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HomeMy WebLinkAbout0138 JONES ROAD - Health 138 Jones Road, Marstons Mills A=047-047 o I UPC 12934 No. 2-153LY HASTINf44 MN f LsL �' k c "� C v t Sa S1s ��— � le��,.,� �✓ �nc, c ,ems z6 6p- ioo M J 1 l i i I P k i i f i i i g gl� 'I I J� SIG ✓�P� 6-7 00 e all s � ^Jf � � I 3 i hall s �oo� l�� ���g ��l , 5X � Murs��5 /�i(l� I _ I �I��� �'�1� ��'��G � �� � � � a°� ���`��o�� ��� �J I� Town of Barnstable �TWHE r° Regulatory Services Barnstable Richard V. Scali,Interim Director * CMAS&ABLE . Public Health Division I ��� A 1 . ��� Thomas McKean Director tFD MA't s ' 2007 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 3, 2014 Re: 138 Jones Road, Marstons Mills, MA Map 047, Parcel 047 To Whom It May Concern: The homeowner submitted a.four(4) bedroom floor plant o the Health Division along with an affidavit indicating that this dwelling consists of four(4)bedrooms since 1981, when the addition was constructed. A 1981 building permit application indicates that a bedroom was to be added over the garage. The septic system consists-of two (2) leaching facilities which would apprear to handle four (4) bedrooms or more. Based upon all of the above information, I have no objections to allowing the existing four (4) bedrooms to be intained at this property.. omasG McKean, R.S., CHO Agent of the Board of Health gA138 Jones.road.marstons.mills.4.bedroom.Itr.03.03.2014.doc i f toc)f- i Commonwealth of Massachusetts _ _Title 5 Official Inspec tion Form u Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 138 Jones Road Property Address: _. Deborah Totten Owner Owner's Name information is Marstons Mills MA 02648 3/30/13 required for every_ page: City/Town=- -- 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. Important:When A. General Information filling out foRns on the computer, use only the tab 1. Inspector: T key to move your �I cursor- not Use the return urn: Ricky Wright - key. Name of Inspector B & B Excavation;Inc. Company Name 14 TeaberrY Lane Company Address Forestdale MA 02644 . City/Town State Zip Code 508-477-0653 S14595 Telephone Number License.Number B. Certification 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 15.3,40.of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes El Fails El Needs Further Evaluation by the Local:Approving Authority ... 001 _.. 3/30/13 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 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 Tl! l he,originashould be sent to the system owner . and copies sent to the buyer, if applicab�fe, 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 notsadgre�s�how the system.will perform in the future under the same or different conditions of use ddV:[10Z t5ins•11/10 Title 5Offical Inspection Form:Sub urface Sewage;Disposal System-,Page 1 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 138 Jones Road Property Address Deborah Totten Owner Owner's Name information is required for every Marstons Mills MA 02648 3/30/13 page. CityfTown 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): l5ins•11/10 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 138 Jones Road Property Address Deborah Totten Owner Owner's Name information is required for every Marstons Mills MA 02648 3/30/13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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•11/10 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 'wM 138 Jones Road Property Address Deborah Totten Owner Owner's Name information is required for every Marstons Mills MA 02648 3/30/13 page. City/Town 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 '/2 day flow t5ins•11/10 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 °M 138 Jones Road Property Address Deborah Totten Owner Owner's Name information is required for every Marstons Mills MA 02648 3/30/13 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts _ Title 5 Official Ins pec ion Form A Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 138 Jones Road s Property Address Deborah Totten Owner Owner's Name information is Marstons Mills MA 02648 3/30/13 required for every . page. City/Town 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? 1Z El 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? 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.: El ® 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); y DESIGN flow based on 310 CMR 15.203.