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0023 JILLIANNS WAY - Health
23 Jillianns Ways ; ' 057-001 -X �, 6 Marstons Mills No. � �T�f THE COMMONWEAL -C-3'If{ MASSACHUSETTS FEE c� BOARD Oj�F �HEALTH (�� J OF c FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT APPLICATION O Application for a Permit to Construct (Iflq-Repair ( ) Upgrade ` ( ) Abandon ( ) ❑Complete System ❑Individual Components- o T �iusrrt� Lucalion Owner's Name ap/P cel# Address eLot#, Telephone# �CJ nn Installer's Nai<7 D ner Name � Address Address T Telephone# Telephone Type of Building: o4Z S/j-e-� Lot Size 22 '1 3 Z'Sq.feet Dwelling—No.of Bedrooms f it- Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min. required) �o gpd Calculated design f ow Kf'<o gpd Design floNy provided I'l gpd Plan: Date Number of sheets Revision Date A1 Title CJ/ cY �A,C J o/G Description of Soil(s) CS C �-•. Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation ; DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees t to lace the system in operation until a Certificate of Compliance has been issued y the Board of Health. Signed Date �' l 4) FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 10 !� ? a THE COMMONWEALrCy MASSACHUSETTS FEE ��•� BOARD bF HEALTH Ct F ,t 4,0. e 0 - APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT r Application for a Permit to Construct (IK.Repair ( ) Upgrade ( ) Abandon ( ) ❑Complete System ❑Individual Components$ Location Owner's Name ap/P cel# Address Lot# Telephone# Installer's Nary. D i ncr Name Address Address -�-J( M4 c3a(s`�Y !-K,S`i/,/ Telephone# Telephone Type of Building: 1,413/c�� c._.e Lot Size 2 2 �1 3 �- Sq.feet Dwelling—.No.of Bedrooms 4 Garbage Grinder ( ) Other-Type-of Building No.of persons Showers ( ), Cafeteria ( -)" Other fixtures Design Flow(min required) gpd Calculated design flow 7'�a gpd Design flow provided r)e5F gpd Plan:.Date /3 Number of sheets / Revision Date 4 Title JAI T� f 5�..�a-4IF Description of Soil(s) �- Soil Evaluator Form No. Name of Soil Evaluator l/ /,ie& Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLES and further agrees to lace the system in operation until a Certificate of Compliance has been issued Oy the Board of Health. Signed Date /� �r . �Inspeefiio"as �i�•-o-y�r� � ��.c,�.. C � _X ._ ,.t FORM 1 #APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. 7�( THE COMMONWEALTH OF MASSACHUSETTS FEE ^� . ,...........-- r13���Z,, �0� r►.5di�i� BOARD OF HEALTH -7 CERTIFICATE OF CO LIANCE "' Description of Work: IndividualEl1 Component(s) om I System The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned( ) by: Ct C i tr a has been installed in accordance w h the rovisions of 310 CMR 5. Title 5) and the approved design plans/as-built plans relating to application No f 7 S dated ��' ��' Approved Design Flow (gpd) Installer Y I C u G Designer: R Inspect Date � 11 The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. J FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 I No. 7 THE COMMONWEALTH OF MASSACHUSETTS FEE /at 'I+ n� IrC BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hey granted to Construct (Repair ( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system at / l�� 4 lido-1 &,) " as described 7 in the application for Disposal System Construction Permit No. dated // 7 r-9,!�;r *Provided: Construction shall be completed within three years of the date of this permit.All local conditions must be met. Date Board of Health yFORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1`255 (REV 5/96) H&W HOBBS&WARREN TM PUBLISHERS- BOSTON No. `s'✓ Fee�— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for -MisposaY 6pstem ConstCUttion permit Application for a Permit to Construct( ) Repairy Upgrade( ) Abandon( ) ❑Complete System `[Individual Components Location Address or Lot No. Z S t�'� , w�7 Owner's Name,Address,and Tel.No.W;t 1.4.rn 1h c l Assessor's Map/Parcel M AaSX0,4 5 d►'":�l S �` Installer's Name,Address,an6 Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms —1 Lot Size 2 Z 73 2 d- sq.ft. Garbage Grinder( ) Other Type of Building a .,- No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design.Flow(min.required) Li`CO gpd Design flow provided L4 S gpd Plan Date Lf-2 2 '7_0 ll Number of sheets Revision Date Title '7 Size of Septic Tank I Type of S.A.S. -3 o® j A 'Lo Description of Soil -2 n Nature of Repairs or Alterations(Answer when applicable) 13 1 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described gn gr sc bed 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 e Signe Date �'� 07 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. �,�� _ l Date Issued Y- �/ Y Fee - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:L Yes v PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 9ppliLation for -Misposal 6psthn Construction Permit Application for a Permit to Construct( ) Repairt )j Upgrade( ) Abandon( ) [:]Complete System LZIndividual Components Location Address or Lot No. 