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HomeMy WebLinkAbout0390 JONES ROAD - Health 390 Jones load Marstons Mills P A = 047 093 Y t _ Town of Rarnsrtable P# Jr' a Department of Regulatory Services Public Health Division Date 200 Again Strtm Hyannis MA 02601 tars��' n Date Scheduled �� � 1 Time_/ e� Fee.Pd.,� oil Suitabili re:� art ®r eW, a J I OsaC , Perforated Dy: tLimemed lay: LOCATION c& NI+�11..IIVFOM.IAT®N - t.acatiou Add ess 0 °s ° � S Assessor'sR3ap?Partel: r j'Z,�r? }�nginc-er'eAtmre :. .a9�v3 �-� y�,':.,�. . _ NEW CONSTRUCTION' r RE}PArR Tel P n'# Land Case t)ismaces(inm: Open Ct+arer t3aLy fi Prnsi6te Wet-.42ex_ U L'f2Drink inS Water Wei} _ ti. ... Otainage Way r3� Prapcm'Line�V it Other SKETCH:(Street name,dinman Ioas of#ot.exact locations of i�,hol¢,t&pen,texas,locate+wetlands in.protimiiy:io hoks) p *y a Ttf- Parent material agacj �L"°"' V i�'Jt �` Depth to Ffextmck - , Depth to Groundwatty Smiutdng Water i3t.Hak- W=pi g from Pit Face_.. Estimated Seasonal I#tgh('rround}satez DETERINI V 4A`T.10N 'OR SS ,?aSQNAL.FUGH WATER`FABLE Method Used: - . Depth Obser ted standing in obs:hole, - - in. Depth to soil aamics:. in.. Depth to weeping from ids of 46-,.hale in Cirnundwaifm Adjusituent tn Index 6VeU N Reariing t7ate: #tt$x hell level Adj.F Mar. Actj.Grot ndwater I evel ' PERCOLATION TEST Date me f)t)aCfVatimt • . Hole# - t Tfnu Ht 9^ f Depth pf Perc �...�.(}1�_�. 3'1mE 616" Sian.Presoul:Tia;eCos.. r TinIC End Ne-.ak Yl_ Rate MindInch .. Site Suitability hssi;.5s,nent. Site Ptt:xd_ Site Fatkd:; ldiSittanal7'ecliny*Needed'MN) _...__,,.. - Original:Public Health Divisio<, Cliise��ltiori Hole i-,)ata To Be Completed on.Back- --- ***If percolation testis to are eondutted within 100 of wetlasrd,you irstrst tirst notify the Barnstable Conservation Div:siosr at least one(1)reek Prior to'beginni.ig,. QASF,PTICAPERt:Pt7RSt:1?{.Ic DUT OBSERVATION HOLE LOG role# _ Depth-fram Sttil Horizon . . Soil Texture: Surface(in.) - - Stijl color - Soil Other!USDA) (.4fvosenj tdataiag (Structutc,Stones„Batilttrn Co i c ;je C+ryvsll .01 r �h DEEr OBSERVAMIN HOLE.LOG" Role#� Dep[h•from Soi.Harizun Soil Texture. Spit Color Surl'aoc(in.) - soil her (Ivtmtsell} iti4oiiliny (Struchim Stones;73ovltlCTS. . c3 L J' DEEP OBSFRVATIUN HOLE LOG €Dcpth from Soil Horizon €Iaal�# .. 1 Sail Texture Soil Color-. Surface(in.'} (USDA) Sail Mix (,0.tunsci!) t�{attligg (Structuic.Stont:s,Butt ders. ......_—_-_---�....— .._..._ tl. DEEP OBSER VA77ON HOLE LOG Hole# Depth£tarn Saillionzon Soil.Texture Soil Color. .Other Surface(in.) Saii (USDA) (.ltuaseti} f Toulins; (Structurc.Stoats,Eloald,m _ %CreavelS Flood Insurancc'Rair Y€aD 1 Above 500 year Pond boopder}' No Yes... Within 500 ycar bouhdaiy No Y es . - Witi»uItlOyearPoati.boundary Ilo Yes _ th of Not rail"Occurryn Pecvi usaterlal Does at least four.feet of naturally occumng pervi u teriai exist in all areas observed throughout tke area propostM for the soil absiirptiou system? It not,what is the depth of naturally occurring pe tous material? Crrtlficatloo �/ —� _.. 1 certify that on atc).I have passed the snrl eva€uaior examinajinn Department of Env' nm y the tat Projection and that the above analysis was perfo r bymern islent with the required train' ,cxpertisa and a gs¢t9b in 370 CMIt I5.01 Z Signature Date!/Ze :\sElr�lOT,=RCF011M.Doc: TRANS.NO.: CITY/TOWN: S a S APPLICANT: 0 Xorc ADDRESS: -40"Y¢-� DESIGN FLOW: gpd REVIEWED BY: DATE: N/A OK NO GENERAL Legal boundaries denoted 310 CMR 15.220(4)(a)] Street, Lot,tax parcel number and lot number noted on plan [310 CMR 15.2204 u ] Locus Provided 310 CMR 15.2204 t Plan proper scale? (1"=40'for plot plans, 1"=20'or fewer for components) 310 CMR 15.220(4)] Easements shown 310 CMR 15.220 4 System located totally on lot served [310 CMR 15.405(1)(a)for u ades -i not, a variance is required 310 CMR 15.412(4)] 1/ Location of impervious surfaces(driveways,parking areas etc.) 310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations 310 CMR 15.220 4 daily flow septic tank ca aci (required andprovided) soil absorption system(required andprovided) whether system desi ed for arba a grindei North arrow 1310 CMR 15.220 4 Existing and ro osed contours 310 CMR 15.220(4)(g)] Location and log of deep observation holes(existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220 4 h and i Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? [310 CMR 15.242 Certification statement by Soil Evaluator[310 CMR 15.220(4 Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220 4 n 9 c-JAddress ( � �� Sheet 1 of 7 Town of Barnstable V.E Tp Regulatory Services Thomas F. Geiler, Director BARNSTABLE _ Public Health Division 9Q�,1 O � i639• A.�� Thomas McKean Director F MP'� `200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: i1 -79-Lj1 Sewage Permit# Zol1 - 4Z& Assessor's Map/Parcel 41.93 Installer & Designer Certification Form Designer: Eny,'ro y%-r_r 6.1 Installer: _rAc w ►.Ai*ov\ Address: -P.O. BOX '91 Address: ly TcaxScc'r'H uJ Yac'mom-11n for —0rCS-{A lc On 1/-Z8.1 T1 i3 EXcavaA %o was issued a permit to.install a (date) (installer) septic system at 390 Toncs Qt based on a design drawn by (address) �avc F'IaHc � dated 11-21 - in (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distri4ution box and/or septic tank. Stripout .(if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any.component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) was inspected and the soils were found satisfactory. DAVID Qi cS?G�� D. staller's Sign ) LAHERI R. No. 1211 T (Designer' Signal. ) (Affix Desig p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.. THANK YOU. q:\office forms\designercertification form.doc TOWN OF BARNSTABLE CATION 390Tonc.s Rc SEWAGE# ZO11 - yZL VILLAGE M,yy): i 15 ASSESSOR'S MAP&PARCEL y'1-9 3 INSTALLER'S NAME&PHONE NO. B 3 EXCcLQ=1,'On 44'1') -Q&S3 SEPTIC TANK CAPACITY /o400 cg�t:i LEACHING FACILITY:(type) z1 s't nc. (size) Z x3,c 33 NO.OF BEDROOMS 3 OWNER a ' o O PERMIT DATE:I 1 -28 - In COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Al - Zy y.• ii► ' 43' Az- 2$'s" REAR a2. 4s"Z" A3- ,gZ ' 133- So,$.. O A4- $2 's By - ' y 3 r No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitatiott for -MIsposar 6pstem Construrtion permit Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.390 Z)bnCS Rd Owner's Name,Address,and Tel.No. qda.+� O'connor' Assessor's Map/Parcel q 9 3 o S Installer's Name,Address,and Tel.No. z 4,Q Excwwb li0 n Designer's Name,Address,and Tel.No. IyTc�cr�H LrJ fo�cs•1da.►c �{7�• OG53 f'Iallc��y E'aysRosn�n-k�.l folkxsl Type of Building: Dwelling No.of Bedrooms �` Lot Size i LI-T AcCr$sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 1130 gpd Design flow provided 369 gpd Plan Date //• 71 - /`7 Number of sheets Z Revision Date Title �r► p,�c Size of Septic Tank f 000 qaJ Type of S.A.S. Ttdo -I fC y%c--kC 5 2 x 3 x 3 S•FcnG- Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date_J�- l k Application Approved by Date f— �- Application Disapproved by Date for the following reasons Permit No. t Date Issued 1 !�—f' _s�'Y �07No. Fee THE COMMONWEALTH OF MASSACHUSETTS' Tv Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Mispo8af 6pstem (Construction Permit Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon-_( ) ❑Complete System ❑Individual Components Location Address or Lot No.390 ion cS RcQ /Y),v+1;� s ` O tner's Name Address and Tel.No. tl• .,, 1 AJarn O'Cannor- Assessor's Map/Parcel qj 193 U-roncs RzL :5 Installer's Name,Address,and Tel.No. ,[i EXCaU:xi JO n Designer's Name,Address,and Tel.No. ('I.XMc_r•i4a1V22omcn-1al l�1Tco.Ser�y LQ Fbr•csid,.�e: y`j� pG53 •Po ox a► Type of Building: ' s " Dwelling No.of Bedrooms ``3 Lot Size f 45/qc r'r$sq.ft. Garbage Grinder( ) �9 Other Type of Building No.of Persons Showers( ) Cafeteria( ) t Other Fixtures t K WDesign Flow(min.required) .`�30 gpd Design flow provided 1359 gpd ;.Plan Date 11 • 21 - /7 Number of sheets Z. Revision Date Title Size of Septic Tank ODD ct Type of S.A.S. -rujo -4 r c nch c -5 2 x 3 X 3 -5i e,� Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date�/ / 2'7- in Application Approved by tZ Date (�^-2k Application Disapproved by Date for the following,reasons r Permit No — Date Issued /"� / --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by 2 �-- 3 at 3 90 :o n c-S RA M. M;1 1 5 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.v QG dated Installer B g B EX CcaJa r o/\ Designer Muc #bedrooms 11� Approved design flow -~ 3 ' gpd The issuance of this permfit sh 11 not be )onstrued as a guarantee that the system�vi1i1 Mdtio as designe . Date / Inspector \\ -- -------------------------------------------------------------------------------------- ----------------- -----------------------_ No. L� Fee . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair(vo� Upgrade( ) Abandon( ) System located at 89 O -To n c S Rd, s 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 permit Date I Approved by / / I i Town of Barnstable Barnstable AHme Regulatory Services Department '' C j RAMSrASM MM 1639.. Public Health Division FO ,�s 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4988 0084 November 17, 2017 OCONNOR, ADAM J & KIM D 390 JONES ROAD MARSTONS MILLS, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 390 Jones Road, Marstons Mills, MA was inspected on 11/08/2017 by Frank Nunes III, 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 the 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 Tho ean, R.S., Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\390 Jones Road Marstons Mills.doc • Town of Barnstable 1 Aa pNCT1A'f i^. R XAM ;b$ Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA'02601 Office: 508-862-4644 Richard Scab Director FAX 508-790-6304 somas A McKean,CEO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO•REPAIR FAILED.SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) _ An` '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 o Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE(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 q Single'Cesspool- ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components, etc) o Leaching pit or cesspool with high liquid level, <12"below inlet (per Town Code §360-9.1.) ❑Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: a\SEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts d�P �3 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 390 Jones Rd. Property Address h.1 O'Connor Owner information Owner's Name is required for every page. Marstons Mills V/ MA 02648 11/8/17 $` Cityrrown State Zip Code Date of Inspection PO h+5 4.1 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. General Information c5/ /a70a- 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 11/8/17 Inspector's S ature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 390 Jones Rd. Property Address O'Connor Owner information Owner's Name is required for every page. Marstons Mills MA 02648 11/8/17 Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 390 Jones Rd. Property Address O'Connor Owner information Owner's Name is required for every page. Marstons Mills MA 02648 11/8/17 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6116 Title 5 Official Inspection Form:.Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 390 Jones Rd. Property Address O'Connor Owner information Owner's Name is required for every page. Marstons Mills MA 02648 11/8/17 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins.doc•rev.6116 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 390 Jones Rd. Property Address O'Connor Owner information Owner's Name is required for every page. Marstons Mills MA 02648 11/8/17 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 390 Jones Rd. Property Address O'Connor Owner information Owner's Name is required for every page. Marstons Mills MA 02648 11/8/17 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? ® ❑ 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. ❑ ® 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). n/a DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 I t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �< 2.90 Jones Rd. Property Address O'Connor Owner information Owner's Name is required for Marstons Mills MA 02648 11/8/17 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 6 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: OccupiedDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 390 Jones Rd. Property Address O'Connor Owner information Owner's Name is required for Marstons Mills MA 02648 11/8/17 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped April 2017 per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form W Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 390 Jones Rd. ) - - Property Address O'Connor Owner information Owner's Name is required for every page. 11Aarstons Mills MA 02648 11/8/17 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Original septic tank per age of home, new d-box and infiltrators 2006 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: >10'feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1 p g feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) Tank appears to be structurally