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0115 LOVELL'S LANE - Health
yy')� rS�drJ� t LL S' i i TOWN OFBARNSTABLE LOCATION //S— to v2 (S C.c.n< SEWAGE # VILLAGE 14 gn inn s 7 ASSESSOR'S MAP & LOT 7 INSTALLER'S NAME&PHONE NO. `:'-e W t a4 SEPTIC TANK CAPACITY poo Sa LEACHING FACILITY: (type) /n�• f'�'�-�r (size) /! X 310 NO. OF BEDROOMS 3 BUILDER OR OWNER J C—tW5 N-C(La r S Q PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility N6 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) do Feet Furnished by T� i(JA �'uQ�'�"t ct o as: o 8 3 1 -7 ga a�. o c. � `� ' • � THE rgsti o� Town of Barnstable ��ASS Inspectional Services Department %6.39• �0 Public Health Division 200 Main Street, Hyannis MA 02601 1 homas A McKean,Clio) (grIce 509-802-4644 FAX 508-790-6304 Feb 6, 2007 Rev. 4/26/19 ' DEADLINE S TO REPAIR FAIL SYSTEMS FAILED (Town Code §360 44 failurd Title e criteria.and asso R ( 00) ated repair deadline An "x" marked in the ❑ is t he 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. gg ed SAS or cesspool ❑ Backupof sewage into the house due to an overloaded or clogged ❑ Structurally unsound septic tank or SAS ONE I) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS; cesspool; or privy is below the high groundwater elevation ion of the cesspool is located within a Zone 1 to a public well ❑ A port well c A portion of the cesspool is located within T111 feet stem of a passes f the watersupplyivate water analysis with no acceptable water quality 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 driveway due to H-10 components; etc) Leaching facility with standing. liquid level at or above the invert pipe (per Town Code §360-20 h) OT R Repair deadline:_ I �'�"�------_ ----------- QASEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 115 Lovell's Lane Property Address D.Mahoney Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/14/2021 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information Sl # 13 a- on the computer, use only the tab Chad Hathaway key to move your Name of Inspector cursor-do not Hathaway Septic Inspections use the return Company Name key. P.O.Box 151 r� Company Address Forestdale Ma 02644 AA City/Town State Zip Code 774 274 2581 12866 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ® Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 4/14/2021 Inspectors Sign Date The system inspector shall s it a co.• of this inspection report to the Approving Authority(Board of Health or DEP)within 30 s ompleting this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. iPlease note:This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7r2612018 TiUe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts �- - R Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 115 Lovell's Lane 1 Property Address D.Mahoney Owner Owners Name information is required for every Marstons Mills Ma 02648 4/14/2021 page. City7rown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ® One or more system components as described in the"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): 1000 gallon septic tank has heavy decay especially on outlet end of tank. roof of tank has rotted through 2/3 of the way through with clear rust line showing. Concrete below rust line flakes off. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 115 Lovell's Lane Property Address D.Mahoney Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/14/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ® Y ❑ N ❑ ND(Explain below): I I The system required pumping more than 4 times a year due to broken or obstructedpipe(s). The ❑ Y q P P 9 Y system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 115 Lovell's Lane Property Address D.Mahoney Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/14/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 115 Lovell's Lane Property Address D.Mahoney Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/14/2021 page. City(rown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but_greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .�, 115 Lovell's Lane Property Address D.Mahoney Owner Owners Name information is required for every Marstons Mills Ma 02648 4/14/2021 page. Citylrown State Zip Code Date of Inspection C. Inspection. Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the.previous two.week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ 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)] t5insp.doc-rev.7126r2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 f Commonwealth of Massachusetts ►� - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 115 Lovell's Lane Property Address D.Mahoney Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/14/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. 