'Z 3 T f 11: y .f - Owner's Name,Address,and Tel.No.k/;t 1,p., A•c 441*w,,,n M _%Tvvi Assessor's Map/Parcel 5'7 pQ --Xb f Installer's Name Address,and Tel.No. t 1 Designer's Name,Address,and Tel.No. c _ tieAp�.a/•( G� QvI j�s 1'd(^M V"' �),,e, 85 ca'.,% atrC Type of Building: Dwelling No.of Bedrooms Lot Size 2 Z?3 Z¢ sq.ft. Garbage Grinder( ) _ t9ther Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 4 q O gpd Design flow provided t4 : 4 gpd Plan Date 4-ZZ `Z-y\7 Number of sheets Revision Date Title 23 •�l\.�.�.s _w'Size of Septic Tank I Type of S.A.S. C3 500 q e-( 14.2-u L-• C.- Description of Soil Nature of Repairs or Alterations(Answer when applicable) 6 ii S 1 t l ! <,t j 3 a r 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 Boardgf.He �Ith. Signed" --.. Date L " Y7 Z-it t 7 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. �" Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO RTIFY,that the On-site Sew ge Disposal system Constructed( ) Repaired Upgraded( ) Abandoned(^ )by .40ueA_j• � EhR_eP`-r ) C at � -�J A'►'-tj pv'►Q" has been constructed in accordance with the pro isions of Title 5 and the for isposal System Construction Permit N��''17' dated "7 7 Installer C t U—t e 'e-rq V�,s C Designer 4✓©ks+� �, -�L2... #bedrooms `4 Approved design flow gpd The issuance of this permit ss all nn/be construed as a guarantee that the system-Vl1'1 uFctio'aos eJsi j ed. Date �/ �// r✓ Inspector"'"" - --------------------------------- J No. 0/ / ��— -. Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair Q Upgrade( ) Abandon( ) System located at 2 IL , ,A�n W�! 4vz. TZ1V1 t" �1 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within ee years of the date of thi`permit. ` �^ Date �--{ Approved,by y Town of Barnstable Regulatory Seirvices. enx�vsUB Thomas F. Geiler,Director NAM 16 9. ,0� Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form I Date: f Sewage Permit# O 7-12Z assessor's Map�Parc¢fl 40/ d 0 Designer: p w~` t r"-, 7 Installer: �e w l A Address: Address: 3 Co rs-,rn-P r-cc a 1 ST i On `1 i 1 C1D2� was issued a permit to install a (da e) (installer) septic system at C?3 based on a design drawn by (address) 0./1 I ail dated S esign r) _ } ✓ I 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. 1 I certify that the septic system referenced above was installed with major changes (i.e. greater than 1.0' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Focal Regulations. Plan revision or certified as-built by designer to follow. ' DAPNIELA CJJA nstaller's Sign e) CIVIL �No. 46502a � r sS�ONAL ECG esigner s Signature) (Affix Designers Siamp Here) PLEASE RETURN TO BARNS`I'ABLIE p UlBLIC HEALTH IDMSION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED IJN L ]BOTH T ffffS FORM AND AS-(BUILT CARD ARE RECEIVED BY TBE BARNSTAIBL E PUBLIC ffIEALTH(DIVISION. THANK YOU. } t Q:Health/Septic/Designer Cerfification Form 3-26-04.doe _ i r Town of Barnstable Barnstable o,� AHlmericaCdr Regulatory Services Department IARNSTABM MASI 16,9. Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7012 1010 0000 2847 8599 March 29, 2017 MACDONALD, PAUL B JR 23 JILLIANNS WAY MARSTONS MILLS, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 23 Jillians Way, Marstons Mills was inspected on 03/17/2017 by David B. Mason, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas cKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\23 Jillians Way Marstons Mills.doc r. Town of Barnstable + a + IARNSTAHLE, " + �f16,59. Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA'02601 Office:.508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5111116 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) _ An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground w ❑ Pumping more than 4 times during the last year not due to clogged or obstructed Pipe ❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool O 1 YEAR DEADLINE CRITERIA tatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching pit or cesspool with high liquid level, <12"below inlet (per Town Code §360-9.1) ❑Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc r , Commonwealth of Massachusetts T v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessment 23 