sound If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000g Sludge depth: undetermined t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M r 390 Jones Rd. Property Address O'Connor Owner information Owner's Name is required for every page. Marstons Mills MA 02648 11/8/17 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle >12" Scum thickness undetermined Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >2" 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.): Obvious signs of backup at the inlet cover 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 390 Jones Rd. Property Address O'Connor Owner information Owner's Name is required for every page. Marstons Mills MA 02648 11/8/17 Ciityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 i assachusetts Commonwealth of M Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 390 Jones Rd. Property Address O'Connor Owner information Owner's Name is required for every page. Marstons Mills MA 02648 11/8/17 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 10" 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 is backed up at this time, the outlet invert is under water with staining above current level Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page U of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 5v0y� 390 Jones Rd. Property Address O'Connor Owner information Owner's Name is required for every page. Marstons Mills MA 02648 11/8/17 Ciyrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 5 Infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The infiltrators were video inspected and are backed up at this time Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M '< 390 Jones Rd. Property Address O'Connor Owner information Owner's Name is required for every page. Marstons Mills MA 02648 11/8/17 Qtyrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 390 Jones Rd. Property Address O'Connor Owner information Owner's Name is required for every page. Marstons Mills MA 02648 11/8/17 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 o� y q(0 �� Ij t5ins.doc•rev.6/16 ' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2.90 Jones Rd. Property Address O'Connor Owner information Owner's Name is required for every page. Marstons Mills MA 02648 11/8/17 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells >12' Estimated depth to high ground water: 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: TOPO mapping You must describe how you established the high ground water elevation: Home is on 100' contour and nearest surface water is approximately on 50' contour Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6f16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form lu Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 390 Jones Rd. Property Address O'Connor Owner information Owner's Name is required for every page. Marstons Mills MA 02648 11/8/17 Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 i c� YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $40.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINESS NAME in town (which you must do by M.G.L.-.it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office,' l st FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. Fill in please: Date: ©I 1 APPLICANT'S NAME r`. YOUR HOME ADDRESS: 3D1 ® S V®C(C BUSINESS TELEPHONE # HOME TELELPHONE #: EIN SOi -d-L12 -3-1F59 NAME OF CORPORATION: FID # __7-4S6 -a G-3-S NAME OF NEW BUSINESS 1:;�/j r;4 S C✓`1Can i•f1CA w�EL. 14VCh,0_P1 CcdTYPE OF BUSINESS ` Ccct U. IS THIS A HOME OCCUPATION? YE NO.' T ADDRESS OF BUSINESS jq® MAP/PARCEL NUMBER 4 (Assessing) When startinga new business there are several thins you must d g y o to be in compliance with the rules and regulations of the Town of Barnstable. This form is to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in town. 1. BUILDING CO ISSIO ER'S OFFICE This individ I ' men opriid of any permit requirements that pertain to this type of business. MUST UPATIO N Aufhorize Si n ure** RULES AND REGULATIONS. FAILURE TO COM NT GOMPLY MAY RESULT III pl!qE�S. 2. BOARD OF HEALTH This individual ha n inform t ft e p r t requir ments that pertain to this type of business. Authorized Sign re** , COMMENTS: MUST �()MPVOAATH ALL RDOUS MATERIA g REG j_Anf ­ 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** H a'fr ous Materials Inventory Sheet Checklist L Date Physical Street Address-Check database toensure:it.exists Working Phone Number - �� Actual Amounts.-( ie. gas being used to'fuel machines,-thinner to clean brushes-all count as hazardous;materials-no blanks) Storage Information-location of storage, how long is:storage for? If none, note that. Disposal Information.-.where and who? If none,:-note that Applicant Signature: understand what is listed and.noted Staff Initial -.any questions;•know who to.ask Vehicle.Washing/Rinsing?/Rinsin --give a vehic.le.washin olic a . - 9 9• -9 9p Y . nd explaimit; ... Attach the Business Certificate with your sign off and comments "The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. � r TOWN OF BARNSTABLE Date: 1 Q3 / I)_ TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: - 's op (a1w (_qw/ BUSINESS LOCATION: _%3qO INVENTORY MAILING ADDRESS: -Sq 3 jsnez TOTAL AMOUNT: TELEPHONE NUMBER: 50Y -d-9. " 3 -7�, CONTACT PERSON: ryi 0 COrt ,1 aY EMERGENCY CONTACT TELEPHONE NUMBER: `]"jy;Z,�£s-�� MSDS ON SITE? TYPE OF BUSINESS: nLo S�vl INFORMATION/RECOMMENDATI S: Fire District: I Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): � Metal polishes Laundry soil &stain removers V (including bleach) Spot removers &cleaning fluids (dry cleaners) i/ Other cleaning solvents Bug and tar removers Windshield wash IL X4 WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Appli ant's Signature Staff's Initials w � , �f i f' \ a� j ` 1 Commonwealth of Massachusetts 00010 Title 5 Official. Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6115/2000. inspection forms may not be altered in anyway. A. Certification Important. When rims out 1. ProD.erty Information: th compputformsteer ii se c7/�,cs COPY .only the tab key re" to move your �'j t 4-1 -OG cursor-do not use the mum Own me key. �i'� S , Owner's rasa '0 fo� A4 ,��(s ^A Citylrown state V / Zip Code Date of Inspection: V O Date 2_ In ct r� rt0 b �, 6 3 . � serr sz � r.31 7 No I r R Company Address City/Town ' State - code > Telephone Number s -=f N y� O Certification Statement: I certify that I have personally inspected the sewage disposal system at this address nd 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-W of Title 5( MR 15.000).The system: Passes ❑ Conditionally Passes ❑ Fails ❑ N ier Evalu by a oval Approving Authority � o Inspedoes Sgna Date The system inspector shall submit a oo y of this Inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater;the Inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. **"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•112004 TNe 5 OtTictal Inspection Form:Subaurrace Sewage Disposal System Page 1 of 16 ' Commonwealth of Massachusetts . Title 5 Official Inspection Form UVNot for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont) D Prppe-?ry Address /L d�Y �code Owner's Name Date of Inspection Summary:Check A,B,C,D or E/always complete all of Section D :;I Passes: 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. Comn, -e&Q. 1 c004fA V STD i`s 4 /Ue `-j B) S ern Conditlonalty Passes: ❑ one re system components as described in the"Conditional Pass"section need to be replaced o �Hevirill The system,upon completion of the replacement or repair,as approved by the Board of pass. Answer yes, no or not determ (Y,N. ND)in the❑ or following statements.'If"not determined,"please explain. `� ❑ The septic tank is metal and over 20 ye old*or septic tank(whether metal or not)Is structurally unsound,exhibits substantial in on or exfiltration or tank failure is imminent System will pass inspection if the existing tank iS aced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally nd,not leaking and if a Certificate of Compliance indicating that the tank Is less than 20 years old available. ND Explain: Wwap.doc•11/2004 Title 5 Offi W inspection Form:subsurface sewage Disposal system Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Ce if cati�cont) state �Code Ownefs Name Date of B) System Conditional Passes(cont): ❑ Observation of sewage ckup or break out or high static water level in the distribution box due to broken or obstructed pi (s)or due to a broken,settled or uneven distribution box System will pass inspection ff(with a a1 of Board of H.eatth): ❑ broken pipe(s)are repia ❑ obstruction is removed .❑ distribution box is leveled or replaced ND Explain: ❑ The system required pum 'ng more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection with approval of the Board of Health): ❑ broken pipe(s)are repla obstruction is removed ND Explain: C) Further Evaluation is Requ d by the Board of Health: ❑ Conditions exist which require fu evaluation by the Board of Health in order to determine If the system is failing to protect public h ,safety or the environment 1. System will pass unless Board of Hea etermtnes in accordance with 310 CMR 5.303(1}(b)that the system is not functioning a manner which will protect public health, safety aril the environment. /j ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy Is within 50 feet of a bordering vegetat wetland or a salt marsh t5mspAoc•1112004 Title 5 Offidal lnspecUm Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification cont.) ern► r �Slo� Code'17? K �te �/� 2 v Owners Name Date Jhnispec4dn C) Further Evaluation Is Required by the Board of Health(cont.): 2. tem will fail unless the Board of Health(and Public Water Supplier, if any) determ es that the system is functioning in a manner that protects the public health, safety a environment: ❑ The ern has a septic tank and soil absorption system(SAS)and the SAS is within 100 f t of a surface water supply or tributary to a surface water supply. ❑ The system s a septic tank an� <.the SAS is within a Zone 1 of a public water supply. �0 , ❑ The system has a se 'c tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank d SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply ell**. Method used to determine distance: **This system passes if the well water analysis,pe at a DEP certified laboratory,for coliform bacteria and volatile organic compounds Ind as that the well Is free from pollution from that facility and the presence of ammonia nitrogen and rn to nitrogen is equal to or less than 5 ppm,proAded4,hat no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. 1'y Snsp.doc•11/2004 Tide 5 Official inspection Form:Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts lugTitle 5 official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Ce ification (cunt.) D 1911 S D"O i 5 KSW Owners Nam Date of 1 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 ❑ P 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 dogged SAS or cesspool ❑ Uquid depth In cesspool is less than 6°below invert or available volume is less f� than Y2 day flow ❑ �( Required pumping more than 4 times in the last year NOT due to dogged 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 I system passes if the well water analysis,performed at a DEP certified laboratory,for colfform bacteria and volatile organic compounds Indicates that the well Is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] Yes No ❑ The system fails.I have detennined 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. 15insp.doc•11/2004 Tide 5 Offidal Inspection Form:.Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 official inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certificate Cont.) W a/s .