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Home My WebLink About0292 JONES ROAD - Health 292 Jones �prS�Jn s - - A= I i C Flynn, Judith From: McKean, Thomas on behalf of Health Sent: Friday, November 8, 2019 2:18 PM To: Flynn,Judith Subject: FW:292 Jones Road Marstons Mills Will you please send Amanda Kundel a copy of the As built card for this property 508-360-7364 Mobile 508-362-9001 Fax From: Amanda Kundel [mailto:akundel@kinlingrover.com] Sent: Wednesday, November 06, 2019 12:09 PM To: Health Cc: Brendan O'Leary Subject: 292 Jones Road Marstons Mills Good morning. Could you please send us a copy of the AsBuilt for this property. There was a recent upgrade to the septic and the buyer needs to obtain a copy. Thank you, Amanda Swift Kundel Kinlin Grover Real Estate P.O. Box 156 3221 Main Street Barnstable, MA 02630 J s . 508-360-7364 Mobile 508-362-9001 Fax Licensed in Massachusetts Broker#009521133 Kinlin Grover Real Estate Like us on Facebook•Follow us on Instagram,Twitter&Linkedin•Watch KGTV on YouTube! View our Listings at www.KinlinGrover.com CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! i TX Result Report P 1 11/12/2019 11:23 Serial No. AM011011287 t TIC: 16434 Addressee I Start Time ITime I Prints I Resultj Note 195063629001 11-12 11:g23 00:00:g00 000/001 S-OK Note DPG:PagerSeparat1 noTX1nNIX MixedloriginalZTXSeCALL:ManualFTXMeCSRCSCSRC._ FWD:ForWard, PC:PC-FAX. BND:Double-Sided Binding Direction, SP:Special Origginal. FCODE:F-code. RTX:Re-TX, RLY:Relay, MBX:Confidential, BUL:Bulletin. SIP:SIP Fax, IPADR:IP Address Fax, I-FAX:Internet Fax Result TEL:CRXmfromaTEL. MG: Other stop communication, Cant: Continue, NoFAns: NO Answer,OFF. POURSReceivingtpageeuODer.BFiLIFBileyErr rru1DCMDeCO Error, MDNRMDN1Response9Error. DEL:CompulsorgsMemor-9 6ocumentCDelete rSENDmCOMPUlsorynMemorgtDocument Send. Commonwealth of Massachusetts Title 5 Official Inspection Form �l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r a ;<1 292 Jones Rd Property Address Lois Sheehan Owner Owner's Name information is required for every Marstons Mills MA 02648 8-1-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 d. 3 Bj_ c 11 4r A -3 - o 1-3 3 tt/ elf t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 _ TOWN OF BARNSTABLE LOCATION � �SON 1d QS SEWAGE VILLAGE ASSESSOR'S MAP&PARCEL ? INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY tr�C f rri i e.f 1C, (Gt7G.G� E s � LEACHING FACILITY:(type) ::Ti2L�« (size) �JC1�-S3J�a. NO.OF BEDROOMS 3 OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �i—'.j. S Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 8 O a STABLE LOCA.'X ON: o` vYtA INST R'.3 NAME&PHOIJ9'N0: rtC TASK.,cAPAcrrY LACFt}NG�/jii .l'E"Y� .E ), (size), . .R..,. ��u.�►�o�:ova.:.,., _ FBRNfgTVATE• Safik, tion�eseunaa Sstvieeu clan;' Oki muFn,Ad'�uste�f Crauredwatec'Cable to the B6ttocn oabina MIRY �Eeet °t ly Viol alid L; dhiakg l�04. t�RPY wells a tst PL;V2l8tl��=CY:� oi�s6tn oP us+fthin 2AQ feat of luctr►S f�cili3}')' e9 wetlaridx east tfllet nd and L ►c tna pa ��isy: MY. Hoge of fee AIIJAn 3UQ Aet ohy � e a o 3 No. 3 /j� Fee *1D THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2ppliLatlon for MispoBaf *pstrm ConstCUttlon 30Prmit Application for a Permit to Construct( ) Repair(e Upgrade( ) Abandon( ) ❑Complete System [jndividual Components Location Address or Lot No 9� nes Owner's Name,Address,and Tel.No._%f-6,93--&&00 Assessor's Map/Parcel�� U �� LntS Sh GoX3I l4 00, 8' Installer's Name,Address,and Tel.No. esigner's Name,Address,and Tel.No. lo' iL'vnS�-fcx.l-t`c�r, T»c, 4Szridl (ry Q xrc Y7 MA Dab`)5- Type of Building: Dwelling No.of Bedrooms Lot Size �� G`� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided .30 gpd Plan DaterQ Number of sheets n� Revision Date Titlei Size of Septic Tank J Cr$ t`ve, i060Q,,P Type of S.A.S a- S ;6Y, Description of Soil v �6 q� Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the E ental a and not to place the system in operation until a Certificate of Compliance has been issued by this of Health. Date Application Approved by DateA %/ Application Disapproved by Date for the following reasons Permit No. 6D(I— 314T Date Issued Ibh 1 No. Fee U THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS `: ftolication for MispoBar 6pstem Construction Permit Application for a Permit to Construct( ) Repair(k' Upgrade( ) Abandon(4) ❑Complete System individual Components Location Address or Lot No.p9D &nes �4rj Owner's Name,Address,and Tel.No.,50V-690_&600 Assessor's Map/Parcel y7 7v MIC1!641 92a 'LoiS Sh h�,r, i X 231 installer's Name,Address,and Tel.No. wb, Designer's Name,cAddress,and Tel.No. Truer_ q3y�i2GY/ e� OMS L Type of Building: Dwelling No.of Bedrooms Lot Size / G S 7 sq.ft. Garbage Grinder( ) Other? Type of Building No.of Persons Showers( ) Cafeteria( ) i Other Fixtures Design Flow(min.required) 3 0 gpd Design flow provided gpd Plan Date .z�(P,L,,�R, y, aol 7 Number of sheets / Revision Date Title Tif .h 5. + � TU1" lV'�24,A l � °, ,r�� Size of Septic Tank PX;c T (f)6n!Q,-Q Type of S.A.S.o2,- 1;iyx- (t/1,adelo,o _1 X S3 j J . Description of Soil sec I t Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Eny ironnienta�and not to place the system in operation until a Certificate of Compliance has been issued by