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 Description: pe asbuilt 4 Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date T t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 i Commonwealth of Massachusetts 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 115 Lovell's Lane Property Address D.Mahoney Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/14/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding.tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: owner pumps every few years Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 115 Lovell's Lane Property Address D.Mahoney Owner Owners Name information is required for every Marstons Mills Ma 02648 4/14/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: tank older 70s or early 80s leaching and Dbox upgraded 10-15 years ago Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 1.5' feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 30+ feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts w, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 115 Lovell's Lane Property Address D.Mahoney Owner Owner's Name information is required for evert Marstons Mills Ma 02648 4/14/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) H 10 1000 gal If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ® Yes ❑ No Dimensions: 8'x5' Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 24 311 Scum thickness Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? tape and sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tees in pace. tank has heavy decay worst on outlet end of tank. 2/3 the way rotted through. defined rust line in concrete with concrete below line flakes off. tank is a risk of blowing in through ceiling of tank and should be replaced t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 115 Lovell's Lane Property Address D.Mahoney Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/14/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: j Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 f Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 115 Lovell's Lane Property Address D.Mahoney Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/14/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Camera'd inspected clean with no carry overs. no major decay at working level t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 I c Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 115 Lovell's Lane Property Address D.Mahoney Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/14/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: infultrators11'x36' Elleaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 F Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 115 Lovell's Lane Property Address D.Mahoney Owner Owner's Name information is required for ever/ Marstons Mills Ma 02648 4/14/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): located inspection port. btoom of Chambers have healthy bio layer. no ponding at time of inspection. system has normal use with 2 adults and 2 Children at time of inspection 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts �tl Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L 115 Lovell's Lane Property Address D.Mahoney Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/14/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): G t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form <� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 115 Lovell's Lane Property Address D.Mahoney Owner Owner's Name information is required for every Marstons Mills Ma 02648 4/14/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately I I FC) 3 C) O 2 5' Az t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form j' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 115 Lovell's Lane Property Address D.Mahoney Owner Owner's Name information is required for every Marstons Mills . Ma 02648 4/14/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depths to high ground water: no water at 11' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: as built 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: per asbuilt that referenced plan .no GM at 11' bottom of SAS 5' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 17 of 18 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 115 Lovell's Lane Property Address D.Mahoney Owner Owners Name information is required for every Marstons Mills Ma 02648 4/14/2021 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7f26f2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 18 of 18 YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates COST $30.00 for 4 years. A Business Certificate (WHICH YOU MUST DO BY M.G.L. - it does not give you permission to operate). You mu st first at 200 Main St., Hyannis. Take the completed form to the Town r ONLY REGISTERS YOUR NAME in the Town Clerks Office, 1'' FI., 367 Main SttaHyannisin the eMA 02601(Tcessary o��es on this form the Business Certificate that is required by law. n Hall) and get ` Fill in please: �tl APPLICANT'S DATE: M� U YOUR NAME: L '+ i- �,( l,1= --- Y.. :;,, �� I �j YOUR HOME �rD,RSS: �TELEPHONE # Home Telephomber: NAME OF NEW.BUSINESS i�j(�-��� IS THIS A HOME OCCUPATION? TYPE OF BUSINESS Have you been ,ven a ----YES V NO + g approval Have from the buildin division? YES ADDRESS So L6, _ NO `I �����j1~ Lr MAP/PARCEL NUMBER When starting a new business there are several things you must do in r / O �� Barnstable. This form is intended to assist you in obtaining the information order tobe in compliance with the rules and regulations of th Yarmouth Rd. & Main Street) to make sure you have the appropriate permits oand licenses r e Town of Y You MUST GO TO 20t Main St. - (corner is of mown. required to legally operate your business in this ` I. BUILDING CO.N ISS10 ER'S OFFICE This individ al h b e irid-or e fan per it require ents that pertain to this type of business. COMMENTS: J ut orized Sign to CAM 2. BOARD OF HEALTH This individual has'be n infor f t ed rm't requirements that pertain to this type of business. c:a Authorized Signature** o COMMENTS: t' -n --.] C" 3. CONSUMER AFFAIRS (LICENSING AU HORITY) This individual has n inyor e f he licensing requirements that pertain to this type of business. 