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HomeMy WebLinkAbout0041 LAKESIDE DRIVE - Health 41 Lakeside Drive Marstons Mills A= 102 -. 08> �t rT Town of Barnstable R I`y i-vi e ulatd , S�eces . wrtsr�► g �w Thomas F Geiler,�Director P:ublic HealWffi*ision Thomas:McKean,:Director 200 Main Street,I3yaii6is,MAC`02601. Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Doran Date: Sewage Permit# 2ooi -oo 3 Assessor's MapTarcel Designer: M16 e'*"'Installer: 6.3 (b Address: �y Address: 41 LAkc,S M. M't<< On l ( i o 1 o-) '� �� �x �v a��o: kwas issued a permit to install a (date) � " (in t�},er). P Y se tics stem at LAk51 t AM Y based on a design drawn by -- (address) �� P9t/ �CC dated d iol c)i (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 distribution box and/or septic tank. 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 acc _- State&Local Regulations: Plan revision or certified a F ,F to follow. DARREN oyGN ME E '' (Installer's ature) No. I, 0 !SANiTAR\AN ' ot (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARN ABLE PUBLIC HEALTH DIVISION.CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVIED BY THE BARNSTABLE PUBLIC HEAL''H DIVISION.TEANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc IV TOWN ON BARNSTABLE LOCATION LI I L�,k S►oQc J:> -. SEWAGE #r2no7 - 03 .T VILLAGE ('t? ry),))5 ASSESSOR'S MAP & LOT1Q;$2 _ Y INSTALLER'S NAME&PHONE NO. aCAVAT2a-J S08• V 77- 0653 SEPTIC TANK CAPACITY %SOo !R ) LEACHING FACMny: (type)13 x 25 x Z. (size) 33o - C u I-1 c c5 NO.OF BEDROOMS 3 BUILDER OR OWNER L o 7- Z; 1 PERMTTDATE: 1- Z- 0 7 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 f32 = /y' A Q33a� Aq 37 REAR $y AS ,s y 3 ` } No. 7 D o f Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for ;Di5po5a1 *pMem ConsAruction Permit Application for a Permit to Construct( )Repair( 'Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. y 1 L q ttS 16 e1)1`%Q'e Owner's Name,Address and Tel.No. Mcir5ton5A1115 !_ots Q• 4Z1'oli Assessor's Map/Parcel '4 i L q kes id t br e v e MQ9 102 Lo+ S Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �obeeT Gl�oy- 3}(3 �xtttvgtl0 D�{S4M -At h�io 5o�-3e2-2922 14'ftobeur Lune restdnIe 508.4-1-•0453 Type of Building: Dwelling No. of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 33 U gallons per day. Calculated daily flow gallons. Plan Date 1217-R 10 4 Number of sheets Revision Date Title `fro ose SQ �S sttm 0CgepdP. ►?tCin tiI L41CestcleDrive Size of Septic Tank Type of S.A.S. Description of Soil 5-er- 5 01 L L G f,_Q A C&Z Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Boar of Health. Signed 1 Date 1"3-b 7 Application Approved by Date 17-�,_y --- Application Disapproved for 9theowing reasons Permit No. �-6'0 7 — 003 Date Issued 3 - 07 No. �cq7—003 ` j" r . Fee / u THE COMMONWEALTH OF MASSACHUSETTS Entered in computerV , Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Application for Digpo!5ar *pgtem (tougtruction Permit Application for a Permit to Construct( )Repair(/j Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. IL1 1 L n Yes o h TDB-^%-,1 t Owner's Name,Address and Tel.No. ba. � E i M 1( 2.1�f1S1_r, tl , yl -�ke sl be T)rI , e Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. t e�2 (T1Lr1)y - %303cc���ctt� 141'r- , im,rI 0�)P i("6 ��.cic, 5() 1-1 j9�53 VC'si 5nf)6(,,,tf tu'� -3(62-2922 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3'zS 0 gallons per day. Calculated daily flow gallons. Plan Date I2Z I 1 r`) 1. Number of sheets Revision Date Title 'Pre,� ry4is 1k( �0\ 411 1..CIILf'��r1P Tit tub Size of-Septic Tank p Type of S.A.S. p Description of Soil: S r P* s u L 1 to -1 p n t.r 2- ' Nature of Repairs or Alterations(Answer when applicable) Date last inspected: k Agreement: ' The undersigned agrees to ensure the construction and maintenance of the afore described o t-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Boar of Health. r Signed r Q p o l-I � Date Application Approved by y Date 17 'G - Application Disapproved for the f lowing reasons Permit No. a O D 7 - O O 3 Date Issued - 3 - 0 --------------------------------------- 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 'Rt'a hf-P .i (-i I I F« -t T, F_)U n v r,4.1„o , at 14 1 � r1%V:�jP.G t t'4 � 4"a c AA 4 i l �_. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2_ad7 s003 dated 1--;-7 Installer 1 t),�-P_Q -1 6 1 L F Designer T).A t'(e fi M e- --g e._r, The issuance of this permit shall not be construed as a guarantee that the system willlff}inc,ion ads designed . Date 1 f? 0 / Inspector`_1 �1 / --------------r—y(-- No. g�01^ oD3 ------------- Fee A THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 1=igpo!5ai *pztem Con5truction Permit Permission is hereby granted to Construct( )Repair( ,Upgrade( )Abandon( ) System located at iT 14r, G 1'�r I P ,U l 1 cS and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date:_ 1 a 7 Approved by Town of Barnstable. P# Department of Regulatory Services Date Public Health Division tbsq. �sr 200 Main Street,Hy#Tins MA 02601 lEp IAltt A. . A06 Date Scheduled' !Time Fee Pd. i Soil Suitability Assessment for Sewage Dis osal i Performed By:. 1'y l• � Q�V Witnessed By LOCATION&GENERAL I FORMATION , Location Address L� "s i'pE W V E ' Owner's Name L dl S Z . OZ I O L I 41 LA-iLES 1OE DR. :MhkST614S Address M. M,;11 M4 A§sessor'sMap/Purcel: Idd—/ Qgq At-,to j EngineeesName b4)QAe4 /geye_r R•S- r J'N Telephone# SD6 NEW CONS1RUt�'C10N REPAIR Land Use L t�P� �'� Slopes(%) Surface Stones Sb d i Z f0 ft Drinking Water Well 7 Z00 ft Distances from: Open Water Body, ft Possible Wee Area Drainage Way S ft Property Line ft Other ft i SKETCH:(street name,dimensiods'of lot,exact locations of test holes&Pere tests,locate wetlands in proxitnity tubules) mow-F . �L_,I_d S N r=^ CP1 M i i i i n N � ,yv, Parent material(geologic) oL i Depth to SedrOck Depth to GroundwaWn Standing Water in Hole:' ' Weeping from Pit Fnae Estimated Seasonal,11igh Groundwater Al 14 DI TERmIIN TION FOR SEASO"L HIGH'WATER TALE lam" a;! in. �F��,c•�Used: in. ;ep 4!to enll tnnttles: Depth Cdb$erved standing din obs.hole: i ©roundwater Adjusttnent tc Depth to;weeping from side of obs.hole , in _ A ,ACtor- -4 Adj.drnudtlwnter l evel. Index Well# Reading Date: Index Well level — PERCOLATIOON.TEST Date 12 Z TIme•. ':M Observation l I Time lit 9"' N Hole# u Time at Depth of Pere 66 Time(9"-61) ----- ---^— Start Pre-soak Time.0 - End Pre-soak Rate MinJinch ! Site Suitability Assessment: Site Passed Site Failed; — Additional Testing Needed(YIN) original:-.Public Health Division Observation Hole Data To Be Completed on Back -- You must first notify the ***If percolajion test is to be conducted w'thin 100, of wetland, Barnstable C�.lservation Division at least 8ne(1).wedk prior to beginning- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure;.Stones,Boulders. Consistency,%Gravel M 4 OV10 1, SA 10YA H % : ; DEEP OBSERVATION HOLE LOG Hole# =Y Depth from Soil Horizon Soil Texture Soil Color Sail •.` Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. t!a 4^ 54nd /0YO/Z<". /V' sMC15s�,q 16 N G a Loq m 1,09616 616 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. o Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Sail Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, l Flood Insurance Rate May: Abarve St)0 year f.00 d boundary No Yes Within 500 year boundary No` Yes Within 100 year flood boundary No x Yes Death of Naturally Occurring:Pervious Material Does at least four feet of naturally occurring pe vioµs�material exist.in all areas observed throughout the area proposed for the,soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on i® �l (date)I have passed the soil evaluator examination approved by the Departme Environmental Protection and that the above analysis was performed by me consistent with the requir d tr;=xp erience described in 3:10 CMR 15.017. Signature �__ Date l u� Q:\.SEl-rl0PERCFORM.DOC Y � 1 'Citizen Web Request Page 1 of 2 JQa t a l.