Jillians Way , M Property Address N3 Paul MacDonald, Jr. F� Owner Owner's Name -JI information is - required for every Marstons Mills MA 02648 March 17, 2017 page. City/Town State Zip Code Date of Inspection CA Q1 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. Important:When filling out forms A. General Information cSJ--* old on the computer, use only the tab 1. Inspector: key to move your cursor-do not David B. Mason use the return Name of Inspector key. Company Name 4 Glacier Path Company Address East Sandwich MA 02537 City/Town State Zip Code 508-833-2177 S1287 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority o / Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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 under1he 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Jillians Way Property Address Paul MacDonald, Jr. Owner Owner's Name information is required for every Marstons Mills MA 02648 March 17, 2017 page. CityT town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): l5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts . W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 23 Jillians Way Property Address Paul MacDonald, Jr. Owner Owner's Name information is every Marstons Mills required for eve MA 02648 March 17, 2017 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): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 23 Jillians Way Property Address Paul MacDonald, Jr. Owner Owner's Name information is required fir every Marstons Mills MA 02648 March 17, 2017 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 1/day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 23 Jillians Way Property Address Paul MacDonald, Jr. Owner Owner's Name information is required for every Marstons Mills MA 02648 March 17, 2017 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 II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 23 Jillians Way Property.Address Paul MacDonald, Jr. Owner Owner's Name required for is every Marstons Mills required for eve MA 02648 March 17, 2017 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? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? p ® ❑ 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): 4 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 449 t5ins.doc•rev.6/16 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 °M 23 Jillians Way Property Address Paul MacDonald, Jr. Owner Owner's Name information is required for every Marstons Mills MA 02648 March 17, 2017 page. City/Town State Zip Code Date of Inspection .D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage Yes 9 ( Y 9 (gpd))� Detail:' Per Cotuit Water District; 2016; 204,000 gallonsa and 2015; 177,000 gallons Sump pump? ❑ Yes ® No Last date of occupancy: Current 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: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 23 Jillians Way M Property Address Paul MacDonald, Jr. Owner Owner's Name information is required for every Marstons Mills MA 02648 March 17, 2017 page. CityTrown 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: Board of Health 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 23 Jillians Way Property Address Paul MacDonald, Jr. Owner Owner's Name information is required for every Marstons Mills MA 02648 March 17, 2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1998 Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: 17" feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Appears to be in working condition at the moment Septic Tank(locate on site plan): Depth below grade: 4"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal. typical Sludge depth: 3" t5ins.doc•rev.6/16 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 23 Jillians Way Property Address Paul MacDonald, Jr. Owner Owner's Name information is required for every Marstons Mills MA 02648 March 17, 2017 page. Citylrown 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 . 