this Board—of Health. Sign _ _ - `�_ Date 9/ 19 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. AD11— 314 Date Issued q//I 1zn/1 - -=---------------------------------------------------------------------------------------------------------------- ------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( )Q Upgraded( ) Abandoned( )by o r eb ,j ' v ^�L at :- -Tnnes has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. _ 61'j dated it/1 �y Installer r �. „�{ �y irm. Tt C_ Designer ` o � f ,� �' � • 1- #bedrooms Approved design flow gpd The issuance of this permit hall not be construed as a guarantee that the system w' 1 funct5o as i Date i Inspector ---------------------------------------------------------------------------------------------------------------------------------------- No. 20,q _. a '�r . Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) ++Repair( Upgrade( ) Abandon( ) System located at 1�2 /p-� 7ew� I K n , I�lr"ia f 1. I vTac TT,T i�py r P. �► And as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions.. Provided:Construction must be completed within three years of the date of this perm' . Date /t 1 ?O/q Approved.by- SEP-25-2019 00:24 From: To:15087906304 Pa9e:1/1 Town ®f-Ba mstablle �fxAr� ]Reply ory Services '�� S' 7CLonmas F.Goiler,Director OAMSTAMIA� Public Realth DiVi�SiOU "fin w Q I-homas MclCean,Director 200 IVlaiu�Staeet,$yaumis,MA 02,601 Fax. 508-790-6304 Office. 508-862-4644 ]6mst er&Besi er CertifisatioTA FOrIn Date: a Sewage Per ao,f-,3 V7 Assessor's 1M[aPTI rcel �t-7 -71 Designer: Address: Addre,31: . OA Was Q issLd pelMit to install a On 1,,/,,w, a . . (date) xnsta er) septic system at Z-9 Z- f o rt,P� based on.a design drawn by (address) lay"N'e, dated 9 (desi. er) - Ica-.tit that the eegtic system xeferenced above was installed substantially according to the design,which may include minor approved dllanges sacb.as lateral relocation of the distribution box and/or septic tank. I certify 'that the sgtic system referenced above was installed with major changes (i.e. eatea;than"lo,lateral relocations of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations. Plan revision or certified y designer to follow. a RANIELA, 6 O.IAIA �y (Iust er's ig�p.ature) CIVIL (4 I•In.013502 (Designer's Sipnatze) (A C�tx Desi er's S'tazap Hate) IEAS RETURN 4J IS )oT8TA7tX'6S �U93]LXC D31;A�TH DJ1va Y� C i RTYI'IC.A T OF. d"DMPLXA]0i("P, ®T Cp, XSgUED ' l3()TH Talk )A'OM AND AS BIMM CARD ARE xtLCEZVYiXI �'T BA A '' IN MLJC BEE141,7. zVJfSXOleL T)-( %YOU- 4;�TB91tI]/AS'CpLi.rJ.'ticSjenet Cerli'ftcatipAI�OIzo 9-26.0�4.duc •• is IKE Town of Barnstable Barnstable Inspectional Services Department AIMMica CRY BA' STABLE, MASS.. ,�� Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL47015 1730 0001 4988 1579 August 13, 2019 SHEEHAN, LOIS ELLEN PO BOX 231 MARSTONS MILLS, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 292 Jones Road, Marstons Mills, MA was inspected on 08/01/2019 by Shawn Meelroy, 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 mean, R.S., 0 Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Madiri ff ailed or Needs Further Evaluation Letters\292.Jones Road Marstons Mills.doe Town of Barnstable i BARNSPABM p b 9 �,�� Inspectional Services Department TfD MA'S Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 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 ❑ 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 ❑ Structurally unsound septic tank or SAS O 1 YEAR DEADLINE CRITERIA *Static 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 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 Commonwealth of Massachusetts ��D�'a / aL✓� Title 5 Official Inspection Form %► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments e,,Y <.40 292 Jones Rd Property Address -A Lois Sheehan r Owner Owner's Name F information is . required for every Marstons Mills MA 02648 8-1-19 r1 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. A. Inspector Information Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CMR 15.000);I have personally inspected the sewage disposal system at theproperty address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails 8-1-19 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.72612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts 3 Title 5 Official Inspection Form �► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments +lr: 292 Jones Rd Property Address Lois Sheehan Owner Owner's Name information is required for every Marstons Mills MA 02648 8-1-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2:, 3, or 5 and all of 4 and 6. 1) 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: 2) System Conditionally Passes: ❑ One or more system components as described in the "ConditionalPass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form PI Subsurface Sewage Disposal System Form Not for Voluntary Assessments r ;:M 292 Jones Rd _ Property Address Lois Sheehan Owner Owner's Name information is required for every Marstons Mills MA 02648 8-1-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 El ❑ ND (Explain below): ❑ obstruction is removed ❑ Y El ❑ 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): 3) 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. a. 