�2Gz (✓ �f \ (i14 ./ Logged Inas: Citizen Request Management Friday,September 232D16 TOWN TOWN\oconnelt Route to Users Search Requests Create Requests Request Information Request ID: 57425 Created: 9/22/2016 2:31:08 PM Status: Assigned To Staff Assigned To: O'Connell,Timothy Health Office Anonymous: No Request Category: Chapter 54-5 : Rubbish and Garbage edit Routine work: No Estimate: No edit Date scheduled: edit Estimated 10/6/2016 Change Estimated Sep October 2016 Nov Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri Sat 25 26 27 28 29 30 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 tZ 3 4 5 Created By: Soto, Kathryn Priority: Medium edit Health Office Citation Numbers: edit Requestor Information Requestor Request Parcel Map: 102 1 Block: 089 i Lot: 000 Neighbor calling about Number ....... white trash bags,couches, windows,etc...all over front Parcel Lookup and back yard. Email: Edit Requestor Information Track Request Progress Request Work History: Internal Note History: System entry on 9/22/2016 2:31:08 PM: A)signed to O'Connell,Timothy v http://issgl2/lnternalWRS/WRequest.aspx?ID=57425 ,� 9/23/2016 Y-lealth Master Detail Page 1 of 1 . � , .� I-- nth Cyr �3 d'% t' .,g 9 Y4t_—W L44fr x0.,. , Logged In As: TOWN\oconnelt Health Master Detail Wednesday,September 28 2016 Application Center Parcel Lookup Selection Items Parcel Septic Perc Well Fuel Tank Parcel: 102-089 Location: 41 LAKESIDE DRIVE, Marstons Mills Owner: OZIOLI, LOIS R Business name: j Business phone: �J I Rental property: ❑ Deed restricted: ❑ Number of bedrooms : 3 f Contaminant released: ❑ Fuel storage tank permit: ❑ {{ Save Parcel Changes I Return to Lookup Parcel Info Parcel ID: 102-089 Developer lot:LOT 70 Location:41 LAKESIDE DRIVE Primary frontage:94 Secondary road:RASPBERRY LANE Secondary frontage: 105 village:Marstons Mills Fire district:C-O-MM Town sewer exists at this address: No Road index:0858 Asbuilt Septic Scan: 102089 1 Interactive map may; Town zone of contribution:GP (Groundwater Protection Overlay District) state zone of contribution:IN Owner Info owner: OZIOLI, LOIS R Co-owner: Streeti:41 LAKESIDE DRIVE Street2: City:MARSTONS MILLS State:MA zip: 02648 Country: Deed date:7/14/2010 Deed reference:24680/326 Land Info Acres: 0.24 use: Single Fam MDL-01 zoning:RF Neighborhood: 0105 Topography:Level Road:Paved utilities:SeptiC,Gas,Public Water Location: Construction Info ItOding N ear Buil Gross ArealLiving pre Bedrooms Bathrooms 1 11968 12145 P60 13 Bedroom 1 Full-0 Half Buildings value:$71,900.00 Extra features: $29,400.00 Land value: $106,000.00 http://issgl2/intranet/healthMaster/HealthMasterDetail.a�px?ID=102089 9/28/2016 c� Town of Barnstable ST" Regulatory Services A 1659- 0 Public Health Division Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 / Fax: 508-790-6304 September 29, 2016 C ziolikeside Drive ons Mills, MA 026 9 G NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE BOARD OF HEALTH REGULATIONS. The property owned by you located at 41 Lakeside Drive Marstons Mills, MA was visited on September 28, 2016 by Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted in response to a complaint filed with the Public Health Division. The following violations of the Town of Barnstable Board of Health egulations, Chapter 54 Building and Premises Maintenance were observed: §54-3 (A) Outdoor Storage Multiple items are-being stored outdoors on this property which are not screened from public view and are not within an enclosed structure as required