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HomeMy WebLinkAbout0325 LONG POND ROAD - Health 325 Long'Pond �6a� Marstons Mills A = 029 = W5. f' F ..Town.of Barnstable _ ti ro Barnsta f U.S.POSTAGE>>PITNEYBOWES Public Health Division o RARNSfARLE. !h Y" MASN. g. 200 Main Street � � s�ti++� :�:� ' �a �'prFO MPS Hyannis,MA 02601 ZIP 0260 $�7 t 02 4NV 006.465 �- 00003.36455 NOV. 02. 2016. f 7012. 1010 0000 2847 8186 Robyn E Ryshavy 325 Long Pond Road Marstons M;u—M_A_n7648—_. - f 1 I RETURN TO SENDER NOT DELIVERABLE AS ADDRESSED UNABLE TO FORWARD �3eo 0:ee:j it3a.e u + F fli: 052601400i6200 L6Z� en®i ac—ua•►— Z '%°a-�L=�--s °= 3 1�3:. .,4! ►.4 es..: tl IL—Liz-Al 1 l,t 1 a! is - + � v_��:r.rn t i r h.n i I �'i i i�� iii.. ;•� i i� i.• ii i�•Iaiii •i lii • ;i: •i.:�'i ,i-7o � 4 SENDER:.COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete -A-Signature item 4 if Restricted Delivery is desired. ❑Agent X ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from Item 1? ❑Yes „ 1. Article Addressed to: If YES,enter delivery address below: ❑No /dab � �• � s�aV 3 a 5 3. Service Type �n J$�ertified Mail® ❑Priority Mail Express- oa yg ❑Registered Return Receipt for Merchandise \ ❑ Insured Mail ❑Collect on Delivery I 4. Restricted Delivery?(Extra Fee) ❑Yes i 2• �+ 7012 1010 0000 2847 8186 PS Form 3811,July 2013 Domestic Return Receipt Og'THE TQ� Town of Barnstable Barnsfabde y0� Regulatory Services Department A9-AmeiiW41 1 BARNSTABLL 1639. ,� Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2847 8186 November 2, 2016 Robyn E Ryshavy 325 Long Pond Road Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 325 Long Pond Road, Marstons Mills,was inspected on 10/31/2016 by Chad Hathaway, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines ` of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\325 Long Pond Road Marstons Mills.doc THE r� Town of Barnstable Barnstable Regulatory Services Department j IARNSCABUM "�: ,,� Public Health Division jFD MA't A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2847 8186 November 2, 2016 Robyn E Ryshavy 325 Long Pond Road Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 325 Long Pond Road,Marstons Mills,was inspected on 10/31/2016 by Chad Hathaway, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health QASEPTIC\Letters Septic Inspection Failures or Future EVI\325 Long Pond Road Marstons Mills.doc l + Of THE Idy. Town of Barnstable a , � HARNSTAHLE, 6 9- Regulatory Services Department QED M1A't� Public Health Division 200 Main Street,Hyannis MA'02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool O 1 YEAR DEADLINE CRITERIA tatic liquid level in the distribution.box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching pit or cesspool with high liquid level, <12" below inlet(per Town Code §360-9.1) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Long Pond Rd c Property Address Ryshavy Owner Owner's Name information is required for every Marstons Mills Ma 10/31/16 page. Cityrrown State Zip Code Date of Inspection {� A L7'1 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. Important:When A. General Information Q filling out forms s51 �� / 7S on the computer, use only the tab 1. Inspector: key to move your cursor-do not Chad Hathaway use the return Name of Inspector key. H.P.S. �y Company Name P.O.Box 151 Company Address AM Forestdale Ma 02644 Cityrrown State Zip Code 774-274-2581 12866 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 10/31/16 Inspector's nature Date The system inspector s II s it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 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. t5ins•3113 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 1 of 17 /w6ly s Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 325 Long Pond Rd _ Property Address Ryshavy Owner Owner's Name information is required for every Marstons Mills Ma 10/31/16 page. Cityrrown 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•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2-of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . �' 325 Long Pond Rd Property Address Ryshavy Owner Owner's Name information is required for every Marstons Mills Ma 10/31/16 page. City/town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 I , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 325 Long Pond Rd Property Address Ryshavy Gunner Owners Name information is required for every Marstons Mills Ma 10/31/16 page. Citylrown 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 Y2 day flow t5ins•3/13 Title 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Long Pond Rd Property Address Ryshavy Owner