------..................---...............-----........._......•---•....... O DS�ari�ti o ravel Soil---- ------------------------------------------------------•----••-----•-------------------------------- x v .....•-•••----•--••------•--•-•-•-•-•-•....--•-•--•.........•--------•--_---- W x r=1�OJ.__�;;allon 7eachi �n pig-:•..--------- 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 of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli nce has eenn issued by the b and health. Signed .. . ... ........ .. .� . '-. 3` 93......:..... ApplicationApproved By ...... .............�..,------------- ----------................ ....................... .._,��... .... Dace Application Disapproved for the following rear s: .......... .... ...................................... ... ....C........� ...---'----.... .--------'-------............----..........----........... -----...........Dace...._............. Permit No. ......... ..... Issued ................................._ Date f .,�,.� ..-.�.•.•wu..i-1r.... �..�, ...�.-.��..v..w.,y _v _..Y� ` 1-�..�-_.,..` •� 7 ..�tv.r `-�., • " V + .--..� _a �,,,�-'.: � -.� '— No. $ 30.00 ._.j. � Fr�s.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ��- Appliration for Diripwial 3Vor1w Towitrnrtion 'Permit Application is hereby made for a Permit to Construct ( ) or Repair T(.X� an Individual Sewage Disposal System at: 31 Jasxier ,�?ad...M . .t. ?1.3...M Mills ... ....................•-•-••• ---•-•-•-•-----•--•• --•-•-------------------------•--------...----•-•----•--•--•••-- Masterson Location-Address or Lot No. .....................•.........•••......... Owner Address W J.P.Macomber Jr. Installer Address UType of Building Size Lot............................Sq. feet Dwelling X No. of Bedrooms._......................3_-__-_.__._____Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers Cafeteria ( ) i pl Other fixtures ---------------------- ------------------------------ W Design Flow............................................gallons per person per day. Total daily flow..................:.........................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width..............__ Diameter................ Depth................ x Disposal Trench— No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date--------------.........---------------- Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water..................... I; "4, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 •---•...........................•---•------------------------------•---••-----------•--•--•--•--•--.........•--•••-----.........--•-•--••-•--••----•-••..---- ODSscri tC ofUra�Te ------------------•---------------------------------•--------- V .---------------------------------------•--...........--•-------•---•-•-•--•- � ----- - ------------- - - - ------------- ---- -- -- ------------ - --- -- I=10J0---�,;a1�on leachiri�-.Pl.t.�............ 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 of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has een``''issued by the board of health. -- �lh � .. - ...:................. 3/23 93 ---:1.: Signed ... y ... .,. :-. .................../7 1. -.-........ �:........ �...A��i ..��L� . G'1 f��^i d,,. Dace Application Approved By ......../��. �..� 31,�73 ..'.......�...... ......................:... .. ..:- ---- . ... .... ... . Application Disapproved for the following rea.rd s: ........................................ .. . . . ................. .......... . ....................re----------------- _.—. .............................................................ram........... .. .................Dace......