(for example: 110 gpd x#of bedrooms): . 330 t5ins•11/10;:; Title 5 Official Inspection Form:Subsurface Sewage Disposal System.•Page 6 of 17 Commonwealth of Massachusetts . w Title 5 Official Ins pec ionform 01 Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 138 Jones Road Property Address:. Deborah Totten Owner. Owner's Name information is re quired for every Marstons Mills MA 02648 3/30/13 page. " City/Town::' State Zip Code Date of Inspection D. System Information Description: Numberof current residents 1 - Does residence have a garbage grinder? ❑ Yes 0 No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry.system inspected? ❑ Yes _® No Seasonaluse? ❑ Yes ® No:. Water meter readings, if available.(last 2 years usage(.gpd)): Detail: 2611 =63 gpd 2012 = 52 gpd: Sump Pump?. . El 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(.3eats/pers6ns/sq.ft., etc.): .. .. Grease trap present? ❑ Yes: ❑ Na Industrial waste holding tank present? .. ❑ Yes .❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ ::No Water meter readings, if available: t5ins•11110::: 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 138 Jones Road Property Address Deborah Totten Owner Owner's Name information is required for every Marstons Mills MA 02648 3/30/13 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): t5ins•11/10 Tide 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 138 Jones Road Property Address Deborah Totten Owner Owner's Name information is required for every Marstons Mills MA 02648 3/30/13 page. CitylTown 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): 1' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in working order. No sign of leakage or blockage. Septic Tank(locate on site plan): 6" 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: 1000 gal Sludge depth: 6" t5ins•11/10 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 138 Jones Road Property Address Deborah Totten Owner Owner's Name information is required for every Marstons Mills MA 02648 3/30/13 page. City/Town 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 31" Scum thickness 4" 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 back-up. 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-11/10 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 138 Jones Road Property Address Deborah Totten Owner Owner's Name information is required for every Marstons Mills MA 02648 3/30/13 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 138 Jones Road Property Address Deborah Totten Owner Owner's Name information is required for every Marstons Mills MA 02648 3/30/13 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 liquid 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.): At time of inspection d-box appears to be in good condition. 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.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 _Official Inspection Form. O Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 138 Jones Road Property Address:. .... .... .... ... _. Deborah Totten Owner: Owner's Name information is required for every Mills MA 02648 3/30/13 CI p g - State Zip Code. Date of Inspection D. System Information (cont.) .. .. Type: ® leaching pits number: 1 _. .. _. ....leaching shambers: ::. number:::. ®: leaching galleries: number: (3) 3 050's ❑ leaching trenches - number, length: ❑ leaching fields number, dimensions: El 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 condition.Water level 1' below invert. No sign 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 .... q. Depth of solids layer _.. :Depth of scum layer:: Dimensions of cesspool .. Materials of construction:.: Indication of groundwater inflow ❑ Yes ❑ .No t5ins•11/10::: _: Title 5 Official Inspection Form:Subsurface Sewage Disposal System•:Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 138 Jones Road Property Address Deborah Totten Owner Owner's Name information is required for every Marstons Mills MA 02648 3/30/13 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•11/10 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 138 Jones Road Property Address Deborah Totten Owner Owner's Name information is required for every Marstons Mills . MA 02648 3/30/13 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 'REAI;� A 13 '� I �',2 (0,6 'r f = 1 t A4 `7�H " -13 70 i t5ins•11/10 