Owner's Name information is required for every Marstons Mills Ma 10/31/16 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Tide 5 Official Insp ection 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 ,•�''t 325 Long Pond Rd Property Address Ryshavy Owner Owner's Name information is required for every Marstons Mills Ma 10/31/16 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ 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): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 325 Long Pond Rd Property Address Ryshavy Owner owner's Name information is required for every Marstons Mills Ma 10/31/16 page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 5 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(9Pd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Fonn:Subsurface Sewage Disposal System-Page 7 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Long Pond Rd lug - Property Address Ryshavy Owner Owner's Name information is required for every Marstons Mills Ma 10/31/16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: owner purred 1year 6 months ago 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•3113 Title 5 Official Inspection Form:Subsurface p Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Long Pond Rd ,p- — Property Address Ryshavy Owner Owner's Name information is required for every Marstons Mills Ma 10/31/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1984 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2'feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 25+ feet Comments(on condition of joints, venting, evidence of leakage, etc.): tank was over full in the riser. Reccomended emergancy pumping to prevent backup into house Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: unable to obtain due to over flowing tank t5ins•3/13 Title 5 Official Ins pection Form:Subsurface Sewage Disposal System•Page 9 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form _ a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Long Pond Rd Property Address Ryshavy Owner Owner's Name information is required for every Marstons Mills Ma 10/31/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle NA Scum thickness NA Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank and inspect during the installation process. tank was over full and unable to inspect tees etc. pump every 2-3 years as maint. to protect leaching Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 official Inspection Forth: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 M ' 325 Long Pond Rd Property Address Ryshavy Owner Owners Name information is Marstons Mills Ma 10/31/16 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 325 Long Pond Rd Property Address Ryshavy Owner Owner's Name information is required for every Marstons Mills Ma 10/31/16 page. Cityfrown 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 Replace dbox with new leaching 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(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: existing leach pit in failure during inspection liquid level of pit was in riser of pit and causing tank to be overloaded. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ' 325 Long Pond Rd Property Address Ryshavy Owner Owners Name information is required for every Marstons Mills 'Ma 10/31/16 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ 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.): 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s•'"t 325 Long Pond Rd Property Address Ryshavy Owner Owner's Name information is required for every Marstons Mills Ma 10/31/16 page. City1rown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Ins pection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .� 325 Long Pond Rd Property Address Ryshavy Owner Owner's Name information is required for every Marstons Mills Ma 10/31/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately l� -UL �0 6� � I 01 t5ins•3113 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 325 Long Pond Rd Property Address Ryshavy Owner Owner's Name information is required for every Marstons Mills Ma 10/31/16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: NAfeet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments k re`p 325 Long Pond Rd Property Address Ryshavy Owner Owner's Name information is required for every Marstons Mills Ma 10/31/16 page. Citylrown State Zip Code bate 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 M t5ins•3113 Title 5 Official Inspection Fore:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION i0 i?d - SEWAGE# Xo 4 I f� VILLAGE/Lf,g S`T LLS ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. T D 1r y g f ZfP rilf SEPTIC TANK CAPACITY Ja G b LEACHING FACILITY:(type) a-:5*6 6 eka Nl 6 er,(size) K J 2 y � NO.OF BEDROOMS 3 OWNER / PERMIT DATE: "7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Welland 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 Ac f3i qib" 02 - 3$ i7 No. J// Fee THE COMMONXVEALTH OF MASSACHUSETTS Entered in computer: a� �_______._, Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS AppliLation for bisposal *pstpm (Cone,tCULtion permit Application for a Permit to Construct( Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components f Location Address or Lot No-3 25-Z oo l& PaodAFOOW Opyner's Name,Address,and Tel.No. �i:9`,sr.005 teli1/,s A.06Y4 Assessor's Map/Parcel p y—a . Inst�aaller's N e,kddrjss,and Tel.No.,f'08' 177'�r? Designer's Name,Address and Tel.No.,_$"09=3 F a—331/ r. /G ,W� e i^asp /� i 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(min.required) 3 c3 y gpd Design flow provided S gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) r14 s;Told ra `J 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 Healt Si dvea Date l Application Approved by Date Application Disapproved by Date for the following reasons Permit No. & Date Issued ' zwo - No. j Fee THE COMMONWEALTti;OF MASSACHUSETTS Entered in computer: �- ---1j. Yes 1 PUBLIC HEALTH DI�ISION - TOWN OF BARNSTABLE, MASSACHUSETTS r application for ]Disposal *pstettl Construction Permit � APPlication for a Permit to Construct( Re air(lUpgrade Abandon( ) ❑Complete System ❑Individual Components ' Location Address or Lot No.3 2s-L o!/!Cr pod? v O ner's Nam Address,and Tel.No. y 6 Name,,�dress H,4 Assessor's Map/Parcel O2 j/-a 3S- /j Installer's Name,Addr ss,and Tel.No.,SU -8 '7 - C2-q yj9' Designer's Name,Address and Tel.No.S'a6 3 -33 7/ L��rvv S/ y����l!i'� Sri' z�✓G. o 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(min.required) 3,30 gpd Design flow provided 3 y gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. ( Description of Soil ( ; i Nature of Repairs or Alterations(Answer when applicable) - l li ,i rl ♦ t Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance"Mth the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issuedby this Board of Health fi r Date >> 1 i7h Application Approved by 1 Date Application Disapproved by Date for the following reasons Permit No. �" �l^ — [] Date Issued f � f 711 GO - r r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( fir- Repaired( 4.-- Upgraded( ) Abandoned( )by � y at - 46`9 v uh /� TUB? 1 i as been constructed inLacccordance h with the provisionsof Title 5 and the for Disposal System Construction Permit Nor- 6`7`Odated h I, Installer,�s�pt� /'i/?j��if/(/s Designer &Z-//% t�SOy,'S 2-1w. #bedrooms Approved desi flow gpd The issuance of this permit shall 'of be construed as a guarantee that the systetfi'will �tion, igned—Date fp Insy� �""`�--.'^ ---------------------------- ----------------------------------------------------------------------------------------------------------- No. /�9 J�� Fee��y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem (Construction Permit Permission is hereby granted to Construct( f�" Repair( Upgrade( ) Abandon( ) System located at 3;7? z of ea e``d 19 al4--1 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be complete w'�hin three years of the date of this ermit. Date -7 �� Approved bb From: 11/29/2016 15:12 *437 P.001/001 Town of Barnstable Regulatory Services Richard V. Scali, Interim Director MASS �� Public Health Division ''� ►� Thomas McKean.. Director 200 Nlain Street, Hyannis,NIA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification! Form Date: 1 Lt Sewage Permit# Assessor's MapTarcel � Designer: ` f e-.y _.- 1� J '?; 14G Installer: Address: PO 6e to I Address: _ IVA Can was issued a permit to install a (date) (installer) septic system at APAff tP` ' L �l,i based on a design drawn by (address) ("k__yew-; Q.9an's dated of 1(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. Strip. out (if required) was inspected and the soils were found satisfacto r`P-o V a ry. � p 7i�r-r1 a�v <5°e4.-.. 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. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was coratruct ie with the terms of the FA approval letters(if applicable) f (Installer's Si;nature) (Designer's Signature) ; (Affix Designer amp Here) PLEASE RETURN " 0 BAH_ ABLE PUBBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILb., V T IBE ISSUED UNTIL BOTH THIS FORIM AND AS- BUILT CARD ARE RECEIVED BY THE BAR,NSTABLE PUBLIC HEALTH DIVISION. THANK YOU. —' Q:`,$epticlDesigner Certiiicalion Form Rry$-! l-i 3.doc 3-5 ASS L O C A T ION SEWAGE PERMIT NO. kot 8 Long Pond Rd. 84-78 VILLAGE Marston Mills INSTA LLER'S NAME i ADDRESS Robert B. Our Co. Inc. Great Western Rd. North Harwich, Mass. S UILDE R OR OWNER RarnctahlP Holding Cn_ DATE PERMIT ISSYE0 � DAT E COMPLIANCE ISSUED 3/�� I a-�'- ^ .. `1 �� �d-`N 1 �� �� � / � i l�� � . � 1'u •• i . I Town of B !astable. P# � a /l Department of Regulatory Services It Public )Eiealh Division Date l `� 16Jy ems$ 200 Main Street:Hyannis MA 02601 C Date Scheduled to I Time Fee Pd. ! �7 i oil Suataba a Assessment for Sew ge Daspo al Performed By: ! Witnessed By f A " �. LOCATION&GENERAL INFORMATION Location Address 32� � Owner] l s Name ]g� rta-goy ��{ lS t�11/1�. i Adatt�s jA.-+vL� / Assessor's Map/P4rcel: � 4®� �• - `"'` Engineer's Names ` c✓ NEW CONSTRUtUON 1 REPAut Telephone# 509 ,360 —3 c3`1 (46)es '`^' l• ( Surface stones Lana use��S i Own t'', Slop 1i,� Distances from: Open Water Body��y ft Possible Wee Area C_ft Drinking Water Well � ft i jj Drainage way > ft Property Line �ft Other ft ! SKETCH:(Street name,dimensioos'of lot,exact locations of te.'t holes&per6 tests,locate.wettands in proxitnity to holes) �qa Y) i • Parent material(gedlogic) A v ' �' "4e7 k Depth to Bedrock • . I t) Depth to Groundwater. Standing Water in Hole:- rJi wccping from Pit Face Estimated Seasonali1fth Groundwater ! D RMIN TION FOR SEASONAL HIGH WATT&R TABLE Method Used: in. Depth obpexved standing in obs.hole: in. Depth t0 ball MOtt1e33 Depth tofweeping from side of obs.hole !' In. (jr0undwhta Adjustment ! !lac tor,,,.._..._. Adj.Graundwaterlevel,,.,., Index Well# _ Reading Date: Index Well Ievd A d PERCOLATION TEST Da M Dille-----, xl Observation I j Tiine at 9" Hole# --�-- r Depth of Pere 41—. ' !line at 6" Start Pre-soak Time.(a? 1102, I t Time(9"•G') -- — 1I .1a i End Pre-soak t ! Rate MinAnch Site Suitability Asselisment: Site Passed ` Site Failed; I Additional Testing Needed(YIN) Original:.Public 1-101th Division ObservadoA Hole Data To Be Completed on Back • i , ***If percolation testis to be conducted within 100 of wetland,-you must first notify the Barnstable C44servation Dhision at least one(1)weep prior to beginning. U VS 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 3t, Cl 5(Ayd t, jqq wo � �• .�- 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) (P4?A /® PAS DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.% ravel I -- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. Consistency-5- ra P� J. Flood Insurance Rate Mali: Above 500 year flood boundary No Yes Within 500 year boundary No Yes Within 106 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist,in all.areas observed throughout the area proposed for the soil absorption system? ' S If not,what is the depth of naturally occurring per ious material? Certification r /� I certify that on I '"i (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the requir tr ' ing,expertise and experience described in 3.10 CMR 15.017. Signature 1 _ Date Q:ISEPTICIPERCFORM.DOC ti LOCATION LO C� ��C� 374/93,,f ryab IJ4, �Qe✓� '/�ljr'D j /'1`1/-b��STd'uS N0. VILLAGE - /�l ✓3 �5. «S DATE r: APPLICANT- 9 J�,ed 4. hiwc�. ceo FEE ADDRESS ,16tJ !�✓�, ,,,/ i= 1-! /�,/ C TELEPHONE .N0. (Non-refundable ENGINEER � G /��n/ ,✓� TELEPHONE. NO '�J:a=2 -y�j! DATE SCHEDULED , �' �� •.•" l . �8 - /� �;_ (Applicant':s signature : f � SOIL LOG: A PL8 163 SUB-DIVISION. NAME "PATE TIME 120 ECCT EXPANSION AREA: YES NO � ENGIN_EER' TOWN .WATER PRIVATE WELL Y �Jo •✓. J i BOARD OF HEALTH EXCAVATOR SKETCH: (Street name,etc. ,dimensions of lot, exact l'ocation .of test holes and percolation tests, locate wetlands in proximity to. test holed) L NOTES: l T I ' q 66 f�f3•G'y ro7 _EETt-� 1. �16,G IL ('�; ,,lot �I< 6�'t 0 17 Na PERCOLATION RATE: < M IN A aiE--0ivM��,-� TEST HOLE NO:0 ELEVATION: TEST HOLE NO: ELEVATION: c -I' LOAM - e, Surl,_s L 1 . 2 IL 2 3 3 4 4 5 5 6 M Eli VM 6 5Ame A 8 2� � SAD 8 9 A 9 10 10 11 11 12 12 13 rib w A-►�2 13 14 14 15. 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: 1 NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ?. ORIGINAL: COMPLETED IN ENTIRETY BY P. E. AND RETURNED TO BOARD OF HEAL''_'H_ a COPY! RETAINED BY APPLICANT _ } c 3 No._It? Fss.. , ............. THE COMMONWEALTH OF MASSACHUSETTS BOAR®SF HEA T ....................... ................OF..............• iL/t/ .... .......................... Appliraatiaan for 14spos al Works Tonstrnrfinn Famit Application is hereby made for a Permit to Construct ( ) epair ( ) an Individual Sewage Disposal Systgn at ......... . ....../-4 I catio Add • .. ....--- - •. --- ... .................. -------- .. '.