----------- - � � --�------•......................................................_....-----........... .... Permit No. Issued Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE �Ptt>C�IE II �IIZYili�tYICE THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( XX) by ...J•.P.,.Macomber...J ......................................... . .............. .. ... ............ ...... at ...31 Jasper Road Marstone Mills .-.......... ._..._._.. ..... .._.. ....... ... .. .......................................... .......... . ..... has been installed in accordance with the provisions of TITLEof- � he St t nvironmental Code as described in the application for Disposal Works Construction Permit No. .__... . . J. dated ..................._.-------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE i SYSTEM WILL FUNCTION SATISFACTORY. DATE r -1 .�........._....... ...._... _.............._ f j _. Y...1.L �_..... ......-........-....... -.. Inspector .... . -- ---. -. .:.. .�.: /t . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE � $ 30.o0 No...! FEE........................ Diopoat Workii Tontrurtion "ermit J.P.Macomber Jr. Permissionis hereby granted------ --------------- --------•------•--------•-------------------------•---------------------------•----.......---•--------.........-- to Construct ( )) or Repair (X ) an Individual Sewage Disposal System at No.........a1 Jasper Road Marstons Mills r. -------- 1. J _ , Street ''') JJ�� as shown on the appli tion f r Disposal Works Construction �er 't Nod! ...7_._3� /v/�_. �..1....... .............. ............. . DATE---......� .� .. ..�1....�-------------- ----------- Board of Health FORM 36508 HOBBS&WARREN.INC..PUBLISHERS t No 7 ..L..._.: .... Fin& 2 S THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .................OF....... QC).. 11: .. .�'----------------------------..._...----------- Appliratiun for Diiputial Morka Tonotrnrtiun runfit Application is hereby made for a Permit to Construct (Yej or Repair ( ) an Individual Sewage Disposal System at: ..............._... r , ? !'---.�...�....--•----•--.......................... ........ .--------- •--- •--•-----------------------..............._. Locati n-Address or Lot o. � -------C&Ap.......... ........ .................. er Address 1-7..... Installer Address Type of Building Size Lot-.__AP_______--------Sq. feet U Dwelling—No. of Bedrooms.......... .............................Expansion Attic ( ) Garbage Grinder (i-}' Other—T e of Building No. of persons...:........................ Showers — Cafeteria dOther fixtures -------------------------------• - rTaorn W Design Flow............Jjk........................gallons pei P@Psen per day. Total daily flow............3_0..................Olons. WSeptic Tank—Liquid*capacity/ -•gallons Length C�__�a:__:_ Width. +`____ Diameter................ Depth. U.I.. x s Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area..__......_.........sq. ft. Seepage Pit No......'............. Diameter.10.�&_..... Depth below inlet...l.L�_..... Total leaching area.... 6.7___sq. ft. z Other Distribution box (�-j Dosing tank ( ) '-' Percolation Test Results Performed by_ej.(V�• ..rah'- __C po•.................... Date_.�c Is1 fd._7(q._.. ,`�a Test Pit No. 1...1®_`�__..._minutes per inch Depth of Test Pit....41_......... Depth to ground water..&.ee............. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to grou r........................ M .......................................... •••••-••••••••-•••••••••••••••.........•...........- -OF. .. .................. 