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 138 Jones Road M Property Address Deborah Totten Owner Owner's Name information is required for every Marstons Mills MA 02648 3/30/13 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: >12 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: 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r Commonwealth of Massachusetts f Title 5 Official Inspection Form _ - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 138 Jones Road Property Address Deborah Totten Owner Owner's Name information is required for every Marstons Mills MA 02648 3/30/13 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 �r 2 Commonwealth of Massachusetts it Title 5 Official Inspection Form Subsurface Sewage Disposal System Form = Not for Voluntary Assessments °N 138 Jones Road Property Address Deborah Totten Owner Owner's Name information is Marstons Mills MA 02648 3/30/13 required for every State Zip Code Date of Inspection page City/Town 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 El ® 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 ® 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? ® Was the facility owner(and occupants if different from owner) provided with El 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 El ® 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): W 330 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 t5ins•11/10 �t FHWE r� Town of Barnstable Barnstable AAmwWaCft Regulatory Services Department BARNSCASLQJ Public Health Division a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Interim Director FAX: 508-790-6304 Thomas A.McKean,CHO March 3, 2014 To Whom It May Concern: The homeowner submitted a four(4) bedroom floor plan to the Health Division along with an affidavit indicating that this dwelling consists of four bedrooms since 1981, when the addition was constructed. A 1981 building permit application indicates that a bedroom was to be added over the new garage. The septic system consists of two (2) leaching facilities which would appear to handle four (4) bedrooms or more. Based upon all of the above information, I have no objections to allowing the existing four (4) bedrooms to be maintained at this property. (�] i v s c ean, R.S., CHO Agent of the Board of Health TOWN Pf BARNSTABLE LOCATION + ` ``� SEWAGE # i VILLAGE t , ► ` ASSESSOR'S MAP & LOT d y 4�y`7 " INSTALLER'S NAME PHONE NO. Al SEPTIC TANK CAPACITY LEACHING FACILITY: (type), L (size) li NO.OF BEDROOMS R BUILDER OR OWNER M ' PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: ; Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet , Private Water Supply Well and Leaching Facility (If any wells existk1A 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 /_Ff rl) � i No. `'� v Fee Z�Z__, 41_1_/ THE COMMONWEALTH OF SSACHUSETTS Entered in computer: Yes" PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipphcation for Mir)upgrade all *p em �tConearuction i3ermit Application for a Permit to Construct( )Repair ( Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. i o_ Owner's Name,Address and Tel.No. ,\•`YY1, b Assessor'sMap/Parcel W 7 4® Installer's Narae,Address, el.No. Z1� �®� Designer's Name,Address and Tel.No. : cl�l Type of Building: Dwelling No.of Bedrooms 13 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Na of Repairs or AltFrations(Answer when applicable) 3 1 fY11ST 9— Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss y this Bo - lth. 2' l� T$ Signed Date Application Approved by Date T Application Disapproved for the following reasons Permit No. _/,0 lor Date Issued �'— TOWNa BARNSTABLE LOCATION � "4� SEWAGE # 6 J VILLAGE ` L�� ASSESSOR'S MAP& LOT,0 JJ-6 INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: ( ) 1 oU f—'LF L (size) NO.OF BEDROOMS BUILDER OR OWNER PERMU DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet J g 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 .tr qd ICA .... ..... . O NO. �,?1,10.01 Fee THE COMMONWEALTH OF SSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Mirr)upgrade ar �p ens (Construction Permit Application for a Permit to Construct( )Repair ( Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. I--_se �` Owner's Name,Address and Tel.No. p vy1 • Y\/) utL M® v ` Assessor's Ma /Pazcel �� , �� C O Insstaller's/NBC_..Address,and Tel.No. �2 Designer's Name,Address and Tel.No. Type of Building: ' Dwelling No.of Bedrooms_��� Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 1 Description of Soil Nature of Repairs or Alterations(Answer when applicable) � �_ 3 1 M1 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal s`.stem in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by this Bo4Fd.QL1k 41th. / Signed Date ZI I �'� Application Approved by - Date .