�1. ��. �r�iJ W ner� Addre � O1 � ........... Installer Address Type of Building Size ------0 feet U Dwelling—No. of Bedrooms........... .....Expansion Attic ( "') Garbage Grinder) WOther—Type of Building -----!1" --4........... No. of persons......+�.'�................... Showers tfto Cafeteria QOther figures '......••-•-•--•----•---- • •-------------•-•......•---------••-•-•••--- --•••--•-••••••••----=-•-•-•--•-••-•-••..--•--•-•------•-••-- W Design Flow......!172.............................gallons per person er ay. Total daily flow---J.9.0..... ____...._...__.....gallons. WSeptic Tank—Liquid capac v��+'�allons ength�!�... Width__krlvr_ Diameter..�.W__.___ Dep h--I-4P x Disposal Trench—No. Width___ . ____._ Total Length_._~�l!4?_._.. Total leaching area_. ,e9 ... sq. ft. Seepage Pit No...../............ Diameter....... .......... Depth below inlet....9 .......... Total leaching area...k�, q. ft. Z Other Distribution box (A Dosing t I Percolation Test Results Performed by..._''�y17Tit .....�V�.n ote ll_ Date.....Z '---Z ....... so � Test Pit No. 1................minutes per inch Depth of Pit.................... Dep to ground water--_-_-_-__--_--------_-. fro Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ - •-•----•••-•-----••------------------- •-- GG _ 0 Description of Soil--••-._��_..'' .... �!��� ---•-�-••----•-- O.i x U UW --••--•--•---------•-•------•-....------f� "j�---------------------- -�-=' ------. 040- C Nature of Repairs or Alterations—Answer when applicable.-_............................................................................................. --••----------------------------------------------------------•-••---•-•--•----•---•--........---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI E 5 of the State Sanitary Code—The un er i n l:p y e d s g e urt er agrees not to place the system in operation until a Certificate of Compliance ha n issu by the board of l 1 ao Application Approved BY ---- -- ...`--"---. - ...... 1 f Date Application Disapproved for e f o owing reasons-------------------•-----------------•-------------------------•---------------................................. ....................................................--------------------------------------•-----•-------•---•-•---•--•--•---•---•-•--•......••-•-•.................................................... Date PermitNo......................................................... Issued_....................................................... Date °No:... :` ... '... Fics... ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ ......... .................OF..............................-.........--- ApplirFatiun for Bispoii al Works Tonstrurtion Errant Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. .....-•---•--...------........................................................................... .................................................................................................. Owner Address W Install er Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of ersons____________________________ Showers — a YP g --------•-•-------••-------• P ( ) Cafeteria ( ) Otherfixtures -------------......................................................................................................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) st a Percolation Test Pit No. I suits Performed nutes p r inch Depth of Test''Pit.................... Depth to ground water........................ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.........-.............. --------•----------------------------•------------•-------...---....-----........-•-----••-•----•-•.......................................................... ODescription of Soil........................................................................................................................................................................ W .............. --•------------•-•---••-•••-••-•-•••--•-•-••---•-------------------••-••-•-••--•--••----•-----•-•••••-•-•-•-•-•••---•-••------•---•--•-................................................ U Nature of Repairs or Alterations—Answer when applicable..................................:.....•.- ................................................... ---------••------------------------•-----------------------•-----------•-----•••••----..............---•-•---•-•• ---•--••••••---•._....-----•••---••-------•-----------•-•-----•-----••------•....--•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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. igned...----= - •-----"...... Application Approved By.... .. .