0 YP � uth rized W M COMMENTS: ure� � e ` TOWN OF BARNSTABLE LOCATION //S— to vQ /Jr C an< SEWAGE # VILLAGE ASSESSOR'S MAP & LOT 17 INSTALLER'S NAME&PHONE NO. w t dt C r` - P?14 a 8 you SEPTIC TANK CAPACITY �OQO S"l LEACHING FACILITY: (type) I A F. i f'�'a-�r' (size) NO. OF BEDROOMS 3 BUILDER OR OWNER J a.MCS (,n.c((e r ;�;Q I PERMTTDATE: COMPLIANCE DATE: i Separation Distance Between the: ' nn I Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility IvO Feet Private Water Supply Well and Leaching Facility j PP Y g ty (If any wells exist on site or within 200 feet of leaching facility) /`O Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) 1Vo Feet Furnished by 61 f Pf,)i>q t5h4 ?[?A, "t G a g � a AY, ° g 5 Aa ag.(, 3 3 1 " ga a�. o C- 4 `fl � r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 115 Lovells Lane Property Address James Miller Owner owners Name information is, required for Marstons Mills, Ma. 02648 8/23/2010 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key l�/ to move your Raymond Dumas cursor-do not Name of Inspector use the return key. Dumas Landscape Const. Company Name ffi 564 Old Stage Rd. Company Address Centerville, Ma. 02632 Cityfrown State Zip Code 508-778-0249 S1437 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 t ❑ Needs Further Evaluation by the Local Approving Authority _ 8/23/2010 Inspe s Sig Mature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. w . ****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. I I �A In lV t5ins•09/08 Title 5 Official Inspection Form:Subsurfacei,. age Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ;M 115 Lovells Lane Property Address James Miller Owner Owner's Name information is required for Marstons Mills, Ma. 02648 8/23/2010 every 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-09/08 Title 5 Official Inspection Form: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 � 115 Lovells Lane Property Address James Miller Owner Owner's Name information is required for Marstons Mills, Ma. 02648 8/23/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form: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 115 Lovells Lane Property Address James Miller Owner Owner's Name information is required for Marstons Mills, Ma. 02648 8/23/2010 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 115 Lovells Lane Property Address James Miller Owner Owner's Name information is required for Marstons Mills, Ma. 02648 8/23/2010 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ E 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 i 1 r I than g ts equal too less t o 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-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System^Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 115 Lovells Lane Property Address James Miller Owner Owners Name information is required for Marstons Mills, Ma. 02648 8/23/2010 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® 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-09/08 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 115 Lovells Lane Property Address James Miller Owner Owner's Name information is required for Marstons Mills, Ma. 02648 8/23/2010 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 1000 gal 2010 g ( y g (gp ))' 39000 gal 2009 Detail: House was being rebuilt 2009-2010 Sump pump? ❑ Yes ® No Last date of occupancy: 2008 Date CommerciaUlndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts 4 Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ;M 115 Lovells Lane Property Address James Miller Owner Owner's Name information is required for Marstons Mills, Ma. 02648 8/23/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 2008 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•09108 Title 5 Official Inspection Form:Subsurface Sewage.Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 115 Lovells Lane Property Address James Miller Owner Owner's Name information is required for Marstons Mills, Ma. 02648 8/23/2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: System upgraded 5/2005 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 24"feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line. 24 feet Comments (on condition of joints, venting, evidence of leakage, etc.): look good Septic Tank(locate on site plan): Depth below grade: 10" inches 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: Sludge depth: t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 115 Lovells Lane Property Address James Miller Owner Owner's Name information is required for Marstons Mills Ma. 02648 8/23/2010 every 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 none Scum thickness none Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? tape measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): pumping not needed at this time 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Fora c Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 115 Lovells Lane Property Address James Miller Owner Owner's Name information is required for Marstons Mills Ma. 02648 8/23/2010 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.): pumping not needed at this tme tees in good condition 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts ugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 115 Lovells Lane Property Address James Miller Owner Owner's Name information is required for Marstons Mills Ma. 02648 8/23/2010 every page. City/Town 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 at level 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.): level and no sign of leaks Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes . ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: located on site plan on record t5ins•09/08 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 115 Lovells Lane Property Address James Miller Owner Owner's Flame information is required for Marstons Mills Ma. 02648 8/23/2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: 4 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology. infilltrators Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): all good 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•09/08 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 47N 5 115 Lovells Lane Property Address James Miller Owner Owner's Name information is required for Marstons Mills Ma. 02648 8/23/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) j Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): all good 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 115 Lovells Lane Property Address James Miller Owner Owner's Name information is required for Marstons Mills, Ma. 02648 8/23/2010 every page. Cityfrown 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-sketci in the area below ® drawing attached separately t5ins•09/08 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 115 Lovells Lane Property Address James Miller Owner Owners Name information is required for Marstons Mills Ma. 02648 8/23/2010 every page. Cityrrowm 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: 33.4 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 5/9/05 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: info on file ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: info on file at BOH Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 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 ;M 115 Lovells Lane Property Address James Miller Owner owners Name information is required for Marstons Mills, Ma. 02648 8/23/2010 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Nay. 3. 2010 2: 16PM k 75'5 P. 1 Garnick & Scudder, P.C. ATTORNEYS AT LAW 28213AIUSTADLE ROAD GERALD S.GARNICK HYANNIS.MASSACHUSMS 02601 LOIS M.FAWNER JOYCE W.SCUDDER (508)771-2320 PAUL 1.ATTI:A PAX!(508)771-3304 FACSIMILE CODER SHEET . TO: Thomas McKean Barnstable Health Department PAX: 508-790-6304 FROM: Paul J. Attea, Esq. Number of Pages Including Cover Sheet: 3 DATE: November 3, 2010 RE: 115 Lovell's sane, Marstons Mills,Na 1 OUR FUX NO.: 18393 MESSAGE: Tom, Attached please find a copy of the UST investigation completed at the above- referenced property. Please advise if filing this letter with the town brings the property into compliance with Town ordinances. Thank you.. **If you do not receive all of the pages,please call(508)771-2320x16 and ask for Claudia.** This transmittal is intended only for the use of the individual'or entity named above. It may contain information which is privileged and/or confidential under applicable law. If you are not the Intended recipient or such recipient's employee or agent,you are hereby notified that any dissemination,copy or disclosure of this communication is strictly. prohibited. If you have received this communication in error,please immediately notify ult , at 508-771-2320 and return the original transmission to us by mail,without making a copy. ^Iov INov, 3. 2010 ; 2: 16PM )BERLATIDI S083750023 No. 15'5 P. 7! 1 •.4 BENNETT]I ENvutoNm - ASSOCIATES9 INC. WCENSE0 51Tz rgonSSIONALa J ENVI"NW914TAL.SVENTliM A 010Lball t1 & tNUINFLRB 1873 MR 1743,BrrweW,MP►O2651 0 908.5W706 G Fak sae-s68-stos 6 wwvrbennek�d,�om D�AlO-lozso NNavemba 2,2010 Tull Retttovel$ewlaee Wapo Cod 58 Wow SL Hyi=h,MA 02 01 . RICr UNDERGROM STORAGE TAM(M)TNVZST 04TAO,}� ?'Odb udel I'to y 11 S Ldv4U'a Lanai IVCaT9W M111j6 MA. Deu MM Mili T, on umber 24 Pi0Booaax Eovlmndaeneal Aeeccistas, Taw. (BBA)pmWQyW VWa at the abave�reeaea per'to.P400 o� apv MMn�=Vd ,$fit eat vWu roWed to tlwa eppaxvnt 'pereugoed-,naval ofa 50�D-goo fi�e� i1 Wd a�cBe taJt(UM. 'fie pwpow of tie i:rvoatf'Oon was to d uaa i �rso►ar'tw�dc w petroleum to the s�tbau�ace, pact aolie. nbuedlala,tbA"writ: ft .000po of the fo=tk inoiuded*g t=inuj:godpW£op!