32" Scum thickness 2" 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 15" How were dimensions determined? Scour Stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tees are in place and effluent is level with outlet invert Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 23 Jillians Way Property Address Paul MacDonald, Jr. Owner Owner's Name information is required for every Marstons Mills MA 02648 March 17, 2017 page. City1rown 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 23 i,••� J Illans Way Property Address Paul MacDonald, Jr. Owner Owner's Name information is every Marstons Mills required for eve MA 02648 March 17, 2017 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Effluent above outlet inverts 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.): Dbox has solids and heavy grease carryover. Dbox is decayed 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: leaching trenches without access.Used video Camara. t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 23 Jillians Way Property Address Paul MacDonald, Jr. Owner Owner's Name information is required for every Marstons Mills MA 02648 March 17, 2017 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2-25' ❑ 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.): Probed soil with indication of effluent standing in trenches. No excessive vegetation growth. No ponding on surface. Used camera in trenches which showed staining in pipes and standing water. 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 l Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c,M 23 Jillians Way Property Address Paul MacDonald, Jr. Owner Owner's Name information is required for every Marstons Mills MA 02648 March 17, 2017 page. Cityrrown 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.doc•rev.6116 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 �M 23 Jillians Way Property Address Paul MacDonald, Jr. Owner Owner's Name information is required for every Marstons Mills MA 02648 March 17, 2017 page. Cityrrown 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 23 Jillians Way Property Address Paul MacDonald, Jr. Owner Owner's Name information fo is every Marstons Mills required for eve MA 02648 March 17, 2017 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 120 + 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: 11/20/1998 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Water Contour Map ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Existing information Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 23 Jillians Way Property Address Paul MacDonald, Jr. Owner Owner's Name information is required for every Marstons Mills MA 02648 March 17, 2017 page. Cityfrown 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 r I b 9 Ai 64 =5a' A -55'5" Al -$q, Commonwealth of Massachusetts . _ Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 23 Jillianns Way s Property Address: Dan Keane Owner Owner's Name information is required for every Marstons Mills MA 02648 10/10/13 page. City/Town - State Zip Code Date oflnspection 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. Important:When A. General Information filling out forms on the computer, use only the tab 1. key to mcve your Inspector: cursor-do not Matthew Gilfo use the return key. Name of Inspector = B&B Excavation, Inc. �y Company Name 14 Teaberry Lane - Company Address Forestdale MA 02644 City/Town State Zip Code (508)477-0653 S113640 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15000). The system: ® Passes. ❑ Conditionally Passes ❑ .Fails ❑ Needs Further Evaluation by the Local Approving Authority 10/15/13 Inspector's Sig ture _ Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,:the inspector and the.system owner shalt 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•V13::: Title 5 Olially tion Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 23 Jillianns Way Property Address Dan Keane Owner Owner's Name information is required for every Marstons Mills MA 02648 10/10/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 I j . Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 23 Jillia_nns Way Property Address Dan Keane Owner Owner's Name information is required for every Marstons Mills MA 02648 10/10/13 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): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of 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 (Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 23 Jillianns Way Property Address Dan Keane Owner Owner's Name information is required for every Marstons Mills MA 02648 10/10/13 page. CitylTown 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. ElThe 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 Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 23 Jillianns Way Property Address Dan Keane Owner Owner's Name information is required for every Marstons Mills MA 02648 10/10/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Ins...pection Form Subsurface Sewage Disposal System Form .