____ _.. `te, Date Application Disapproved for he f otlowing reasons:-----•--------•---------------•-•---•-----------------...--------------------------•------------.•..------..._.. ---•-•--•-•----------------------•-•-•---•--------•--•-----•-----•-•-•-••--•-_.-.._..-----•--••....._.._•••. Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Orrtifirate of Tompliana TO CERTIFY, That the Individual Sewage Disposal System constructed ( ,)-,Or Repaired ( ) by ...••-•-••--••......--- •-•- jI /------------- --------------------------------------------------"------------------ ----------- � ... �! --Installer ------ at... ... .... �? .p -. m u r- --------- has been installed in acc dance with the rovisions of I i I�, p�The State SanitaryCo 6 as des ribed in the application for Disposal Works Construction Permit No.- _------�_______________________ dated-..!'//VVXJ�,�-- ..................... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE AS A GUARANTEE THAT THE SYSTEM W L F NCTION SATISFACTORY. DATE.��. ............................................................ Inspector ........ -.........•-•-•--••••-----•---•----•---•---•----•--•-._......._---_-•--•- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH lf— ...........................................OF.......--....:.....-............_.-.....-...-.-...._.-_..........-......_..--........ No............�......... FEE........................ rk�Permission is hereby granted--- � -- ------ Xisposal --------•--•---------------••---•-----------------...----••-•-•- to Construct ( � Repair ( �-an'In l�fidual'�Se a'g System r.. � at No.. ...:.....:......... Zosal - .......--------••-------------------------------------...---•----------------------•----••----------•--•-•-•-- ! Street as shown on the ap licat' n for Works Construction Permit No.--.---= ated.......................................... A DATE. _ �_ Board of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS /YOTF /F E/TNER 7'Mr SEPT/C TANK OR 20 R7. MIN. . LEACHAiVS PIT A RAr VOR& 7N^,V /?"&&l0P /O fT MIN., SRAOdr� A 2�4 At71AAof A 74 COiyCRj T1.¢ COML S.+�A14L BLr B0404J6N7- TO G/{AOE'.CAN ASrrRA �. •¢'PYC P/PE GONCIfL"TE trE.4Yy Ci'15T IRON Co VCR Sh�.4LL BE USFO : M/". P/TCX. /F/N OR/VEWA y 2�iL M/N. CONCRL'TE cy of CO✓ER CG EA/V .SA APO lQ «. BACAe,0=/L.G A ER Z L Y RON P// Q� l� _'/e ` MOM P/Tc/,l l U C�'O. GAL. • •:o -.1 , . .. a • • 0.1 a •a WASH" 37t�NE V4VPt�e l:T. SEPTIC TANK D/ST • � • • • ea Box 4 or ;� • ° • •:. • pL•PT/N • • ' • • r WASHED STOWE %- — 470 � • 1 • 1 • • • •• • .. Z,S i ss • • • • r • •• • AV PRECA5T SE.f.A4GE 7 br x �. • • • • • • • • ° P/7 DR LVVI V. lIi/f�CR"T !.'LENAT/CWS'Fr C;gn^ci-ry 413 G ��'AY ..� �r,_.9 3 0 G P7. D/AM. /NLE7. .SiEpT/rC T.4/VK :; 9 9,8 ..FT. C C �7tls/ILATION),; Ot/7LET 3L�PT/C 7A, 9 y,4 GROUND I1�ITER 7AALE /IVLET D/S7R/®//T/ON. BOX FT SECT/ON GF. ou7zro�stxieurio/v ear 99-Z Fr /NLET:LE.4CXiA6G oIT 99.�' FT. .Sjff;VAOR VISA AL SY.STEW/i? T/tBlJtATION ° LEACH/NG /T DINAMSION A 0ES1ajY,CR/TEM IA. D/M�nrs/aw S' ��✓ NLJMQER OF;BEDiRCOMS D/MEII/S/0/Y : C.. FT..�''� zZ� TOTAL EST/M6 7-- .FLGN/ GAL.�DAY So/L TEST Jib/ SOIL 7FST402_ `SG/L TE�T / JYVMBER QF /,E°ACJVI/VZ P/TS l f`ECEY. OOP 7 ELEY fCO,/ p�gTE.OF SOIL TEST i'Z S/GE LtACH/NG PER:P/T / Ft�' ,S't'� /•7 U, RESULTS IVITNESSEO dY h'�3E.J�cy9 r BOT"rO/N 4Z4CN/NG Pam$P/T 7 so. .FT av Low n� �/j-a�-^�-�-- �RCOLAT/ON RATE jo �k'5S MIIN�IINCN r TOTAL LEAC'K//VG AREA z 6 G SO FT n 5"ir3 Tit.9-n/ / AE�JtCotATioN RATE�tk2 Muv. /Ncf/ leRSERVELEACNlN4RREA �. LUj5D`L .Rt�3.t.RT' s'�` `acQ ft�! ri1Cl�!'/t� /y' �5T(� vS' ��LC �� C3 No 095i o ELORED6EA.Akr E IPN /NC. $° ?/Z MAIN .9F NYANNl9 AfA fS�p 511 9°IFS E�G GIs � NO GRO[!Nl Y.YAn'R ENCDUNTEREO CL/ENT 7ONAI /f�c�J ✓G 2 JOle /VtO. $3 3 1 Fr SHEET?OP 45PO No.�!!L_�'_- -- � Fee---= -`"�------------ BOARD OF HEALTH TOWN OF BARNSTABLE ZIppfication-*rVell Cootruction Permit Application is he eby made for a permit to Construct ( ), Alter ( ), or Repair (-)an individual Well at: ow _�'y.,�_/ �aj _/Llu�S7` zi yi,,//----------------------01 - --- ----- -- / ocation — Address As essors Nfap and Parcel 1?6c1C !21/ 3---- ,ti Por .2tG�S(cgn,s Own r Address :j V e --'—--- -- - t= Installer — Driller Address Typeof Building Dwelling__A6uc f-- -- - --— - - - Other - Type of Building--------_____________:____ No. of Persons----------------------_________ i• Type of Well-�---------------------- ----- -- - - Capacity------------------------------------- --- Purpose of Well Q�+^Z� T'c �JaP/_ ----------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the. Board of Health. Signed-•� ------ - ---------- ------------------------------------- A? date Application Approved By--�� `- — date Application Disapproved for the following reasons:-------------------------------______-__________—___—______—_ - ------- - -- ------------ date r Permit No. —--_�- j —'J�-- Issued ---- r✓� -��- -- _;5_ date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of (Compliance THIS IS TO CERTIFY, That the Individual ell Constructed ( ), Altered ( ), or Repaired ( L} Installer at� v S' o.