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 292 Jones Rd Property Address Lois Sheehan Owner Owner's Name information is required for every Marstons Mills MA 02648 8-1-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health and Public Water Supplier, if an Y ( pp � Y) 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. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts 3 Title 5 Official Inspection Form ICI' I�i Subsurface Sewage Disposal System Form Not for Voluntary Assessments 292 Jones Rd Property Address Lois Sheehan Owner Owner's Name information is required for every Marstons Mills MA 02648 8-1-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ® ❑ 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 ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ® ❑ 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form nl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r a ,1a1 292 Jones Rd Property Address Lois Sheehan Owner Owner's Name information is required for every Marstons Mills MA 02648 8-1-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: 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? ® ❑ Wasthe 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)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form "i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 292 Jones Rd Property Address Lois Sheehan Owner Owner's Name information is required for every Marstons Mills MA 02648 8-1-19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No .If yes, discharges to: 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: 8-2019Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 s Commonwealth of Massachusetts p Title 5 Official Inspection Form ws� i�I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a ' 292 Jones Rd Property Address Lois Sheehan Owner Owner's Name information is required for every Marstons Mills MA 02648 8-1-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day a P Y�9p ) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If es discharges to: y 9 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner---pumped 2016 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 i Commonwealth of Massachusetts r� 3� Title 5 Official Inspection Form '�A '.'I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � r 292 Jones Rd Property Address Lois Sheehan Owner Owner's Name information is required for every Marstons Mills MA 02648 8-1-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information: 1979 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 12"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.): Good condition. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts (-1' Title 5 Official Inspection Form Ipl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 292 Jones Rd Property Address Lois Sheehan Owner Owner's Name information is required for every Marstons Mills MA 02648 8-1-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. 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: 1000 gal Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form lei Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 292 Jones Rd Property Address Lois Sheehan Owner Owner's Name information is required for every Marstons Mills MA 02648 8-1-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form PI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments U 292 Jones Rd Property Address Lois Sheehan Owner Owner's Name information is required for every Marstons Mills MA 02648 8-1-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) 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 9. Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 1" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box had water level at 1" above outlet invert. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 I Commonwealth of Massachusetts 1� ;w Title 5 Official Inspection Form I�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 292 Jones Rd Property Address Lois Sheehan Owner Owner's Name information is required for every Marstons Mills MA 02648 8-1-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1-1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts w:. Title 5 Official Inspection Form lbl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments e 292 Jones Rd Property Address Lois Sheehan Owner Owner's Name information is required for every Marstons Mills MA 02648 8-1-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit was filled beyond capacity and into riser at inspection. 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 I Commonwealth of Massachusetts ,w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 292 Jones Rd Property Address Lois Sheehan Owner Owner's Name information is required for every Marstons Mills MA 02648 8-1-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 'i�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r a 292 Jones Rd Property Address Lois Sheehan Owner Owner's Name information is required for every Marstons Mills MA 02648 8-1-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 d dA -3 T'3 dry•- t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 I Commonwealth of Massachusetts w� 3 Title 5 Official Inspection Form ial w:, Al Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 292 Jones Rd Property Address Lois Sheehan Owner Owner's Name information is Marstons Mills MA 02648 8-1-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 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: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.'712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts a Title 5 Official Inspection Form IV Ir I I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 292 Jones Rd Property Address Lois Sheehan Owner Owner's Name information is required for every Marstons Mills MA 02648 8-1-19 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 No.