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0104 JASPER ROAD - Health
104 Jasper s cIL 0 A=047-040 i Commonwealth of Massachusetts 0�/� "00 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w„ 104 Jasper Rd. - Property Address Emily Baker Owner Owner's Name information is Marston Mills MA 02648 1/6/2016 required for every per_ Crityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. kn When A. Genera! Information filling out forms on the computer, use onty the tab 1. Inspector key to move your cursor-do not Paul Martin use Use return Name of Inspector key. Cape Cod Septic Services Company Name ®� 350 Main St Company Address W.Yarmouth MA 02673 Cityrrown State Zip Code 508-775-2825 S15016 Telephone Number License Number B. Certification 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 DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes Conditional) Passes ❑ Fails❑ y ❑ Needs Further Evaluation by the Local Approving Authority —� 1/7/2016 Inspectors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Boar of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Title 5 official kispedim Form:Subsurface Sewage Drsposal System'Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ,M 104 Jasper Rd Property Address Emily Baker Owner Owner's Name information is required for every Marstons Mills MA 02648 1/6/2016 page. City/Town State Zip Code Date of Inspection B. Certification (coat.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System in working condition. S) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•W13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Jasper Rd. Property Address Emily Baker Owner Owner's Name information is required for every Marstons Mills MA 02648 1/6/2016 page. City[Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if.(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ Y N ND (Explain below obstruction Is removed ❑ ❑ ❑ ( p ): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Forman Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 104 Jasper Rd Property Address Emily Baker Owner Owner's Name information is Marstons Mills MA 02648 1/6/2016 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/�day flow t5ins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Jasper Rd Property Address Emily Baker Owner Owner's Name information is required for every Marstons Mills MA 02648 1/6/2016 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone I! of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Jasper Rd Property Address Emily Baker Owner Owner's Name information is Marstons Mills MA 02648 1/6/2016 required for every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El available as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 = 110x3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 11Ox3 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 M 104 Jasper Rd Property Address Emily Baker - Owner Owner's Name info,mation is MA 02648 1/6/2016 required for every Marstons Mills page City/Town State Zip Code Date of Inspection D. System Information Description: 4 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): 2014=90gpd2015=85gpd Detail Sump pump? ❑ Yes ® No Current Last date of occupancy: Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5in3•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 104 Jasper Rd Property Address Emily Baker Owner Owner's Name information is Marstons Mills MA 02648 1/6/2016 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: No records. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form -' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 104 Jasper Rd. Property Address Emily Baker Owner Owner's Name information is required for every Marstons Mills MA 02648 1/6/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2009 Per BOH records. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 18" Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: +10'feet Comments(on condition of joints, venting, evidence of leakage, etc.): Line checked with sewer camera and was found to be clean properly pitched with no sign of root intrusion. Septic Tank(locate on site plan): 10" Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000Gal H-10 Sludge depth: 6 8 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page.9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 104 Jasper Rd. Property Address Emily Baker Owner Owner's Name information is required for every Marstons Mills MA 02648 1/6/2016 page. Cityrrown State „Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 24 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? Estimated Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1000Gal H-10 tank in good condition. PVC tees in place and clean. Tank at normal operating level. Covers 10" below grade. Grease Trap (locate on site plan).- Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts 4 W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 104 Jasper Rd Property Address Emily Baker Owner Owner's Name information.is required for every Marstons Mills MA 02648 1/6/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 f Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Jasper Rd. Property Address Emily Baker Owner Owner's Name information is required for every Marstons Mills MA 02648 1/6/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of Irquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): H-10 DB-3 with 1 line in and 2 lines out in good condition. Box is clean and level with no solids carryover. No sign of overloading or hydraulic failure. Cover 210" below grade. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 104 Jasper Rd Property Address Emily Baker Owner Owner's Name information is required for every Marstons Mills MA 02648 1/6/2016 page. City/Town State Zip Code Date of Inspection D. System Information (coat) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ 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.): 2-500 Gal Chambers in a 13'x25'x2'trench. 6" of standing effluent with no staining above current level No sign of overloading or hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 104 Jasper Rd. Property Address Emily Baker Owner Owner's Name information is Marstons Mills MA 02648 1/6/2016 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Jasper Rd. Property Address Emily Baker Owner Owner's Name information is Marstons Mills MA 02648 1/6/2016 required for every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑' hand-sketch in the area below ® drawing attached separately t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Jasper Rd Property Address Emily Baker Owner Owner's Name information is MA 02648 1/6/2016 required for every Marstons Mills page. City/Town State Zip Code Date of Inspection D. System Information (cons.