by above ordinance. These items include: A couch and other debris. (Pipes,window framing, etc.) f You are directed to correct the violations listed above within (15) days of your receipt of this letter by removing said items from property or storing them in an enclosed structure You may request a hearing before the Board of Health if written petition requesting same is received within 10 (10) .days after the date the order is served Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH Coamas A. McKean, R.S. Director of Public Health Town of Barnstable 1 ® Fs Conunonwealth of Massachusetts Executive Office of Envirownent.al Affairs Dept. of Environmental Protection John Grad One winter Street,Boston,Ma, 02108 U_L,p. Title V Septic luspector N.O. Box2119 Teaticket, MA 02536 (508) - WILLIAMF.WELo �� _ -'_). • t Governor o S ARGEO PAUL CELLUCCI Lt.Governor 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 1 REC�ErIV 9 PART A CERTIFICATION O NOV 2 4 199 Property Address: 19 Lakeside Dr.Marstons Mills Address of Owner: TOWN OFBARNSTABLE Date of Inspection: 11114/97 (If different) HEALTHDEPT. Yeutter:66 Paddock Way Brewster Ma. Name of Inspector: John Graci I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: This Inspection Is based on criteria donned In Title V % Passes code 310 CMR 16.303.My findings are of how the system is _ Conditionally Passes performing atthe time of the Inspection.My Inspection does not Needs F ith r Evaluation By the Local Approving Authority septicimply Lemanany rantyorgucompo a tsussfullifs.he lonnevity of the . - septic system and any of ita components useful Ilia. Fails `I Inspector's Signature: Date: 11117197 , The System Inspector shall s bmit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B,C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes Inspection. Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of CoMpllance(attached)Indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked, structurally unsound,shows substantial infiltration or exfiltialioll,or tank failure 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. (revised 0/f27197) One Winter Street 0 Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 19 Lakeside or.Marston Mills Owner: Yeutter:66 Paddock Way Brewster Ma.02031 Date of Inspection:11/14197 _ Sewaae backup or.breakout.or. hiah.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _The system required pumping more than four 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 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _ Conditions exist which require further evaluation by the Board or Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feel to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone i of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS Is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well Is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D) SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: _ 1 have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage in facility or system component due to an 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 cesspool. SAS is in hydraulic failure. trevbed 04RA97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 19 Lakeside Dr.Marstons Mills Owner: Yeutter:80 Paddock Way Brewster Ma.02031 Date of Inspection:11114197 D]SYSTEM FAILS(continued) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. _ Liquid depth In cesspool is less than 6"below Invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health 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 operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. pwlad 04R7l87) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 19 Lakeside Dr.Marston Mills Owner: Yeutter:66 Paddock Way Brewster Ma.02631 Date of Inspection:11114197 Check if the