- Not for Voluntary Assessments ,M 23 Jillianns Way Property Address Dan Keane Owner Owner's Name information is required for every Marstons Mills MA 02648 10/10/13 page. City/Town -- State Zip Code. Date ofinspection C. Checklist Check if the following.have been done..You must indicate"yes" or"no".as to each.of the following: Yes: No El ® Pumping information was provided by the owner, occupant, or Board of Health ❑ Z Were.any of:the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two we period? 0 ® Have large volumes of water been introduced to the system recently or as part of this inspection? Were:as built plans of the ystem:obtained and examined? (If they were not ® El available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? Z El 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. ® ElDetermined 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)::: 4 Number of bedrooms (actual):: 3 DESIGN flow based,on 310 CMR 15.203.(for example: 110 gpd x#of bedrooms): 449 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 °M 23 Jillianns Way Property Address Dan Keane Owner Owner's Name information is required for every Marstons Mills MA 02648 10/10/13 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current 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: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 23 Jillianns Way Property Address Dan Keane Owner Owner's Name information is required for every Marstons Mills MA 02648 10/10/13 page. Cityrrown 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: 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): 15ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 23 Jillianns Way Property Address Dan Keane Owner Owner's Name requir required is Marstons Mills MA 02648 10/10/13 required far every 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: 1998 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appears to be in working condition. No sign of leakage Septic Tank(locate on site plan): 4" 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: 1500 gal 5 li Sludge depth: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 23 Jillianns Way Property Address Dan Keane Owner Owner's Name information is required for every Marstons Mills MA 02648 10/10/13 page. Cityfrown 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 30" Scum thickness 2" 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 15" How were dimensions determined? scour stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appears to be structurally sound. No sign of leakage. 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 23 Jillianns Way Property Address Dan Keane Owner Owner's Name information is required for every Marstons Mills MA 02648 10/10/13 page. City/Town 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 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 23 Jillianns Way Property Address Dan Keane Owner Owner's Name information is Marstons Mills MA 02648 10/10/13 required for every � page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence cf leakage into or out of box, etc.): At time of inspection d-box appears to be structurally sound. No sign of solid carryover or leakage 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 23 Jillianns Way Property Address Dan Keane Owner Owner's Name informatics is required for every Marstons Mills. MA 02648 10/10/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: (2)4'x6'x2' ❑ 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.): At time of inspection leaching appears to be in working order. No signs of 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 cf construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 23 Jillianns Way Property Address Dan Keane Owner Owner's Name information is required=or every Marstons Mills MA 02648 10/10/13 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 I i Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Jillianns Way Property Address Dan-Keane Owner Owner's Name information is required for every Marstons Mills MA 02648 10/10/13 page. City/Town 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: M hand-sketch in the area below ❑ drawing attached separately A ; I w SU r Ai _30'31 ' gt �B SIr Az_ -34'5 02--alb" J A3 .581 64 .5at A5-55'5', 65 -30%5' A6,50' t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 23 Jillianns Way Property Address Dan Keane Owner Owner's Name information is required for every Marstons Mills MA 02648 10/10/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check.cellar ® Shallow wells Estimated depth to high ground water: > 120 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: 11/20/98 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: 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 23 Jillianns Way Property Address Dan Keane Owner Owner's Name information is Marstons Mills MA 02648 10/10/13 required for every 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 Q5 7— 6V/Xo7 Date: _ae2 k0 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: L&wffi, 1c. al� BUSINESS LOCATION: / MAILINGADDRESS: ® Mail To: If Board of Health TELEPHONE NUMBER: S-09 :7 3 7_,_�r�) 7 V Town of Barnstable CONTACT PERSON: DaI4 t LaOe P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: .Sd 9 ya R, g a 1 1 Hyannis, MA 02601 TYPEOFBUSINESS: La,.