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high round water: feet p 9 g feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 2009 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Test hole data and engineer letter on file at BOH. Syem certified as put in per plan. Minimum of 6' separation Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 104 Jasper Rd. Property Address Emily Baker Owner Owner's Name information is required for every Marstons Mills MA 02648 1/6/2016 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Assessing As-Built Cards Page 1 of 2 T � ' a TOWN OF BARNSTA R E LOCATION /b y �' a,4— AX SEWAGE# �S—Alff VUJAGE igiGS � .lt+fz/�SASSESSOR'S MAP&PARCEL Z;lq*—QV0 INSTALLER'S NAME&PROM,NO. SEPTIC TANK CAPACITY IQoo LEACHING FACIIM(type) NO.OF BEDROOMS a OWNER 7Z^ PERMIT DAZE- CUWLIANCE DATE: Separation Distance Between the: Man==Adj oted Groin dwatef Table to the Boa=ofLeachmg Facility feet Private Watw supply MW ad I,=hmg Facilay Crf any wells east on site or within 200 feet of kachn facility) fed Edge of Vl B arut Leaching Fae ity(if=W wcdan&exist within 3M feet of kachwg facility). feet FURNISHED BY ov �-c/Y.� D 3 f-33.0 htt»://www_town-barnstable ma.us/assessin¢/HMdisplay.asp?mappar-047040&seq=2 1/5/2016 J.E.,,LANDERS-CAULEY, P.E. CIVIL • ENVIR-dNMENTAL ENGINEERING - P.O:Box 364•W. Falmouth, Massachusetts 02574 Phone 508.540.7733 • 508.540.3022 FAX 508.540.3344 DATE JOB NO. E-Mail: jlandersca@aol.com ^1� A ENTION RE: TO `2Kp:a mca s H SA)aM\S WE ARE SENDING YOU Est Attached ❑ Under separate cove via the following items: > ❑ Shop drawings ❑ Prints T9 Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION V THESE ARE TRANSMITTED as checked below: ,S For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS CCs. w�-Nn Ck cork( COPY TO SIGNED ��_Asz\�� _ . La I if enclosures are not as noted,kindly notify us at once. �� t lam/S? �22®¢?eS �£C�vi C11T � .1V O C�1/c C at,,, No. 2o,Wq Fee 0- -THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0[pprication for �hgpoal *paem Construction Permit Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. ®y � �&� Ow er's Name, dd ss,and T o. Assessor's Map/Parcel l�; Installer's Name,Address,and Tel.No. Designer's ame,A dress nd Tel.N 91 Type of Building: , Dwelling No.of Bedrooms G— Lot Size �Zi Ge,9 S sq.ft. Garbage Grinder ( Q Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.re Mired Z® gpd Design flow provided � gpd Plan Date 7 Number of sheets Revision Date ir Title . Size of Septic Tank / 9 / Type of S.A.S. Z" 210 ¢ C AV rs Description of Soil f Nature of Repairs or Alterations(Answer when applicable) PP ) 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 Boar f Health. p Signed Date Application Approved by S Date Z- Application Disapproved by::;f Date for the following reasons Permit No. _0 S ei — I .5 Date Issued 2 ZOO $ /lJG HCet�, 4_ IIL or THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC-HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpprication for Di000l *pgtem Con.5truction permit Applicatioriifor a Permit to Construct( ) Repair( Upgrade( ) Abandon O ❑ Complete System EV Individual Components Location Address or Lot No. /�y �fG� .5�e� ��/�� Ow er's Name,Add ss;and Te No. Assessor's Map/Parcel Installer's Name,Address;and Tel.No. Designer's Name'A dress and Tel.No. Ile Type of Building: `� 7 -''`Dwelling No.of Bedrooms Lot Size Z Z/7-0-5 sq. ft. Garbage Grinder ( Q Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures /� Design Flow(min.re uired �c/ gpd Design flow provided ,33 gpd Plan.. Date /ZA0 Number of sheets Revision Date � r 7 Q Title � � Size of Septic Tank e!�'aQ QQ'/ Type of S.A.S. Z — j OCR P,:W C f,;W. _ Y Description of Soil 43�;,�Z 57�Z' Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board: f Health. Signed ot 01-J '.�,� Date 47 ~ / Application Approved by— Application Date Application Disapproved by: Date =i for the following reasons y f� Permit No. 2_D b,1 Date Issued Z Zoo THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIF ,that the On-site Sewage Disposal System Constructed ( ) Repaired (1/) Upgraded ( ) Abandoned( )byD� at t 5/ lfl f0,)&45Tr_ JN . /11.5has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.°2..006j �S dated _ _ p- Installer U (Z--T0l_c)11 Designer #bedrooms , Approved desig�ow SO ZU • gpd The issuance of this permithall not be construed as a guarantee that the system will function as designed. Date �{ //(� Inspector \ / . ,� �G✓{ No. ���-�- }s'�--- ----- ------------------.------ .____ _—.--_�. T —Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS lwigool *p!5tem construction permit Permission is hereby granted to Construct ( ) Repair (t/) Upgrade ( ) Abandon ( ) .System located at l©�� �,Q � r� ,/���,•��//�s 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: Constructio: mus be completed within three years of the date of this p• - it. Date (., � Q Approved by Town of Barnstable Regulatory Services 0 Thomas F. Geiler,Director BAxxSTABr e. f 9 MASS. p ' Public Health Division �Ar 1639. ��0 Thomas McKean Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date:eq Sewage Permit# Assessor's Map/Parcel ° -_ Installer& Designer Certification Form Designer: 16C, Installer: Address: p_ -�� Address: PS L 't—u�1 YYtetic,�h On was issued a permit to install a (date) (installer) septic system at J0.3w &A based on a design drawn by (address) Jake LyJZY3- dated © O• ksca .. 00 J 12.108 (designer) - ✓/ © 1011 1 certify that the septic system referenced above was installed substantially according to the design, which may include minor 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 certify that the septic system referenced above was installed with major changes (i.e. greater than 10' 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 follow. Stripout (if required) was inspected and the soils were found satisfactory. _0 `1 0� JoHra �. (Installer's Signature) � ..APJfJ[F�S-irt,LL'r ii ens 4 i No.35101 (D signer's Signature) (A �, ec� ;f; ', p Here) PLEAS RETURN TO BARN TABLE PUBLIC HEALTH VISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoftice fonmsWesignercertification form.doc f Jul 113 09 11:57a.