� � Application Disapproved for the following reasons Permit No. -- Date Issued °-- -————————————————17--———————————————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS ,-• (Certificate of (Compliance THIS IS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( ' Upgraded t Abandoned( )by ; # x at has been constructed in accordance # with the provisions of Title 5 and the for Disposal System Construction Permit No. dated A! q'. i Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date 9 q Inspector --------------------------------------- No. _4=�.0 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 'Wi5P05af *pgtem Congtn)A nhermit Permission is hereby granted to Con truct( )Repair pgrade( don( ) System located at 1`2)� i CS1til4 � � ��� � MA , and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this p t. Date:_ W OF/ - �,, Approved b ,t v—t �Z•� !L 91 1,-p and lot number ..... ........ �pF THE ,:Permit number SEVHC SYSTEM M . �. � 1t �enLe, ;Gse number ........................:........................................:....... . INSTALLED IN CONtlWITH TITLE 5 r�ea � TAL COD`- ♦♦♦ TOWN: OF BAnN if 1E. C ?7..Fli..Am 103 , RU K. D I A t 1-NSP ECT APPLICATION FOR PERM TYPE OF CONSTRUCTION .............: { :. .f�....:........:........................................ 1..2./.T.................. .19 i TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 131 ........... a2S.... r(.�<''� t1/k� .....�/.,% ...............: ll.T.... 4�.. Proposed Use ..�!1..�'�/1...r`/.���..... . z..... .....(J! (7i . ... /// .. ..�, ZoningDistrict ........:..................................:............:...............Fire District ...........................................:....................:............. Name of Owner .: /���1 5 /. %.. /..<..C,-Y..............Address ..1..3.9........�t��K u.....l�2................................ Name of Builder' . Y1 .,....:................Address ..U.—C .... �.�, ,,, �...-.. �............. Name of Architect i Address .................................:....................:............................. Number of Rooms ............Foundation p...........................40-,441C jJ.....�.+��✓. �!C Exterior ...... .. ..............................................................::......Roofing .... .. L. .:`.......:...................................... -Y Floors ...0 l¢ {ZI....... ..�.,OX �.!`�. .1 ...................Interior .. ......................................... ( Heating ,r{aja,��tliL/(...� :.�,�.....�,�?. .......................Plumbing ....../Z......A� , .r ............................................ Fireplace ...... .............Approximate Cost .............. Definitive Plan Aporoved by Planning Board -----------_-------------------19------- , Area ......... .................. Diagram of Lot and Building with Dimensions �� Fee ....................r....................... SUBJECT TO APPROVAL OF BOARD OF HEALTH i V 1 . OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS hereby agree to conform to all the Rules and Regulations of the Town of Barnstable'regarding the above construction. Name . ........ .... c ... ........................ Z /10,Tl2t3A � L/ // LO•CA '-VON SEWAGE PERMIT NO. col 25 p-0 k3 0 0 V LLAGE CA- iIa 4,4 4 C5/-/T2 f I N S T A LLER'S NAME & ADDRESS B UILDE R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED 2/17� 1 �� _ _ �� ��_ �,-.�--t � l - � f�, .. . �,� � . . -dt ��� � i . _,.._.� _ J�fir?S ��z�f.� '"--,-- �......:.._____ ,�.,. �� � . -. x Fes$.. ��� No........... .. _............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ......................Town........OF......Ba ns.table ry ApplirFatilan for Diipn,i al Worko Tnnitrurtiun Vamit Application is hereby made for a Permit to Construct (,g) or Repair ( ) an Individual Sewage Disposal System at Jones Road -_-------_•---_______Lot 326 Location-Address or Lot No. k4 _. .....-JCOAR�-------------------------------------- --------------- y,�? c�S.._........-----•............................................ Owner Address W a Installer Address dType of Building e A•P2 • SAc.7-�X Size Lot.