�atd tba i Dn 0f R Soil vapor pout ip RI Un Jan off too 3tea18 i4 and,of f#ae sub ct d $� upon a ival at the prOQectY� BEh pex3Ma1 obu be oeppar�itvea'euad�1 vapor pointwi�i0 a 10'iar>S x 8'v,dfla x 6"deep mcaavalloas. r Satnpla9 dFflatlVe 1#4vroM4a11����in�a8�1��st4XION of ?h�e Bnv[ra�e MO& 5 rho apparent t ddeotdr (PD) by ja"ehWA ° method. No oancearadOM of MadBl SBOB phatobo� 0FWj4 vapa" were dolootta (ND) above buokgw6d 40 t"daw (0,3 PPM) '"ny of the ASMOIee co 1MA ,A,,composite eo11 ogle of eenh of 16 fow eidMile(SW COOP-2+6')tub R =Via hate thobattow of hale ores(0 1_ V,)wets BW)MItM4 to a MA oeriifxed labonttety�r total peom�A(T ay . I $OJct+txuY aeelytiee!rea" raceLved *A INoveaber 1, 2010 tapoftd na oon"MdOw 0i TP 1 abow the m&od deteayan ivaite Of the MWAII,VAW&SU of'"MP%dna 11:mite.U0 well below the'appticobie RCS-1 ROM MO COOponWoa(IAA )to well as the Mo!R BWgVnt a•11GW-1- MotbA S r. Risk Mo dt6ndoa sltruaW (100oo aSBl1c8). As such, no ovldcam of egvlr0M4ftW-IM""Pci4W with the Ibrmer USX has barn doomnted at the location toaw end �o rrmuediel reepvt►$o lte�ii� under J10 CjdR 40.000 ill ANUM. t EnAGRs6�8N4ER � 8 VVl18ft;$♦1j GI.EIIMv h 91T!mmmew 6 pou1h1�11',CPOFgA`710N 6 NWMON vt+rsA gUppCroeveta�n,at�r+no+aee�u� 0 Received Time Nav, 3. 2010 11:21AM No. 7509 Nov 'Nov, 1 2010. ; 2: 16PM BERLANDI 50837SO023 b. 75.5 P. 31 iN[)V-3•-P610 10114A FROMTOi1508�758Q37 rA�OW!boa A+!usl cv{V An:au nuddYwllf� taoyBl�e�r.�,9G[8 7tE5CC-NJFMlUbRR�iDBNCg-ths'C� ��� PAM 3 oP: Notwlsbetao�ioF1 fWS faawW jnvadgatlon ShOUid not ba aonshWA to Md all requ�t�Dlare�or L"Dua� Diligawar area ofaB �n vAth"all ��� implied Bte �widwut t�azbsl . ions or dmrminsdoos bgYond tlu sovestl�tion, IfYOU Uve UT queetiom reguft&b fAvastigwon or requlrc t►ddltial>ad � plow Wnwt Ve at Yom earliest convabim• BENT�TT y�pMM0 ,e fi80CL�,TEB,IIr1C. 70 d! o�� aBCr D Q p• pall EuoL GrOUA AM A,o►alY6951 I.AMtotxo6—R0p°tt(11/112010) notOWM W Cc, COMM Firo Dolt Received Time Nov. 3. 2010 11:21AM No. 7509 Town of Barnstable �tHE Tp��o Regulatory Services Thomas F. Geiler, Director • anexsenai.E. 9� MAS Public Health Division �Ee 3+0. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 5/11/05 Designer: _Shay Environmental Services, Inc. Installer: Capewide Enterprises, LLC Address: P.O. Box 627 East Falmouth Address: P.O. Box 763, MA 02536 Centerville, MA On 5/10/05 Capewide Enterprises, LLC was issued a permit to install a (date) (installer) septic system at 115 Lovell's Lane, Marstons Mills, MA based on a design drawn by (address) i Shay Environmental Services, Inc. dated 05/09/05 (designer) XX 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 accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. 1 N Of Mgss9c o� CARMENe-T o� E. (In ller's Signa ure) SHAY No. 1181 �'�'G/STERCa a&aun 4\ T4 EO SgNI TAR\P� x. esigner'sSignature) Z,,l (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 1 \ 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems.Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM d r ew ,hereby certify that the engineered plan signed by me dated 0" 0 3 concerning the property located at --1 53 \\`3 tN1-3 e �i- 1L1;\\S meets all of the following criteria: 9 This failed system is connected to'a residential dwelling only..There are no.commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or.may conduct deep test holes and percolation tests at-the site without a health agent present. • There is no increase in flow and/or change in use proposed t There are no variances requested or needed. The.bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) Cal.C B) G.W.Elevation +adjustment for high G.W.'� _ , Q_- DIFFERENCE BETWEEN A and B .G} SIGNED DATE: ICI 0 NOTICE Based upon the above information;a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. gASeptrc\perceXMw.doc Permit Number: Date: Completed by: HIGH GROUNDWATER LEVEL COMPUTATION Site Location: .S L-nI-C���.5 `:�iNt �-(. M+ 1�j Lot No. Owner: Q Address: � b4 Contractor: a !1, ) \.� Address: Notes: '� \j \��`'o� STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date month/day/year STEP 2 Using Water•Level Range Zone and Index Well Map locate site and determine: 30 Appropriate index well................•.•.........•....................... �S3 0 Water-level range zone ••......................•........................ . STEP 3 Using monthly report "Current Water Resources Conditions determine current depth to water level for index well ........•.....•.....•...... 4 49. month/year STEP 4 Using Table of Water level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 26) determine water-level adjustment ..•..•,•••„•••„•.. 3; ..................... ......................... STEP 5 Estimate depth to high water by subtracting the water• level adjustment (STEP 4) from measured depth to water level at site (STEP 1) ...............................•..••.•. ............................•................... Figure 13.