- John Cauley 508-546=3344 p.1 Town of Barnstable �6*1ME rq� Regulatory Services Thomas F.Geiler,Director MASI& Public Health Division i6J9• '�Faa Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Oft-ice: 508-862-4644 ty Fax: 508-790-6304 Date: Sewage Permit# ` 6>r Assessor's Map/Parcel OX - U Installer& Designer Certification Form Designer: Installer: kk// �G.L5 Address: 'P;-ar Address: `Z On � �I � was issued a ermit to install a (date) -- i (installer) septic system at 1�4 11, K-0aclll based on a design drawn by tt i (address) John �. lA K6"- LLt dated 04 1,D4 'rrL1k&Cc l. 00+111o8 (designer) I P s}' �� C>I +o1 I Xcertify that the septic stem referenced above was installed substantiall}1� according to p the design, which may include minor approved changes such as lateral relocation of the distribution box andlor septic tank. Stripout (if required) was inspected and the soils vvere found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than I W 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 follow. Stripout (if required) was inspected and the soils were found satisfactory. JOHN Insta s Signature) J CNl:_ i No.3.5101 (D igner's Signature) ( � ter,"tg titp Here) PLEAS RETURN TO BARN TABLE PUBLIC HEALTCI SION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORMI AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gaol'li�c limnsldesigncrccnilicntion f'nnn.Jnc i `- TOWN OF BARNSTABLE LOCATION A®� /�S® aSEWAGE# !-/S�{ VILLAGE S t 144CMASSESSOR'S MAP&PARCEL 47�1°1- ®�C� INSTALLER'S NAME&PHONE NO.r �� SEPTIC TANK CAPACITY LEACHING FACILITY.(type) (size) l 3 L J NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: a2 Separation.Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY '} D J1.3 r 33c 0 Mq Town of Barnkable P# Department of Regulatory Services oFTME r, Public Health Division Date ///v5 K/? 200 Main Street,Hyannis MA 02601 BARNSrABM T MA99. i639• �s°rfo .r• Date Scheduled Time Fee Pd. IUD Soil Citabi Sewage Disposal Performed By: Witnessed By: :.........:...:..: T _ .......a r,.:......,,n,....:,..:.._. ............I.r u:_,,...i..:._.. ,.. .,.,.. ......� M� AR Location Address ® ,..:.. r.. . Owner's Name `"- �/! /+ Address Assessor's Map/Parcel: Engineer's Name JD C 12i- NEW CONSTRUCTION -REPAIR ,V� - Telenhonef`- S� Land Use 1 A4— Slopes(%) Surface Stones Distances from: Open Water Body11 45 A, ft Possible Wet Area—'*) A ft Drinking Water Well — Drainage Way 01A ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) tJ ® Cs J c r- r cn r— s - M A. +;r y 1 J Parent material(geologic) CAAA tg_ Depth to Bedrock A Depth to Groundwater: Standing Water in Hole: k1 A Weeping from Pit Face AY )!A Estimated Seasonal High Groundwater •91� :...:...........::.....................,...............,.,....-............,................. :;::::::::s�,::r,:,..,,,,:,r,r:,::::::.::�,!:::::,:,:,!:::::::::::::::>:�;=� .._._._........,.i.:!�_�,::,::,::.....,,�:,�:.:�: r,:......�............._...........,,,...:.....,,......_........:.,:..III:!:,., Method Used: Depth Observed standing in obs.hole:' in. Depth to soil mottles: W ¢ in Depth to weeping from side of obs.hole: in. Groundwater Adjustment. Ift. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level ...................:......_...:......... ....... .. .. . ..... ...:... ,... .....L........:.:...... �P T�AT1. :� . Observation 4z-- Hole# Time at 9" " 4 Depth.of Per Time at 6" II � Start Pre-soak Time @ l\1 Time(9"-6") End Pre-soak a Rate Min./Inch Evi 1 Site Suitability Assessment: Site Passed_� Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----=--- Q:HF.ALTH/WP/PERCFORM 'Yr ,1�-c�N►��t Fi.1 CA'" ...:.:;.:.:....... Depth from Soil Horizon Soil Texture Soil Color _ Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consislency ° t, l I 0 c- Y6V E. QBERY�,TXON HUE L,i7G::::< ;:::: H.ole:;#:: Depth from Soil Horizon Soil Texture. Soil Color .I Soil Other(USDA) (Munsell) Mottling - Surface(in.) (Structure,Stones;Boulderes: _ I Consistency.° l C Depth from Soil Horizon Soil Texture Soiolor Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistcrigy.° 40. Depth from Soil Horizon Soii Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boul.dcres. Consistency, Gravel) Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally-Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? � If not,what is the depth of naturally occurring pervious material? Q Certification I certify that on L _ (date)I have passed the soil evaluator examination approved by the Department of Envi nmental Protection and that the above analysis was performed by me consistent with the required training,expertise d experi-ne described m 310 CMR 15.017. Signature _ �. )ate 49 �Z —� TOWN OF BARNSTABLE LOCATION 0� SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by "� LA C IA � 6 C o �s AD PA N �C y� COMMONWEAL TH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION m a 4 h s b i �e TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VLUNTARY S SYSTEM p�ESSMENTS SUBSURFACE SEWAGE DISPOSAL PART A CERTIFICATION Property Address: 104 JASPER RD MARSTONS MILLS,MA 02648 �` O L y S� Owner's Name: TURNER Owner's Address: 104 JASPER RD MA RSTONS MILLS,MA 02648 RE CF�VF� Date of Inspection: 4/26/01 Name of Inspector: (please print) JOHN GRACI MAY 4 Company Name: SEPTIC INSPECTIONS Tp ?0�� Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 NN op D�P�gelE Telephone Number: 508-564-6813 FAX 508-564-7270 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 site sewage disposal systems. I am a DEP approved system 'Inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes _ Conditionally Passes _ Needs Furth valuation by the Local Approving Authority Fails Inspector's Signature: Date: 4/26/01 The system inspector shall submit copy of this inspection report to the Approving Authority(Board of dHoalth DEP)within 30 days of completing this'inspecti n. If the system is a shared system or has a design flow of 10,000 gp greater, 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 TION.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO THE SYSTEM PASSES TITLE V 1NPEC PROLONG THE SYSTEM'S USEFULL LIFE. ****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. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 104 JASPER RD MARSTONS MILLS,MA 02648 Owner: TURNER Date of Inspection: 4/26/01 ]inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: THE SYSTEM PASSES TITLE V 1NPECTION.