� j.t J /Ld M c,i S jb.ti S /� `/If /-4`v 036 k has been installed in accordance with the provisions of the Town of Barnstable Board of HealthPrivate Well Protection_ Regulation as described in the application for Well Construction Permit No�1/ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-- -- ---- - - -- --- - ------------ Inspector---- ---- -- ----- - No.-------- Fee-------------------- BOARD OF HEALTH TOWN OF BARNSTABLE avVlirat ion Ar Well Conotructionpermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair Man individual Well at: /� ,Location — Address Anss/es-rsf Map and Parcel TD/-4 /t o C 1i J V 'c�S I�z G /'o d ./&-)• 1.. & Owner - Address / Installer — Driller Address ! Type of Building Dwelling- / �� —--- --- --— -- - Other - Type of Building ----- No. of Persons----------------------------------------------- -- Capacity ~Type of Well=�-/-�--------------------------=------------ p Y------------------------------------------------------------------------ Purpose of Well---------------------_---------------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed--___—__ date Application Approved By----� t!'—`' �-� J— ---------date------ Application Disapproved for the following reasons:— --- ----- _---____—— ------------------------------- date - — -- --- Issued - '���`� �' �_ ----------------- Permit No. ----_-------'-`' ------ date BOARD OF HEALTH TOWN OF BARNSTABLE �- �ertifitate=�f �Com�riance � �--- THIS //II�STO`,CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( �) Installer __C_---------------- at-----=---------------� -------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection_ Regulation as described in the application for Well Construction Permit No�!�/�= ���ated LF`--F-91 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE —----- --------------------------------------------------- Inspector-------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Well Co0tructioupermit No. — `� Fee Permission is hereby granted -- to Construct ( ), Alter ( ), or Repair (v) an Individual Well at: No. -- --- --- --- - -- - -�� --------- —=-- - -- -— - - -- -- — Street as shown�on�the applicattii-onn for a Well Construction Permit _ No.- !/�/ c"� t�/ '� - Dated-------' - - -�- -- - - Board of Health DATE —�/--- -- - ---C—�----____ 1 4 r o \ \ \ 40r, O cG 1 ht r� 15 • _ _ asp _ 0 S o to G lC [ � • ' `,f,a o .AFL,,; / Air VC LEGEND s of EXISTING SPOT ELEVATION 0 0 ��� M�ss� CERTIFIED PLOT PLAN k. O�. 6' L U Nc . /ICJ/1/L3 EXISTING CONTOUR --- 0 -- - - " ,. �, .� �oT FINISHED SPOT ELEVATION �Q, FINISHED CONTOUR 0 MORSE ,p No.10951�O I N t j' APPROVED BOARD OF HEALTHF�,sTE�```��`��' /pNA1. r. DATE AGENT SCALEt / (,v DATE' ,- TLDREDGE ENGINEERING CO. IN CLIENT Nv�A�irt -' ` v �y I CERTIFY THAT THE PROPOSED ........... RORERT EGISTERE REGISTERED J08 NQ. 83 -� BRUC;E - UILDING SHOWN ON THIS PLAN _ CIVIL LAND ONFORMS TO THE ZONING LAWS ENGINEER URV Y F Q�����s rat` c c M A S ,. gfi 712 MAIN -STRE-.ET 1 CH, �T a DA E. RED. LAND SURVEYOR ` NYAN;N i S,� MASS "_. � , �' 'k . ; L 4�8�a fi�gg,, . 'fi;r'@5a '� ,.. ;.,; .:, ;.. ..,.. . ., 4 �,::;. .._,.. =i�-;ti ..�.-. :q�kx .Ex,. s �� �� �_,� t ... .. ;.F•:" .. { LEGEND I MARSTONS MILLS PROPOSED CONTOUR ® PROPOSED SPOT GRADE —— 98 —— EXISTING CONTOUR PLO �QQ' + 96.52 EXISTING SPOT GRADE A SCHOOL AS W— EXISTING WATER SERVICE MEI STREET r. TEST PIT ROAD 100 ft FROM WELL � N SCALE: 1"=20' Z LA ESHO ;E!, LOCUS DR. 325 LONG z 618.9 4' _- __ - w POND RD ' Z � ;. 00 O a WELL I 150 ft FRO WELL a FROM WELL o LOC S MAP EAST. 1TANKG 100 ft FR LiLOT 8 - LOCUS INFORMATION t + 98.2 -_-ss-- PLAN REF: LCP 37493-B AREA = 2.07 ac +- y I TITLE REF: CTF# 157285 LAND COURT PLAN 37493-B �� 1{ s O PARCEL ID: MAP 029 PAR. 035 ASSR MAP 29 PCL 35 ; � Z o � ��:, ' FLOOD ZONE: NOT IN FLOOD ZONE I��� _ + 98.5 � ` rO xW a� � , I SEPTIC SYSTEM REPAIR PLAN , � � LOCATED AT: N TH-1 325 LONG POND RD. co w MARSTONS MILLS, MA. o 20 ft - PREPARED FOR O l ' ROBYN RYSHAVY + 98.3 \ DRIVEWAY `\ NOVEMBER 16, 2016 -� � t ss ' � � � OF �Ss + 98.5 .A REP .9�y✓ R r, ---- - 562'27' MNITAR�a� illb� �10 BENCH MARK PAINT SPOT oN PL A', MEYER & SONS, . INC. BULKHEAD CORNER 99. 