—ZOp�Qp2 Fee---- - BOARD OF HEALTH TOWN OF BARNSTABLE Zipplicatioll rVet[ Construction Permit ,� e I Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: — L9,qq-- o 17d -- Location.— Address �Assemrss Map and PPaarrcel �✓�!r_�—a2---11 Gendt '— --- Owner Address — _ — Installer — Driller _-- — Address — Type of B ' Dwelling— — ---------------------- Other - Type of Building—= ----- No. of Persons-- --------------___ Type of Well � Capacity— Purpose of Well--- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a ertificate.of Compliance has been issued by the Board of Health. Signed — -- a //D — Ate Application Approved By ------ -- h daatete Application Disapproved for the following reasons: -------- -- -- _ — --._____— _-___--- - - ------ date Permit No. W Z003-06s — Issued 2 11 U date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) Installer has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well rot tion Regulation as described in the application for Well Construction Permit No.t6-4�=—Q?Dated ; �03- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE - Inspector---— ------ —_____ ------ No.------------ -- Fee------�-- - BOARD OF HEALTH TOWN OF BARNS tABLE � application for Witf—t hgtructi+onPermit Application is hereby made for a permi .to Construct ( Alter ( ), or Repair ( )an individual Well at: zN&s Y1921, 14rl-_0 qr) Location — Address 1 Assessors Map and Parcel — Owner Address — %��/�! Installer — Driller Address Type of B il.din. Dwelling ------------____________--- Other - Type of Building-- ---_ No. of Persons--------- - ----- Type of Well�i ,�Y Capacity- — -—----- —__ Purpose of Well — — Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed --- -- --- / � to Application Approved By ------- Z �t 03------ date Application Disapproved for the following reasons: ----- -- — ---- -- - ---- — - ----- date --- Permit No. 2003 001-- — Issued 2�f11/U 3 - - ------- date BOARD OF HEALTH TOWN OF•. BARNSTABLE C ertif icate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repairedby— ( ) �y / Installer -------------- -------�— ----- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well rot tion Regulation as described in the application for Well Construction Permit NO.0 200 -�Z Dated 2 f r 03_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE - — Inspector-----------------= ------------- BOARD OF HEALTH TOWN OF BARNSTABLE VnrY d �.... Con.: �tr.u[t ion Permit NO.W&x3_coZ Fee- -�6- — Permission is hereby granted --- to Construct ( ), Alter ( ), or epair ( ) an Indi idual Well at: No. rn��s / fL,1 - Street / as shown on the application for a Well Construction Permit No.- W 206 3-CO2' Dated 2 !t '0 2 �l?J Board of Health DATE lJ { sz-:xv COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS A Z DEPARTMENT OF ENVIRONMENTAL PROTECTION q h W� —(61 07 ,� bYs�e ti�F TT�e<F TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 292 JONES RD MARSTONS MILLS,MA 02648 L95 Owner's Name: ROBERT SHEEHAN Owner's Address: BOX 574 MARSTONS MILLS MA.02648 Date of Inspection: 5/17/01 Name of Inspector: (please print) JOHN GRACI Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes _ Conditionally Passes _ Needs Furthe aluation by the Local Approving Authority Fails Inspector's Signature: Date: 5/17/01 The system inspector shall submit 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 now of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments THE SYSTEM PASSES TITLE V INPECTION. RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. ` Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 292 JONES RD MARSTONS MILLS,MA 02648 L95 Owner: ROBERT SHEEHAN Date of Inspection: 5/17/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: THE SYSTEM PASSES TITLE V INPECTION. RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a IPage3 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 292 JONES RD MARSTONS MILLS,MA 02648 L95 Owner: ROBERT SHEEHAN Date of Inspection: 5/17/01 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. L 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 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 n/a "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: n/a Page 4 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 292 JONES RD MARSTONS MILLS,MA 02648 L95 Owner: ROBERT SHEEHAN Date of Inspection: 5/17/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for alLinspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped 199R. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forma (Yes/No)The system fails. 