�K �_ n Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES _X NO This form must be returned to the Board of Health regardless of ayes or no answer. Use the enclosed envelope for your convenience. If you answered YES above,please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar _ Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor& furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids ' PA, (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Town Of BarllStaMe 7LJ / ('� v Department of Health,Safety,and Environmental Services �„m Public Health Division Date �— � � 367 Main Street,Hyannis MA 02601 CMAM C unxartetA j Date Scheduled I( Time Fee Pd. r>® Soil Suitability Assessment for Sewage Disposal . � Performed By: ��-' ®��1 �s,. P -` L�jWitnessed B Y LOCATION & CCENEIiAL I1POR1vIATIIV Location Address i - Owner's Name — IU l Address Assessor'sMap/Parcel: C5-/zP" — X Engineer's Name 0,,J.-X NEW CONSTRUCTION REPAIR Telephone# 3 -7- — d"" ! 1 Land Use oitG�°- Slopes(%) �� Surface Stones Distances from: Open Water Body �J ft Possible Wet Area '�;-(-Z) ft Drinking Water Well 7 ft P Drainage Way �� ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 7 Parent material(geologic) 9,.-v Depth to Bedrock Depth to Groundwater: Standing Water in Hole: �J' Weeping from Pit Face Estimated Seasonal High Groundwater ✓0 P DETERMINATION VOR SEASONAL HYGGH.WATM Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well#_ -Reading Date:_ Index Well level._,___ Adj.factor Adj.Groundwater Level PERCOLATION TEST:: to Observation Hole# Time at 9" Depth of Perc Time at 6" Start Pre-soak Time© Time(9"-6") End Pre-soak Rate Min./Inch v �� v�,n.11 t A/ Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back---� Copy: Applicant lYole# UI;EI' 013SERVA'I'ION HOLE LOG Soil other Soil I lorizon Soil Texture Soil Color I)cpllt from (USDA) (Munsell) Mottling (Structure,Stones,13ouldercs. e Surface(in.) 0 �j1- ---------------- 7-77-777 DEEP OBSERVATION HOLE LOG :Soil Texture Soil other Soil I lorizon Soil Color Depth from (USDA) (Munsell) Mottling (Structure,Stones,Doulderes. Surface(in.) e Q_ "2._ 2 —W `.-20 t✓ 't��.Lrj k' �, 1Ia1e# DEEP 0�3SECtVA`I10N 14OLE I,OG oil Color soil other Depth from Soil llorizon S1f a (Munsell) Mottling (Structure,Stones,Doulderes. (USDA) Surface(in.) e g t I j f r DEEP OI3SERVA'TION HOLE LOG Hole# oilier Soil Color Soil Depth from Soil Ilorizon 5oil re (Munsell) Mottling (Structure,Stones,Doulderes. (USDA) Surface(in.) e r I Mood insurance Rate MapL �( Above 500 year flood boundary No_ Yes / Within 50o year boundary No Yes Within 100 year flood boundary No Yes pehth of Naturally Qgcurrina lervinuc 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? I I If not,what is the depth of naturally occurring pervious material? Certification E Y I certify that on t i (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CM 15.017. �� O� TOWN OF BARNSTABLE LOCATION . R t SEWAGE # VILLAGE z' ASSESSOR'S MAP & LOT A, ` i INSTALLER'S NAME&PHONE NO. �" "ay y SEPTIC TANK CAPACITY LEACHING FACMITY: (type)' er—'t l E �x ~ `a (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTI'DATE: 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 i 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 yy I �tf k y � X I I _ YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate UNLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. r;.;;�,,� DATE: Fill in please: APPLICANT'S YOUR NAME/S: V'u,"a- ' �r ; - Y BUSINESS YOUR HOME ADDRESS: 2-5 Ii I li ahn- Way srra; a Y _ N(ar-.4-p ►s Mill-, NIA, 02648 TELEPHONE # Home Telephone Number Sb$ 958- gc?A NAME OF CORPORATION. NAME OF NEW BUSINESS 1vrFu�ki oh TYPE OF BUSINESS vl�f ui-Five, Con5u(4i We.' . IS THIS A:HOME OCCUPATION? X YES NO ADDRESS OF BUSINESS 23 �Iiiani,s Ma�Fohs M�Its MA MAP/PARCEL NUMBER o57 001 -XOG (Assessing) 02648 When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE MUST COMPLY WITH HOME OCCUPATION This individ al h s n info, of ny permit requirements that pertain to this type of business. RULES AND