0 Description of So 1•• -• •• ••••••..... P P-------------- .............. B= S, W - A o M ._...yV Nature of Repairs or Alterations— nswerwhen applicable........................................... No2?654 ..._.....AA O Q_ ••--------------------------------------------------------------------------------•-----•--------------...............__....----••••••••••••• ..... .�o�F TES Agreement: / The undersigned agrees to install the aforedescribed Individual Sewage Disposal NAI ance with the provisions of iI'i 11JE 5 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. Sie . .................................................... ................................ Date Application Approved By........ ............................ _ _ ............. Date Application Disapproved for the following reasons-----------------------------•----------------------------..................................................... -••••••••••-•••••.........-••••••---••-•-....•••••--•-••••••-•-•--•••••••-••••••••--•.................••-••••••••....••••-•••••••••••----•......••-----•----•-••--•••••••--•••......-•••-•-••-......... Date PermitNo......................................................... Issued....................................................... Date l y No.........�. :..... Fss....�..... ............_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ---frV-W17................OF.......Z rd f"llslc� 4.............................................. ApplirFation for Disposal Works Tonstrur#ion Prrutit Application is hereby made for a Permit to Construct (g,-) or Repair ( ) an Individual Sewage Disposal System at: ......................J.. /........................................ .......Lv..---..447, ------........-------------------•------------.•...........------. Location-Address or Lot No. _}16, .1. ►- �! �L �-454.1p........... ................... 1 ` ........................................ er Address W � ' Installer Address Type of Building Size Lot ,l71aQ----.-_-Sq. feet U Dwelling—No. of Bedrooms..........3.............................Expansion Attic ( ) Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ................................. 3Z.0 W Design Flow............/JO-------------t""'-'gallons pd" Per day. Total daily flow............3•.Q.-•--••-----------melons. WSeptic Tank—Liquid capacity��l�..gallons Lengthlt�_�. ..'.. WidthS�40"._.. Diameter................ Depth.4-140... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----I............. Diameter4o.t.o'°_.... Depth below inlet...(e:(:d..... Total leaching area...7-4 7...sq. ft. Z Other Distribution box (b/) Dosing tank ( ) p aPercolation Test Results Performed by._l'� ..C� 1IrV___r4t *.`...................... Date..Jau,��. Test Pit No. 1...,�s 10..._,:.minutes per inch Depth of Test Pit....48--......._ Depth to ground water..' �. ............. Test Pit No. 2................ininutesper inch Depth of Test Pit.................... Depth to groun r:-...................... a+ .....-•-----•-----------------••--•---...............----------..............................••....._•.........•... �\Z..PE yj •--••••-- ODescription of Soil .. . ....... •--•--------........•••••.... 1..... ........ �� ••-•......may ......... ,/. w ••-••----•-.... --.. -j- .-- ---------•---------------------•---•-•----••-•••------ err��nn air W U Nature of Repairs or Alterations—Answe when applicable................................................ .. ..y�Ne-��rq- -_. ..•_-. •----••-----•---•--•.................•---•••-------•-••••-••w.......