1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes'or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 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. f Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 292 JONES RD MARSTONS MILLS,MA 02648 L95 Owner: ROBERT SHEEHAN Date of Inspection: 5/17/01 Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection '? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out'? X _ Were all system components,excluding the SAS, located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X Existing information„ For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 292 JONES RD MARSTONS MILLS,MA 02648 L95 Owner: ROBERT SHEEHAN Date of Inspection: 5/17/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents:2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required) Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: 1998 Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) r _Tight tank Attach a copy of the DEP approval Other(describe): n/a i Approximate age of all components,date installed(if known)and source of information: 1978 r Were sewage odors detected when arriving at the site(yes or no): NO Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 292 JONES RD MARSTONS MILLS,MA 02648 L95 Owner: ROBERT SHEEHAN Date of Inspection: 5/17/01 BUILDING SEWER(locate on site plan) Depth below grade: 10" Materials of construction:_cast iron —40 PVC Xother(explain): 20 PVC Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 2" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6" H 5' 7" W 4' 10"" Sludge depth: 20" Distance from top of sludge to bottom of outlet tee or baffle: 14" Scum thickness: I" Distance from top of scum to top of outlet tee or baffle:6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND. RECOMMEND PUMPING EVERY TWO YEARS. GREASE TRAP: _(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 292 JONES RD MARSTONS MILLS,MA 02648 L95 Owner: ROBERT SHEEHAN Date of Inspection: 5/17/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX: _(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert, n/a 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.): DID NOT EXPOSE PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a I Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 292 JONES RD MARSTONS MILLS,MA 02648 L95 Owner: ROBERT SHEEHAN Date of Inspection: 5/17/01 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: nla n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT HAD 2' OF LEACHING LEFT AT THE TIME OF THE INSPECTION.RECOMMEND KEEPING BRUSH OFF SYSTEM. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of:soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) *' Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a • Page 10 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 292 JONES RD MARSTONS MILLS,MA 02648 L95 Owner: ROBERT SHEEHAN Date of Inspection: 5/17/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benclunarks. Locate all wells within 100 feet. Locate where public water supply enters the building. � A 0 ec� e q . vg C BA IS �c ,i n • Page I I of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 292 JONES RD MARSTONS MILLS,MA 02648 L95 Owner: ROBERT SHEEHAN Date of Inspection: 5/17/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12+FEET r.: Sep-06101 14- 27 BARNSTABLE HEALTH DEPT 5087906304 P_07 .e: Town of Barnstable Regulatory Services e+M�16 Thomas F.Geiler, Director 19- fo �',e Public Health Division Thomas McKean,Director 367 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 DATE: 7Z/-- Z a 1 _ 6- C- RE: Z 5 Z. �a ka Z a k The Barnstable Heatth Division has reviewed the Title 5 septic inspection form for the above referenced property. The following comments listed below are deficiencies according to 310 CMR 15.300 and the Town of Barnstable Health regulations. Please re- inspect the system, if necessary, complete a new report form or revise the pages pertinent to the deficiencies listed and resubmit the report to this office within fourteen (14) days: 2k-fZ,(,1 7&-A4 r A< / scnarr'.aac f *Page eof 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 292 JONES RD MARSTONS MILLS,MA 02648 L95 Owner: ROBERT SHEEHAN Date of Inspection: 5/17/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX: _(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a 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.): DID NOT EXPOSE-THERE WAS DENSE BUSH COVER- PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): n/a R f .�Page h of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 292 JONES RD MARSTONS MILLS,MA 02648 L95 Owner: ROBERT SHEEHAN Date of Inspection: 5/17/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 10+feet Please indicate(check)all methods used to determine the high ground water elevation: YES Obtained from system design plans on record- If checked, date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: GROUNDWATER OBTAINED BY ENGINEERED PLANS FROM HOMEOWNER Town of Barnstable Regulatory Services * BARNSTABLE, s MASS. g Thomas F.Geiler,Director i63q. 10 ATEo►��' Public Health Division Thomas McKean,Director 367 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 DATE: 7//V o / �. 