following have been done:YOU must Indicate either"Yes"or"No"as to each of the following: ,c_ — Pumping information was requested of the owner.occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been Introduced Into(lie system recently or as part of this inspection. x As built plans have been obtained and examined. Note if they are not available with N/A. x The facility or dwelling was Inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _t_ — The site was inspected for signs of breakout. x All system components,excluding the Soil Absorption System,have been located on the site. x 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. x 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 Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is unacceptable)115.302(3)(b)] pw1u404R79Ti SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 19 Lakeside Dr.Marstons Mills Owner: Yeutter:80 Paddock Way Brewster Ma.02031 Date of Inspection:111114197 FLOW CONDITIONS RESIDENTIAL: d./bedroom for S.A.S. Design flow: Ito g p' Number of bedrooms: 2 Number of current residents: 0 Garbage grinder(yes or no): No Laundry connected to system(yes or no): No Seasonal use(yes or no): Yet last two 2 year usage d Water meter readings,if avallable:( ( )y g (gp )• rda Sump Pump(yes or no): No Last date of occupancy: summers only COMMERCIAL/INDUSTRIAL: Type of establishment: nra Design flow:o gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no)Ne Water meter readings,if available: We Last date of occupancy: We OTHER:(Describe) de Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped In the feet year. System pumped as part of inspection: (yes or no)L- If yes,volume pumped:0 gallons Reason for pumping: We TYPE OF SYSTEM Septic tank/distribution box/soil absorptions system x 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 Information: Approximately tie years Sewage odors detected when arriving at the site: (yes or no) No (revised 0412101) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 19 Lakeslde Dr.Marston Mills Owner: Yeutter:66 Paddock Way Brewster Ma.02031 Date of Inspection:11r14►97 SEPTIC TANK: (locate on site plan) Depth below grade: rfa Material of construction:x concreate metal FRP Polyethylene_other(explain) If tank is metal, list age o . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: rife Sludge depth:We Distance from top of sludge to bottom of outlet tee or baffle: nia Scum thickness:We Distance from top of scum 10 top of outlet tee or baffle:rda Distance form bottom of scum to bottom of outlet tee or baffle:Na How dimensions were determined: Measured 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.) Ne GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: concrete metal FRP Polyethylene_other(explaln) Dimensions: rda Scum thickness:nla Distance from top of scum to top of outlet lee or baffle:rda Distance from bottom of scum 10 bottom of outlet tee or baffle:Wa Date of last pumping* 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.) rra BUILDING SEWER: (Locate on site plan) Depth below grade: s' Material of construction:_cast iron_40 PVC_other(explain) Distance from private water supply well or suction line!— Diameter: 4„ Qmments:(conditions of joints,venting,evidence of leakage, etc,) (revised 0AR7►97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Properly Address: 19 Lakeside Dr.Marston Mills Owner: Yeutter:66 Paddock Way Brewster Ma.02631 Date of Inspection:11114197 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: Wa Material of construction:_concrete_metal_FRP_Polyethylene—other(explain) Dimensions: we Capacity: Na gallons Design flow: Na allons/day Alarm level:_rda larm In working order?