� � v % �� Owner's Name Date of I E) t_a Systems: To be considered a large system the system must serve a facility with a design of 10,000 gpd to 15,000 gpdo For large Sys s,you must Indicate either'res"or"no'to each of the following,In addition to the questions in Sec' D. YES NO � ❑ ❑ the syst within 400 feet of a surface drinking water supply ❑ ❑ the system.is withM feet of a tributary to a surface drinking water.supply ❑ ❑ the system is located in a n n sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zo of a public water supply well If you have answered"yes'to any question in Section E the tem is considered a significant threat, or answered'yes"in Section D above the large system has fail 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. Mnsp.doc•1 MOO T09 5 ORM inspection Form:Subsurface Sewage Dh pmal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. C c list D �/je3 T�. Props dress �-r Iva �Zip Code 1' Owners Name Date of Inspection/ 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? ❑ J� Has the system received normal flows In the previous two week period? El this 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 WA) ❑ Was the facility or dwelling Inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? ❑ Were all system components,excluding the SAS, located on site? ❑ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ Existing information. For example,a plan at the Board of Health. /// ___ ❑ Determined In the field(if any of the failure criteria related to Part C is at Issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] LgW.doc•I M2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 IQA Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information 00_je �b4 _ Zip Code owners Name Qate of f (� Residential Ficw Conditions: Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 for example: 110 -�_-- ( mp gpd x#of bedrooms): AUrJ`Q Number of current residents: Does residence have a garbage grinder? ❑ Yes 4/No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes No Laundry system inspected? Yes ❑ No Seasonal use? ❑ Yes No Water meter readings,if available(last 2 years usage(gpd)): Sump pump? ❑ Yes [ No Last date of occupancy: n� pa cy: DaW CommercialAndustrial Flow onditions: Type of Establishment: Design flow(based on 310 CMR 152 Mons Per day(om) Basis of design flow(seats/persons/sq.ft.,e Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? f� ❑ 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): tSmsp.doc•11/2004 We 5 offidal InspecOm Fow..Subsurface Sewage Disposal System Page 8 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form. C. System Information ( t) U CW.Q ��t s ��t�l city[T sta` v/ o owners Name Date of irmpecm— General Information Pumping Records: �J Source of information: Was system pumped as part of the inspection? ❑ Ye "I If yes,volume pumped: fit$ 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/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,date ins II (if known)and source of information: --L p / Were sewage odors detected when arriving at the site? ❑ Yes No t5insp.doc-i MOM Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 9 of 16 Commonwealth of Massachusetts Title 5 Official. Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont. -7 Ar"' 7z) -,t_rT l< stele o:&�a Owner's Name Date of l Building Sewer(locate on site plan): Depth below grade: feet Material of construction: �'(� ❑ cast iron ❑40 PVC ❑other explain): Distance from private water supply well or n line: feet Comments(on condition of joints,venting,evide of leakage,etc.): Septic Tank(locate on Site plan): A /� Depth below grade: feet 1 f Material of nstruction: Crete ❑metal ❑fiberglass ❑polyethylene ❑other(explain) If tank is metal, list age: Years Is age confirmed by a Certificate of Compliance?(attach a copy of Yes No certificate) Dimensions: ��/� � Sludge depth: ` Z Distance from top of sludge to bottom of outlet tee or baffle �2 Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle / How were dimensions determined? t5lnsp.doc-11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (co CItY7TW // state 11 code �� 1` d a Owners Name Date of Inspection Comments(on pumping mme,Wti ,inlet and outlet tee or baffle cond n,structural integrity, liquid levels as related to t inve e)qence of leakage,etc. : Grease Trap(locat on site plan): Depth below grade: teat Material of construction: ❑concrete ❑metal Q 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: Data 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 pum at time of Inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑metal ❑fibe\[]polyethylene ❑ other(explain): t5imp.doc.112004 Title 5 Oftal Inspection Form:Subsurface Sewage D System. Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cons P dress Owners Name Date R1nsr*c*A It Tight or Holding Tank(cunt.) Dimensions: Capacity. �. .,gakm Design Flow: gallons Per day Alarm present: ❑ Yes ❑ No Alarm level: No, in wonting order. ❑ Yes❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.): Distribution Box(if present must be opened)(locate on sit plan): ( J Depth of liquid level above outlet invert ` 4 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.): /16C Pump Chamber(locate on site Ian): Pumps in working order. ❑ Yes ❑ No Alarms in working order. ❑ Yes ❑ No t5tnsp.doc•11/2Q04 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont ) 25o Jo'je-s Pro a dress -F VJ Ziryrr Sta'� ` � Zip Code Owners Name Date of Inspe ton Comments (note con ition of pump mber,condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan,excavation not required): If S t located, explai why Type: ❑ leaching pits number cv leaching chambers number � ❑ leaching galleries number. ❑. leaching trenches number,length: i ❑ leaching fields number,dimensions: ❑ overflow cesspool number. ❑ innovative/altemative system Type/name of technology. Comments(note condition of soil, signs of hydraulic failure,level of ponding, dam soil,condition of vegetation, etc.): C S 1 IV e-4 -<-e (� v t5insp.doc-11/2004 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System- Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information t) D v�e5 P d. ,;ily ztp code Owner's Name Date of I Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to in 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.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure,level of po.ding,condition of vegetation, etc.): t5insp.doc•11/2004 Title 5 Official inspection Forth:Subsurface Sewage DispoEa►system Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Informatio Q OfA �,,� S scare / zp v C036- Ownees Name Date off n Sketch Of Sewage Disposal System:Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 1 W feet Locate where I p y e ers /u°'e��` i � CIA A � �a d , j�,%) K 10 ,� as A 3 'IV 83 �'B t5nsp.doc•11/2004 Trde 5 Official Inspection Form:Subsurface sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts : Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (con Property AddressAT 6 CityfTo State Code �.� 4 .�1 , Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: 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 [Q/ Observed site(abutting property/observation hole within 150 feet of SAS) Checked wi al Board Qf Health -e n: Checked with local excavators, installers-(attach documentation) [ Accessed USGS database- e p in: se-le You must describe how you established the high ground water elevation: F t5insp.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 Town of Barnstable �p THE Tp� Regulatory Services BARNSTABLE Thomas F. Geiler,Director y Mass. i639. Public Health Division ArED��A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAI MER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at, a particular property would be listed on the "Disposal Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. OASEPTICTisclaimer Private Septic Inspections.DOC TOWN OF BARNSTABLE LOCATION O �6 � 1�-� SEWAGE # VILLAGE �� ASSESSOR'S MAP &LOT 1 INSTALLER'S NAME&PHONE NO. . SEPTIC TANK CAPACITY O 6O � - LEACHING FACEL=: (type) c��V V'ZV�n�d/1-size) d �C NO.OF BEDROOMS BUILDER OR OWNVR � qr-j Nv PERMITDATE: ' 7' COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by I - " l � 3/ A• a 6 , • ++ovv 44.v6 rRA ®001/001 Town of Barnstable Regulatory Services f _ Thomas F.Geller, Director umeum¢ , ' Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office; 508-862-4644 Fax: 508.790-6304 rtiSca Date: oCa Designer: Shay_Environmen Se`nrices Inc Installer: a►�-F�-, ��ra i c� Address: _2.0. Box 627 Address: East Falmouth. MA_0 D was issued a (date) (installers permit to install a i septic system at �/� wed on a design drawn by IX Env. < .Q15' �$8.�.� _, dated� p� (designzrJ ----t---_� .. I cert* that the septic system referenced above the design, which may include minor was bled substantially according to distribution box and/or septic tank. approved changes such as lateral relocation of the - I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of anycom o nt of the septic system) but in accordance with State & Local Regulations. Plan revistone or certified as-built by designer to follow, NB��s �n CARMEN E. SHAY No. 1181 4 0 ®r 'rs s'NITARk�`�' "er-9 A est�neris tip ere) SE A RE TO 8 iJRL OF COAMOPAN S N TH � F CE ICAT A NE EP . D N. Q;Heaith/5epWOolper Certifls won Form v TOWN OF BARNSTABLE c L ATION SEWAGE # ' VILLAGE �� ASSESSOR'S MAP & LOT 2 Q —u:3TALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY O f � , f LEACHING FACILITY: (type) < < -W4�100size) NO.OF BEDROOMS BUILDER OR OWNER SZ'` PERMITDATE: >t'�Q- —COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by - r i tea . G ' No.- .— /3c r Fee �V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zippricattou for Migoal bpgtemc Cow6truction Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑ Complete System RIndividual Components Location Address or Lot No. 39.0 Mws r & Owner's Name,Address,and Tel.No. M,M;lt S l-irsDA ty�s���c�� Assessor's Map/Parcel .G� `1, f5A M F Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Robes Vs a 9-49 ce Type of Building: Dwelling No.of Bedrooms 3 Lot Size 0_ sq.ft. Garbage Grinder (A,14_ Other Type of Building Nco!e No.of Persons 0 Showers Cafeteria Other Fixtures ( Ail flTo i?,Q kvrc yiirnl Design Flow(min.required) 3�)o gpd Design flow provided gpd Plan Date 2A?:=6 1 ow Number of sheets 1 Revision Date -- Title c skry\ UpCVC& Size of Septic Tank Type of S.A.S. /D° X ° Xl� q t1�r_,�1 Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued b :-ard o Sig Date Application Approved by Date V b Application Disapproved by: Date for the following reasons Permit No. �9 Date Issue k No. �,�,�/' / • `� `'- �: ,!i(/((J � 1�� Fee ®V THE,d*M' �IONWEALTli OF MASSACHUSETTS Entered in computer: f/ b PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipplication for iq o!6oY p!5tem Con!5truction ermit 0 1 Application for a Permit to Construct O Repair(X Upgrade O Abandon O J❑Complete System ®,Individual Components _ F Lo5ation Addressor Lot No. 390 ZUrQS Z� Owner's Name,Address,and Tel.No. r l M,M;II S L,ruDta t-\a� c�s Assessor's Map/Parcel Lf� 9 3 SA M E Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Lyg - s3�o 53�i--49 Type of Building: Dwelling No.of Bedrooms ,3 Lot Size �`'i0 sq.ft. Garbage Grinder (/V/,A- Other Type of Building j yp g N!`�t-,P No.of Persons I Showers( Cafeteria( � Other Fixtures FITCsF, AT-w'"EN `Jtnik ` A Design Flow(min.required) 3 3 O gpd Design flow provided 3 3 ,�' gpd Plan _Date �� Ole Number of sheets --„;. Revision Date ,. Title i C S 11 She M UC�G�CCLA J Size of Septic Tank �X t .-,'r' 1 f�Gc�� -\-u, - Type of S.A.S. /p X Description of Soil C j /N f` ►LT��TCES i - Nature of Repairs or Alterations(Answer when applicable) RZ,Qer -In rn\ctt, Date last inspected:' Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of r Compliance has been issued by this Board of Heapo � Sigdned .,ti _ Date Application Approved byj - _ Date J7 Application Disapproved by: Date for the following reasons t It Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded (X) Abandoned( p)by 5gZ�0\ce at 3 1 O has been constructed in accordance / with the provisions of Title 5 and the for Disposall System Construct ion Permit No dated a .6 . Installer �D Vec'NS f��C -i-A J�ce-5 1 Designer .5y-,w)".,► Lo. SACS. #bedrooms Approved design flow `) 3 gpd Now- The issuance of this pe t shall not be construed as a guarantee that the s stem willfuncttl6n a`ls�,d�esigned. Date � In Inspector , __ �s i�aJ�..-,� ~ -------------------------------------------- No. 6 — f -3 Fee THE COMMONWEALTH OF MASSACHUSETTS l PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Mf 5pont *p.5tem Con6truction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at ® Cam-S v � 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 inust be completed within three years of the date of this Date j �f Approved by 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM /'j • I, stifle ,hereby certify that the engineered plan signed by me dated 2 )cam: , concerning the property located at meets. all of the following criteria: • This failed system is.connected to a residential dwelling only,. There.are.no.commercial or bwiness.uses.associated with the.dwelling. • The soil is classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or.may conduct deep test holes and percolation tests,at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. 0 The.bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) it) S B) G.W. Elevation `S® +adjustment for high G.W.z'Le _ Z� DIFFERENCE BETWEEN A and B SZ P SIGNFD : L DATE: 2`i NOTICE Based upon the above information; a repair permit will be issued for bedrooms s maximum.. No additional bedroom are authorized in the future without engineered septic system plans. Spy z`s q Asepdc\percexemp.doc TOWN OF BARNSTABLE LOCATION 390 304ti R 8 SEWAGE # LLAGE t ASSESSOR'S MAP & LOT 62 dSTALLER'S NAME&PHONE NO. Zd7' 3 96v SEPTIC TANK.CAPACITY C�lb LEACHING FACILITY: (type) (ox& (size) /0" (;Al NO. OF BEDROOMS 3 BUELDER OR OWNER L91 G4 ATIS PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching�'f�acility) Feet Furnished by �/1 SQC p^ �4� 1n 60� a A B �pj a 4? a9 3 CO MMONWEA,TH OF MASSACHUSETTS . ExEcuT vE OFFICE OF ENVIRO DEPARTMENT OF ENVIRONMENTAL,AFFAIRS ERONMENTAI, PROTECTION /V" OY 09-3 LE 5 OFFICIAL, LNSpECTION FORM_TITNOT FOR VOL SUBSURFACE NOT DISPOSAL YSTEY FOR ASSESSMENTS PART A M CERTIFICATION Property Address: 701leS RcJ Ar N Ow;ier'S Na me: /� Owner's Address: L,h ci q 14 C Oa 6�$ ; 90 one Date of Ins RCS °0 Sri Ncu Inspection: /_a — �6 Z Name of 7nspecta�lease // r cn Print _ / Company Name: _) �rh' olS2/� iVMailing Address: o t E C H co Ma -, Telephone N �� ' Od A P umber: o _ � CERTIFICATION STATEMENT I certify that I have personally below is true inspected the sewage disposal system at this a accurate and complete as of the address and that the - � g and experience in.the proper time of and The formation reported approved s stem u function andance Inspection was performed based on my . Y inspector pursuant to Section is o 't1e 5 n site sewage disposal systems.I am a DEP (310 CMIZ 15.000). The system; Passes _.