•..................... Q,r �' F. w�. Agreement: FS The undersigned agrees to install the aforedescribed Individual Sewage Disposal Syste ce with the provisions of TITIZ 5 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. �Siged --"1 .t -------------------------------------------------- .......................... /r Date Application Approved By........!._ ,r '- ----_----_---_-------- - rZ , °:----------- Date................ Application Disapproved for the following reasons:............................................................ ..............•------••------•••-••-----..............-•••••••-•--------•-------••--........••------...--••-•-- ....••---•---_....._._.....----•--•--------------------------••......•-------...--•--- Date PermitNo........................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS I BOARD OF HEALTH ..O F...... . �.. ,�r,�, ................. CIrr#ifiratr of Tontpha td--. THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by-•••••••........._•--•............... .rt. .1�l.---•-......-•-•........... --•-••-••-•-......•-••--...................-•------------••-----------••-•........._......--..._...... bb Installer ----------------------------- has been installed in accordance with the provisions of T 5 of to State Sanitary Code as described in the application for Disposal Works Construction Permit No. _._.2.-4/1.................. dated------ ---74znt.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SAT FACTORY. DATE..............^:�. ......_.:.2N .._ ............ Inspector.... ---•---•------•--------------•-----------..-..------. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....OF........::.... .... ......................... � No......................... FEE...:2 �'� Disposal Vorks T-PaInstrurtion Vprrmit Permission is hereby granted 1..-•-•-•.......................................•---------------...........------.......-•-•---•-- ..._ to Construct }(��,4-or /Repair ( ) anF dJ idual Sewage Disposal System at No... C�-T'• tl►-' ..........�A'4 f s�T"J� .......... ' ../) Street 1 J* /'� .A.�................ ...................... as shown on the application for Disposal Works Construction Permit No..................... Dated_ - . � = ---------•---------------•---•--••.-•-•- "� Bid f DATE................................................................................ Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS71 '?•' �•., 1 2X9 LEDGER BD. W/ n EXIST.2X4 EXTER WALL (3)16d EA. D W/ "ICE t WATER"FLASHING UP —EXIST.SECOND FL OR LSU26 TYP. EXIST.WALL a ENTIRE NEW ROOF EXTER. REAR WALL - NEW 2 X 25 STEEL _ 1/2"CDX OR EQ.SHT'G. -- BEA _ EA.RAFTER O ON 2X8e a 16°G.C. - (SE DETAIL) - MATCH EXIST.SOFFIT DETAIL NEW ROOF @ KITCHEN ADDITION -- �`1 2X4 FRAMED BOX WINDOW \ .. _ ._ EXIST.REAR - WALL LOC. i NEW KIT. REBUILT DECK l SEE FLOOR STL COL.DN FRAMING PLAN) x 2 I/2"LAG TO NEW PIER 771 On _ 14'-8n BOLTS 32"O.C.!®ALT.STUDS J 2XIO LEDGER BD. _ -— EXIST. FLO R/GIFT.ASSEMBLY P.T. �-P.T. - ........- N£W PIER "e (3)2XIO (2)2XIO PLATE 1/4"X 8"CONTINUOUS !2 LOCATIONS) ,Ja - SIMI-SON ANCHOR - REAR FACE OF SECOND (FILLET 2"s 8"G.G.-112J EA.SIDE J DN TO EXIST,FT'G. BASE - FLOOR WALL/FOUNDATION 1/2' CENTER LINE 4" 3"D.SCHED.40 EXIST.HSE. - �' TUBE STEEL COL. STL COL. FDN. � : I SIMPSON ADJUST.BASE 12"SQ.PIER W/(2)•4 VERT DOWELS ON 36"X 3S"X12'D.CONC.FOOTING'S 12"PIER 04 a 12"G.G. F�,4MIl�l SCT(01�1 . EXIST.FOUND. O� OLSON DESIGN ASSOCIATES f�I DENNIS PORT,MA 02639 SCALE3�81I O I_OII 508-775-0300 email-olsondesign®verizon.net (� KITCHEN ADDITION 31 BEAN( DETAIL MARSTO ARSTOERROAn NS MILLS,MA SCALE I/211 = 1I_OII DRAWN FOR: SHEILA WRING FRAMING SECTION &DETAILS see a ,e�z�:o"` D.O. clp er OCT.29, 2015 ^� AS NOTED j IST/.HOUSE FOUNDATION 41_9" I EX �" Llll! !