—Reproducible computation form, 15 • _ I TOWN OF BARNSTABLE LOCATION //S— In uO Ji s C a.n< SEWAGE # VILLAGE /- Yc 4gn,s ASSESSOR'S MAP & LOT 7 INSTALLER'S NAME&PHONE No. Cape w t oQ C r,4- So 8'f a yak F SEPTIC TANK CAPACITY POO LEACHING FACILITY: (type) Ili r. f (size) _ // X .,'lo NO. OF BEDROOMS 3 I BUILDER OR OWNER Tn.W5 (\n.t((Ar Q PERMITDATE: COMPLIANCE DATE: Separation Distance Between the:Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility N n0 � Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) /`O Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300.feet of leaching facility) yo Feet Furnished by 6a J 4 6'4�QA'" t C O � a S 5 3s.3 a � 31Lt C. 4 No. Fee oho THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for 33igpogar *pgtem Construction Permit Application for a Permit to Construct( , j Repair9Q Upgrade( )Abandon( ) ❑Complete System dividual Components Location Address or Lot No. j= I 1 s LouF_WS LA Nv Owner's Name,Address and Tel.No. M.ice.t i S t Pit 1 -T.-A M-e n, Assessor's Map/Parcel � M Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. CAPE Wi)S F.k-3`Isue-Z�S SHAY ��>fLrrnirnE�i�9i. S�fCS 4A15 --4A©a8 +91Q(o Type of Building: �P Dwelling No.of Bedrooms Lot Size 14S,8C&q.ft. Garbage Grinder Other Type of Building tl)IJ No.of Persons Showers(f Cafeteria(A Other Fixtures Design.Flow gallons per day. Calculated daily flow 3 "�? gallons. Plan Date �1 Jb S Number of sheets I Revision Date Title lac tsg,oskgC 5�Gce nC2, CSKe --t>iS(mci lsCa sue► Size of Septic Tank 9--.)t 1 Sr, f , ©OCR Gam, A CType of S.A.S. ' V 4. t,u�►iTea�-u2s Description of Soil a Q X— of LgC, Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreeinent: r 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 Board of Health. Signed Date S- 110 -2,1ba4' Application Approved by 1N16U. Date Application Disapproved for a following reasons Permit No. 2,uC i—/17 Date Issued 5--(d _0S at!• It ~ � � K� � � -4.�' a - nt� ..Y. ;' . .. '7nvS=I �7`7 ! ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer; Yes PUBLIC HEALTH-DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYicaf on for ]3i2;pogal *pgtem Congtruction Permit ' Application for a Permit to Constrict \pp' ( )Repair )Upgrade( )Abandon( ) Complete System�dividual Components Location Address or Lot No. *t: I,I 5 LoVF u2 S LA r4c Owner's/`Name,Address and Tel.No. Assessor's Map/Parcel Q p ��'� Q� 1 ��7 ��ME S, '".� / �•o { yam, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. t✓PPE W tQ 6 �N TE2P2�SE.S rj>+sx� 'E�1v'2on1MrEv'FW,S.-t���S 4Ab L40aB 53ei. Type of Building: Dwelling No.of Bedrooms 3 Lot Size 451 RcSsq.ft. Garbage Grinder Other Type of Building /\IOtl E No.of Persons S Shgwe rs(i/)Cafeteria(A Other Fixtures ' Design.Flow 3 gallons per day. Calculated daily flow 3 I'-y' � gallons. Plan Date 51914)S Number of sheets ,/ Revision Date- Title po.= h SJ1oSc�C �GCa Spt.�ccP �tS c,\ Sc,S1irri< Size of Septic Tank s i I , 0 G i-�-�A M; Type of S.A.S. 11 ' x 2,(" 't'RENCti'' -. 4 1 rJ411.'C Ei47'�S f"t Description of Soil�'sar _Vg,tT-,\0 C�, Y Nature of Repairs or Alterations(Answer when applicable) ' ��pc.c- 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 Board of Health.. 1 Signed tC C Date S- 10 '2tio Application Approved by - Date �-/J—Q Application Disapproved for he following reasons t Permit No. 20 d t""'—/0/7 Date Issued /d Us Y _t THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance �a THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded(�14j_ Abandoned( )by at 1 t 5- C��<s1 S 1_ ,,, ILI d-g s o has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ?Q.d —15-7 dated 57— /,,J=US-- Installer �Cc�2 ��34�� Designer The issuance of this permit shall not be construed as a guarantee that the system w;11 n i as designed. Date �� S Inspector i �4, No. .200_: I CI'7 Fee �3l U — THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS rigpogaf *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade)Abandon( ) System located at 11,5 L t14,2.c mnc m l I S 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)..; *he completed within thrce years of the date of this permit. Date: .� //a /—��. Approved by_ 2✓ _ ((_`� orr� `__ l I No. 4 c1 ' Fee go--✓: ` computer: Entered.in +� THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 2pplication for 30iopozal *p!tem. Construction Permit =' Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) ❑Complete System individual Components Si Location Address or Lot No. 1 IS— LCAJF LL'S t-A NC Owner's Name,Address and Tel.No. M:t✓i;i i s , f�i� ?,a C-e- Assessor's Map/Parcel 5A t"1 c c� (DC3 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -6 4,4'e' SZc:rJ ,E,.s ►�L QCS 4 Type of Building: Dwelling No.of Bedrooms 3 Lot Size 45 AGsq.ft. Garbage Grinder( - Other Type of Building DNS No. of Persons S Showers( -v-")' Cafeteria(�) Other Fixtures ' Design Flow .330 gallons per day. Calculated daily flow. 3 `'�' gallons. Plan Date /b S' Number of sheets f Revision Date Title �,Gce �Q,_,: s�g Size of Septic Tank Ex i 5 i GC7 Gn A cn Type of S.A.S. iI ` ,+t 3c�' Tit v�vr✓c� 5 Q in1� �TeAT� Description of Soil : A:!L. t?i c _� Nature of Repairs or Alterations(Answer when applicable) L — i `{ Date last inspected: } Agreeinent: The undersigned agrees to ensure the construction and maintenan m in accordance with.the provisions of Title 5 of the Environmental Code------- � '� t- cate of Compliance has been issued b s Board of Health. l % CL✓�'!..._:_. ., Signed — Application Approved by Application Disapproved for Yhe following reasons Permit No. u Cl.,i/q 7 - --- J r`_�- W THE COMMONWEALTH OF MASSACHUSE S BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired ( )Upgraded Abandoned( )by t S't-� at 1 T l.d mitt S L�....