53 SCALE: 1 i in = 30 ft P.O. BOX 981 uscs DATUM ASSUMED F 0 30 � slo EAST SANDWICH, MA. 02537 0 10 20 30 1 60 PH: (508)360-3311 FAX (774)413-9468 meyerandsonsincOgmail.com F SHEET 1 OF 2 J 1789 I ELEV. TOP FOUNDATION NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS (Existing) BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE FINISHED GRADE (98.50) = 99.98 F.G.EL: 99.0 F.G.EL: 99.0 F.G. EL: 98.50 - J a f- MAINTAIN 27. MIN SLOPE OVER LEACHING AREA .D 3/4" 1-1/2" 2" OF,_3/8" DOUBLE WASHED - F.G.E .: 9 � STONE OR FILTER FABRIC DOUBLE WASHED STONE 7.41 A 6" l 4" SCH 40 PVC 41 10'I 6 ffil ®®®r p ®®®® © S= 1% MIN. ®E3E3E ®®®® ".: TEE'S ARE TO BE 14 INV.95.40 ( ' ) ®®®®®®®®®®® : 4" SCH 40 PVC 2 EFF. DEPTH Eal 3r ®®®®® INV.96.15 I r INV.95.20 > 4 2X8.5 4 1 GAS PROPOSED DB-3 EXISTING OUTLET BAFFLE EFFECTIVE LENGTH = 25' ••• « DISTRIBUTION BOX INV. 96.40 - (1-120) INV. ELEV.= 94.90 EXISTING 1,000 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON �N`� OF 'ass OUTLET TEE AS MANUFACTURED BY BREAKOUT TUF-TITE, ZABEL, OR EQUAL D RRE M TOP CONC. ELEV.= 95.90 ELEV.= 95.90 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING N1 0 INV. ELEV.= 94.9 E3 E3 0 ®® PIPE INVERTS PRIOR TO CONSTRUCTION §3IE3E3E3IE3E3E3 ®®®®®®® 2) D-BOX SHALL BE SET LEVEL AND TRUE TO S1 ®®®®®®® GRADE ON A MECHANICALLY COMPACTED SIX NITAR�aa BOTTOM EL.= 92.90 ®®®®®®® , INCH CRUSHED STONE BASE, AS SPECIFIED IN I l� 3.75 5 FT. 3.75 310 CMR 15.221(2) 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK EFFECTIVE WIDTH = 12.5' WITH 1500 GALLON SEPTIC TANK IF FAILED, SEPTIC SYSTEM PROFILE ' SEPARATION 6.40 FT. DAMAGED, NOT H2O LOADING, OR UNDERSIZED. 4) INSTALL INLET & OUTLET TEES W/ ! BOTTOM OF TESTHOLE EL: 86.5 _ SOIL ABSORPTION SYSTEM (SECTION) GAS BAFFLE AS REQUIRED (500 GALLON H2O LEACH CHAMBER) GENERAL NOTES: 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL LOGS p# 15211 DESIGN CRITERIA BOARD OF HEALTH AND THE DESIGN ENGINEER. DATE: NOVEMBER 15 2016 NUMBER OF BEDROOMS: 3 BEDROOMM LL 2. OF THETHE 8T TD��SAL CODE, TITLE V, AND�APPLICABLE SOIL EVALUATOR: DARREN MEYER, R.S., CSE #1614 SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/SF) LOCAL RULES AND REGULATIONS. WITNESS: DAVE STANTON, BARNSTABLE HEALTH DESIGN PERCOLATION RATE: <2 MIN/IN 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFlLLED PRIOR DAILY FLOW: 110 G.P.D. X 3 BR = DESIGN FLOW: 330 G.P.D. TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. Elev. TP-1 Depth Elev.- TP-2 Depth GARBAGE GRINDER: NO (not designed for garbage grinder) D 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 98.50 0" 98.50 0" SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXISTING•1,000 GAL. SEPTIC TANK FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN A LOAMY A SAND ENGINEER BEFORE CONSTRUCTION CONTINUES. tOYR SAND i L0� SAND =5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 98.17 4" 98.17 3/2 4" LEACHING AREA REQUIRED: (330) 445.94 S.F. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF B LOAMY SAND ' B -74 THE HEALTH FOR CONTRACTOR ROPER INSPECTIONS DURING CONS TO NOTIFY THE TRUCTION. OF 10YR 5/8 ' LOAMY 1 SAND HEALTH 97.50 12" 97.so 12" USE TWO (2) 500 GALLON PRECAST H2O LEACH CHAMBERS W/ 4' 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. C SANDY STONE ON ENDS & 3.75' STONE ON SIDES: 25' L x 12.5' W x 2'D ' 8- ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED LOAM C tOYR 6/6 TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 10YR 6/6 LOAM BOTTOM AREA: 25 x 12.5= 312.5 SF 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE 94.92 43" 94.92 43" THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CZ SIDE AREA: (25 t 12.5) X 2 X 2 = 150 SF CONSTRUCTION. MEDIUM MEDIUM TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. SAND 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 2.5Y 6/4 2.5Y 6/4 DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY 86.50 144" 86.50 144" PROPOSED SEPTIC SYSTEM UPGRADE PLAN AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 13. NO PRIVATE WELLS WITHIN 100' OF PROPOSED LEACHING. PERC RATE <2 MIN/IN. ('CD' HORIZON) 325 LONG POND ROAD, MARSTONS MILLS, MA 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. NO GROUNDWATER OSSERVED 15. ALL PIPING TO BE 4" SCH 40 O 1/8-/FT (UNLESS SPECIFIED) Prepared for. R shav Engineering and Survey by: SCALE DRAWN ' DATE • I. Domes M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 MEYER&SONS,INC. N.T.S. DMM 1 1/16/16 to conduct soil evaluations and that the above analysis harr been performed by me consistent-with the PO BOX 981 roquirementa of 310 CMR 15.017. 1 further certify that I hove passed the Soil Eval. Exam in October, 1999. EASTSANDW/CH,MA02537 REV- DATE CHECKED SHEET NO. 508 W-29V DMM 2 of 2