0 Z//'7 RE: Z% 2 6 PS 6CL X4 a,.Y -t4L'%/S The Barnstable Health Division has reviewed the Title 5 septic inspection form for the. above referenced property. The following comments listed below are deficiencies according to 31.0 CMR 15.300 and the Town of Barnstable Health regulations. Please re- inspect the system, if necessary, complete a new report form or revise the pages pertinent to the deficiencies listed and resubmit the report to this office within fourteen(14) days: (4 0 f 16 &)C-4,,, t47,/ qr lk Arr, 76---w, %z4_14I sepdef.doe ly C -C AT ION SEWAGE PERMIT NO. �' LLAGE c� Y7._ G"7 ® r INSTALLER'S NAME i ADDRESS B U I'L D E R OR OWNER aZ4 DATE PERMIT ISSUED C DATE COMPLIANCE ISSUED ��_ _ ,� .�� a .. j �; N,:. _� M 6��, 3 ��hc� {J L L W � " f, =` No.......... ... 1...... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...... own.....................OF................Barnstable......................................... A p iratiou for Bi_qvuaal Worko Tomitrurtion truth Application is hereby made for aa Per to onstruct/ Repair ( ) an Individual Sewage Disposal System at: \r/ ................_........_.--•...Jone5�-..oad.................................. ...................L01...95.............................................................. Location- dress Lot No/zp----------------------------------------- ---------h�J!f �1. . or ........................................... c_o W ` I yer SAM p Address Installer Address 21,056 Type of Buildi� /2 P-AtC 14 Size Lot___.____:------------------Sq. feet U Dwelling—No. of Bedrooms_______________3...........................Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ____________________________ Design Flow__________________5.r._.._..___.__________-gallons per person er da�. Total daily flow--------.33.0...........................gallons. WSeptic Tank—Liquid capacit�000...gallons Length._I -E?_T_ Width--- Deptly_T-4n x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No._._._._-1____.__.. Diameter....... 0.___.•._. Depth below inlet____..__._6______ al 1 �hi area_26 .......sq. ft. Z Other Distribution box (X ) Dosing(tank ( ) 7- /7- / o Percolation Test Results Performed b aps Od-•_SurVey.••Cons 1tantS Date......7/13/78_____________. Test Pit No. I ____ ........minutes per inch Depth of Test Pit.....1-_2......... Depth to ground water....nQ_T>.P-________- (i, Test Pit No. 2................minutes per inch Depth of Test Pit_________-_:________ Depth to ground water........................ ----- -----•--•-••••-----••••••-•-•........................•••••-•-._._....-------......_.........................• .................. O Description of Soil__0.0-0.5__wood-••loam, 0.5-2.4---rocky-_subs�il,�•-_2•, �•..... �9 _--_•__.•- 1... rocker sand,...4.6-12_.0 med,.._sand. ------... oa U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------- ----e+tAPMAN v .......---•-----•---••-•------•----•-------------------•--...-•------•-•---...-•-----•-•--•• ....................................................... ,e p--lo:2-M a Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal step tl the provisions of iiTLE 5 of the State Sanitary Code— The undersigned further agree o to operation until a Certificate of Compliance has be'e7i sued the board of health. r Sid---- - ---- - -----•-••------------------•------• .. ..._ Date Application Approved B ~----------------------------- •-•-- pp - Date Application Disapproved for the following reasons:------•-----------------------------•-----------------------................................................... --••-----••-- ----•...------•--•-----•--•---••-•••••-•----•••-•---•---••-•--•...... Date PermitNo......................................................... Issued_. y_../_~7__.__...--------------------- Date T 'A No........fly.... FRic THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............OF..............,,.Barnstable......................................... Apofiration for Disposal Vork� Tonstrurtion "nuat V Application is hereby made for a Permit to Construct ( X) or Repair an Individual Sewage Disposal System at: ....&.04.................................. ..................L01..�95................................................................ Location-Address or Lot No. --(I/" I A141 /f ............................................................................................... ................................................................................................... /?, Owner dF Address .................................................7............................................... ................................................................................................. Installer Address Type of Buildiv P 4, f, - '_ Size Lot...2.11056.........Sq. feet U 3 ... ... Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ........................................................................................ ....................... ............... Flow 5 V I Design F ...............5................. ......gallons per person_per day. Total daily flow........330--------..................gallons. 1� if W Septic Tank—Liquid capacit�.Q ...gallons Length..617&. Width---4 .—.'. .1QY)iamcter................ Dept1-5.'..n-.4."... Disposal Trench—No. .................... Width............... Total Length.................... Total leaching area....................sq. ft. D'epth beloyinlet ..... ...L.Tot 1 2.67.......sq. ft. Seepage Pit No..................... Diameter-__-__._.