�Conditionally passes / Further L Evaluation b.,+�,e T __, F j ��Local Approving Authority Inspector's Signature: Date.— The system � are: Y inspector shalt submit a COPY _ Dom')within 30 days of completin pY of Inspection report to the Approving Authority gpd or greater, the ' g this Inspection.If the system is a s (Board of Health or DEP.The or3 Inspector and the system owner shall submit the report to thetam or has a design flow of 10,000 should be sent to the system owner and copies sent to the the abuyeppf pr1aP t abl regional of ce of the authority. , and the approving '\totes and Comments " This report only describes conditions at the time of inspection and under the conditions of time. This inspection does not address how the system will perform in the future under the same or different Title Slnspect a,;row bl 5/2000 page 1 Page 2 of 1 I OFFICIAL, INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property:address: 39�U ✓�'o�tes ,Qcl Owner: Dd 6 q� q � Date of Inspection: /_ _ O a Inspection Summary: Check A,B,C,D or E!ALWAYS complete all of Section D A. .System Passes: `V I have not found any'formation which indicate at any of the failure criteria 15.303 or in 310 Cla 15.3Ct4 exist.Any failure criteria not evaluated are indicated below. bed in 310 CNM Comments: B_ System Conditionally passes: One or more system components as described in the"Conditional Pass"section need to be d or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,ewill pass. explaL yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined" lease explain.: P 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 r tank is Placed with a complying septic tank as approved by the Board of Health. :4 metal septic tank will Pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in theistribution box due to broken or d obstructed pipe(s)or due to a broken,settled or uneven distribution box. System wi 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. The system required pumping more than 4 times a year due.to broken or obstructed i e s . The system will Pass inspection if(with a y P P ( ) y approval of tse Board of Health); broken pipes)are replaced obstruction is removed ND expl:�in All S/7nnn 2 OFFICE, LNSPE S CTION FORM-NOT FOR VOLUNTARY UBSURFACE SEWAGE DISPOSAL SYSTEM LNSPE TON FORMS PART A CERTIFICATION(continued) Property Address: 320 �o . Owner: OL Date of Inspection: C. Further Evaluation is Required by the Board of Health: ' v Conditions exist which require further evaluation . failin r non by the Board of Health in order to determine if the system g.o protect public health,safety or the environment.. I• System will pass unless Board of Health determines in accordance with 310 CVIR 15.303 I 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 _ CesspooI or privy is within 50 feet of a bordering vegetated wetland or a salt marsh System win fad unless the Board of Health(and Public Water Supplier,if any) determines system is functioning in a manner that protects the public heal that the th,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. _ The system k=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 wafer supply well**.Method used to determine distance This system passes if the well bacteria water analysis,performed at a DEP certified laboratory,for coliform and volatile organic the presence of compounds indicates that the well is free from pollution from that facili and ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ty failure criteria are triggered.A copy of the analysis must be attached to this form provided that no other 3. Other: T ilo S f,.r� irnr. 1 nrm(. lll 3 " Page 4 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION CTIONFORM PART A CERTIFICATION(continued) Property Address: J % 0"l es J �RrS - mil./l j �� ©d 6� Owner: �7�q�5-�,h Date of Inspection: — p 6 D. System Failure Criteria applicable to all systems: You must indicate "yes"or"no"to each of the following for all inspections: . Ye _ mockup.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 slegged SAS or cesspool ✓Stagy liquid level in the distribution box above outlet invert due to an overloaded or clogged SA,S or cesspool � uid depth in cesspool is less than 6"below invert or available volume is less than%z day flow Required pumping more than.4 times in the last year NOT due to clogged or obstructed times pumped gg trusted pipe(s).Number _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. `/ portion of a cesspool or privy is within a Zone 1 of a public well. wry 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 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 pp provided provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CbIR 15.303,therefore the system fails.The system owner should contact.thP Board of He alt 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) X he system is within 400 feet of a surface drinking water supply he system is within 200 feet of a tributary to a surface water su 1drinking PP Y e system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped one 11 of a public water supply well LI you rave answered "yes"ro any qucsnon 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 CIMR i 5.304. The system owner shouid contact the appropriate regional office of the Departrnent. Tirlu Q 7ncnurtinn nrrn FJ7G/7f1l1l1 4 - Page 5 of 11 OFFICIAL L�ISPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: ✓ o 704le-5 RCIJ Owner: j?C:i S Date of Inspection: /--c2 - oj', Check it The Following have been done.You must indicate"yes"or"no"as to each of the following: Yes : o — _ Pumping information was provided by the owner,occupant,or Board of Health — ere 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 P � '?inspection �i � Were as built plans of the system obtained and examined?(If they were not available note as NIA) Was the facility or dwelling inspected for signs of sewage back up? 44 as the site inspected for signs of break out? Were all system components,mponents,excluding the SAS,located on site? _/_ Were the septic tank.manholes uncover Tr the baffles or rees,material o_construction,dimensions depth ofened,and liquid, depth of slinterior I of the udge and depth of scum inspected for.the condition / proper Was the facility owner(and occupants if different from owner)provided with information on the maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no/ Existing information.For example,a plan at the Board of Health. _ Determined in the field.(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CIMR 15.302(3)(b)) T�rlo� incrurrinn Fnrm���;i-�rnnn 5 gage 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SLBSL-RFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: 4 S i / Date of Inspection: / .—pZ_ p b FLOW CONDITIONS RESIDE��iTLAI, Number of bedrooms(design): Number of bedrooms(actual):,- DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 0 Number of current residents: �2,— Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no):;R2[if yes separate inspection required] Laundry system inspected(yes or no):11(-,V Seasonal use: (yes or no): ZC"70 Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):L±/o Last dare of occupancy: CONMRCIAL/IN-DUSTRLAL Type of establishment: Design flow(based on 310 CMR 15-203): and Basis of design.flow(seats/persons/sgtetc.): Grease trap present(yes or no):— Industrial waste holding tank present(yes or no):_ tion-sanitary waste discharged to the Title 5 system(yes or no):_ Water ureter readings,if available: Last date of occupancy/use: OTHER(descnbe)- GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes o no):" If yes,volume pumped: ,allons—How was quantity pumped determined? Reason for pump' TYP SYSTEM �f14- _Septic rank;d�ox,sail$bsaxies system —Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _InnovativeiAlternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) - —Tight tank _Attach a copy of the DEP approval _,Other(describe): ADproxi ar--age of all componenrs,date installed(if known)and source O info lion: N ere sewage OCOrs detected when arriving at the site(yes Or no). Tirlc tn:nurrinn r n, ,,���.�onnn 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SL'BSLRFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: J ✓00e,f 9 Ci- �) Gas o 6i S- /y! //S /l�/f 0,2 64r� Owner: 1 6z D<te of Inspection: —a- Oft, BUILDLYG SEWER(locate on site plan) Depth below grade: Materials of construction: mast iron _-45PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of omi t's,venting,evidence of leakage,etc.): SEPTIC T_ 'AtI K:_�(Iocate,, site plan) �j Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene _orher(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) i Dimensions: Sludge depth. of 'F/ a� y Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum:o bottom of outlet tee or b4ffle:�� / How were dimensions determined: yoo le Kay c�v�C Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as Iated to outlet invert,a 'deuce of leakz e, Pr°�L� GREASE TRAP- V (locate on site plan) Depth below grade:_ 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 iast pumping: Comments(on pumping recommendations,inlet and outlet we or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Titles Page&of I 1 OFFIC :- L4I. INSPECTION FORM—NOT FOR VOLUNTAR Y TARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 ,�ocles �/ Owner: // S Date of Inspection: TIGHT or HOLDEN G T_2iK: /" (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm,and float switches,etc.): DISTRIBUTION BOX:�if present ( p t must be opened)(locate on site plan) Depth of liquid level above outlet invert 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.): PUMP CHAMBER:/—/oocate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Ts{o fncsurrinn g7n_ Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: JgQ ✓��e1�- ��� ©OZ 6 Owner: Date of Inspection• SOIL ABSORPTIOti SYS=EM(SAS):&(/locate on site plan,excavation not required) f SAS not located explain why: Type leaching pits,number. leaching chambers,mum 3er. .leaching galleries,number: ` leaching trenches,number,length. leaching fields,number,dimensions: overflow cesspool, number: innovative/alternative system Type/name of technology: Comments(note condition of sail,signs of hydraulic failure,level of ponding,damp soil, condition of vegetation, etc.): CESSPOOLS:Z(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: / Depth—top of liquid to inlet invert '2 'l Depth of solids layer: O Depth of scum layer. n Dimensions of cesspool: !( 6 Materials of construction: -7L G2N^eI4 Indication of groundwater inflow(yes or no):/fV Comments(dote condition of soil,si,ps�f hydraulic failure,leve of ponding, ndil on of vegetation.etc.): `x to t✓ t ✓► v�✓- — d�c /'c —a PRIVY: l" (locate on site plat) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): O 1 Page OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property-Address: O / O Pl e S Owner: ��S �H Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet Locate where public water supply enters the building. 4/ y V �d 63- -rirlo : inc.,—i— F/i v,nnn 10 Page 11 of 11 - INSPECTION FOR1V1—NOT FOR VOLUNTARY ASSESSO�NTS OFFICIAL SLBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F PART C SYSTEM INFORMATION(continued) � o�eS � Property Address 3CJ . Oak'� O Owner: Date of Inspection: SITE EXAM Slope Surface water Check cellar O Shallow wells / Uc p Estimated depth to ground water 3© feet Please indicate(check)all methods USed to dete�e the high ground water elevation: , laps on record-If checked,��of design P�reviewed:--- from from system design p Observed site(abut property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach(d1ocumentation) Accessed USGS database-explain: describe ho you established a high ground water elevatio� �� id cle You must �y s o �v"► 0C C4 l ?O G✓o ✓ ro K N t,✓'— ✓ C � � � 11 �. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENT L PROTECTION RECEIVED JUL 10 2003 TOWN OF BARPJSTABLE HEALTH DEPT. TITLE 5 -- OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 390 Jones Road Marstons Mills, MA 02648 Owner's Name: Jessica Bates Owner's Address: Date of Inspection: June 30, 2003 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Map: 047 Mailing Address: P.O. Box 49 Parcel: 093 Osterville,MA 02655-0049 Lot: 396 Telephone Number: (508) 862-9400 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: ✓ Passes Conditionally Passes Nqeos Further Evaluation by the Local Approving Authority Fa 1 Inspector's Signature: Date: July 6, 2003 The system inspector shall subraeopy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 390 Jones Road Marstons Mills, MA Owner: Jessica Bates Date of Inspection: June 30, 2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes, no or not determined(Y,N,ND) in the 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. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: 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: 2 I Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 390 Jones Road Marston Mills, MA Owner: Jessica Bates Date of Inspection: June 30, 2003 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 CNIR 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 "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 f Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 390 Jones Road Marstons Mills, MA Owner: Jessica Bates Date of Inspection: June 30, 2003 D. System Failure Criteria applicable to all systems: You must indicate either`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 ✓ 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 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.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No _ the system is within 400 feet of a surface drinking water supply 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. 4 r ` Page 5 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 390 Jones Road Marston Mills, MA Owner: Jessica Bates Date of Inspection: June 30, 2003 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant, or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period ? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ Were all system components, excluding the SAS, located on site? ✓ _ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid, depth of sludge and depth of scum ? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 • Page 6 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 390 Jones Road Marston Mills, MA Owner: Jessica Bates Date of Inspection: June 30, 2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 1 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped 4 months ago-per owner Was system pumped as part of the inspection (yes or no): 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) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Dec. 13178-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 390 Jones Road Marstons Mills, MA Owner: Jessica Bates Date of Inspection: June 30, 2003 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron 40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 15" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 13" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There were no signs of leakage. GREASE TRAP: None (locate on site plan) Depth below grade: 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 f Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 390 Jones Road Marstons Mills, AM Owner: Jessica Bates Date of Inspection: June 30, 2003 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.): PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): 8 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: 390 Jones Road Marstons Mills, MA Owner: Jessica Bates Date of Inspection: June 30, 2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 - 6'x 6'(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: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): The pit had Y ofwater on the bottom. There were no signs of failure The bottom to.grade was TV The cover was 2'below grade. — CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): PRIVY: None (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.): 9 a Page 10 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 390 Jones Road Marstons Mills, MA Owner: Jessica Bates Date of Inspection: June 30, 2003 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. a � Q 3 3 107 10 Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 390 Jones Road Marston Mills, MA Owner: Jessica Bates Date of Inspection: June 30, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 40 +/- feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using the Barnstable topographic map and the Cape Cod Commission water contours map,the maps were showing approximately 40' to ground water at this site. This.report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 CER"rIF"11H"D SEPTIC SYSTEM REPORT 2 LOCATION 390 JONES RD. PECE71VEO MARSTONS MILLS. MA APR 10 1998 MAP 047 PARCEL 093 LOT 396 TOWN OF�ARNsTASLE HEALI H DEPT. f PREPARED FOR SELLER ADELARD L. CAOUETTE 185 MANVILLE HILL RD. CUMBERLAND, RI 02864 BUYER MS. JESSICA BATES BOX 733 E. DENNIS, MA 02641 PREPARED BY HILLIARD HILLER P.O. BOX 250 CENTERVILLE, 111A 02632 508-778-1472 t COMMONWEALTH OF MASSACHUSETTS 7 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON,, MA 02108 617.292.5500 WILLIAM F `.t ELD TRUDI'CO.\E Govemor Sec re tan ARGEO PAUL CELLUCCI DAVID B STRI`HS Lt Governor SL:BSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissionci PART A CERTIFICATION PropDateertylAddress : _3�70 ,V,P/�S i`O � 2SiZ.cs �lG4�s, Address of Owner: 11742-L /7Qo L, <�cY���7-�• /'% (If different) iFrS f/ ,vim-ems! Name of Inspector: 17', .�y/a,d _ I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15,000) Company Name:. ^� Mailing Address: a�iGz,rt Telephone Number, CERTIFICATICN STATEMENT I cenify that I have personally inspected Le)e sewage disposal system at this address and that the information reposed below is true, accurate and complete as of the time of inspection The inspection was performed based on my training and experience in the proper function and maintenance o'" on-site sewage disposal systems. The system: ✓Passes Conditionally Passes Needs Funher Evaluation By the Local Approving Authority Fails Inspector's Signature: ��` ?� � Date: The System Inspector shall submit a copy :)f this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall suom,t the report to the appropriate regional offic= of the Department of Environmental Protection. The original should be sent to the system ovine, and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Chec A; B, C, or D: AI SYSTEM PASSES: have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303 Any failure criteria not evaluated are indicated below, COMMENTS: BI SYSTEM CONDITIO ALLY PASSES: One or more stem 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. Indicate yes, no, or n I determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. T e septic tank is metal, unless the owner or operator has provided the system inspector with a coPe of a Certificate of mpliance (anached) indicating that the tank was installed within twenty (20) years prior to the date of the jnspeciion; or e septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tan, allure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (r•vio•d 0//25/7) Page 1 of 10 C+EP on the World Wide Web: rnttp3twww,magnet.state.ma.usidep CJ Printed on Recycled Paper StUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1�0 �xxozs' <,J Owner: ✓f p�Lf�rPf� L. L�9ou,E i�L Date of Inspection: B) SYSTEM CONDITIONALLY PA SES :continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due i a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Healt I. Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system re uired pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection. if( ith approval of the Board of Health): broken pipe(s) are replaced ob:>truaion 'is removed C) FURTHER EVALUATION I REQUIRM BY THE BOARD OF HEALTH: Conditions exist whi require funher evaluation by the.Board of Health in order to determine if the system is failing to protect the ,public health, safety nd the environment. i) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PRO ECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool r privy is within 50 feet of a surface water Cesspool r privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAI UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS F NCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The syst m has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The syst m has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well The sys m has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The sys em has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private ater supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the we I is free from po lution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less th n S ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04,25/91) ?&g• 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 3� �.v�s ,re���rSw -14-/Lea- Owner: /1,0,Q Z-Ae 0 L . f'J';p Date of Inspection: D] SYSTEM FAILS: You must indicate ei; ,er " es" or "No" as to each of the following: I have determine that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determin tion is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backu of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Disch rge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cessp of. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liqu' depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Req ired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Nu ber of times pumped _. An portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. An portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. A portion of a cesspool or privy is within a Zone I of a public well. A y portion of a cesspool or privy is within 50 feet of.a private water supply well. y portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no a ceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for liform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM AILS: You must indicate ither "Yes" or "No" as -,o each of the following: The folio ing criteria apply to large systems in addition to the criteria above: The syst m serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public h alth and safety and the environment because one or more of the following conditions exist: 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) The owner or perator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04,/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: ,3 Sa uP;V-eZ ' A4P , 1".OZ6"T�.c.s /L4 Owner: Date of Inspection: y�j�9 t 313J�SP e ti Check if the following have been done: You must indicate either "Yes" or"No"as to each of the following: Yes No _ Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _Ae _ The facility or dwelling was inspected for signs of sewage back-up. rL _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. All system components, 4luding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 115.302(3)(b)) (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: ,',4-5 1Z,0 / Owner: �C¢t /9/lp 4-r217;f Date of Inspectiz)n: FLOW CONDITIONS RESIDENTIAL: Design flow: ✓O .p.d./bedroom for S.A.S.. Number of bedrooms: 3 Number of current residents: O Garbage grinder (yes or no):—A,� Laundry connected to system (yes or no):_�-lire h'�d9/GA�SG� Seasonal use (yes or no):LW- Water meter readings, if available (last two (2) year usage (gpd): _/ C G� Cam'L ySsj • ovv ��C Sump Pump (yes or no):­1�0 ' Last date of occupancy: A COMMERCIAUINDIn RIAL: Type of establishme Design flow: ons/dayGrease trap present or no)_Industrial Waste Ho Tank present: (yes or no)Non-sanitary was:earged to the Title 5 system: (yes or no)Water meter readin available: Last date of occup cy: OTHER: (Describ Last date of occu an 1 GENERAL INFORMATION PUMPING RECORDS and sourcq of information: System pumped as part of inspection: (yes or no)_� If yes, volume pumped: gallons /.4-1 Reason :or pumping: TYPE OF SYSTEM 1/ 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source •f information: ��/�ilT 7� S�� +%•/ 1a� G1UT Vrq Sewage odors detected when arriving at the site: (yes or no) (revised 04/25/91) page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: leO �i/�STvca �iG� Owner: l�Od a?D L, e—e,- � �- Date of Inspection: BUILDING SE ER: (Locate on site Ian) Depth below ade: Material of co struction: _cast iron _40 PVC_other (explain) Distance ;( nc,t'oprivate water supply well or suction line Diameter Commentn of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction; i concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: g 11,91, 411 Y„(6101 W/ OCo Sludge depth: 16-1 Distance from top of sludge to bottom of outlet tee or baffle: i5!s Scum thickness: D Distance from top of scum to top of outlet tee or baffle: cf Distance from bottom of scum to bottom of outlet,tee or baffle: /g How dimensions were determined: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) _Ti'9i�K /�ti9 I-X/S Za�"�Cd ��:0 , tom: L41116 d o�� lyle elle_w GREASE TRAP: (locate on site pla ) Depth below gra e: Material of cons uction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Scum thickness Distance from op of scum to top of outlet tee or baffle: Distance from ottom of scum to bottom of outlet tee or baffle: Date of last p mping: Comments: (recommend tion for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, ev' ence of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Sz;W'14;S 40 Owner: Date of Inspection: TIGHT OR HOLDIN TANK: (Tank must be pumped prior to, or at time; of inspection) (locate on site plan) Depth below grade- Material of constru ion: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons. Design flow: gallons/day Alarm level: Alarm in working order_Yes; _ No Date of previo s pumping: Comments: (condition of nlet tee, condition of alarm and! float switches, etc.) it I DISTRIBUTION BOX:_ (locate on site plan) � L® ,��j e,dT , lwrz" Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CH MBER:_ (locate on ite plan) Pumps in orking order: (Yes or No) Alarms in orking order (Yes or No) Comment (note co ition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Sv Jp.!