REGULATIONS. FAILURE TO COMPLY MAY RESULT IN FINES. Au oriz Si rat re* e COMMENT S r L':r c sL. .e-I, 1 2. BOARD OF HEALTH This individual h -.be n info o pe i re u ements that pertain to this type of business. L . Authorized S' nature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: 713122 „ T.O.F. AT EL. 58.0' SEPTIC PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) A.H. OJALA, PE ACCESS COVER (WATERTIGHT) TO ENGINEER: WITHIN 6" OF FIN, GRADE 2y, SLOPE REQUIRED OVER SYSTEM 55.0' WITNESS: JERKY DUNNING I_ MINIMUM: :75' OF COVER OVER PRECAST o RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE DATE: 11/5/97 F54. FOR FIRST 2' PERC. RATE _ < 2 MIN/INCH PROPOSED 1500 3 MAX. O ' GALLON SEPTIC 54.0' CLASS I SOILS P# 9050 TANK (H- 10 ) GAS BAFFLE 53.09' 1_ 52.92 (7.5 % SLOPE) �b" CRUSHED STONE OR MECHANICAL 52.50 2' 50.5' COMPACTION. (15.221 [21) 1 ELEV. 2 , 4 SET PIPE AT .005� SLOPE Q Q 54.E DEPTH OF FLOW = ( 3 SLOPE) O 54.0' 0' TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED STONE 0 & A INLET DEPTH = 10 2" 3" O & A OUTLET DEPTH = 1 4" 6.5' E LOCATION MAP SCALE 1" = Zoos LS E LEACHING i FOUNDATION- 10' SEPTIC TANK 29' D' BOX 6' 6„ 10YR 5/2 " 1OYRS5/2 ASSESSORS MAP 57 PARCEL 1-1 w FAG LITY 6 B ZONING DISTRICT: RF (OPEN SPACE) B YARD SETBACKS: 44.0' LS LS FRONT = 30' 24" 1OYR 3/6 52.0' 10YR 3/6 52 8° SIDE = 15' - 24„ REAR = 15' CATCH BASIN C C PLAN REF. .- 533/41 E / BENCHMARK: FLOOD ZONE: C �f `,231 51 ® ELEV. 59.9' MED/COS MED/COS P03 . 1OYR 5/6 1OYR 5/6 ` --� 150 c0 120" 44.0' 120" 44.8' �\ - NOTES: LOT 9 i NO WATER ENCOUNTERED 22,732 s.f. / ASSUMED FROM BARNSTABLE GIS MAP _SEPTIC _DESIGN_ 1. DATUM IS __(GARBAGE DISPOSER IS _.NOT ALLOWED )_ _ \\ S SGAR.LAB !• DESIGN FLOW: 4- BEDROOMS (110 GPD) = 440 GPD 2. MUNICIPAL 'WATER IS AVAILABLE 1 6 , ` EL. 58.5' / USE A 440 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8 PER FOOT. \ \\ \ 10 SEPTIC TANK: 440 GPD ( 2 ) = 880 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- - 2• 5. PIPE JOINTS TO BE MADE WATERTIGHT. PROP_ DWELLING \ \' USE A L500- GALLON SEPTIC TANK 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. I \ T.F. 59.0' LEACHING: ENVIRONMENTAL CODE TITLE V. )\ SIDES: [2(36 + 4 2] 2 (.74) = 236.8 GPD 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE USED FOR LOT LINE STAKING. BOTTOM: 36 x 4 (.74) = 213.1 GPD 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. TOTAL: 608 S.F. 449.9 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED USE (2) 36' LONG x 4' WIDE x 2' DEEP LEACH FROM BOARD OF HEALTH. TRENCHES `� \ \\ 2 �\ `\ 1 \.� I I �`�� \ TH \ SEND SI I E AND SEWAGE PLAN 100.0 R�OPOSED SPOT ELEVATION OF LOT 9 JILLIANN S WAY 100x0 EXISTING SPOT ELEVATION IN THE TOWN OF: ` MO PROPOSED CONTOUR ( COTUIT) B A R N S T A B L E \ \ - 100 - - EXISTING CONTOUR PREPARED FOR: \ \ DONALD PIRES 90 hh BOARD OF HEALTH MA SCALE: 1" = 20' DATE: NOVEMBER 13, 1998 APPROVED DATE off 506-362-4541 fox 506 362-9880 OF �M /VINE N. ARNE down cape engineering, inc. OJALA =4N. CIVIL OJALA„ N g CIVIL ENGINEERS- PST30792 r $ N°'s�� LAND SURVEYORS G�' 98-438 939 main st. yarmouth, ma 02675 ARNE H. OJALA, P.E., P.L.S. DATE LEGENDD SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES /� MARKED WITH MAGNETIC TAPE OR SYSTEM DESIGN PROVIDE MIN. 20" DIAM. WATERTIGHT NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 99 -- EXISTING CONTOUR 1. DATUM IS NAVD '88 FIRST FLR. EL. 57.8t ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVER TO WITHIN 3" GRADE X 99•1 EXIST. SPOT ELEV. GARBAGE DISPOSER IS NOT ALLOWED FILTER PEASABRITONE OR GEOTEXNE 2. MUNICIPAL WATER IS EXISTING �95 \ FILTER FABRIC OVER STONE -[99]- PROPOSED CONTOUR DESIGN FLOW: 4 BEDROOMS 110 GPD = 440 GPD 55.5' MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 55.0 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. I R�� p� [9 B.4 NOTE: 2" MIN. WALL O ] PROPOSED SPOT EL. USE A 440 GPD DESIGN FLOW PRECAST H-�o THICKNESS REQUIRED BLOCKS OR 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS ,p RISERS (TYP.) , PRECAST RISERS 3' MAX. TOP TO GRADE TO BE AASHO H-ZQ �( O TH1 2'0 54.8 4"0SCH40 PVC MORTAR ALL H-10 ( ) PIPES LEVEL 1ST 2' COMPONENTS INV'S EL. 51.5 ' 5. PIPE JOINTS TO BE MADE WATERTIGHT. .nTEST HOLE SEPTIC TANK: 440 GPD 2 = 880 4'*EXIST. .. ENDS ( ) �-4 IDES 52.33 ��\P RE-USE EXIST. 