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. n/a 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: n/a n/a 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: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a f Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 104 JASPER RD MARSTONS MILLS,MA 02648 Owner: TURNER Date of Inspection: 4/26/01 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance n/a "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: n/a Z Page 4 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 104 JASPER RD MARSTONS MILLS,MA 02648 Owner: TURNER Date of Inspection: 4/26/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No _ X Backup of sewage into facility or system component due to 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''/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 n1a. X Any portion of the SAS,cesspool or privy is below high ground water elevation. _ X Any portion of 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 1 of a public 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 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.] _ (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 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 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 " ves 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. Page 5 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 104 JASPER RD MARSTONS MILLS,MA 02648 Owner: TURNER Date of Inspection: 4/26/01 Check if the following have been done.You must indicate"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 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? X Have large volumes of water been introduced to the system recently or as part of this inspection'? X Were as built plans of the system obtained and examined?(If they were not available note as 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 _ 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? 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: Yes no X Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 104 JASPER RD MARSTONS MILLS,MA 02648 Owner: TURNER Date of Inspection: 4/26/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 1 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIALANDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): 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/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a Reason for pumping: n/a 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 Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1978 Were sewage odors detected when arriving at the site(yes or no): NO Page 7 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 104 JASPER RD MARSTONS MILLS,MA 02648 Owner: TURNER Date of Inspection: 4/26/01 BUILDING SEWER(locate on site plan) Depth below grade: 12" Materials of construction:_cast iron =40 PVC Xother(explain): 20 PVC Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 6" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6" H 5' 7" W 4' 10"" Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle:30" Scum thickness:3" 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 were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. GREASE TRAP:_(locate on siterplan) Depth below grade: n/a 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(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 104 JASPER RD MARSTONS MILLS,MA 02648 Owner: TURNER Date of Inspection: 4/26/01 TIGHT or HOLDING TANK: (tank must be pumped 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(yes or no): N/A Alarm level:N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX: X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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.): 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 a Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 104 JASPER RD MARSTONS MILLS,MA 02648 Owner: TURNER Date of Inspection: 4/26/01 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type LEACH PIT leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH PIT APPEAR TO BE FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE. SOIL PROBED DRY CESSPOOLS: (cesspool must be pumped as part of inspection)(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 inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a 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 f Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 104 JASPER RD MARSTONS MILLS,MA 02648 Owner: TURNER Date of Inspection: 4/26/01 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. saw �° D 6 A (D AhS Ll 14 FbC i a°Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 104 JASPER RD MARSTONS MILLS,MA 02648 Owner: TURNER Date of Inspection: 4/26/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+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: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USG'S database-explain: n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12+FEET L Oi CA T 10N SEWAGE PERMIT NO.. ✓0 0�7- 0�0 VI AG E INSTALLER'S NAME & ADDRESS Jo B Uf'LDE R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED g�3 �. fir, a L7 . THE COMMONWEALTH OF MASSACHUSETTS 0" BOAR® OF HEALTH TOWN.....OF.....-.BARNSTABLE. . . ............. ........... .. ............... Appliration for UhnVaii al Works Cfon itrurtaon ramit Application is hereby made for a Permit to Construct ( 35 or Repair ( ) an Individual Sewage Disposal System at: Jasper Road, Marston Mills Lot 457 .........•--..................�....._..___.....----••-•-••-•-•--•.......--•----___••-----•_.. ......._..----------••--............-------•-•-•-•••••---•••-.....-••---•-•-•---•--•-••---•-•-•--- Location-Address or Lot No. a.�L!._. 1!,......... ...(.?:�:.................................. ----- tl J�1h11 .............._............................. Owner Address a ................................ ......................................... --•••---•---------------- 'f`!............................................................ Installer Address d Type of Building Cpf"Io2 - $A-C%hmA Size Lot......2.2_,_205.....Sq. feet U Dwelling—No. of Bedrooms.............3.............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building ....._..... No. of persons..................--------- Showers — Cafeteria a yP g P ( ) ( ) Q' Other fixtures .-__-•------.--•---------_-. W Design Flow................55............_._.._...__gallons per person per day. Total daily flow..