-38z_926____....Sq. feet Dwelling—No. of Bedrooms__.______.3 ...............................Expansion 6Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures -----•-------------------------- - Q • ---•-----•------------••- W Design Flow_._.._____5..._______________•---00..--gallons per persop�per60y. Tota4daily Oflgw.......................33 --___..__5 allp s. W Septic Tank—Liquid capacity............gallons Length________________ Width.-.__.___._.._-- Diameter................ Depth______ ....-_... Disposal Trench=No_.................... Width.................... Total Length....... .____._.__ Total leaching area---_.______ sq. ft. x 1 10' 6 f 2�7 Seepage Pit No..................... Diameter._-....-.-..._-_.... Depth below inlet-_......___.________ Total leaching area.................. ft. Z Other Distribution box ( X) Dosing tank ( ) '-' Percolation Test Results Performed byCape---COd-•-SLIY'Vey--_CollSultantS Date....Jun-e 8,__•19V.. aTest Pit No. 1......2.......minutes per inch Depth of Test Pit....! .......... Depth to ground water_.--_nOne_-_----- Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water................... phi •.......0. -- ••-----.----•- _00wdam.-.-- , .- t•0.•. ubil_ 12Description of S • •• •• ------------------------- s 0- x ------------ ----•----• ------•-- --- --• ------- ------•---• 4Z RUBERT""- U W -----------------•----------•-----------------•---•----•-- •------------••• F U Nature of Repairs or Alterations—Answer when applicable.................................. -------------•-•---•----- U- ------QAYLOR..... <+ 23741 Agreement: s The undersigned agrees to install the aforedescribed Individual Sewage Disposal System i the provisions of iI'IT-. 5 of the State Sanitary Code—The undersigned further agrees not to place em in operation until a Certificate of Compliance has been issued by the board of health. Si '0 DatY Application Approved By...... - •• -•••--- ----- ... .1!.....4 4!- 7�------��Xl...--•�= � Date Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------•••--- _...-•••-•-•-•••••--•-••--•---•••-••-•------••--•-•••--•-••••-••••--•-•--•----•--•---------------•-----•----••-•-•••---•--•--•••••••---------•--••--•-----------•------•-••----------------•---•--••---- Date sPermit No......................................................... Issued....................................................... Date o�.. ...... FEs... N 'y�f •••ram THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... ..... .. ..TOJk M.._....oF...... rnstable................................................... Appliration for wiupoual Workii Tonotrnrtion rani Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: ................ .....J6110ja-.Rowl............................................. ----••---- -•---•--Lod--- t6........................................................ Location-Acj�lress � j or Lot No. _ ` -.......--- Owner t^A��� Address W .�. -----------------------•--•.....-••--------------------------- ... ... ----- ` Installer Address U Type of Building ! 1�y'/' 4_ �f Size Lot__:_j .. Sq. feet Dwelling—No. of Bedrooms...._....3............. ...._.....Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons........6.............._._ Showers ( ) — Cafeteria ( ) a' Other fixtures ............................................................ W Design Flow.........55............. _.....gallons per person per day. Total daily flow................... JaQ............gallons. WSeptic Tank—Liquid capacit�QQQ._gallons Lengtl8 1""6".__ Width4 f!,tWI Diameter................ Deptlfj ?4" . x Disposal Trench—No.................... Width.................... Total Length.................... Total leaching area___ ..____.......sq. ft. Seepage Pit No....1__-_._____-. Diameter------1Q1------- Depth below inlet.....6'!.......... Total leaching area,_._.267....sq. ft. Z Other Distribution box (X) Dosing tank ( ) • aPercolation Test Results Performed bOA-pe...God..SUr.Vtie-y aDate.•_ URe 8....� .. Test Pit No. 1.... .......minutes per inch Depth of Test Pit..1.21......... Depth to ground water .fjoX}�-------- Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ - --- ---- -•--- - K O Description of Soil...... 01!0- wacu loam 4r !-2,( s b's,01 ...... 3 � U ----•---------- -- -•-••--- •. •••-•___._-- . ------•. ----•••_. .....-------------•- •-••--_.....