/ES 1ZF9 �L'$>U,vs Ar IGLf Owner: ffoerG/,,o Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): L/ (locate on site plan, if possible; excavation no: required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type leaching pits,.number: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions:. overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) /°r was IA91 5e Go S fzyGL Ed�7Yi S C v.�, v,ei 7v� S T,e' Ti9 pis CESSPOOLS: In (locate on site Number and couration: Depth-top of li to inlet invert: Depth of solidser: Depth of scum er: Dimensions of pool: Materials of co4ction: Indication of grdwater: inflowsspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: _ (locate on sit plan; Materials of c nstruction: Dimensions: Depth of soli s: Comments: (note con1ti n of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) ?age 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: .3�;o GGs Owner: 1111�"v,-17-6- Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 49 0 I °u I ; / / I i I ' l3fI�K (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C .SYSTEM INFORMATION (continued) Property Address: ?jeJv ,PXvS Owner: Date of Inspection: Depth to Groundwater 2011feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record _f Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps, Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) 5 ilk is o,ri 19 N/G/,' /7'/4 /T (revised 04/25/97, Page 10 of 10 � �,z� � � c � �� -� ��� /,f�z -,�j o- 63 0y W �Ot. s I a � a i�pp x U D ► y � �R`a��€ £ k►STrr•q I�nl�s� � 3 b 4 3 P oc,:L'7 I�r4- 11 . _ LA R ►N - d r \� :2,. ,fie 310 Tori1 E, RAI �rwn.+.•�w+!n+.arc^�•�`ria•� i .� ' I n � p it �` { sf 14 `' LIVA LOCA..T//ION SEWAG PERMIT N0. 7�Sa 7 VI L L A G E I N S T A LLER'S NAME ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED I � - �. ---- { ;. �`��, �� � �. �.. , � �..� �i, THE COMMONWEALTH OF MASSACHUSETTS BOARD' OF HEALTH ...............OF....R,09 h/�STf�-, G_?-..................-------- Appliration for Diipooal Workii Tonotrnrtion ramit Application is hereby made for a Permit to Construct ( `for Repair ( ) an Individual Sewage Disposal System at: l ................_....... N ..... .................. ...rn........-•--------.........--•----- ....... `ryat o r -Y-.-_ --------------- s .........6...ymm i s:.---- Addre ................... ...�f9CZPw ................................... Ins a�ller T Address Q Z. O Type of Building Size Lot.Z f______ __ ____Sq. feet Dwelling—No. of Bedrooms_____________:_J?....... ................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons-_-__.-___---..___________ Showers ( ) — Cafeteria ( ) a Other fixtures W .. $Design Flow......... ..........................gallons p "e�R per day. Total daily flow...............3rZG................gallons. WSeptic Tank—Liquid capacity/ajAo.gallons Length 8R.' ". Width__-O.�- "'Diameter................ Depth._s.. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.,_../............. Diameter...4 _F*--- Depth below inlet...G fT... Total leaching area... ip 7...sq. ft. Z Other Distribution box ( y' Dosing tank0-4 ( ) a Percolation Test Results Performed by.........Z d.�........................... ................ Date...-?_-/.3/Z a........... Test Pit No. l... _Z_--.minutes per inch Depth of Test Pit_..1 .. . .__... Depth to ground water................•....... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' ---------- --------------------------•......------ ---------------------*- ....------------------------------------ 3 /� U �R ?lal� /4zYC1.........�9 . ?Illl ----- ......................................................... W ----_--------_--------------------------------------------------------------------•-------------------------------------------------------------------------------------------------............ U Nature of Repairs or Alterations—Answe when applicable........................................................................................_....... ........... Agreement: LL%L The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT?,,,. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signp :. -------- :: -•-•----------------------------------••-------• ----- ----------------_..._ - .D to-_.. r .� Application Approved By V= ���'� 7 =5- � r Date Application Disapproved for the following reasons:......................................... --------- ............................................................ ..-•-•--------------•------------------------•-------------------•--------•-----••------............-----I------------------------------------•------..---------•-------------------------------•.---- Date Permit No.......................................................... Issued.... - ................. Date i - �NO .... ' THE COMw10NWEALTH OF MASSACHUSETTS BOARD OF HEALTH . µ;. Appliratiou for 11isposal ,arks-:C onstrurtinri grmit Application is hereby made for a Permit to Construct ( 41'-or Repair ( )' an Individual Sewage Disposal System at !- > - cage Add r or Lot No. ....... � _.... ,L............... `'. �" ..I-.W S ..... ..... 7........ Address µ W ' ............................... ................•. ....._.... .. ........ --------•----- ....... .•.................. .. ...._ = f- Installer 4 " Address d Type of Building Size Lot.. .Z...._a... feet V Dwelling—No. of Bedrooms ,.3 ._.,:';-.Expansion Attic ( ) Garbage Grinder ( ) a No. of ersons.. .................. Showers — Cafeteria Other—Type of Building ......... ..... � p ^� ( ) ( ) Other fixtures .-••-•-••-• [3D2oo�7 r, ' .-• ••-•--......•....-- ..............................................•...................-••---...--•• Design Flow............./M.......................gallons per_por-s�er day. Total daily flow......3...� ...........gallons. a Septic Tank—Liquid capacity,/ ..gallons Width.'4�`._Diameter........ Depth...rg.�' Disposal Trench—No..................... Width... rotal Length.......*. ......_ Total leacHaiig area........__._.....sq. ft. Seepage Pit No......1---------:...Dlameter.�l/ F1'� DeptllUelow inlet G F�.:..Tofal leaching area._. 'uP sq. ft: Z Other.Distribution box ( - Dogtng tank ( '-' Percolation Test Results Performedl1y � `.. Date.../ 7<+�.......... Test Pit No. L.5.1 minutes per mch Depth of;Test Pit l '�'...... Depth to ground water....................... Test Pit No. 2................niinute-s per inch Depth"&Test Pit .?............ Deptlapto ground water........................ a `�1 Description of Solt`,.G J'YQol1 /X19!"?t................................... .0........... 0l.......:`3�e = -----•--------- ..................f............ W a z }... J s VNature of Repairs or Alterations—Answer "en applicable 'x . 1 .. --------- -- . .....................x Z ----------.......................................... Agreement. 5� c � The uridersigned.:agrees to install �the2 aforedescribed Ind vidual'Sewage Disposal System in accordance with r; the provisions of TIT..,, rk 5 of.the State Sanitary? de--The undersig ed further agrees not to place the ystem in t: operation until a Certificate of Compliance has.been,issued by thy'board`of health. Signed ` . APPlication'Approved. By ,l ' �, 7�'C•.- "�"1 .. 7� "` _ `•ar ;'r 7� �� k4. ""'"x �+.�'1Ci•` ,^ Mw x$ ,c,., ^�..c abate;,„ �w..x k :s,.t Application Disapproved for the PIP f ollowang reasons:.................... -..- "` " " ..........••... _- t h �q .. Date _ 0 � t Permit No......................... ....... *-.":I*, ...I* r' Is ued................................... _-._ ... s Date k $THE COMMONWEALTH OF MASSACHUSETTSi ' BOARD �F HEALTH .OF...... .j... ... t_.............................. �r ira of u�tpliattrr vT ' hat,t n : al e D' posal System constructed ( or Repaired ( ) b .----__. ..... .............. :... 1.._ .... ............................................................. -•-- ............-----•---•-••----------•. ... d � '.•""'' Installer has be i sta� d ir3'a c7fr�n w h the provisions of TI� > f Th'e State Sanitary Code as described-'in the.. r application-for,,Disposal Works Construction Permit No------ ?....... dated------- .. .�-7 ....... THE ISSUANCE OF-THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE ; - SYSTEM WILL FUNCTION SATISFACTORY.: t'. DATE--- •......�............. ��............................ Inspector,..... -- ......................................... 1 • a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...:... ..:.. . . No.........J ;z7 FEE....................... Mops irk � rrutit ; v� , rh Permission s hereby granted - --- :.!' , to'Construct' ( ) or epal ) a ,,Individual Sewage tsposal System ` # ---------- --------..............•-• - reet «. V t.'� w. - as shown on the application for Disposal,.Works Construction P it !� , Dated._..._.__ _ �✓ / Board of Heal DATE --••-•----•--••-------•---.....-•--••--•----•-----•-•--- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ,i .. r. ' _ , �-t � ';1 ` r $•`' 'I�'i • fit/`.�r ° t- J } t S:. , J9 °2`1 ��. AC T / , A. ' #- , ► ,nor` �o:�E-.., i � aA i z p ,_"' .: as er' # t _ SO' WAY .. s XlS /�i';• F�/ci f /^r CyrF';v/ fo,,4 {' �Z,A Of Af P�t1 OF.fA SSA^�/=>• � ��p r RICHARD 'S RICHARD DAMES a: EARN O'H_A' 27871. } v;',pt. -` No.69+ .� L'> n• ,:� ... � � .:�f +`k ' ,1�. \� . U 17�,". 1�' ..-� ' i •+FI'1,1-I-F.►��'4+,� � ' t j LEGEND EXISTING,: SPOT ELEVATIONS 0x0 , EXISTING-,, CONTOUR — — — 0 — — — — p `` FINISHED SPOT ELEVATIONS 0.0 ` FINISHED CONTOUR --- 0 PROPOSED, PLOT PLAN,s APPROVED: BOARD OF HEALTH A �BARNS E1 , MASS. r U1,7 E ASS:'T LOT �96 J'6 F's�.v,A.D � .. a F7 ITiFY THAT T{i F'ROPOE.D R O'rii.�l 'i�, 11'�lC, 1,�1.�, f?S P� 19C P9�'�1Pd ST. (RTE. 28 ) PLA U!L Di N;G' aH0'V+!•N'1_.GfJi ,, i ►�'S. lip a IN 1 , �CONa=0R�15 ' .TU THE i'i��IG LAINS`. 1^J�s� ► fV�l.i. I`� l�S� . _� �. ,t:AT y` F2 GI;;Tr.Rr; ',.D17 ��UF2VFYG1. !Jti?. E3`YPI" .Pi _.,�,. � $'�•&ri h,,c»-a' Aff ,n•� i I,,- �",A� ''.nM7+ 2>• 'SOIL, V I_ TEST _ .: M �lE; T- ELSE A IONS IyoTES• . =- N E A 98,3 FT ALL WORKMANSHIP AND MATERIALS DATE,-: OF SO4L TEST / �1 V RT ..4 T BUILDING I , WITNESSED BY 's h'. a � i�t:• INLET SEPTIC TANK 28.0 FT SHALL CONFORM TO D:E.Q.E. TITLE . 5 _PERCOLATION RATE_G�, _MIN./t�lCFB OUTLET SEPTIC TANK 97. 3 F AND THE TOWN OF h8a.(ST,aBLE RULES ; T.` AND REGULATIONS FO.R SUBSURFACE OBSERVATION HOLE I OBSERVATION HOLE INLET DiSTF3IBlJTIC{N BOX `�� '' FT. DISPOSAL OF SANITARY SEWAGE ELEVAT101i=.. <` ELEVATION= C'4TLET DISTRIBUTION .BOX 27 FT �.a. INLET LEACHING ' PIT FT. BOTTOM LEACHING PIT FT. DESIGN CALCULATIONS NUMBER OF BEDROOMS .. . , _-. .,. . . . . . . . : . . � f GARBAGE DISPOSAL UNIT.. TOTAL. ESTIMATED FLOW W.L GAL./BR./DAY x 5 BR.)... :,moo GAL,/DAY i AN% JE'_ REQUIRED SEPTIC TANK CAPACITY. . . . . . . . . . . . . .. . . . . . .. j -- GAL. ACTUAL SIZE OF SEPTIC TANK TO BE INSTALLED:.. . GAL. f LEACHING AREA REQUIRE,11ENTS Jyy" —SIDE WALL AREA '.' GAL./S.F. }a ` T A L— GAL./S.F. i BOTTOM ARE a LEACHING APACITY BOTTOM SIDEWALL ) . .... : . . . . . SRO GAL. , RESERVE LEACHING CAP CITY. . . . . . . . . 5 U GAL TOP OF FOUND. , ELEV 7CONCRETE 4 SCH. 40 CLEAN SAND �.. COVERS PVC PIPE �,,.'°° MIN PITCH CONCRETE _ �. .. j- - V8` PER: FT. ` COVER �H Oc A �? ,�r�`H OF, {> �� ` 2% MIN. PITCH � ��• � R� a i �� _ RICH, �y 7 R, AD E CHA R 2 MAX. � D y ' ' 4 JAMES c �H�. tyv r 5= ern O'HEARN � O oR c_ 2 LAYER OF 1/8- 1/2 No. 27871 ti �. No. 674 V FLOW LINE (— Ir WASHED STONE ,r,T< _ o G 1 / n n u 1 , D 7 i o J�oz a 3/4— 11/2 T..' 4 IRON - � u IN. PITCH � ° ° >_ D WASHED STONE tics I PER FT: `DIST. o � t-t- 'PRECAST LEACHING BOX = ��; c� w a .v BASIN OR EQUIV. :- UL LU � � � GAL 3;,�;vvT 73LE MASS. _ IL �- SEPT IC - I-- --� : < t' - TANK R. J. O HEARN, INC., RLS, Ra _ 191 MAIN ST. {RTE 28 ) r WEST DENNIS , MASS . - PROFILE OF _ GROUND WATER TABL..E SEACE DISPOSAL SYSTEM JOB N0. 7c5268 CLIENT. 1U/'FY r+ . NOT TO SCALE r., - r �` DATE 7//,,/76 , SHEET 2 OF.�.� p y TOWN OF BARNSTABLE LOCATION 3%F 224-rS 4�9 SEWAGE # VILLAGE *-K,Z,425. ASSESSOR'S MAP& LOT 'S NAME&PHONE NO. /°f, l�/GG. /L 32& SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) �xL NO.OF BEDROOMS .3 BUILDER O E Ll e ,:n ?T,� PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by o-„r� -//7/qjl Vlf faP '`, _�} '�;� '�_ '� �`` �. . �� ��� ' � • .. � '- r O j �� ' ` " ' V� • + � � (i �. 1 � . • I r ,0�� � , � � i3r�c/� ��. � . f S's Y `� .y � 3 } i •' ,� L vn �J�1� �� ~�4 x � j 3 �I 1 'l/t,n T i i, y.� 4 ••i e } �'*`'P,. a a~s; .%�• r i` � i _ i 411 } ,August 19., 1970 s r . t Mr Richard J. O Hearn'" `+ ` ^P j'.">v/."'-Hox ��� y'at e a s3'• '4t Dennis � aus02WGs h 0# <aM ••'+ Re: ariance for Mr: Th m B V ' o as Duf �., Dear Mr.."O'HeayM n pC� -� .' t rF^� •rd ...