_ IST.SEPTIC EXIST.OIV uuu. rtnoA awi NE-OUT u EXIST.FOUNDATION r ra va r e r v'm.co"c.PEAS tv awu. r w ae� paouT•�odu�e•iYcc > I v ---------------------------- - 9 - _IT, I aF io PiFR P.D.SONO RUBE PIERS r I A fie. .PER o".io sxisr. W/.(L e4 VERT.ON a&'X 38°X IT°D.CONC.FTG'6. _ — — ot v I KI .ADDIT"AS VE a _ iEXIST. I w l_ =L=__ = J Q __ _ _ _\IJ-- :5'l O _ I i 1 1 T-0 " 1 I n•D.SONO mBE PIERS DECK ABOVE I( W/BIG FOOT FCOTW. f 1 1 RE BUI r ROOF FRAMING PLAN 12b.SON.mME PIERS NOfE VERIFY LOCATION SCALE 1/4" = 11-0" O YA•BIG FOOT FOOTING OF SEPTIC TANK PRIOR TO BELTING FOOTINGS SEPTIC I - ACCESS PNL. - CID !"V�IQIPT 6" 6" 14'-0" 61"2" FOUNDATION-PLAN FLOOR FRAMING PLAN SCALE-1/4 -_:i O - SCALE 1/4 = 1-0 CI]X 8 STEEL BM. 3 i NEW KIT. i 6 10Ve i i i` - I EXIST,REAR 1 1 10,_ 14'_6" REBUILT DECK WALL WC. 1 ® ODE N DESIGN ASSOCIATES .. DENNI S IAT S PORT, SS 02AT 5081-1154300 .mall- oleondeElgn®verizon.na KITC-IEN ADDITION 31 JASPER ROAD MARSTONS MILLS,MA - - DRAWN FOR A. SHEILA WRING SECTION THRU KITCHEN ( SEE DETAIL DWG. S-2 FOUNDATION PLAN, o°" ,„ ," a �, FRAMING PLANS m TOP _ aC°zw a'1L "' D.O. /� m a„ SCALE 3/16" = 11—OII o 1� 6CT29,2015 1 j L.1/4"-1'-1" / i r 4- 20-1 OWN' a N M T r E-X--IS-T--.-LIVING P8H'ROOM OM a ;7-5'IST.BA --- _ N � - 20 7" 24-5" EXIST,DINING ENLARGED KITCHEN - - z = _ _ __I W--rw___=5cg= F m g 10'Fz" po a o B 7 - !'VERIFY TO CLEAR - \L'L\�T\�D' FILL J ECK N 1 AGOE99 PNL \I r Z1FY vEtx YOG1TIbN) O WALL LEDGEND ', FLAN EXIST.2X4 INTERIOR WALL PROPOSED FLOOR '` 1 L^N •` - EXIST.2X4 EXTERIOR WALL SCALE 1/4" a V-0II w _ NEW 2X&EXTERIOR WALL ® OL50N ASSOCIATES 8 PORT, + DENNIS PORT,MA 04639 508-715-4300 email- oleondeBiyr-vertzoa t. KITCHEN ADDITION 31 JASPER ROAD MARSTONS MILLS,MA DRAWN FOR SHEILA WRING ° FLOOR FLAN a oPMUCTURAL.�c D.O. N0.2 U. By Ao2 l I I &T.29,2015 1/4" 1! MATCH ALL EXISTING EXTERIOR - - - EXTERIOR FINISH MATERIALS AND COLORS M1 r 1 �� h, I -'I- T. ,r� Lf r7 I - - ADDITION - _1 _ --_ _1 _ I ._ ADDITION - SIDE ELEVATION REAR ELEVATION SCALE 1/4" = 11-0" `SCALE 1/4" = 11-Oil ® OLSON DESIGN MAAS50CIATES02 DENNIS PORT,MA O?63S39 509-115-4300 amell- oleondealgnmverizon.nei KITCHEN ADDITION 31 JASPER ROAD MARSTONS MILLS,MA DRAWN FOR SHEILA WRING EXTERIOR ELEVATIONS omN 3TRUOTUBPI x ��• D.O. �U N0.2se 8 \ � Cbcmni Oy: E ss, EH 610T.29,2015 i ' 4 SOIL LOS �X�>!Il�U�V>l�/.,,�v-.!rnl cx/./.�.ur,u w_v�r�'�x l40•S¢ 2'•.PEAS TONE_LOAM 9 FILL 12" MAX. b� t� o�xJ aA wti ^IQ o.OG4 /( L 41oC.1. DIST. /37 4 BOX �( �izc rssr !3 •y �I a ,24"MINa ° U M 1F r�' IsIE--a /O'MIN, -- 1rjJrr��O D p ° 1000— GAL. I' g.7)A, ° p GAL. °o ° ° PRECAST OR p� SEPTIC 6' to o"° BLOCK ° TANK I°° ° SEEPAGE PIT D ° f� S,W°Ama=1 tag 9F o C° �1 _ y$x r2 05+ p , ° Boi, y, 20' MINIMUM o,° '° °o TD � 2676F ° 01 FOUNDATION I %2" WASHED STONE I i hereby c�rfr'� i1?,g1s A0�_-S Crtlrz-_ s1x wn lErmn was ,�c 9 �Jla�� `ua/fie/�sur>re I _ an f&.20,1 wy1ann ¢mn •,�„� r- a► s D7r7 eTown ate r sfa�fG, Leach arcs raJr_r��a(=f`9�8f sF(i) h garb e 9r1 -EST BY : • P �r,c •:c"A, TOWN INSPECTOR: BACKHOE OPERATOR moo' DAt(,4 4� TEST MADE ON : hicnE-`.. 'tE PE i ' / =32- 07 E Weil l 3'r ii 20 00 it 139 It 54- OP lip Des}•Buc. r �Q 117 f ,� a ^,ape - ,Area `•, �� . °'�� , e SDP 3 \41�tl ELEVATION SCHEDULE t s", -07 EPROPOSED SITE PLAN I INV. AT FOUNDATION 13 .�� ell SEWAGE SYSTEM DESIGN 2. 1 NV. INTO SEPTIC TANK = �� IN 3. 1 NV. OUT OF SEPTIC TANKy = �3tp.'�t1 PS7_0A ,� I /L L5, AIA55, 4. INV. INTO DISTRIBUTION BOX SCALE 1"720' Jan. f9, 191S 5 1 NV OUT OF DISTRIBUTION BOX C-5G'i_0 ° 6. INV INTO SEEPAGE PIT = 135.00� CAPE COD SURVEY CONSULTANTS q r� ROUTE 132 7. BOTTOM OF PIT _ 1 V HYANNIS, MASS. i A DIVISION BOSTON SURVEY CONSULTANTS, INC.B. BOTTOM OF STONE LAYER = '