------ yyti�--- .. --•--------------------------------•--------•----•--------------- RQBERT' tiG. U Nature of Repairs or Alterations—Answer when applicable-_____•------------------------------------------------------- . ........... ----_---.-. -- .......................................................•--•-•--•----------------•-----••-----------........---------------------------------------...--- --- DAYL04R-- Agreement: 41 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System 1 qw-� the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to pla `��/�NAbef� operation unt&a Certificate of Compliance has been issued by the board of health. Si e Applic44-11Z - ation Approved By...__ ........ ....... ............................ ... __611------------------------- ---------------------------------------- Date Applica.tion`Disapproved for the following reasons:.............................................................................. ..------•--------•-•------------------•---•-••------------------•------------------------------•---•.....-----•-----•---------•-••-•------•----•--•---•------•-••--•-•..-------------•---•------------ -Date PermitNo......................................................... Issued.----•-. •••------------••- --•- , -- Date 'e THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEAL �.>�...�_ / wwrtifirtttr of Toutplianrr THIS IS TO CERTIFY, That,tbe Individual Sewage Disposal System constructed ( ) or Repaired ( ) by------------------------------------------------------------ f� �31p l'� ?. tiE pns{lr _. 4 at. 1". � has been installed in accordance with the provisions of T r' j�O The State:Sanitary e a n rpe' ir; the r k^ application for Disposal Works Construction Permit No.. ...............................i ' date—....._._...................................... THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ; DATE....• Inspector. .......... .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH 7........OF..--.. aryY��:::........................•--...... � S NC ....... ..... FEE........................ �iu�roo�tl; urk,� �onu�rttr� un �eratti� Permission is hereby granted '--• 14 �=-- -----------------.---•-----•--------••-•---------•-•--•-•---••--•---•••••----•--•••.........-•--••--..........._. to Construct t-)' or Repair ( an Individual Sewage Disposal System at No.._/-�' _'.c .`._1 /7 G1 d1'1 r o '. ---•--------------------------•--•- •-- --------------- =�'---:.......• •----•..if_/.................._•--_:... --------- Street j�+ as shown on the application for Disposal Works Construction Per . - - ted.......................................... _ f rF^•• -•------ - ................... _ Board of Health DATE........ - FORM 1255 HOBBS & WARREN, INC., PUBLISHERS "�• $ 1L SOS i Y.L-2 PEAS'ONEGJtl 47 o!"4 /) .� f _ • . r �e e t ILT/ 4t�C.1. Ili, i I i FIST , , a. .� ° c I I 24 MIN 1000— GAL. -'J MIN 1000 -.__— __. • d "L /35Z.__� GAL. �' PRECAST OR ° 'i lei•7' I SEPTIC 6 to o ° BLOCK TANK ", SEEPAGE PIT I • I J — -- — 20' MINIMUM 'f' iZG Z FOUNDATION ----'i I %: WASHED STONE - I , /.?G t 0 ----{ ►[R C. RATE. 4-,vGas'_ '�,. ! dvc• ELEVATION SKETCH _ __ _ .- TEST BY . G'.!' GJ,Ji SCALE i �= 4' _TOWN INSPECTOR Y9lat-a 4- dy't I. iCm ,p�D BACKHOE OPERATOR .Po 64ze- .leis-1 of:$. TEST MADE ON _—�v.•__ —_8y L?Z '_-__ \' "CIO 17 tcLL �3 4f ItdP w okZ.L a�ttS 4' 13�, 3Z 7 M I Q7 P° ° Ida 2 f yp - 1 G. % ; t5� f, S /°fFr�ti ti' tV. Y %f .7 �"s4✓1 J CL t 54- ,�T.s'"ci C 7��G'6't a"7`�q G.t l.✓ Nl-..it.O°.r.�li./ G-�?f�5 �C7Gw4i�, y �.,/ f.�c 7:�dn3�,.l=•�:;�t..:'a ,ram s*r..�y ©,•./ Jzl.:rC 2C!��7 7� t�i �"�„ . NYj p i✓.�r�Ce s.+S 7"G ci °Ow//.!/Gs /^ .Z.d%,> S ti d ST'o{r,,..�..!• pq v� d�Ar /e�,'Ayf•�hrgr�A 3 6t3fL ti 11 O �b�+2e'11"U+�y = 3 0 to 1 D�Stlo G A:, .ITS/ f36TT 1 = 7c x t (,AL/ *110I It y t 7 g.51 o� • r, 2.5 4AL� dp/°,pA*-/ = 4-7 1 . &Ate BOA ' DALµftyG� 'ptiT glv5,,;ALL t84�.4 � 1 � 1 ELEVATION SCHEDULE 13� ,"g-�'Q`��,�. PROPOSED SITE PLAN ROBET � ti t c R01:3ERr F. 1. INV AT FOUNDATION = 13ro F. ` ""+ DAYLCR S� v DAt'1.OR ' „, SEWAGE SYSTEM DESIGN 2. INV INTO SEPTIC TANK - 1,R.��• IN _ `,'t�JN tit E 3. INV. OUT OF SEPTIC TANK = � 0 � '-- 4. INV. INTO DISTRIBUTION BOX � i p SCALE I'= Za ' ,,Jr>�1y 197 c —67 5 INV OUT OF DISTRIBUTION BOX " 6. INV INTO SEEPAGE PIT = I ,�,.` CAPE COD SURVEY CONSULTANTS ROUTE 132 7. BOTTOM OF PIT = HYANNIS, MASS. A DIVIsloN BOSTON SUNVIY CONSULTANTS, IIIC. 1 �.. 8. BOTTOM OF STONE LAYER ' '¢*•'