_Yes_No Date of previous pumping: Comments: (condition of inlet lee,condition of alarm and float switches,etc.) Na DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Na Comments: (note if level and distribution is equal,evidence of solids.carryover,evidence of leakage into or out of box etc.) Na PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_v►a Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) Na pavlpd 0427AII V • 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 19 Lakeside Dr.Marstons Mills Owner: Yeutter:66 Paddock Way Brewster Me.02831 Date of Inspection:1111114197 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,if possible,excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: rya Type: leaching pits,number: nta leaching chambers,number:Ne leaching galleries,number: nia leaching trenches,number,length: Na leaching fields,number,dimensions:Na overflow cesspool,number:n►e Alternate system: Na Name of Technology:_rra Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) We CESSPOOLS:x (locate on site plan) Number and configuration: one Depth-top of liquid to Inlet invert: empty Depth of solids layer: Na Depth of scum layer: Ne Dimensions of cesspool: SVX310 Materials of construction: back Indication of groundwater: Na Inflow(cesspool must be pumped as part of inspection) rda Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Mein cesepool is structurally found.There he$never been more than 2'of water In It System wee not Inspected under normal use. PRIVY: (locate on site plan) Materials of construction: We Dimensions: Na Depth of solids: nle Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Ne (rwlud 04r1719r) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM • PART C SYSTEM INFORMATION(continued) 19 Lakeside Dr.Marstons Mllls Yeutter:00 Paddock Way Brewster Ma.02631 11114197 Depth of groundwater 12 Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. 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 X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and Cherie I (revlsed041t7197) page 10 of 10 1 .. _. .. LEGEND C. Np�ORD I \ / � PROPOSED CONTOUR tic DR v — — PROPOSED SPOT GRADE — 98 — EXISTING CONTOUR F s N E S IDF- ��� + 96.52 EXISTING SPOT GRADE AY I � �gKESIDE l� MEN W— EXISTING WATER SERVICEDF TEST PIT — 74•45 ft O WATER GATE R \ 1 ! L10 T 70 LOCUS MAP N.T.S. j ARE/ = 10800 Sf GENERAL NOTES: 1 i G PS LINE,1— N 1• ALL CHANGES TO HIS PLAN MUST 6E APPROVED BY HE LOCAL O BOARD, OF HEALTH AND THE DESIGN ENGINEER. 2. OF HE L RSTATE CONFORM REQUIREMENTS ENVIRONMENTAL CODE, TITLE V. AND ANYAPPLICAB E I \`�G / LOCAL RULES AND REGULATIONS: L3. HE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILED PRIOR TO OCo' �p_0 9 2 4 / DESIGNPE GI NEER D APPROVAL 8Y THE BOARD OF HEALTH AND HE 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING U FROM THOSE SHOWN HEREON SHALL BE REPORTED TO HE DESIGN O 1 I CONC / 1 ` ' ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED 014 ASSUMED DATUM. 6. HE DESIGN ENGINEER IS NOT RESPONSIBLE FOR HE FAILURE OF THE OR! \� o / � ! HEALTH FORCTOR PROPER INSPECTIONS DURING CONSTRUCTIONWER TO NOTIFY TH LOCAL . OF 71/-2 1 �! 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 9. IT SHALL BE HE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE ! 1 HE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 1 12 f / 1 CONSTRUCTION. \ 1 10. EXISTING LEACHING PIT TO BE PUMPED, CRUSHED AND FILLED / SHED 1` 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION M BENCH MARK 1 12. HIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY !! '`' _ J ! _ AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY BULKHEAD C O RN E Rx ` 2 5 I—ELEVATION = 92.17 _--- — 13. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING 1 � ___ BARNSTABLE GIS DATUM — _- _- 14) REMOVE UNSUITABLE SOILS 5 FT. AROUND LEACHING TO EL: 86.33 — 1 00.00 f t �> 83.25 (variable) OR TOP OF C2 LAYER AND REPLACE WITH CLEAN EXISTING CESSPOOL (NOTE 10) MEDIUM SAND. 5 FT. REMOVAL TO EL 86.33 — 83.25 1 OR TOP OF C2 LAYER OF PROPOSED SEPTIC SYSTEM UPGRADE PLAN DA '�P1N 41 LAKESIDE DRIVE, �, ' MEY° � MAR STO N S MILLS, MA SCALE: 1 in = 20 ft V '" No. 1140 "' MAP. 102 : Prepared for: Lois R. Ozioli SURVEY REFERENCE , 20 0 20 40 LOT.'89 Engineering by: Surveying by: SCALE. DRAWN JOB. NO. '�G�STE � DEEDBK:3293 DARRENM.MEYER,R.S. Boo—Tech Ahv/ronmental 1°=20� DMM "PLAN OF LAND BY GERALD A. MERCER & Co. SANITAR��`� Posox9al DATED: OCTOBER 1957 0 10 20 ���� DEED PG:88 EASTSANDWICH,MA02537 (508) 364-0894 DATE CHECKED SHEET NO. 2- 50"62-2922 12/28/06 DMM 1 of 2 ELEV. TOP FOUNDATION (Existing) _ .92.45 F.G. EL: 91.6 F.G.EL: 91.2 F.G. EL: 91.0 FINISH GRADE=91.0 l MAINTAIN 2X MIN SLOPE OVER LEACHING AREA .Y COVERS TO WITHIN 6 OF GRADE 5W�l TION PORT L = 18 L F FINISH GRADE • . , L6" 4" SCH 40 PVCK L - 7, 10OI O O O O O O e O (MIN.)° 14 :INV.88.75 5= 1% (MIN.) ® S= 1%TEES ARE TO BE 4" SCH 40 PVC INV.88.60 INV.88.43 ° OUTLET EL: 90.95 GAS PROPOSED DB-3 0 HO e o H., o 0 0 BAFFLE (SEE NOTE 3) y H-10 DISTRIBUTION BOX . ... I. 24.35' PROPOSED 1500 GALLON SEPTIC TANK NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING INV. 89.0 GAS BAFFLE TO BE INSTALLED ON PIPE INVERTS PRIOR TO CONSTRUCTION aa.TMNa ao 9" MIN. OUTLET TEE AS MANUFACTURED BY 2) D-BOX SHALL BE SET LEVEL AND TRUE TO F`TE"F PER 77TLE 5 GRADE ON A MECHANICALL COMPACTED SIX TUF-TITE, ZABEL, OR EQUAL INCH CRUSHED STONE BASE, AS SPECIFIED IN BREAKOUT EL ® 88.60 310 CMR 15.221(2) INV. ELEV.-88.0 3) PLUMBING TO BE MODIFIED TO MEET OUTLET a 4._ T-I . 24"ITINE " SEPTIC SYSTEM PROFILE 4> ELEVATION INLET(PLUMBING& OUTLET TEES RAS REQUIRED S INI/ERT 3015 BOTTOM EL- 86.0 - _I 8" CUL TEC RECHARGER 330 SEPARATION 6.75 Fr. I_ I48" I BOTTOM OF TH-2 EL: 79.25 SOIL ABSORPTION SYSTEM (SECTION) - MODEL 330 R STAND ALONE MODEL 330 1 INTERMEDIATE SMALL RIB LARGE RIB SMALL RIB LARGE RIB SOIL LOGS DESIGN CRITERIA 5 " r7 NUMBER OF BEDROOMS: 3 BEDROOM MODEL 330 S STARTER MODEL 330 E END DATE: DECEMBER 26, 2006 SOIL TEXTURAL CLASS: CLASS I DESIGN- PERCOLATION RATE: <2 MIN/IN SMALL RIB I LARGE RIB SMALL RIB LARGE RIB SOIL EVALUATOR: DARREN MEYER, R.S., CSE DAILY FLAW: 110 G.P.D. WITNESS: DONALD DESMARAIS, BARNS B.O.H. DESIGN FLOW: 330 G.P.D. 7n GARBAGE GRINDER: NO (not designed for garbage grinder) 6" DlA. INSPECTION POR LEACHING AREA REQUIRED: ' 330 = 446 S.F. TRIM TO ACCEPT •74 HVLV F24x4 a Elev. TH-1 Depth Eiev. TH-2 D/Dth USE THREE (3) CULTEC RECHARGER 330 UNIT FEED CONNECTOR 7.5 91.00 0. 91.25 0• 4" DIA. AVAILABLE 9033 10YR 3/2 8- 75 FILL te- N STANDARD DUTY022!' e A (24.35'L x 12.33'W x"2'D) ONL Y. SANDY LOAM LOAMY SAND • • • • • . 10YR 6/8 89.42 s toYR 3/z22. BOTTOM AREA: 24.35 x 12.33 = 300.24 SF SANDY LOAM SIDE AREA: 24.35.+ 12.33 X 2 X 2 = 146.7 SF 3 .5" 88 o cl 30• 10YR 6/8 ( )• • s0YR 6/AM ea09 ct �• TOTAL SQUARE FEET PROVIDED = 446.94 vs 446 REQ'D 24 » SANDY LOAM .3 10YR 6/6 LLR/B LARGE RIB• 4207" 86.33 cz 56. 83•25 cs 96" PROPOSED SEPTIC SYSTEM UPGRADE PLAN 4_q., 84.50 MSAM SANDM CULTEC RECHARGER s60 CHAMBER STORAX_ Z459 CF/Fr 41 LAKESIDE DRIVE, MARSTONS MILLS, MA ALL RECHARGER MOHD HEAVY DUTY UNITS ARE MARKED WITH A COLOR STRIPE FORMED INTO THE PART ALONG THE LENGTH OF THE CHAMBER. 2.5Y7/4 2.5Y7/4 CULTEC, Inc. PH. (203) 775-4416 TM CULTEC Contactor®and Rechar er Prepared for: Lois R. Ozioli 9 81.00 120- 79.25 t44• Engineerin PH: (800 4-CULTEC g by: Surveying by: SCALE DRAWN JOB. NO. P.O. Box280 > P/astlC Septic and Stormwater Chambers { DARRENM.MEYER,R.S. Boo-reob SAvlmnmental N.T.S. DMM FX.• (203) 775-f 462 0. 878 Federal Road WWW.CU/fec.com DATE SCALE File Name PERC RATE <2 MIN/IN. (-C2- HORIZON) PO Box981 (508) 364-0894 Brookfield CT 06804 USA CULTEC XXXXX N/S LU I S NO GROUNDWATER OBSERVED EASTSANDWICH,MA 02537 DATE CHECKED SHEET NO. 508-W--2922 12/28/06 DMM 2 of 2