___.___.__. _�__ 61 ,,a Z Other Distribution box (X ) Dosing tank ( ) e . f* Percolation Test Results Performed b94P9---994...a Y--- Date......71-13/7A.............. �4 q, 0-a Test Pit No. I.....?--------minutesperinch Depth of Test Pit ...... Depth to ground water_,1.10.110......... 1-4 �N Test Pit No. 2................minutes per inch Depth of Test Pit......t.............. Depth to ground water..__._.............._... 0 0 ..0....................................................................................................*---------------------------------------"............ 0 Description of Soil_.....!...........5 wood loam, 0-5-2-4' rocky subs&ill....... . .. ............... '*--*--------------------6------ --------------------------------------------------------- 4�9.�ky �.12.0 med. sand. ............................ ... .... ...4.!................................................................................. QFM ..... ............... ................................................................................................................................... ... Qz _RE ...... U Nature of Repairs or Alterations—Answer when applicable_____________ I............... ........... ........... ....... CHA ............................................................................................................................................ ........ --- ....... Agreement: The undersigned agrees to install the aforedescribQ Individual Sewage 1 osal with the provisions of T I T 1E 5 of the State Sanitary Code— The undersigned f' rtl":,r agrees no N y3tem in e.- operation until a Certificate of Compliance has been issued by the board of health: S A_ k—fe,/ Sig / ' *..................................................... ................................ ... ............... D Uge Application Approved By...... . .... . ... ...... ...... .......... Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo.......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS` BOARD OF HEALTH OOVA ............... elp OF.......... ............................................... (Irrfifiratr 'of Toutpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed,(J-) or Repaired b ............................................................................................... Installer at... P/1 / /_ / ( I _�d /' ...................... ...............................................;.....................................................................................------------------...... has been installed in accordance with the provisions of T 5 of The State Sanitary Cqde as described in the application for Disposal Works Construction Permit Nor . .. .................. dated-----01 :--.---------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACT9 RY. s .......... DATE_................................................v1.. .......... Inspector........ ...GN................................................... J THE COMMONWEALTH OF MASSACHUSETTS v� BOARD OF HEALTH, 0 F.........eK� ........ ...................................... N�*;Ey ........ FEE........................ Wopood u��r.-k u�unu# t ion` rrnti Permission is hereby granted...........12.-..... ..................................................................................................... to Construct (') or Repair an Individual Sewage Disposal System at No.XA�l`7L ef N/I .................................................................................................................................................................................. Street A as shown on the application for Disposal Works Construction Purl No.-. Dated... ---------------7d--------I V--- - ----------- 4 .......................... Board of Healt DATE.______:'........................................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS f a F, SOIL , LOl ' 'r, ♦']Cl.3AA i,'A.Ss:. t>✓h eXl �,�t'wy-�,,sVi1r 1Jtx ^, 2"PEAS ONE LOAM d "ILL� i2 M-- C-r. 4 C.I. DI ST: t' • ' S5 �/05.� ,•- BOX 1, � •.• e. I � . , r� 20 MIN' �,.... .. " 1000 I. ; o, . 1000— GAL- ' °I ,�b♦'„�• ' t "J MIN —,. I e PRECAST OR t GAL_ o o AI�„/�3,p ' SEPTIC 6 V BLOCK u I�g ` ..., l 1 TANK �;'•. o • SEEPAGE PIT ° ♦I �NAAO: MINIMUM . • I •' - - - - - �' I �� (ara ICA FOUNDATION Iy:" WASHED STONE I i lo' '[RC. RAT[ �(_- ---- � . -Y 'ELEVATION SKETCH TEST BY �'• cV N!T'/J?/! t ♦ SCALE I = 4' TOWN INSPECTOR AMC » A '� BACKHOE OPERATOR TEST MADE ON --- - — • — �0 i — .00 .1 • _ 5 •.. , 'Y �Z+ [. - • - - �� tom•o�. ` Fw4 no, ' � , ! - ' � ' 1 ,�.•,; �A�� • � ,� � Svc, .01 ID A 'i. , 4' -i /�. .. .A71 �r •. t J' •fit _ .J �, V`Q4w A �W w }�r ' .. (- /I � ��.7 f N/� /old f At• ,�.� U1 4kt z _ ScmrIICayr x Tt Q o R •SY~r' <° �•'r } ' - � .li!,J ,.�^- wait `a, r „ rye: - f '� •. ,y� ::�+�xx++ �(j� � ,� , -.i. s r F A f _ _ +�' •"4 .we. 'r.''.rr r s/( mummow•w. ,.w� as iream71 5, wwom t r "� .. - ,y �' _� �Y +"".'' .•ne. �afn/e awns rp•IP_ � '� y I `� '. .. 'o.,.,- �• • p :• _ .. f ma's .�•,. Ilk t �!<c*re .raw ..ate +.s per` rL� _ � • IIII APdFFw IL i , - y , _..._.._. _-.-....,_Z...•- ...cam.-..•."'^t"` --•r...... t.,..,, .. �... r Its LGIrd/ a a e x (/O o /�+IG, d� 3 3 G7 qa /"4 q / r ` L'L'Slc?m r 4007 0M In "W'S X1,030r/'0/ d4 '7 •57 y'A�/404y Cam' J Avl . � rul9G c j se, ' x 2. 