__......_....•...3_3-Q..................gallons. WSeptic Tank—Liquid capacity.1009gallons Length Width4.'„-1Q."Diameter---------------- Depth3.'.M4.".. Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......... Diameter.._IQ... Depth below inlet......° 't_________ Total leaching area...... -_-sq. ft. z Other Distribution box (X) Dosing tank ( ) '-' Percolation Test Results Performed b ape-•-Cod--Survey---Consult3ntsDate P.KjJ.-_26l__•1978 as Test Pit No. 1...... .......minutes per inch Depth of Test Pit....12.'......_. Depth to ground water-----none-........ i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------------------------------------------------------------------------------------•-•-•--•_.............................................................. O Description of Soil...0=0. 8 wood loam -- _ -3:0 subsoil . . um,. 0 .. _- ....................................... x & grave 0 ....................................... t �;t� ----------------•---- x �° U Nature of Repairs or Alterations—Answe when applicable...................................................................... !. ...........F:_-. ...... ................. ............................................................... _..._.....--•...............•---•••---•-••--•--...._.._.`'r'....... R r Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in acco the provisions of i IT.E 5 of the State Sanitary Code— The undersigned further agrees not to place ` operation until a Certificate of Compliance has bee sued by the board of health. 'gnelld Date Application Approved By.....- = ...... -- ./// -� .....---•------...-•---•-•---- ....... ........� ° Date Application Disapproved for the following reasons--------------------------------•------------•---------------.....--------------...•••-••......•------•....••_... -•-•-•-•-•-•-----•--......-•------•------•-------•----------------------------------•----....-------•--...---------------•--•------•--------------------------------------------------------------------- Date �/� PermitNo.............................•------------------•-----... Issued_--•- ---•----------------•----. ........._.......... Date i No................ F�s..��.:dam.......... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................TOWN......OF......BARNSTA�B_LE Appliration for Dispoii al Works Tonstrnr#ion ramit Application is hereby made:'£or a Permit to Construct ( 30 or Repair ( ) an Individual Sewage Disposal System at: Jasper Road, Marston Mills Lot 457 ......... _.. ............ .......... .............................................. -••-•-•-•.....•----•----...---..............-------•-•-•-•----•-••-------•--•---...............--- Location-Address-� ...or Lot No.� � C'l.j.._......Ca.(����..............•-•--------•---•----•-•... -----•--.... +.1� 1�11� --.•......-•----•-•--•------•----------............... Owner Address -------------------------------R. 1.o ka...----•-------------.......----•-........ ..---------------------. ........ ............................................................. � Installer Address U Type of Building C-Po-P C - 5AL-74*A Size Lot.....2.2_.r-y.0.5......Sq. feet Dwelling—No. of Bedrooms............3----•-----------------------Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a Other fixtures .------•-------------------------•••--•--•........._... W Design Flow...............55........................gallons per person per day. Total daily flow.................330L..................gallons. WSeptic Tank—Liquid capacity_LO.Ojlgallons Length$_!-V"... Widtht.'..-.10" •Diameter________________ Depths•' .4!1 x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------1----------- Diameter...10........... Depth below inlet...k;............. Total leaching area......._2,0.4..sq. ft. z Other Distribution box (X ) Dosing tank ( ) '-' Percolation Test Results Performed bjCdpe...Gad-..Surue ..Consultants DateApri l....2b_,•--.19.7-8 ,aa Test Pit No. 1-----2........minutes per inch Depth of Test Pit...l2'......... Depth to ground water....none----,--. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..............p ._.� ..................................................................................................... � O Description of Soil... 4- ..8..-:Wood... -3..fl...subsosl.,----�-__O---12-.O..-medi.um_- --------- sq , W ROB T ER \? V ....................&...sr"�vL1........................................................................................................................ �- col F. ----------------•------------------------------------- ..........?---•--------.._...............-----•----•••-----------------•-------------••-••---••----•--•-••----•-•----- -S ------CfXYCbR y'h V Nature of Repairs or Alterations—Answer when applicable....................................................................... ;p--tda.23741 K;° -----••--•----------------•--................---•----------...................._.................---...---------------------------------------------------------------......... Agreement: StON L EN . The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accorda the provisions of LIT?:t. 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 b the board of health. f Date Application Approved By..... ---- ......... .... ----•........................ 17—^ 4?' Application Disapproved for the following reasons:.:................''__._........_._____.._.._...........---..._....._......_........._..._........._._.._...._.. ....-•---------------------------------------------------------•-•--------•------•--------....-----......••---------........•-----•-•-•-----•-------•-----------•--•-••••--•----•-----------•----------- Date Permit No.............:. ...---• -•-------..... Issued . Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH M.. i'!} ............................... (iCnr#ifirtttr of Tompliaifir.�4 THIS IS TO CERTIFY, That the,Individual Sewage Disposal System constructed ( or Repaired ( ) ' Installer at........i-: ...... ...... ......... -----•--................. .......:5-----•-------•-•-•----•-------------------•-••---•--------------------------- has been installed in accordance wit •the provisions of . E 5 of The State Sanitary Code as described in the application for Disposal Works Co struction Permit i' , : .. da.ted:... -�- _ .... .____._.. THE ISSUANCE OF THIS CERTIFICATE SH 07:BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. r f DATE............................................................................. Inspector....... THE COMMONWEALTH OF MASSACHUSETTS A BOARD OF HEALTH ^f ....... ........ ... ...OF................. N j ,C�'aJ �... ;010 � 1................................ ......................... FEE...A:J. ....... T Uispoiiaall Workii T-1onotrndion rrmit Permission is hereby granted......_•%c>•' J AI---•---•-•-------•---------•...........................................................................•----. to Construct k�'.) or Repair ( ) an Individual Sewage Disposal System , at .........7o.�.�L g....All...........M M...... .......... ........................................................... Street r as shown on the application for Disposal Works Construction Permit No..................... .................... ..Y •----------------------------4` %r�Grr6darl�tl , DATE..........7t-a - �". .................................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 1,2 rJ - •f. k, r it. ,� ��.�— (sue/f�' r� , ���� \ i t:C C /July 20, 1978" .".Mr. Stuart•'Bornstein C a Holy Entf erprizes, Inc'In - Box' 957 P.. .O, r Hyannis, Massachusetts .Lot,'4'S7 Jakp6r2 and .Jones Road, stops Mills •e•, Dear: Mr,. 'Borinstein: r ,. , You are granted a_variance to install a sewage disposa], v system`= on Lot 4S7"at ,the scorner',of'.Jasper;Road and,,Jones. :Y,} Road -in-Marstons Milks at •distances of 125 128 and .132 }, feet .from .private,wells inl eu of the,requirod`,150 feet. ;.r• The 'sewage _disposal 'system must be installed .in strict + -.conformance to "they engineering plan .submitted",prior'; to: � issuance .Of, a certificate of co mpliance._ This variance expires August 1, 1979.: .' Very 'truly., yours• f: Ann J e hbaugh, Chikrman ,Robert L. .Child - . . .. A =W Mande M�'D...c.;-.,...a.,.... ` j: , r BOARD'OF,,,HEALTH f'r t f z" i rsn.e. `2 e "'' 's' r, .. , S r i -_ : y„ tM^. .r ' a •{ ti, ,' s, 's.s it ' F s ,. "„� -.t.• -i ,. .,w �. + t ' - - r . f • r }` . '.� t•.r r y�yii xaF a � 'f �>,r?a_.S � Q. i 7'k4 !` �..M : r.. �: k .. , - HOLLY. ENTERPRIZES INC. P.O. BOX 957 HYANNIS, MASS. 02601 July 18, 1978 Board of Health Town of Barnstable Hyannis, MA Dear Members; Attached please find an application and plan for the proposed disposal system on Lot 457 . at the corner of Jasper Rd. and Jones Rd.. in Marstons Mills. The system has been designed to give, the maximum distance from the wells on Lots 456 and 470. It was not possible to maintain the required 150 feet, but we have maintained the minimum of 100 feet required by the State Sanitary Code - Title 5. (The actual distances are 125 feet, 128 feet, and 132 feet. ) We, therefore, wish to apply for a variance on this system so that we might obtain a building permit for this, lot. Thank you for your consideration in this matter. Sincerely, Stuart Bornstein, President •Ps N m O JAIC`J � PER ROAD , �E OF _BASIN ° g0 /7902 � 99 _ — RACE LANE co �11 \`�\ i ► 8 25 E 53 g0, \ , C CB/DH •00. Q Ln '. ,.. (fnd) Off, a NN LOT 457 22,205 S.F. j` ��� \\ (fnd) I Z LOCUS MAP � \ I IN N' O I CIRCULAR $ '� I DIRPRESSION �O� � � IN\\ * ACCORDING TO COMM WATER N O�o EXISTING 2 \ � ' DISTRICT LOTS 456 & 458 ARE REUSE EXISTING BEDROOM HOUSE F SERVED BY TOWN WATER. SEPTIC TANK d� , FIRST FLOOR 44.0, ENCE \ Q ELEV. 103.86 r� l l LOT 458 0M / 2 oT 1 �c�. NN\ �' o � •, h . OBSERVATION �cS 2 f ,t PORTS O-' O cv �\ �` j SITE PLAN PREPARED FOR / Or, JENNIFER PICKETT ENCROACHMENTS SHED WELL'IS `\� / ` -c ,JLEY � �'� of F'ENCfj ABANDONED ( �\ 104 JASPER ROAD '' BARNSTABLE MA LOT 456 1•' �' e �$°�� J.E. LANDERS—CAULEY, P. E. . CIVIL ENVIRONMENTAL ENGINEERING UTILITIES P.O. BOX 384 WEST FALMOUTH, MA 02574 CB DH � ,+ CB/DH 508 540 — 7733 ph. 0 10' 20' 30'. 40' (fnd) dq-Cc) (fnd) 508 540 — 3344 fax ASS.#04 7-040 DATE: 07 07 08 SCALE: 1" 20' REV.7 09 09 JLC SCALE: 1" - 20' DRAWN BY: JDR REV.8 A 08 DLC JOB NO. 1784 SHEET: 1 OF 2 d F.F. ELEV=103.86 � _ __ � 1� �I� � L��i t 'OBSERVATION PORTS TO J BE INSTALLED ACCORDING ELEV.=102.0 20'MIN. lv-rh tN ���r oC TO TITLE 5 STANDARDS. `� rlL ELEV.=102.5 4" CAST IRON OR CONCRETE COVE + SCHEDULE 40 P.V.C. / ' �-� 4" CAST IRON OR r�" V SCHEDULE 40 P.V.C. C 12 MIN. 3" LAYER OF DIST.=KXT'G SLP.=*_-- SLP.=Q,9Q5 INVERT CONCRETE COVER DIST.= �� WASHED STONE FLOW LINE DIST.=10_3_ SLP.=-0_02_ °"°"°"°"o" °"°"°" °" ° �° °-° °.,°.,°.,°„°.,°.,°. ELEV.=EXT G ELEV.= 100.1 lo" MIN. 19" INVERT ELEV. 2 ,°o°o°o°o°o°o°o°o°o°o°o °o°o° °_°°o°o°°°o°o°o°o° THE SLOPE OF THE PIPE G F ELEV.= 99_85 99.59 ®®®® ®®®® 0 8� b < 24" LAYER OF o 0 0 0 0 0 0 ELEV.=____ ELEV. 0 0 0 0 0 0 ®®®®®®®®®®® 0 0 0 0 0 /4" TO 1-1/2" SHALL BE DETERMINED IN D�rs°RUM= � 4" CAST IRON OR 0000000000000 ®®®®®5a5aE3 000000000000 c ��D $ i QUm DEPTH OF scHEDULE 4o P.vc. DISTRIBUTION BOX 0.,0 0 o O 0 0 ®®®®®®®®®®® 0„0„0 0 0„0„0- E 7�Q THE FIELD AFTER THE THE TANK USED. in INVERT OUT OF THE (SEE CHART AT RIGHT) IF MORE THAN 4' OF COVER. HOUSE IS DETERMINED. USE H-20 ,LOADING USE STONE TO 2 ® 4' 10" x 8' 6" LEACHING CHAMBERS EXISTING 1500 GALLON SEPTIC TANK TO BE WET TESTED IF LEVEL THE BED EQUALLY SPACED IN A MORE THAN ONE OUTLET. AS NEEDED. 13.0' x 25.0' BED 5.0' LIQUID OENfLGT TEE TO BE PLACED ON DEPTH BELOW FLAW LINE 6 OF STONE OR BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV =92.50 4 FEET.......14 INCHES MECHANICALLY COMPACTED SOIL. 5 FEET........19 INCHES 8 FEET........24 INCHES SOIL TEST DONE BY. J.E. LANDERS—CAULEY P.E. SEE.227 (8 MR WITNESSED BY: DON ____________________ PERCOLATION RATE: -.5---MIN/INCH P# 12309 TEST HOLE 1 DATE: �31108 _ ELEV. 102.5- PROFILE OF DEPTH HORIZON TEXTURE COLOR MOTT. OTHER I CERTIFY THAT I AM CURRENTLY APPROVED BY THE SEWAGE DISPOSAL SYSTEM DEPARTMENT OF ENVIRONMENTAL PROTECTION PURSUANT 0-12 0/A TO 310 CMR 15.017 TO CONDUCT SOIL EVALUATIONS NOT TO SCALE AND THAT THE ANALYSIS GIVEN HAS BEEN PERFORMED 12-38 B LOAM lOYR e/8 BY ME CONSISTENT WITH THE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE DESCRIBED IN 310 CMR 38-80 Cl MED. COARSE 10YR 6/6 15.017. I FURTHER CERTIFY THAT THE RESULTS OF MY SOIL EVALUATION, AS INDICATED ON THE ATTACHED GENERAL NOTES: s`''IID SOIL EVALUATION FORM, ARE ACCURATE AND IN 80-120 C2,; MED. SAND lOYR 8/4 ACCORDANCE WITH 310 CMR 15.000 THROUGH 15.017. F, i. THIS PLAN IS FOR THE REPAIR OF AN EXISTING SEWAGE DISPOSAL SYSTEM. r �a'�'YA OF 2. PLAN REFERENCE L.C. 30751 I SI LOM 457 BARNSTABLE REG. OF DEEDS. F, JOHN GJ,� 3. THIS PLAN IS FOR THE INSTALLATION /REPAIR OF SEPTIC SYSTEM R CAUSE AND NOT TO BE USED FOR SURVEYING AND ZONING PURPOSES. NO H2O NO WETLANDS 35101 DESIGN DATA: 4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. P TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. TEST HOLE 2 DATE: _______ BER OF BEDROOMS ELEV. 5. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN GARBAGE DISPOSAL NONE (p�_____ 12" OF THE FINISHED GRADE. DEPTH HORIZON TEXTURE COLOR MOTT. OTHER 6. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE TOTAL ESTIMATED FLOW -a3Q----- GPD SAME, UNLESS NOTED BY FINAL CONTOURS. e 7. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE 0-12 0/A ( 11(L__ GAL /BR./DAY X ____ BR. OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR 12-36 B LOAM 10YR 6/8 SEPTIC TANK CAPACITY 150-SxAL__ u► �+'� WITHIN 10' OF DRIVES OR PARKING AREAS. H-20 LOADING 38-80 Cl MED. COARSE 10YR 6/6 f. SHALL BE USED UNDER OR WITHIN 10 OF DRIVES OR PARKING LEACHING AREA REQUIREMENTS Co AREAS UNLESS NOTED. B. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL 80-120 C21 MED. SAND lOYR 6/4 BE MORTARED IN PLACE. SIDEWALL AREA 14Q�0_ GAL/S.F. F i,9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH BOTTOM ARE A _��___ G DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO �ACH G CAP.(BOT. & SIDEWALL 344 5 GALOBTAIN SUCH DETERMINATION FROM APPROPIATE AUTHORITY. )---=- 10. THE EXCAVATOR/CONTRACTOR SHALL VERIFY THE LOCATION OF NO H2O NO WETLANDS ALL UNDERGROUND UTILITIES PRIOR TO ANY EXCAVATION. RESERVE A-P'ACITY=3 ___ GAL 5 APPLICANT: JENNIFER PICKETT DATE: 8/04/08 REV. 7/09/09 JLC SHEET 2 OF 2 JOB # 1784 ,�► MO JASPER R®A p AVEMENT— — — — — �E� E °F� 11 BASIN 14�, _ co g0' R= �790 RACE 0 •� `\'•� I I CB/DH(fnd) /00 � I co 11 LOT 457 "' ,, ---1°° 22,205 S.F. j` C LOCUS MAP �� ( n ) Z I � I I Z- I O ,CIRCULAR DIRPRESSION ® -----' \ Go * ACCORDING TO COMM WATER N pl`' EXISTING 2 W DISTRICT LOTS 456 & 458 ARE w BEDROOM HOUSE SERVED BY TOWN WATER. rn REUSE EXISTING SEPTIC TANK d� FIRST FLOOR 44 0' ENCE \ 6° g' � ��. ELEV. 103.86 LOT 458 oT OBSERVATION r'cS 2 0 `rp PORTS O' / SITE PLAN et ` jl' ;1� p�Rsy PREPARED a3 5 JENNIFER PIC�> T ENCROACHMENTS SHED WELL IS f� ��' �'' `` ' > of 41 FENCE 79, 8,25 ABANDON / �:�v �i10i a 104 JASPER ROAD * W 12p p-, 1 / ' BARNSTABLE, MA LOT 456 O } J.E. LANDERS-CAULEY, P.E. / CIVIL ENVIRONMENTAL ENGINEERING UTILI 3ES 0 P.O. BOX 364 WEST FALMOUTH, MA 02574 CB/DH CB/DH 508 540 — 7733 ph. (fnd) (fnd) 508 540 — 3344 fax 0 10' 20' 30' 40' ASS. 047-040 DATE: 07 07 08 SCALE: 1" = 20' DRAWN BY: JDR SCALE: 1" = 20' REV.B 1 08 DLC JOB NO. 1784 4: 1 OF 2 F.F. ELEV.=103.86 I: OBSERVATION PORTS TO 20'MIN. BE INSTALLED ACCORDING ELEV.=102_0 y TO TITLE 5 STANDARDS. = 4" CAST IRON OR CONCRETE COVERS, ELEV. 102.5 SCHEDULE 40 P.V C. 4" CAST IRON OR 3" LAYER OF SCHEDULE 40 P.V.C. 12"MIN. 3" LAYER DIST.=EXISTIN(ELP,_* INVERT CONCRETE COVER SLP.=Q`QQs�2 FLAW LINE DIST.=10_3_ SLP.=0.02 DIST.=_ _ WASHED STONE EXISTIN _ INVERT — 000 o0o0o0o0o000000000 oa000000000000000a000000" ELEV.= CtLEV.= 99.18 10" MIN. 19" ELE Q$.sr2Q o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0. 0 o_o_o_o_o_o_o_o_o_o _o o_ o_ o o_ o o_o_o_ THE SLOPE OF THE PIPE Isx of ELEV•=98.93 98.73 ®®®® ®®®® b gs 8- o - b V < 24" LAYER OF GTH „ „ „ o 0 0 0 0 0 0 0 �O LEf TSE IS a ELEV.=---- ELEV. �0 0 0O0O0 ®®®5RE30E3 E3 000000000o�o�oC /4" TO 1-1/z" - SHALL BE DETERMINED IN DEfSRMItiSD BY THE 4" CAST IRON OR o 0 0 0 0 0 ®®®®®®®®®®® o 0 0 0 0 0 o WAs is vID DEPTH OF scHEDULE 4o P.vc. DISTRIBUTION BOX 0 ,0 0 0 0 0 0 ®®®®®®®®®®® 0„o„0 0 o„o„o� E =���4 THE FIELD AFTER THE T�E TANK USED. INVERT OUT OF THE (SEE CHART AT RIGHT) IF MORE THAN 4' OF COVER. 2 ® 4' 10" x 8' 6" LEACHING CHAMBERS HOUSE IS DETERMINED. USE H-20 LOADING USE STONE E EQUALLY SPACED IN A EXISTING 1500 GALLON SEPTIC TANK TO BE WET, TESTED IF LEVEL THE BED MORE THAN ONE OUTLET. AS NEEDED. 13.0' x 25.0' BED 5.0' LIQUID OUTLET TEE TO BE PLACED ON DEPTH BELOW FLOW LINE 6 OF STONE OR — — — — — — — — — — — — — — — — — — — — - --� — 4 FEET........14 INCHES MECHANICALLY COMPACTED SOIL BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE E V - " 5 5 FEET........19 INCHES 8 FEET........24 INCHES SOIL TEST DONE BY: J.E. LANDERS—CAULEY P.E. SEE 310 CMR 15.227 (8) WITNESSED BY: DON _ -----i PERCOLATION RATE: -.5___MIN P# 1230 ? TEST HOLE 1 DATE: i31108 _ V. ------ PROFILE OF DEPTH HORIZON TEXTURE OLO MOTT. OTffER I CERTIFY THAT I AM CURRENTLY APPROVED BY THE DEPARTMENT OF ENVIRONMENTAL PROTECTION PURSUANT SEWAGE DISPOSAL SYSTEM TO 310 CMR 15.017 TO CONDUCT SOIL EVALUATIONS NOT TO SCALE 0-12 O/A AND THAT THE ANALYSIS GIVEN HAS BEEN PERFORMED 12-48 B LOAM lOYR e/8 BY ME CONSISTENT WITH THE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE DESCRIBED IN 310 CMR 48-80 Cl MED. COARSE 10YR 6/6 15.017. I FURTHER CERTIFY THAT THE RESULTS OF MY SOIL EVALUATION, AS INDICATED ON THE ATTACHED GENERAL NOTES: SAND SOIL EVALUATION FORM, ARE ACCURATE AND IN 80-120 C2 MED. SAND lOYR 6/4 ACCORDANCE WITH 310 CMR 15.000 THROUGH 15.017. 1. THIS PLAN IS FOR THE REPAIR OF AN EXISTING SEWAGE DISPOSAL SYSTEM. 2. PLAN REFERENCE L.C. 30751 I SHLOM 457 BARNSTABLE REG. OF DEEDS. 3. THIS PLAN IS FOR THE INSTALLATION /REPAIR OF SEPTIC SYSTEM AND NOT TO BE USED FOR SURVEYING AND ZONING PURPOSES. NO H2O , NO WETLANDS 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------ 5. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN TEST HOLE 2 SATE: _______ ELEV. ___ GARBAGE DISPOSAL 12" OF THE FINISHED GRADE. DEPTH HORIZON TEXTURE OLOR MOTT: THER 6. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE t` TOTAL ESTIMATED FLOW -a3Il----- GPD SAME, UNLESS NOTED BY FINAL CONTOURS. 7. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE o-iz o/A ( 11(L__ GAL/BR./DAY X ____ BR. ) OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR 12-48 B LOAM 10YR 6/8 SEPTIC TANK CAPACITY -150-0- GAI�_ WITHIN 10' OF DRIVES OR PARKING AREAS. H-20 LOADING r SHALL BE USED UNDER OR WITHIN 10' OF DRIVES OR PARKING 48-80 Cl MED. COARSE 10YR 6/6 AREAS UNLESS NOTED. LEACHING AREA REQUIREMENTS 8. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL 80-120 C2 MED. SAND lOYR 6/4 SIDEWALL AREA 15?,__ GAL/S.F. BE MORTARED IN PLACE. 9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH BOTTOM AREA _32 ___ GAL/S.F. DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPIATE AUTHORITY. LEACHING CAP.(BOT. & SIDEWALL)_358 _ GAL 10. THE EXCAVATOR/CONTRACTOR SHALL VERIFY THE LOCATION OF NO H2O NO WETLANDS ALL UNDERGROUND UTILITIES PRIOR TO ANY EXCAVATION. RESERVE LEACHING CAPACITY -qLEL---- Gam,, APPLICANT: JENNIFER PICKETT DATE: 8/04/08 REV. 8/12/08 DLC SHEET 2 OF 2 JOB # 1784 t Y r a J. SOIL , LOG ,+ At �x11iU l 5(,fetly/I/la/A►/T 2".PEASTONE '�.