�♦r y Yr # t .. Y iE .. r , - - =Your a egranted a varianc6' to inata l a ,leaching pit ,140 feet' i f r fr`om the,prop osed`'leaching,.;pit and a �e�ai38k.feet from the Iieu,of 'the -required 1.g0'` eet on Lot 396,` Jones ? , Road,--.Marstons=°Milla for Mr. *.Th6-as-'Duffy. All :o-ther "flown- Health 'Regulaticin aria th'e`reguIationsY contained° inYT .t1,e' .5, o€ .t1ie (State Efivironmentak Code, .apply. * 9.• .P .� < it 'Li VKtfy i Y^ya b� w �� "y { f' i SR ani i"' pit, .This variance"expires° September•':i 1979 s l. very truly-yours, �' s Ann Jane Eshbaugh, :Chairman`''w ti� i E Robert."rL.� Chi-1 4 ,Y P i. T i t K Y ✓}bX Y ''� �rrinrr�wrwirY�iirrrr.�irnr�rrr��i.rirtin�yi rltirr+r� _' .- x L i .;�.. Mandelstaft_ M, D.'" +a �,a J�'��.�, ;p( 4 BOARD .OF i HEALTH 5�,'i a l� ayK D.i x i•. TOWN. OF $<ARNSTABLE'. f, mm ' •R a j rKx,a ,.�4 'q. y a '^y. �,. 4Y= a�'. __ .K H r 4� ""�� .Rw _ F t �� .sy r°} * h _0� t,.e Cr•>. _ .. a ,.,. .- _~ y �. �'.. � a �` xA.:.Y •y 4 r , Y; �. � - r ,i� } '� `` -sky }r, a"• Ar.If s .`e«rl � t ,yt` r` {'n s ••¢ a ,.w k = s 4 tr t .`f. v f .. t '� rCy r. R •` t Rtt � 1ti �:,� � a i,m ,,e � ,. ._ a �. +� i r r , i RICHARD J. O'HEARN Registered Land Surveyor Registered Sanitarian 191 MAIN STREET P.O. BOX III WEST DENNIS, MASS 02670 617-398-8535 Board of Health . Town of Barnstable , Mass. Gentlemen; Enclosed are copies of plot plans for Thomas Duffy. We would like the boards consideration for granting a variance from the towns regulation of 150 feet Ar between a well and a leaching facility. Very truly ours, //*'ORich J . O 'Hearn, R.S. //o AboH RITased L 'I e sz-x a e Grp ry ego we// e.04 r THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) M 7 IL DATA r tr J ? r+. } 1 ti+ i,' :l�\ rf 4�iJ- p to I 1 \�I,I--,:��,�-, Y ' „ t'� ', r ,� , ,,- I,*I I�:,.., �1; I"44�;'�;I I,I-�.�,,,1 1..,,A,:�,.:,;�I,.��� 4 I1'-,;�-���:,,t,.t;:'..�:�,,-,,.,,� I,.�", tI- :1�:,�..:-,���,.;:,.",,,-..�I*,,,I!I,�,,�—�,,Iv,. t .I I 1 r' r,, �. �i y / 1. ( ..1. 1, t r, W { x1. I'* k n /�j/ J II r i Ia-,T r~1u0 t; iC�t - Iic,K oj-�/ul,i KJ Y', , f f t `I 1 / �_l /�� / r t q . �1 ror s/ �" ; 4 I r �' ,a / I j �/ �Y , \r (1". r 5 I \k,, D� /(lU�a- �:.. L P1 i h I 'I )J rl., s () t,. t t a r ,, r / �j�� �,�� t, \:I -, 3` k a r \ �)�' . \ y 1 �./ t ,1;1,' i ;3Fbf�('/! 1. - ,, 4 , '� * rl 1a�. .7 1 ;•y ,� ��- T 1 h, 5� 5T,c f'! { / k ! II r - IN 1 I > i as nl s '. r F f �' C} i.. , 11 I k fi, t 1, \a) ��7 t �1�I ry 4 , - FJ iI Vy( -.,5 � r ., ` , f M1 { ! - t „1 cat ! *� r_'n a yx#,e-# ,�,,,i1 I R IE b �l�"' 0 ` rb i,. 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'may 't 11 (r A /�/ `OI a../7'v 19,4 �/ , M,LD"7 IJ `.d! "D Y n 1 } N�a h S 1. �� 1 F.{ pkr'•�1 f XJS,! / H ti ' 1' yI + S 1 b/ /a. , / ", .Y ' a * 1`Sn 'y".1 4.I r an+�c r F� t N OF � `fit%yr M �' {0 f �7n7, °' r t m �i, a P�j d%� ��. r� d ra, tt�` i f� .' ,k ., a /k a '* d �' a D .. s0, RICHARD � ' RICiIARD: 4t; �i a r i t f r•" r tt I K �, r 1 r �A °JAA4E$ G '1 r 1- 1AME$ �' 0I a rw e ' a`� g�Y D" a.: n �, 4* f � �- a v O'HfARN ,b* (D r O'HEAf N ; —' w, 1,�*, �t 'l N t tKa 1'✓ 'IIrt ,q;q �* �10j 1x r r, �" yM. 47871'. _�!.: ' p�No. 694 '�_) 1-s' r"^ui rt ,¢,. 2p � - w fir P f , " -T , * " 9 FG7ST,F;`� �'�3T:ice.,. ` N . g 1 / ;r <_ 'LQ - tt r Ir , �' ;I .Y ,a r ,v'µ h 'a 4 .,t �' ,4 x{w k: <..SU nv. I ..�NITP-' J y, `,.�` 1 ;a, ,I !, a Y f / I Y ' _` IL EGEI�D } ,� r },.k ,r ,k y `�` � , A .eFf ? ( 'r �� �.G. � r v, " xM>1�471, pw"t � 'EXISTING SPOT "ELEVATIONS Ox0 u� r p 4^ •� L1 .;, ` ,, * f , "a! EXISTING CONTOUR — — — 0 = — " '" ��� v )! kj 1 k 3 , k':` t ' FINISHED SPOT ` ELEVATIONS O:n �, LAN a n ' r�r ,h o PF;G '� 1 8 t. ,k FGFJISHEO CONTOUR, N: S'E ,��,_(�� 'AP���' w,� APPROVED BOARD of ' 1iEALTH �� ` t �' R 5_ �IFsL , �J1t 11S,J: " r h „t z _ ,r, l /� T fr Y�1 '{ , • i1�� I "`'':r_(?TIFY..,;.'w THAT THE PROPOSED t 1 k {.; !91 PAAlP� ST_- (RTC 2E " ., x +r;� �``9 l I i L'D I;�I G� �H`01�'�1 ,` O N T t��S �?L A�1 r t ,:r ors ;' . � . A'Y�:<:,'f (3 E 1�l��I I S.;''. : M A.S,S " .` ' �';'z` ,,, 1. C()�IFORhtS ,,i:U� THE rt�G a' LAWS ------ I' (''I ,�N �a/� L ' . '."MAC. � , : irk .,"". Y tiY r1�TL. ° '.:.. -s(". t E r —o� 1 { " +w; / / j ;( 1 ;I� } try I i 0 1—`6f''' pit =n;T _C� )11 :L' S '�1`* - // ;/ _ : T'ATF. Ri - i�r Rr.l",, I4 -.:SUrVEYGR fj l ,01 ��� _ _ PE.a r / ij,Fl , �x ,�. _.. ......�..w� i 1 3 AA• .., :::...,�.....�.�n1�..a<_...—"a `#ar,,'...�, .1..va�lew,ws l'A= rEw.bt.- .,°'1+P{,..._ a ,.,..::a.�° {,! ,r sir ..`4- ,r.,Jard...I�.ar.rtt' a'9R +-s t •-, a,:-, r F v 4 A EI. N01ESIJ /ERTEV�1l® V®'L TEST `. SATE " OF SOIL TEST ��`3/7�i INVER`t AT .: BUILDING 98 3' FT ' ALL WORKMANSHIP AND MATERIALS: .. z u r 28.o F T.. SHALL BY � G'.. � � �� INLET SEPTIC TANK SHA CONFORM- TO' TITLE 5 LLDE. E. T FERCOLATION RATE LZ_MIN.%INCH OUTLET SEPTIC" TANK 97. 8 `FT. AND THE TOWN --OF LARNSTA RULES " INLET DISTR.13UTi0N BOX , `�� '� FT. AND REGULATIONS FOR SUBSURFACE OBSERVATION -HOLE OBSERVATION HOLE Z DLSPOSAL OF SANITARY SEWAGE I ELEVATfQ[st- ELEVATION= OUTLET DISTRIBUTION. - BOX 97. 3 F.T. _ INLET LEACHING PIT_ `�6• 8 FT. BOTTOM LEACHING PIT �c .8 FT. DE !GPI CALCULATIONS NUMBED OF BEDROOMS . :GARBAGE DISPOSAL UNIT.: VON - TOTAL` ESTIMATED FLOW (�/G GAL:/BR./CIAY x _ BR.).. ? v GAL./D;�Y d" REQUIRED SEPTIC TANK CAPACITY. . .. . . . . : . . . : . . . . . . . .. '/9,.Z GAL. j ACTUAL SIZE OF SEPTIC TANK ..JO BE INSTALLED... . /G�v GAL, LEACHING AREA REQUIREMENTS : SIDE WALL AREA GAL./S.F. �7 BOTTOM-­�, AREAL GAL./S.F. T M L. LEACHIN CAPACITY BO TO SIDEWAL L SSO GA 77- S - : . . . . . . . . . . RESERVE LEACHING CAPACITY GAL t OF 2- TOP FOUND. ELEV.=/OZ� 1/�% r►: —CONCRETE �-- 4" SCH. 40 CLEAN SAND 1 COVERS PVC PIPE CONCRETE MINA PITCH O ^ASH OF4f I/8 PER. FT. �. w �A�SH o, qr C VER _11 2% MIN.' "PITCH 6,� RICHARD �. ' • 1 12 MAX. / �+\, RIC7lARD JAM.E5 o JAM IES 7 ` - 4 - e o c� O'HEARN - Z n n u c� O'HEARN No. 694 6, a — 2 LAYER OF 1/S- 1/2 No. 27871 ;o FLOW LINE WASHED STONE ` ��c �° ' \`' ,,T y LJ 1 �i �i 2 /S i�� �d 4" CAST IRON — _L U a 3/4— 1 1/2 �SURvE PIPE— MIN. PITCH o o ' >= Don WASHED STONE a/4 PER FT. _ DISC: / PRECAST LEACHING BOX n c~i°- a BASIN OR EQUIV. .:- v �w 35 °�- o � U. ob - LOT. , T�n;Es RU,�U _ /vC, Q GAL MASS . 6 SEPTIC TANK, R. J. 0` HEARN, INC., RLS, RS z; 191 MAIN ST. 4RTE '2S ) . 1F WEST DENNIS , MASS . ' PROFILE OF GROUND WATER: TABLE SEWAGE DISPOSAL �SYSTEI'Jl . JOB <N0. '8-268 CLIENT. DUFFS DATE7 T 0 ,' TO . SCALE. SHE E NOT .a >__ 4 - 1 TOP OF FOUNDATION COVERS BROUGHTO BE WATERTIGHT AND TO WITHIN 6" OF FINAL GRADE SEPTIC SYSTEM PROFILE Flaherty Environmental Services EL. 100.0' EL. 98.0' (not to scale) INSP. PORT W I 3" OF GRADE P.O. BOX 81 2" PEASTONE OR EL.98.0'f CLEAN SAND Yarmouth Port, MA 02675 4" CAST IRON or EQUIVALENT GEOTEXTILE1111.11[l ""fill 774.994. 1166 MIN. PITCH 1 4" PER FOOT FILTER FABRIC _ VENT (IF REQUIRED) 4"SCHEDULE 40 PVC PIPE 4" SCHEDULE 40 PVC PIPE FLOW LINE (Nrst 2'to be/eve0 ---L� EL. 94.87' 11;.e.'•: L. EXIST. --+o —► 14" EL.EXIST EL.95.4' —_ —� 2' EL.94.2' EL.92.0' EL.94.37' GAS BAFFLE 94.17' (0 005%SLOPE` CLEAN, DOUBLE- • '• H-20DBOX SOIL ABSORPTION SYSTEM WASHED 3i TO 1 �" STONE • • 6"CRUSHED STONE OR (2) TRENCHES 3 W X 33 L X 2 D USING 5.0 ' ' '•�' •" °•�•':'•e•• '• MECHANICALLY COMPACTED PERFORATED PIPE AND SURROUNDED 1000 GALLON SEPTIC TANK(DATUM: ASSUMED) (EXISTING) BY DOUBLE-WASHED J" TO 1 illSTONE EL. 87.0' 99 BOTTOM OF TEST HOLE EL. 87.0' USGS ADJUSTMENT: N/A LOCATIONMAP GROUNDWATER ELEV: N/A / N TH / Race ZA PAVED RIVEWAY / ,� \ ✓on®SRd LOCUS 9S 28.5 cJ�, EDT 29.!-1 NTS EXISTING �_ \ 3 BR NTH OF TH-2 DECK DWELLING �D4V1 gsS90 D. 99 FLA - j EXIST. SAS 11 <APPROX•) lSl EXIST. S. v 04/VITARkPN DATE.'1112112017 EVl D.1112812017 (PAGE 1 ONLY) LOT 396 -98 0,45 ACRES± �000 r ,��A SITE AND SEWAGE PLAN FOR B & B EXCAVATION INC./ ADAM O'CONNOR SCALE : 1 = 3 O' MARSTONS MILLS MA G � REF:LCP 30751-H PAGE I OF2 TOP OF FOUNDATION COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM PROFILE EL. 100.0' EL. 9$,0' BROUGHT TO WITHIN 6" OF FINAL GRADE Flaherty Environmental Services (not to scale) INSP. PORT W I 3" OF GRADE P.O. Box 89 Z" PEASTONE OR EL.98.0'f CLEAN SAND Yarmouth Port, MA 02675 4" CAST IRON or EQUIVALENT GEOTEXTILE MIN. PITCH 1 4" PER FOOT FILTER FABRIC VENT (IF REQUIRED) 774.994. 1166 a^SCHEDULE 40 PVC PIPE 4" SCHEDULE 40 PVC PIPE ..•.y FLOW LINE ... .. ... .' .. .. .... Itlrst2'to be level) ;.u.'••: L. EXIST. _, EL. 94.87' EL.EXIST 14" •' EL.95.4' —� 2 EL.94.2' EL.94.37' EL.92.0' •" GAS BAFFLE 94.17' (0 005%SLOPE` CLEAN DOUBLE- SOIL ABSORPTION SYSTEM WASHEDONE e^CRUSHED STONE OR (2) TRENCHES 3'W X 33'L X 2'D USING 5.0' —�•g' •" �'' ° MECHANICALLY COMPACTED PERFORATED PIPE AND SURROUNDED 1000 GALLON SEPTIC TANK M: ASSUMED) (EXISTING) BY DOUBLE-WASHED " TO 13,1 STONE EL. 87.0 99 BOTTOM OF TEST HOLE EL. 87.0' USGS ADJUSTMENT: N/A LOCATIONMAP GROUNDWATER ELEV: N/A � N TH Race Cn. PAVED RIVEWAY ( ✓ one 98 28.5' �� Ry, LOCUS �9 _ 8 SHED 29' \-1 T�Ll NTS EXISTING �_ \\ OF MgSS9 3 BR TH-2 DECK DWELLING DAVIXIO _ 14.8' ` FLA E ,J 99 EXIST. SAS (APPROX.) W G/ TER S4AII R� sr EXIST• S. DATE:1112112017 REVISED:1112812017 (PAGE 1 ONLY) LOT 396 _qa 0.45 ACRES+ �oo� . SITE AND SEWAGE PLAN FOR P► S & B EXCAVATION INC./ ADAM O'CONNOR � i 390 JONES ROAD SCALE : 1 = 3 0� MARSTONS MILLS, MA G REF.,LCP 30751-H PAGE 1 OF2 a _ �,. 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G_:�:a?,:.:.:r'_:. __:�._ Lr'-,.•. _ ___ r,_.,r'':.. _,._r_ _.?,:t*��.5..,, ,_ r.� .-,,.. �L r. __._ _. _. u..2-ice,_ : r. - _ -t',...:.. .• .-.. - �:r,. , ,?3 —ate ..�...a_ --"tY ?.,_ .,-A.T'z=:r:'_��r.:_, �r�a..-:rr ._:�.'^�:2�' f.•-:-'.,'.r� I is- -_\\. ;__,. ...- ,.._..__.�_...._-_.. ..._.,.,_4:?z?. »r..r: ._::cam. � ,• ..--.,. OC -- -._ - f - • C f O _..__- _ .—_ 1 J ._._.__—... ..- .._..__...__: I - I---- __:. ._ _'•-_....... ,.. C 4 I -- - L�ul�a r _ •?! fi ti ,,:t_--! .- --{ I W _ill.) _-- - - i - - _.y I_ ��-�- �� I� - - - _; IC C ful4ul 0 Y __ - - In - N a(3mtn c�ac <fn FRONT VIEW - FACES JONES ROAD NORTH SCALE: 1/4" = 1'-0" �. ] Lu LOU a r W W i O -a Sul So,fir' ADDITION EXISTING HOUSEISTIN&HOUSE ADDITION II � I 1 2016 --_ - - li u e®I�— I SCALE: 1 — LEFT. SIDE VIEW - FACES GRISTMILL PATH SCALE: 1/4 = 1'-0" RIGHT SIDE VIEW REAR VIEW NTS SHE ET. 4 A-1 MOR ADDITION EXISTING HOUSE 1 st Floor ThisDesigner rwommmi,15 products byShepley turnber :a 0 EXISTING HOIJ515 ;;GARAGE ADDITION <---———————————---- V_�P L C� z = _Q c -5 ST�_Z 11 -0 -*t IL Z12 9 2 W. ---- -4 -14--0- 24'-0­ 21'-8*X 17-11" 17-0—- 2 EXISTING HOUSE ;FLOq,,R PLAN E E T­�_TF—_ .... ....... . ..... -3 --- - 1 5CAL IS E In 2446 RO 76 114 4�SIV Saba 43 w-,u --- - ---------- k 2. ptnb.9. I a I E VE MASTER CLOSES17 r BATH Fl- 1140TE:5/6"TYPE W FR GYP NOT Iiii BUT Iai_ = E MASTER BATH f ;DESIGNER RECOMMEND5 ON HS.VVLL CL.AND � ,l bl-01,x 151-1" BEAMS IN GARAGE WH E w c-M BEDROOM NO.2 CI I % 0,� 28'-2*XhW-q- 51 .fg. PROPOSED OARAC7E M E > V , g E 4, BATH/LAUNDRY A !.7TE:W .0 MAY ':SMOKEIGO DETECTORS '_­kk b"r A fit, -OW MASTER BDRMII i. 2bba 2666- E:E UP- -,�O� ,0.g,TO HALL ;n ! I 24'-9"X3'-2- PRbFO5EV ADDITION 0 NEV! MSR& MPATH II d z LIVING cc tu _j 20'-11 X 13'.2'r APA PORTAL DESIGN FULL lull .SPECS Z Q CLOSET BEDROOM NO 5 DEN LENGTH HDR.-SEE SEP 4'-b"X9'-8" IT-4"XT-5- 13'4"X 16'-2" < It in a x e IL Z PFORS 044%3 r-wiI569 ..4563 in T--- z 101-11 6--9- z d3 6-2" 11'4' 6--b- -0. 24'-0" -0 it cn <" ci 71 24'-D'- _j 14< Lu C, i11J S'E: 1 N6 HIP 0 20I3 2513 ADDITION W. , i� ii 4 > 0 I, Z <a <W Z m w z —i Z IL < <th X 0 It !NOTE:515*TYPE FR GYP NOT REG D.BUT -4 II 'DESIGNER REGOMMEND5 ON HS.ViALL CL.AND ISEAMS IN GARAGE uj z Lu it Aai �A A A\ Q1 0 T jifOUNDATION PLAN . fOU NVATION PGkW 23'-4*X 22-5- it.�-- . __--.-. -___�.. .I __­ . �- . _­ �i - - -i ___. ____. fl MIN.(4)24'LVL GIRT SEAM POC.KEr5 EA.END 2x io rLR.J5T5 0 9� I I - 7_ :3 12-OC,2X10JST.HGR'SkV8I_K.&HID SPAN Lu Ai I' Iz Er it 41-00. IW­ 4.— F )` ML POLY BARER-SLOPE BIAS a-(p M.. APA PORTAL DESIGN-FULL LENGTH HDR. SEE SEP.SPECS ------ ---------- --- T w U,z z in J, ADDITION EXISTING-HOUSE T > SHEET. 26'-0­ 46'-0* 14'4" 24-1- FA 2 This Designer recornmends,products by SN*y LLMI;'e'r all G) c M z Z 24*-0"- Q.C IE E 9.9 0 Em r I 'z Oti :E 2X12RIDCEove ------------- E PLATE C. (4)l.75x24"LVL RIDGE PUTS bI.D,Nxs.IASDJ VIf-per F;111 Segral.2 i1II(SEE SEP.SPECS) 12 Minimum Vlid:h TA.lil.m Height 12 & 6 IN e.j (in.) L-e F­ E jec 0" 9 E 12 is 0 W g:b 10 -2 - IS a • IS 5 a-b ROOF ASSEMBLY:5/5'COX 24 8 675 0.36 �88 0 10 r 10 .5 3.42 SHEATHING.ANPASF�T STORAGE ONLY-NO LIVE LOAD SHINGLES AS PER MANF.SPECS. 0 IS Be0 sts :E yl X� .% "M i ra-1.1icas fat Vilicud Seismic i to., I., g r. R38 5M-T&6 SUE PLR.GLUE&NML crre T.O.FLAT.TO AILLMIN-GUTTERSYSTe :I: I - 1-1 . . - -1, PC. sov,_'_i__ .U.-H BE.-MI.E.D.. lANT.VENTS.B011,111 THE FIELP + rare Is D.1...E MQJ_L ASSEMBLY q2 516�1-2l(b .0 M cONI.-7.sOF1.11 4-1- 7 IWOG-IrrCDXSHEATHrNC K"PAR P21 E ple,EDGE :E APA PORTAL DESIGN-FULL LENGTHMDR.-SEE SEP.5PErS H5�RAP AND R-21 INS.TYP ALL TYPYCAL WALL A55EMMY 102 EKTEMOR WALLS @ WOC-12'COX SHEATNING W/1YPAR R21 ..hre ce-sH­S HS" PANOOPTR­2iINS.WPAU_ r N V 2,fi EXTERIORr4su.5 FIR.Te 1.C-s-tince.Details I'mrAPA P-1-F-Doc D,­!g..pith Role,D-, WHITE CEDAR SHINGLES -O-- 6--ce, q, errv_Imo :Ed V II, (2)1 SILLSl FUR E:6 _._RgS 0' -1-WNGR FLOOR MN 4,00M 4 -.'a ='Og s MIL.POLY E S NY X 12 ANCHOR I NOTE:T.O.P.5 TO MN 3 DEGREES TO OHVS-THK SOI 0 BE DETERMINED :cm,T.O�­Iro I OTE:1O.F.'B- o)--aILL e-stse. ­U.SEALE06ES 1.THE 1IfLD HIM IXIFOM' IN THE FIELD R30 T BE DETERMINED IN THE FIe_. 