9a/� �d� t ' 2r �. RENWICK r� HAP%,AN N Q. E- 4 ♦ r Jar/ N "�t ��....,.,... f t ELEVATION SCk.EDUL'E . PROPOSED SITE PLAN t �f; ` "f" INV. AT FOUNDATION Ao �� A w s SEWAGE SYSTEM DESIGN 2 r INV IWTO SEPTIC TANK cos 9 ry � r . .. I "4/y ,C5� Ro490 LoT g� `3 1NV. O'6t`OF`SEP'7:1C SANK k- . , ' - •. r M�9�S Tlo.nrS f1?/L'G.S� �1'� :5 S , , INTO DISTRIB N BO'X=_4 INV 19 78" G I I li t l 4} S 1• { •5 1NV'. OUT OF. C�15TRIBUTION`. BOX , `•' ,' ri •: ' �+, , t �G � p CAPE COD SURVEY CONSULTANTS :.6 }INV INTO SEEPAGE PIT. ROUTE 132. T BOTTOM OF " PIT 7 GD HYANNfS,MA?rS. % - .T., •, A OIYIS7ON SOSTON SUNYST CONSULTANTS. INC. `• =8 :!BOTTOM 0F `'TONE LAY E R ALL SYTE SHALL SYSTEM PROFILE MARKED WITHCMAGNETICTTAPE OR BE NOTES (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. PROVIDE MIN. 20" DIAM. WATERTIGHT 1. DATUM IS NAVD 88 ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE Q �. Roc Lone 2. MUNICIPAL WATER IS CI � �, o \ FILTER FABRIC OVER STONE �� 5 2 a�� Locus \o TOP FOUND. EL. 69.5' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. P c� co MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 69.0 NOTE: 2" MIN. WALL 4. DESIGN LOADING FOR ALL PROPOSED PRECAST PRECAST H-10 THICKNESS REQUIRED BLOCKS OR UNITS TO BE AASHO H-2_Q RISERS (TYP.) PRECAST RISERS 2'o 67.1 ' 4"OSCH40 PVC MORTAR ALL H-20 6" MIN. SUMP PIPES LEVEL 1ST 2' [� COMPONENTS 4, 5. PIPE JOINTS TO BE MADE WATERTIGHT. 12" MIN. INT. DIM. I ENDS (NP') 6 �S_lDES 66.06' 10" **EXISTING 14" y 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE d TEE SEPTIC TANK TEE °°°°°°°° o 0 0 0 o a a a a o 0 o a o >°o°oho°o O\ *65.8 00�� ®aoa �oaa o 0 0 0 WITH 310 CMR 15.000 (TITLE 5.) o ° ° ° ° ° WATERTEST D'BOX 'o°o°o°o° ®��D��L�.O aaoao��000® °°o°'oog° 7, THIS PLAN IS FOR PROPOSED WORK ONLY AND As �L1ei s of o ° 000 ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ®®®®®®®®®�® ®®®®®®®®®®® ° ° ° NOT TO BE USED FOR LOT LINE STAKING OR ANY goo°00000000 o000000° o0000000 0 0 GAS BAFFLE ::: FOR LEVELNESS >0000g000 ®®®®�®�D�C® ®�®��®0�®� oog000go S 65.33' 65.16' °° °°°°° 63.06 OTHER PURPOSE. +: 4' LIQ. LEVEL (ACME OR EQUAL) ° ° c o°0000000000,00000ao°oo°oo;o;o;o0000oo°o°ao° 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. �o °o°o°°°o°o°°°o°°°°°°°o°°°°°o°o°°°oho°o°°°o°°° H-20 500 GAL.°�EACHING CHAMBER BY ACME PRECAST OR EQUAL. 3 ,o�o„o_r_°_n_o_o 0 0 0 0 o r_r_r_ _n_o.o 0 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. ALL AROUND PRECAST STRUCTURES (2) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFIILLED OR er L'o 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12.83' CONCEALED WITHOUT INSPECTION BY BOARD OF COMPACTION. (15.221 [2]) io HEALTH AND PERMISSION OBTAINED FROM BOARD c ( 1 % SLOPE) ( 1 SLOPE) � OF HEALTH. 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LEACHING CALLING DIGSAFE (1-888-344-7233) AND FOUNDATION— EXIST. SEPTIC TANK 47' D' BOX 12' FACILITY 57.5' BOTTOM TH-1 VERIFYING THE LOCATION OF ALL UNDERGROUND & LOCUS MAP NO GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF SCALE 1"=2000'f *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC WORK. UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS TANK SIZE AT 1000 GALLONS AND ITS SUITABILITY 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL ASSESSORS MAP 47 PARCEL 70 PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM FOR RE—USE. REPLACE WITH 1500 GALLON i BE REMOVED BENEATH AND 5' AROUND THE SEPTIC TANK APPROPRIATE TO SITE CONDITIONS IF / PROPOSED LEACHING FACILITY. SITE IS LOCATED WITHIN A ZONE II NOT SUITABLE 12. EXISTING LEACHING FACILITY SHALL BE PUMPED /M H1 P" 6`-4 69 �O � ANDSAN REMOVED OR PUMPED AND FILLED WITH CLEAN LEGEND 4 -z8o ')o1AE5 99— EXISTING CONTOUR VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE SYSTEM DESIGN. X 99 EXIST. SPOT ELEV. IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR BY HEALTH INSPECTOR. PAPERWORK AND HEARING REDUCTION 6� GARBAGE DISPOSER IS NOT ALLOWED PROPOSALS APPROVED BY THE BOARD OF HEALTH REVISED —[99]-- PROPOSED CONTOUR DURING A PUBLIC HEARING HELD ON DEC. 10, 2013 �G / `30 �S• f98.4� PROPOSED SPOT EL. l • st4�, O� DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD 3) FAILED SYSTEMS ONLY, SAS TO PRIVATE WELL SEPARATION Aj D % USE A 330 GPD DESIGN FLOW TH1 DISTANCE VARIANCES, IF LOCATED IN THE SAME GENERAL ��tij 68 N TEST HOLE LOCATION AS THE OLD SAS AND MORE THAN 100 FEET Y SEPARATION IS PROPOSED BOTH FROM ON-SITE WELL AND L SEPTIC TANK: 330 GPD (2) = 660 2% SLOPE OF GROUND ANY AND ALL WELLS ON ADJACENT AND NEIGHBORING PARCELS. **RE-USE EXISTING 1000 GAL. SEPTIC TANK 70 UTILITY POLE FIRE HYDRANT BENCHMARK: I / LEACHING: BULKHEAD COR I SIDES: 2 (25 + 12.93) 2 (.74 119 CPE) _ NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING =68.8' NAVD88 / \� ) BOTTOM 25 x 12.83 (.74) = 237 GPD ---------- z` EXISTING TOTAL: 472 S.F. 349 GPD DWELLING i /WELL TEST HOLE LOGS TOF = 69.5 / } USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) GRAVEL / WITH 4' STONE ALL AROUND ENGINEER: CRAIG J. FERRARI, SE #13871 DRIVE� `�� ^ ,�� ,� / WITNESS: DAVID W. STANTON RS 8 26 2019 DATE: / 2 MIN INCH _ 10 \ / MA < PERC. RATE _ / _ \ o APPROVED DATE BOARD OF HEALTH CLASS I SOILS P# 19-121 o \ 68 \ ELEV. 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