� 7 rt~✓tsS�.v+1 �"'�� l�� has been constructed in accordance with the provisions of Title 5 and thqjfor Disposal System Construction Permit No. Uu�_l 977 dated Installer Designer The issuance of this pe t sha 1 not be construed as a guarantee that the stem jhs designed. Date Evil /15 Inspector J ]� S 1, No. 200 I C4 7 _ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS 3Digo5al 6pgtem Con.5truction permit Permission is hereby granted to Construct( )Repair( )Upgrade )Abandon( ) System located at 115, 4,7 c tv n�,. 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:Constru tion�:.; he completed within t>sce,years of the date of this permit.�' ,. 2S Date: S %6 / v Appoved'oy_ �11J No. 0 r) Fee-A10 12- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for Ziopooal Opotem Con!gtruction Permit Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) ❑Complete System>4ttdividual Components -Sf Location Address or Lot No. L0Uru5 LANE Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. C ?Ec� �7b zra Tc�2Pe�5 S j1+A� -J'4Z -tam EN�-Tv)t_ SACS 5,39 Type of Building: Dwelling4 No.of Bedrooms 3 Lot Size 4 t 8g sq.ft. Garbage Grinder( - Other Type of Building _ No.of Persons J Showers( ✓) Cafeteria(�) 30 Other Fixtures in. Design Flow 3 —gallons per day. Calculated daily flow 'fir P Y Y � �'� -gallons. rc Plan Date �� cl/Cs 5' Number of sheets Revision Date 2! Title 6b5u� Size of Septic Tank 5`r. 1 1 000 2 S1, —Type of S.A.S. ii ` >c L�,ial �-rQeN6.i� 35 v" 4 ]n 4i;7t L P-A TL ZS Description of Soil ., , Qi S' { E Nature of Repairs or Alterations(Answer when applicable) -RQ Q;,- Date last inspected: Agreeinent: 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 b s Board of Health. Signed Date S- 110 'ZA c Application Approved by ,,j (ZS Date Application Disapproved for Yhe following reasons Permit No. 2 u a i-//7 Date Issued US THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired ( )Upgraded(044 Abandoned( )by Aar+�4 0- JaIA&a(k-1.e.- at 4�T L4-,c%l Lam„: �,tsr,v;� •�►•����` has been constructed in accordance with the provisions of Title 5 and tholfor Disposal System Construction Permit No: 2.0o. -15 7 dated Installer a Designer The issuance of this permit sha 1 not be construed as a guarantee that the stem o as designed. Date Inspector k4cl ✓ rSsIvp ed Q /eftwe Cl (I,— � e C � No. �UD'S �� - - Fee 10 U -? THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS I� Ogar *P!5tem Cow6truction permit Permission is.hereby granted to Construct( )Repair( )Upgrade )Abandon( ) System located at 115 N 1 S ( a 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,�..;,�he completed within t>zce years of the date of this permit. !� � P Date: 5 r !v ' PP�oved b,A v t Town of Barnstable �tHE Tp�� Regulatory Services '1 Thomas F. Geiler,Director 9 MASS. Public Health Division 1639. �0 iOrEn�►+°i Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 5/11/05 Designer: _Shgy Environmental Services, Inc. Installer: Capewide Enterprises, LLC Address: P.O. Box 627 East Falmouth Address: P.O. Box 763, MA 02536 w, Centerville, MA On 5/10/05 Ca ewide E me rises LLC was issued a permit to install a (date) (install r) septic system at 115 Lovell's Lane Marstons Mills, MA based on a design drawn by (address) Shay Environmental Services, Inc.. dated 05/09/05 (designer) XX 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 accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. ZH Of MASO o� CARMEN y�N o E. (In ller's Signa ure) U SHAY N No. 1181 SANITAR\Pa esigner's ignature) (Affix Designer's Stamp Here) \ PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS BUILT CARD ARE RECEIVED BY THE BARN STABLE PUBLIC'HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form l I. t / TOWN OF BARNSTABLE LOCATION //.S— /o uQ C an.c SEWAGE # VILLAGE_� ASSESSOR'S MAP & LOT 7 INSTALLER'S NAME&PHONE NO. Ca-oe w e o14 C,4- SEPTIC TANK CAPACITY LEACHING FACILITY: (type) /n F. (f►�o-�r j (size) /! X J(o NO. OF BEDROOMS 3 I BUILDER OR OWNER J Q-W5 �(� j PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility NO Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) /`a Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility H ) � o Feet Furnished by ��'>7 7i t G'KZ?A"" h 0 g5 3 3 31 a-7 ga a�. o C. 4 `f1 . � C a�, i 079 o 6 900,';' CF THE Town of Barnstable AR MASS.LE, ' Board of Health 16 ,39.orA`� P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 503-790-6304 Ralph A.Murphy,M.D. Sumner Kaufman,M.S.P.H. To: MILLER,JAMES O JR& Date Monday,March 05,2001 MILLER,MARGARET P 115 LOVELLS LANE MARSTONS MILLS MA 02648 RE: Underground Tank at 115 LOVELL'S LANE C Map/Parcel 078069008 Tank NO: 02 Tag NO: 01270 The Town of Barnstable Public Health Division records indicate that your undergroud or chemical storage tank is 19 years of age,and has not been tested as required under section 07:(5)of th health regulation