12 ANINO C. R O.@ 11 4­4 BOLTS .. we- z 0P-. 11 FROM VAHPROOPI 46 �1_1_MIN.3,00011 : FRO.6-X4'./-CONCR rND.BrLON GRADE COMPACTED 0. UNDISTURBED SOIL r IL lu 16'X b, ID"XlO'-I-CONCIR DAM ROOFING FND.BELON GRADE WALL MIN.3,00040 ZOO.N'T FORIW1'EO !, :i �2,�T I 1 !--. L- = ,","J.OFI.. ff'.3, RE :- "Z..;aift :'N' FT. , LOW GRADE REFW(2)0 6 VERT. 2X4 KEYYJAY hve, '? 43 046-06 7-13 ­1 FLOON Ms.-.ad. s.1 SECTION A 24'X24' C7ARAC7E VW5TORA&E ONLY ABOVE POLY­Ele-THK StAS 0 SOSES LU 0 X cc SCALE HIM.2�X 12'CONT- FORMED RrINF GONr FT6 INJ2X4 KEYWAY SECTION B 26'X30' MBR ADDITION COMPACTED OR UNDISTURBED 501L 0 1 SCALE z z go go <Ln X S Quadruple 1-3/4"x 24"VERSA-LAMO 2.0 3100 SO Floor BearrtWBOII Triple 1-3/4"x 24"VERSA-LAM@ 2.0 31100 SP Roof Bearri'liR1301 j-li Dry 11 span I No cantilevers 10112 Slope Triple 1-3/4"x 24"VERSA-LAMO 2.0 3100 SP Roof EleamIRB01 Quadruple 1-3/4"x 24"VERSA-LAMO 2.0 3100 SP Floor Beam1FB01 < LU BC CALCU,Design Report August 12.2016 12:53:27 Dry 11 span I No cantilever,10/12 slope August 12.201612:53:50 0 %j Dry 11 span I No ecatflevem 10112 slope August 12.2016 12:53 50 Dry 1 1 soon I No cranil-,10112 top. August 12.201612:53:21 Build 4516 File Na- BC CALC Protect BC CALCS Design Report BCCALCT-Desig,Repon er-� lm=- 0 Job Name- O'ChmN Description:BASEMENT Build4516 File Name: BKeene Ocormo, Build 4516 File BKeene-Oconmer, SC CALCC)Design Repon Z Build 4516 FileName BCCALCPmjecl <Ul Z Ad ress: 390 Jones Road Specilia, it. Job Name O'Connor Description:RIDGE Job Name O'Connor Description RIDGE Job Name: OIC am De=iptio,BASEMENT -i z 'L City,State,Zip:M-lons MIIK.MA Designer: Ad ess: 390 Jones Road Specifier: ilm Address: 390 Jones Read Specific, it, Add-, - 390 Jones Road Specifig, Lim z Customer Barry Keene Company: Shepley Wood Products City,State.ZIP.Mar Mills.MA Designer: City.State.Zip:Morstom,Mills.MA Desigr.r. 0 City.State.Zip Most...Mills.MA Designs,: . I C)d,0 Code reports: ESR-1040 Mr7 Customs,: Barry Keene Company: Shepley Wood Products Customs,: Barry Keene Company Shepley Wood Product, Customer: Sony Keane Company Shepley Wood Products U) Code reports: ESR-1040 Misc, Code reports: ESR-1040 Misc: Code repots. ESR-1040 Mis.: UZI<< Connection Diamram, Disclosure Con eson Diagram Disclosure < nr I Z,,�oifZCcy.n,,ne..-asb. ..,,Iynn pa ov, • a,NPa.x_­­1xoaI' nion-PP.Do'sa...'Pal b basso Par-taruascafion Outbanol.-D . . . . . . . . . . . . . n1b..Idin,.do­NxIdesign • bid ­­ted d.Pqn a.pan-nd.rel,no.baInxi Prop.mes anti.rr­­t­­ In-h­S.i,.C,s.d,angx­d zl._'__,� E7 7-� -.Wp.d.-must D.-Doenhoo-In . . . . . . . . . . . . . . . . damebas,norm I.stall.tion Guido Ird.,xiosei. oemsm. baseor ask .-Guieven Ncau d.pps... Bl -re-To...en Is lae­=1.0-asudI Is oxi I'm bate- I- onext., Pov.L.ngm 2.­00-00 Dr-q-­ min a minimum 2' c=10" (SM;23247" D. im.nn 2" e=10' ...)M-USS 141 =on Summary(Down I Uplift)(lba t b minimum 4' 111=24" so b minimum 4" 111 24' Live Duut S­ ad R­Li- ih'mu. l' BCCA t.13CFRAMER�.­" T-1-a-a FBI,--an, 264.- E!,hanon 1' 8C�CQ'BC FRAMERC1.A.JS"'. z 80.3-1/2' 7.800/0 2.58210 ­0 S�­SC le.BOARD-,ScN,. ALLJO­X BC RIM BOARD-BCT� B1,3.112" 7.800/0 2,58210 All T,uasLDk S­may be in from one snh,of multiple ply VERSA-LAM beams. 8 ISE GLULAM-.SIMPLE FaAmiNG Reaction Summary(Down I Uplift)(I.I Beams 7 inches wide will be assumed to be either top-loaded only,or equally loaded from B ISE GLULAM".SIMPLE FRAIAING S All TrusSLok Stews may be installed from one side of multiply Verse-Lam beams. PYST NIS.VERSA-ME.VERSA-RIM Bearing Live dibul sa.. Wind R-1 It- ..On Bids SYSTEMS.V0RS­A­.VERSA.R-M Member PLUM.VERSA,R sci� LU L. D..d an- .no.-U.. T.D. has no side leads. LUM.VERSA,RIM. 50.�112- 3.399/D 5.850!0 All TrussLok sc,ows may be installed from on,side of multiple ply VERSA-LAM beams. VSRSIST-M.VEA�SIUD%-0,am VERSA-STRANDS,VERSA-STUDS.1. - All Thes Lok scrows may be installed from on,side of multiply Versa-Lam beam IT mmary Correct FMTSLOO5 tanserna-fBase Cox-. 81.3-112 3.39910 5,85010 =7 Lodi!` F-D,L.L C. Member has no side loads. L LC 1,, Lad Type R.I. I.. End I..% so% Is% 1-1- - ...d s- no Its.,liv. Irlb. Connectors are:FMTSL634 U Z Uj Its. Na I Standard Load Unf.Area(IbUt-2) L 00-00-00 26-00-00 40 10 15-00-00 Load Summary on a. R.f.so, End 100% -..% is, 125% Umb"T" L S 26-00-00 15 30 Controls O 1 Sta; rd Lead UrfgiM(Ibift-2) L 00-00-00 154)0.00 .mWnT 65.1 Sli-lbs 40.5% 00% 1 1YOO-00 8.5 ul End Shear 52 lbs 26.8-1. 100% 1 02�03.08 %AA.-N,Dome- C­ L-il. Q Total Load Dell. U646(0.474-) 37.1% ale 1 13�MOD Pas Controls Summary y.bo, z ut Moment 58.020 fl-lbs 41-IlIt 115% 4 13-00-00 ILI L1860�0356-j 41.8% nia 2 13-00-00 End Shea, 7.619 lbs 2T7% 115% 4 02-03-08 "n 10 Max 0 0.474 47.4% his 1 13-00-00 Total Lead Dell. V544(0.563-) 33.1A N. 4 13.0.00 LU Live Lead Defl. Cob AGO -1 U) . I 1 S F Span/Depth 12.8 We W. 0 00-00-00 Live Load Dail. I.JS60(0.356-) 27.9% n/. 5 13-0-00 Max D A. 0.563' 56.3% at. 4 3.00-00 a' in %,117 %Anew Span I Depth 12.8 .1. n;. 0 00-00-00 Bearing Supports Di.IL M vina, S_n ...b., si-nio ED et i: -7- 10.382 lbe . 56 5, Uh:pe-1i.d1 Bi P.1 3�;/`Z',7' 10.382 IDS rile 56:5% Unspecified BearinkSupport$ Dim.R.-I viue. F 0 sup en Member Meleaal 3-1r2.x 5-1/4 9.249 IDS n1a 671% Unspecified Notes at Post 3-,/2'x r,14" 9.249 Ibis a/. 67.1% Unspecified Designme ets Code mini n�L24 T tat load deflection criteria. Design mIRS Code minimum L360�Live load deflection criteria. a In" Design meets arbitrary(1-1 Maximum total hiod cleflectipb criteria rM,.��rs with slope(114)112 or less Final design most ensure that pending instability C ations assume Member is Fully Braced, will net occur. Design based on Dry Service Condition. For met members with slope(V2y12 or less final design must account for Rain-or-Snow Deflections less than 118'were ignored in(he results. surcharge load, Fastener ManufacturarTrussLok(1m) NDesign otes SCALE: E:.' ,a merens.- dela�r cal.,.,., me mmore Design meets B ra IL.1.1 LIve lead deflection on Design meets arbitrary(1-t Maximum tots:load deflection criteria. ClAwtations assume Member is Fully Braced. Design based on Dry Service Condition. Deflections less than 118'were ignored in the results. Fastener Manufacturer:TnussLok(tm) SHEET: Page 1 of 2 Page 1.12 A-4 r *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. SECTION A -A 10' min. from ALL OUTLET PIPES FROM THE Existing Foundation [house to septic tank o-Box must PROFILE VIEW OF ADDITION TO LEACHING SYSTEM sET�710NMR=AT�Bz Fr 12• �►�EtE�+ / ;`/ 1 M " , ,,,•ao' TOP OF FOUNDATION = ELEV. 100.00 (Assumed) tank °°"°" must be within s in. of finished grads ,/ within 6 in. of finished grads si-•' . .:�, b' f �r�J . ' a� /�`� ` Grads over septic Tank-99.00 dads over D-Box- 99.00 over SAS- 99.00 3"of 1/8' - 1/2" Washed Peast _ Ts KNOCKOUTS 3/4' iIET • f 3/4' to 1 1/2 " Washed Crushed Stan s s' 1Y KEr / •�y 0°�� 4 S - 0.02 3 HOLE H-10 4•PVC(CAPPED)INSPECTION PORT TO BE a a• _ S=o.01 T. BOX 3' Yadrrsen Cover INSTALLED AND TO BE IN1I1IN 6•of GRADE O 16' EXIST. ar Greater Top OF Swtae-Elev. -96.2s _ r�,,. ' �' v�! S J�Jms, Exisr. P1PE \\\ 1,000 GAL S- o-01• . tss- o` r r` O 10' Per foot 0"Ettective Depth 1.73• e p �, FROI EXIST. FDIRIDAT>al rn SEPTIC TANK rn /1 ° °° C4s PLAN SECTION CROSS-SECTION 83' (10 inches) di m CONCRETE FULL FouHOrTiott-� o I H-10 °i ui 5 Units a 6 25' = 30' R° ,� '�R•� o > 0. ��`` SYSTEM PROFILE 6 In.af 3/4--1 1/2' o o rn O n 3' � 40 9 31.25 3 3 HOLE H-10 DISTRIBUTION BOX Not to Scale a oontpoeted stars c o c a' A rn 37.25' NOT TO SCALE Iso a j a/ C c 3.5' 3.5' Effective Length s70o1rti,ratnrrZC«e�ne2eofnAyfEa.� 1 tW o SOIL ABSORPTION SYSTEM (SAS) p GENERAL NOTES 6 Tn.of 3/4"-1 1/Y o axnpocted ,tone < Effective Width INFILTATROR HIGH CAPACITY (H-20 LOADING)/ GEORGE O'BRIEN NOTE: ALL COMPONENTS MUST HAVE RISERS To WITHIN 6' BELOW GRADE 0 1. Contractor is responsible for Digsafe notification, Verification of Utilities o m (OR EQUIVALENT) Not to Scale and protection of all underground utilities and pipes. Z Bottom ter 1 a Observed Q��� NOTE: OVERALL HEIGHT OF INFILTRATOR Is 18" /EFFECTIVE HEIGHT IS 10" 2. The septic tank one distribution box shall be set Grow level on 6 of 3/4 -1 1/2 stone. 3. Backfill should be clean sand or gravel with no stones over 3" in size. PERCOLATION TEST 4. This system is subject to inspection during installation by Carmen E. Shay - Environmental Services, Inc. 5. The contractor shall install this system in accordance Date of Percolation Test: MARCH 22, 2006 with Title V of the Massachusetts state code, the approved plan Test Performed By. CARMEN E. SHAY, R.S., C.S.E. and Local Regulations. Results Witnessed By. WAIVER (Per Barnstable B.O.H.) PROJECT BENCH MARK 9 y 6. If, Burin installation the contractor encounters an EXCAVATOR: Shay Env. Svcs. TOP OF FOUNDATION soil conditions or site conditions that are different Percolation Rate: Less Than 2 MPI 0 40" ELEV. = 100.00 (Assumed) from those shown on the soil log or in our design Test Hole installation must halt do immediate notification be Test Hole LOT made to Carmen E. Shay - Environmental Services, Inc. No. 1 No, 2 7. No vehicle or heavy machinery shall drive over the DEPTH SOILS ELEV._ DEPTH SOILS ELEV. I septic system unless noted as H-20 septic components. 0 99.00 0 99.00 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. 9 Sandy Loam Sandy Loam ( � 9 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. i � TEST HOLE #2 10 YR 3/2 10 rR 3/2 _ 10. All solid piping, tees dt fittings shall be 4" diameter As 98.25 0•_9. As 98.75 �' Failed ELF- 99 Leach Pit Schedule 40 NSF PVC pipes with water tight joints. =dy sand 11. Municipal Water is Connected to ALL OF The Residence and Abutting Loam Loam I 151.25 1 TEST HOLE #1 Properties Within 150 Feet. 00= 99 ELEV. . O 100 10 YR 5/6 to YR s/b THE PROPERTY LINES ARE APPROXIMATE AND 9"- M. Be 96.00 g-_ 40- Be 95.67 } � .�� 37.25 Medium Coarse Medium Coarse Q / 0.5 i COMPILED FROM THE SURVEY PLAN GENERATED BY Sand Sad I f � D-Box ;;:j- = ? .:«1 '< T;:iA•.y�v,��- i J.J. O HEARN OF HYANNIS, MA zs Y 7/4 • • • :1 / ENTITLED "CERTIFIED PLOT PLAN OF LOT 396 JONES ROAD, M. MILLS MA 26 Y 7/4 I i �� 'l;�;„ ,•-, ;�- Y :;�.c:�: DATED JUL:Y 19, 1975 } 36 - 132 C, H&QQ 40"- 132 C, 88.00 � ' i AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN ly = IT SHOULD BE USED FOR NO PURPOSE OTHER THAN r- -� �� THE SEPTIC SYSTEM INSTALLATION. EXISTING LEACH PIT TO BE PUMPED OUT AND FILLED IN PLACE O o L3 ' j NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE EXIST. 1,000 GAL 1 o I i i �' FROM THE EXISTING LEACH PIT TO BE DISPOSED 1 to o i SEPTIC TANK �! OF_AS PFR ROAR.n or wEki TH spEc!F!cgr.o,`,. EECK Perc #1 I ,� THERE ARE NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY Depth to Perc: 42' to 60" , Perc Rate= 2 MPI I 1 ; LOT #397 ASSESSORS MAP 047PARCEL 093 Groundwater Not Observed of 1 No observed ESHWT ' it I I ` LEGEND ADJUSTED H2O Elev. None G 1 -13 BEDROOX OUS DEN OTES PR OPOSED HE 104X1 2-16' EXAM.. ACCESS MANHOLES SPOT GRADE DEN` e x 104.46 SPOT GRADEES ,146 o PL PROPERTY LINE o -- °u BOX DRIIVEWAYI PROPOSED CONTOUR THE ACCESS COVERS TOR THE SEPTIC TANK, ••-s •-�r- •r•s-rr•-- SET DEEPER IMAM INCHES BELOW nNtSHEDT -�------------ - - ----99 .fir- .•R } , • = - - - -- -97 EXISTING CONTOUR ��• GRADE SHALL BE RAISED TO WITHIN 6"OF t ---- t - ------ STEEL REINFORCED PRECAST CONCRETE Ft"ISHED CRAM LOT #396 DEEP TEST HOLE & PLAN VIEW INSTALL n�F-nTE GAS eAFFtEs at EauALs 1 I I PERCOLATION TEST LOCATION 3-24' REMOVABLE COVERS \\ 119,350 Square Feet +/- 1 1� I ( ♦-� 6 FOOT STOCKADE FENCE 3' min. clearance INIET Br min-T- 2'mtn. Inlet to outlet e.Th tYfirr f23.99'Uqutd level � T = P LOT P LAN ' E$ ' 4*--0'min. 1: 1 .o v w sere. .` :• Liquid depth OF PROPOSED SEPTIC SYSTEM UPGRADE -_ -- -:t JONE,S` ROAD-��- -4•-1tY - PREPARED FOR CROSS SECTION END-SECTION (50 FOOT RIGHT OF WAY) M S. LI N DA HASTI N G S AT TYPICAL 1000 GALLON SEPTIC TANK #390 J O N ES ROAD NOT TO SCALE MARSTONS MILLS, MA Bedroom Bath Bath Design Calculations Kitchen :. 9 /Dining qss� REPARED BY: c•, A CH11 A Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gal./Day Min. per Title V) Garbage Grinder: No yG ,� CARMEN E. !.J Y ° Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) U U Septic Tank - 2 x 330 Gal./Day = 660 USE EXIST. 1,000 GAL Septic Tank. Bedroom Bedroom Living Room o ENVIRONMENTAL SERVICES, INC. SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch o Bottom Area: 0.74 gal/sq. ft. x 372.5 sq. ft. = 275.65 gallons R 1STEfz� P.O. BOX 627 Sidewall Area: 0.74 gal./sq. ft. x 78.72 sq. ft. = 58.25 gallons 0 20 40 50 1 gNITAR\P� EAST FALMOUTH, MA 02536 Providing: = 333.90 gallons 3 BE HOUSE FLOOR SCHEMATIC TEL/FAX : 508-539-7966 Use: (5) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, SCALE: 1"=20' DRAWN BY: CES DATE: MARCH 28, 2006 TO BE USED NTH 3.5' OF WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE ON THE ENDS. NO STONE UNDER. SCALE: 1"=20' PROJECT SD884 FILENAME: SD884PP.DWG SHEET 1 OF 1