• LOAM B .FILL- 12"MAX. CJOrfj ll4wy ; ,r�k. '* .- / y>_ q_-!, f11 • O O 0 � `J'.{y/G, - y � ~ mot a frw. 4 C.I. DI sT 1 I',•• ° e ° I f /. Ufa ri ` MIN.BOX' I •:,e -- . e � 24 ° /o'MIN. 1000 4rlr°� .e.., 6200— GAL. d o GAL. PRECAST OR ° ° SEPTIC TANK BLOCK °o ° t SEEPAGE _PIT _ o i 20` MINI.MUM apj ro? FOUNDATION ... - tt$2- I*ASlIED STONE ELEVATION SKETCH r= lo' 'RIFC. RATE s �KD�� �.w SCALE. 1`!: 4` TEST BY :, cr �v,rt.fsc.,.f-yip �ar..�rvrr�, .;• '? � J" TOWN INSPECTOR[ P4-.xl. ~AQOPV� •�"• BACKHOE OPERATOR 3 t T, TEST MADE ON otOl /2 $ ' M •• � \� ` -•--ems' � � f�.l • N4, s _,..,-----�-•..•f � ��� Ste- 6© 'l�,t�a ►,3��x'� .�' t > Nl m- "Ilk _..�•_.�. .. _.,,+:y •---••- .-.,r • >-r. -•..:--.».►.,�trs=w�•.. ,.«.-yam.•, •�'- -., �e+..:�_ I + ��. s^..1 a } 'y''`��'� �-w,.,� ' �'.�.i� �,C w1 - t �� - 3""iyk •t^'•'.`a• Rw3.vy,�.++a•-.Y:.•...•.-•_...wl.'r:•.:..,e•._.� _.xe....� Y..,`!' - � �r�. t 4 f Y,-{._ NcD t ,! ► r 4,5 7 A;I ,ta► t \\'. �)rd,,/ „ /ls.. i\ - ,.' •i air St .r Tf/4� •$;;�:/r_';ter$�; •✓;h✓Ot.i,11r� - /�, '` `' .. '�...1 s` .` �'� � r .�'eW,X��.tii d.:�n4� �f G.p17"`G��l 'w�, � � ` � \ �� � •`r: + ':, ';�" "� ,1 .:+�//..r�v,�'/C_ �,:+.i���. /rfa'y� '��iYe�zs%t.'s�r� �*.. i t� • .. � `` 't - � ; .j `� -, J."•dtvv:�ts' �F"T.�Ix` � LE�.AG>rtl.> . � \ ,� r ° � ,t '� �i�`•+� .�! ."�".'JJIGr/N rJI� 4 /Q'�✓Y S�y+,,.y /w ,_}.,� - •�j \ ,pt `} x ,- '�' S,' l� �R:. ot IT I.C•L:IL'AY ' \ V G/:/lf7ri v r�'�i I ��.• ` ` - r 5.. ,� X ra'� rc..:�.. 3 P DR.M W 110 -OALl t7AY. ' � 4•�G�'I�;l'�1A,15�tf�6��,�`(.'i�� 1�x� 13� �,,f ,;9 0 �f • ,e S,ram, . ��` • - !.�'o,�r� j 010SWA1.d. its °°,�2i5�e./ss=/r r�i4►?r t.1 tart`( .�- a.� 18.6ioX I-DeA/S 7AY;• '7&16 P� t FO M `9 y !_ FWBERT ✓�J Ogg: F. 1 DA'FLCrR iP A* r ROBERT ELEVATION SCHEDULE p� No.23iR1 � DAYLOR�' , ,: . . PROPOSED SITE PLAN` 1 f�o;zot f- 1. . INV. AT FOUNDATION SEWAGE. SYSTEM, DESIGN �d�v��' 2. 1 NV. INTO S-EPTIC TANK = 112-1 1 N L 3. 1 NV. OUT OF SEPTIC TANK 4. 1 N V. INTO DISTRIBUTION BOX SCALE: 1 = '4psaiL.- 19 v 5. I.NV. OUT OF DISTRIBUTION BOX = 13b C—.641 j r S: CAPE COD SURVEY CONSULTANTS. ;d: 6. INV INTO '.SEEPAGE PIT = t36.¢T ROUTE 132 }� T. :BOTTOM OF PIT HYANNIS,MASS. A DIVISION BOSTON SURVEY CONSULTANTS, INC. 8. BOTTOM OF STONE LAYER i•�i�x1��` - _ y4 ter t i o e ,r -; t r J fit•,� t d`Y ray +�.e�s5 :~�',.� ..lei~�>� •a <y+f - ! - .y"' r - 0',` ,�••O , x.r t t':.F �''`#,ya°•r`t; U Y.I%k4 xllN�r/ri.�..•ctrJ�r.aiV�Wi�/ x r tt /� ." - •'� 2 PEASTONE ,�...LOAM 8 FILL 12'MAX.. M. BOX I° 0 °O • 0 /O MIN. 1000 I; >, f 00— GAL. a °c� PY�c. /3d s� ,'• GAL. , e. PRECAST OR a SEPTIC I� o BLOCK - TANK 1=•�', ' . SEEPAGE PIT ° ft ° i o t 20' MINIMUM `FOUNDATION" >y ,_ s « is _• i1"WASHED STONE ELEVATION SKETCH �' Y 10, ltltC. RATa s`' ,V� �J >i,� SCALE; 1°= 4` TEST BY i� iia-..i�d� ,✓��Q�iG. 3�s 't ^ .z�A ' sr Vk Pa TOWN INSPE6.T0_R.:.,P_Jav4 iiiiar20Ja-1, • r N� " BACKHOE•OPERATOR : `y TEST MADE. ON d I-*,4 1 > •✓ } '� '"''"-.�` . r. \, •fib' p-•'' v _ •`„' ��'. i L.�iGt"� p'"f`r�r':I - ,. 3 .. \ '. � r � t.i +x� N. �e � "..�{ + .'�� Y� d -� „• +fir r. ,y...k.««-.+r'rwr.. _..:,:..-.::-e..-.?----�'°-.""—'-`.'• ,:r��. .-..,..�' .+::.,.,.r.f v,s-+^.'+;.:"�4^!^+`"'.++'«:,».r ;�.�:.C,a='cr-«,-.*-%+..-. �:L t..+«!,.y. f ...n.,,n,.-.. ` - - 'F _ ,. ,♦ Mr s+� �" ` i p> .. . � - .., � ,__.+"`,�`-. ••»Sw<"^'yr'"""+y u•�•-...•,--.-�w.•a.'.:y�....-,....,-•».-..-»�,•a�a^.ax•• -..•..�..-,.�..}.,.�, - `� ' � �'�' o o � _ I C�DG' !��-• �tiV '39 M� G '� KrA 7:^If�G"' 'S��k:✓� urt S .r.�ia+�...1,^.l , •�v :� �` (.�t�` / \` - � ;}� � ..� �'`ry- Jt" 5 GG.evTdl3 66}< ` , f t ,1 �„ h t,`.., • x . _ tJ•�/Vl.^7i�a�i.+(.,, Y's •l+/•!�/� I��,.,r `^�i�'Y!"iJC�, �! �f"t.�r � .`�'r - r• -� R �, �• - +�• 4 I, 7,. !. � s° 'r �y��/�.�► `•��// J �y +iT'..r„a j-.. /',is.�{y {� +,F b� J'1 *��, i*ra(.yha a �r A�y�;. n Y .-^ yy 9'S.-r W f�G#.'�YYV ��"',K/'��� �"F' ��� %` x., !!p��7'�i �t* j 4 .4'C .` :1'' �f�•i' '�y 5 L 1'i� 4 MS:Ij � fi M« �r �.•y,.�,t� , .y r 4. /`•• y tf . - f,P l qi't'•:''i ' f^1N✓/Y,1/+Q�.T' E7A!?I�". / 1: / •r. +' t y /I +� lt 'C�'. ' �.,r' ;• . .Z 1.:,' .L •�Y fir , y j < .i, • i^_" J , .' *7 : t= r.d-wiz"'raw w} �.,. a A•� ��Ira1 :G/hlr1.11.. Tj1*.# •,� �, p t v } #\ _j is s a r_"a $3 70"'1�fiJ S't R.M �'u� c. `f a '. ► �%PP►'1✓. _ - �3y `_� f, " �,, F y s N Y, )/M�•[• #3 . .� '�1 .a 1 - \ �. .• y 1,yr FxWA ' # +""IZSg >C2, 6.a►/tom t�AYs3jAI 'GtAJ• t '1! Ay+,. { :� `" �.•, , '� 1,. °.. _ Y n t�C i 7rJ" V9 •I" �. .. p+-M �4r !.c 1 �"'�"-' Rt7BERT .�m71V , � 1 0k4'� }k� ELEVATION SCHEDULE r fp;�I..23741 PlAYLQ °� I PROP08E0° '.SITE PLAN ,�w r " �• �J. 1 N'V. AT • F N T - � `f �•�_ �,� �-'.. t• 'Ast �- •�,; �, � �N s y+s, �,^=}`k ,' 8EINAAE.'SYSTE* °0K'SI6N , , .i ` '•' �Ir e• i.. 2. ,I,N V. INTO SEPTIC TANK e - 'I-' •1r i�f' t + �, 'i•-13 '.3 ' ' '' w".r`"'*5e, 'e f fi i• vF 't J� 70 I � s I NV. OUT OF SEPTIC TANK = 'j /J1 - ^T' 4' 7'/ :.J+� +f1P,.•� ; y� .'�a d `:{ r' ='_" '� �_ � � �r ` .. s _, .' - ' /l!���iv+�'���� � -4. s'iiiRr '�:'� �!'!`'.. � •,.�" x tom• ��}. 4. 1NV. INTO 'DISTRIBUTION' BOX c c aR u_ �` �,: r SCALE:.I - - / iL 19 a `' s J t ~OUT,- OF• � � � ' "'` .h N .r'E. ,�'��. a '' 'a•�,+I , ,� { •r, `� t 5. I NV. DISTRIBUTION BOX = Ib C 6. <.INV INTO SEEPAGE PIT _ CAPE COD SURVEY ,CONSULTANTS'. Z BOTTOM Of PIT, /3?. a: HYANNIS,MASS. 4 �trl}}' A. DIVISION BOST ' RNSULTANTB INC.' ON SURVEY. C0• «` ' " + a.*• r ,"• h �tiELF:,' 3 ij ;"`J'"�.wr $._$OTTOM OF.' STONE LAYER = �� ¢ ; J� '< + �, r ', "�"-vz � e, n.e. ��• NT e��� F y kr� ST° I'= s7k: 4'lip. F r+ '�. r.. ;.... ^_• 'i`.. _ x> «t,+ .E # i!`.^�'f. F ,F yp L',i� t"�i',-. -".•,7"1:d-,:th^ ; 3k,•.�o-;Uyi�i 'ia°"'�•r ..".;-." � .` _'• - ':{ .` tft�9� "�r"' -f�.3*�:s "� "� � '` �'+ ,rr. '� ... d, .. .. •t � r. . . .•:k Imo•"� % .s"t���+'i"'�f'��4�i 'L"��+r'`'�•.' *" .MX't°'`�'.� y�f •�t i r_ + ` a f �.. + T4 ,. .. »k !�..g .I-i•.�.+Ji 4• `�r"`k�.�t A.``^� ♦. yrt�t 't;yr,,''"it.re .a���' .•�,�,fi.-'�'`'r•:L.� r '� SX>•`# �• ?. `ems 'r.�. `�' llf`w� 3 °t•`+.. 1=nazi r 1,' z„q SY"-,.r 'fifiA,';✓i�.:_t. ,�+ �,�,.. a,,, �'C% '1�`.� a 5r...- ..f, �f.?- }:- .. '.i ..� 'tr. •' .,"v H r. ".dQ�:: � ti� :�:.. .-� ..x' ti s• k. ,rn - c : , ,�a{4" �' .'.'�,= •i•.[ •' ,.,, '. ;.t r ._ s'"if: > ry �a k'�.{�:�. 1,x0. iw, r.d,/:�, , , w au;•. ., b.,..Ss.,e.,t,-_ • , � _ ..�. .*:y �` p', `• a �,. 6Y k�i U�^" a'�}''.°��r '�`�xv/M- v � ��,