1500 GAL. SEPTIC TANK** 10• EXISTING 14 �o�o�oo 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH O 2 SLOPE OF GROUND ° . :. , TEE 1500 GAL H-10 TEE o 0 0 0 _ o t� O O O O O >ooioo° °o° SEPTIC TANK 53.4'* ° ®®� 0�0� ��®� -®O0� o 0, o 310 CMR 15.000 (TITLE 5.) <v UTILITY POLE LEACHING: cAD,ADs BAFFLE :: ,00000000000, '00000000 DO®®®®®®O®O ���DO®0®®�® °0°�°0 4' LIQ. LEVEL ° ° ° ° ° ° WATERTEST D'BOX o > ° ° o ° ° ° ° ° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO ° ° ° ° 000a00000®® ®oF0000®®oo °°°°°°°° FOR LEVELNESS N °°°°°°° ®®�FM�00M�� 0®®�®�0���� ;oo 000�oo BE USED FOR LOT LINE STAKING OR ANY OTHER LOCUS SIDES: 2 (12.8 + 33.5) 2 (.74) = 137 GPD ' � o ° ° ° Q� FIRE HYDRANT 53.24 53.07 °o°o°°°o °o;oo°o°g BOTTOM 49.5' PURPOSE. NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING BOTTOM 12.8' x 33.5 (.74) = 317 GPD J n. °°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°° 6" MIN. 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. Q ° °0° °^°^°^°o°�°�°�°�°�°�°�°�°�°^°�°�°o°o°° --[H--10 500 GAL LEACHING CHAMBER BY ACME PRECAST OR EQUAL. SUMP 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. (3) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED TOTAL: 614 S.F. 454 GPD ALL AROUND PRECAST STRUCTURES 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 33.5' X 12.83' WITHOUT INSPECTION BY BOARD OF HEALTH AND LOCUS MAP USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) COMPACTION. (15.221 [2]) PERMISSION OBTAINED FROM BOARD OF HEALTH. *THE INSTALLER SHALL VERIFY THE ' 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING NOT TO SCALE SCALE 1"=2000'f LOCATIONS OF ALL UTILITIES AND ALL WITH 4 STONE AT ENDS AND 4 AT SIDES DIGSAFE (1-888-344-7233) AND VERIFYING THE BUILDING SEWER OUTLETS AND MIN. LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES ASSESSORS MAP 57 PARCEL 001-X06 ELEVATIONS PRIOR TO INSTALLING ANY 43.0' BOTTOM 7H-1 PRIOR TO COMMENCEMENT OF WORK. LOT SIZE: 0.52 ACRE IN OPEN SPACE SUBDIV. (EQUIV. 1 AC.) PORTION OF SEPTIC SYSTEM ( 1 % SLOPE) ( 15 % SLOPE) NO GROUNDWATER FOUND MA EXISTING NEW 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE APPROVED DATE BOARD OF HEALTH FOUNDATION- EXIST. SEPTIC TANK 16' LEACHING REMOVED 5' BENEATH AND AROUND THE PROPOSED LOCUS IS NOT WITHIN A FEMA HIGH FLOOD HAZARD ZONE D BOX 12 FACILITY LEACHING FACILITY. NOTE: OPEN SPACE SUBDIVISION- ONE ACRE EQUIVALENT 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND SITE IS NOT IN A ZONE II TO A PUBLIC WELL REMOVED CR PUMPED AND FILLED WITH CLEAN SAND. SITE MAPPED AP AQUIFER PROTECTION ZONE (NOT GP/WP) **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT SITE IS WITHIN ESTUARINE SALT WATER OVERLAY (EXIST. 4 BR) 1500 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE WITH NEW 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE I ; CONDITIONS IF NOT SUITABLE. ADD GAS BAFFLE, TEE, NEW LINE OUT. `�J v �� a \ ASSESSED OWNER: PAUL B. MACDONALD, JR. DEED REFERENCE: DB 27997 PG 69 C'p� \ \ PLAN REFERENCE: PB 533 PG 41 Gi'X 3 (OPEN SPACE SUBDIVISION ONE ACRE ZONING EQUIVALENT) 3 3��� LP1 C o/S�x \ �� 2 L=27� Q �'� \ �% � o' -� � 82 ��� � TEST L\� o H O E LOGS GO ENGINEER: ARNE H. OJALA PE, PLS SE WITNESS: JERRY DUNNING, BOH r M/L 2 .5 M�� CB2 DATE: 1 1 -5-1997 5.0 WSO 7X a PERC. RATE _ < 2 MIN/INCH 4f B1 CLASS I SOILS P# 9050 / O ELEV. ELEV. 011 LO 9 0& A 0& A I \ E 22,73 SF LS E LS ❑ O.cJ2, C. Q w% .,.„ 10YR 5/2 10YR 5/2 N 3" 3,> ° CAUTION: (OPEN SP CE 9 LECTRIC B B \ 23 JILLIANS WAY SUBDIVI ION) LS LS s6 EXISTING HOME o 10YR 3/6 / FFLR 57.8f 24" 51.0' 24„ 10YR 3 6 51.5' \ CAUTION: O \GAS 00 OO C C 6 ° PERC PERC D \\ \ O O �� MED/COS MED/COS \ BENCHMARK: EXISTING 6 \ Q SAND SAND T NZa TOP PRECAST SEPTIC 5 �p�� 10YR 5 6 10YR 5 6 \ TANK EL. 54.8' NAVD8 �o / / o \ o � O TH \ OPEN SPA E 59 O � LOT 43.5' BENCHMARK: EMO CENTER CA CH BASIN NO GROUNDWATERENCOUNTERED `z EL. 49.3 NA D88 EXIST. DBOX - `" 7 CB:3 -1 20' NEW 4 BEDROOM SA C) F h� 3) 500 GAL. LEA ING (,H MBE (" / CB 0 RgiNq � WITH TON \ARO D CIp // GF \ 0 LP2 � � � � .S5 p � TITLE 5 SITE PLAN p 1,V6 EXISTI G 4 BEDRO M SASP. 7 33 �TR�ICHE BANDO PLACE �F` i / OF JJ ) S 8 7�9p 6'' Sik O� �' / / H Q c I / �� / / #23 ALLIANS WAY 11 A ARST® S MILLS, M/A 40 o OPE SPACE o // p+J PREPARED FOR LOT CAPEWIDE ENT. �HOFMgs �ZN Ftitgss S DATE: 4-22-2017 525� AAN I EL 9Gs�> �?� DAN I LA. ��� nJA OJALA U, CIVIL Scale: 1"= 20' o q No.40960 N .46502 1 0 10 20 30 40 50 FEET � ZN OF M4Ss9c OF MgSs off 508-362-4541 SITE PLAN q ��� DANIEL yG� �o� DANIEL A. cyG� I fax 508-362-9880 o A. ti o OJALA downcope.com OJALA �' CIVIL No.40980 down cope eagineepiag MC. ' .o -o No.46502 Scale: 1 '= 20 ��OFEss�o`'P� P�� 1F11 ERA'°a`` l D SURVEw O FSSCc/ ENG� civil engineers 0 10 20 30 40 50 FEET r O . land surveyors t� / '� j-23- 2017 939 Main Street ( Rte 6A) DICE # > 7- > O9 DANIEL A. OJALA PLS PE DATE YARMOUTHPORT MA 02675 17-109.DWG I � �