regarding fuel and chemical storage systems. You are directed to have each tank and its piping tested within thirty(30)days of the receipt of this notice. Results of the testing shall be filed with the Board of Health and the Fire Department. You are reminded that you shall have the tank and its piping tested during the loth,13th, 15th, 17th, and 19th year after installation,and annually thereafter. Failure to comply with this order may result in a fine of up to$300.00.Each day's failure to comply with an order shall constitute a separate violation. You may request a hearing if a written petition requesting same is received by the Board of Health within ten(10) days after this order is served. Per Order of the Board of Health Thomas A.McKean, RS, CHO Health Agent L ���1 ���� �1���� ��� � �� � a� ; Z � ���� a TOWN OF BARNSTABLE' j UNDERGROUND FUEL�AND CHEMICAL STORAGE. REGISTRATION tt MAP NO. 6-7 q PARCEL NO. ADDRESS OF TANK: 5 -1�U4.�R� �Gl i'1�/ VILLAGE: i` 1a�5ly-n Number - �tr�st MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : }OWNER AMEe� Ja6lE�S .�- �/ q�j,(Q, 1Vt t �.r PHONE: 7a C� INSTALLATION DATE: BY: I"lSTALLER ADDRESS: CERT.NO. *TANK LOCATION: [_ .61e NeAp, Mani QF+ House. (ORMORIas TANK LOCATION WITH R=0"KCT TO HUILOSNO) CAPACITY Q 61a TYPE OF TANK 01*L- AGE ILYRS4, FUEL/CHEMICAL 1 ` TESTING CERTIFICATION C � PASS [ ]-FA DATE Y�+ LEAK DETECTION [ ] CHECK `IF- N/A TYPE/BRAND ZONE OF CONTRIBUTION [ ] YES C NO DATE TO BE-:,'REMOVED. . FIRE DEPT. PERM T) ISSUED [ ] YES C ] NO ��ti DOTE tA. CONSERVATION k I CHECK IF N/A DATE BOARD OF HEALTH TAG NO. C ] DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK -OF THIS CARD TOWN OF BARNS T ABLE,4_ CUNDERGROUNO"FUEU PNbC-,HE.MICAL STORAGE REGISTRATION MAP NO. t. PARCEL NO. ao n _ ADDRESS OF TANK: VILLAGE: 10 f'5 NLAmkomp— r-�dw ft .MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : *OWNER NAME1, i PHONE: ,INSTALLIATI'6N DATE: - l h l BY: INSTALLER ADDRESS: CERT.NO. *TANK LOCATION: Lex-T -6leteN,, WeAf, o u s e-, (0M0CRZ=K YANK LOCATION WITH PRKOF-KCT TO 0UXL_0XNW) CAPACITY )or) �,Ja JYFE OF TANK of AGE YRS"i-- FUEL/CHEMICAL TESTING CERTIFICATION 0 PASS FAIL ,,,,, DATE 1 LEAK DETECTION C ICHECK IF N/A TYPE/BRAND ZONE OF CONTR' I,BU..T.I,ON [- -]. -YES--[-Y,:NO -----,DATE..-TO--BE-REMOVED---,��,140,0 7 FIRE DEPT. PERMIVISSUED CI YES C I NO DATE CONSERVATION CHECK IF N/A PATE BOARD OF HEALTH TAG- NO. DATE *,,PLEASE 'PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD R The Town of Barnstable Health Department 1 "Nua am&" 1 367 Main Street, Hyannis, MA 02601 p 1639. `p . .. _ �1 mill Office 508-790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health date 0�3 / 1 3 9 Dear o Enclosed is brass valve tag # Please attach to the fill pipe of your underground nk. You must do the following as indicated: ---- Remove your tank. I have enclosed information for you regarding tank removal.Have our tank tested startingMqu) You must y test during the loth, 13th, 15th, 17th and 19th year and • nually thereafter. Removal in the year I have enclosed information regarding tank testing. ** In order to have your - tank tested you must first contact an engineering company (see attached) to have a monitoring well installed. Once the monitoring well has been installed you can then cal 362-2511, extension 334 and ask for Charlotte Stiefel or George Heufelder at the Barnstable .County Health Department, to have your tank tested via the Soil Vapor Analysis Test. ---- Due to the unknown age of your tank we must presume it is twenty. (20) years of age. You must have it tested every year and remove it by the year DEC 1993 . To have it tested please follow the procedure as indicated above from the ** (asterisk) on. If you have any questions, please feel free to call me at 790-6265. T you. l ; � ® c Thomas A. McKean Director of Public Health BARNSTABLE ✓ ` SEWAGE # ` VILLAGE ASSESSOR'S MAP & LOT -` `— -� -- 5 INSTALLER'S NAME & PHONE NO. r SEPTIC TANK CAPACITY \0 0 LEACHING FACILITY:(type) (size) �o NO. OF BEDROOMS PRIVATE WELL O UBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE . COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No � Ica=,�"a � � � C��� ,�-�-- x �.�'� - h' °� h� - s r - -- - i� DF �� - ` �� i r. :3� r� � ��� � ��� ,: k '� , '.,r "+��. 1 0 ou-r Cq rr-No...... Fmz............ ........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH vv. 1_7> J�A.................0 F..'C.> ................................. Appliration for Disposal Works Toustrurtion rrrmit ' Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: .............. . . ............................Lc>-T--r7----------A....L1 S .. ... ........... ..... Lodai I. ............. . . ............ ................................................................................... j_Addres. . ..... ...... -;a r ................................ ...... . . ........... .. .......... I............. Installer Address Type of Building Size Lot.A1.60b........Sq. feet Dwelling—No. of Bedrooms------3---------------------------------Expansion Attic 4.6 Garbage Grinder A Other—Type of Building ............................ No. of persons........_................... Showers Cafeteria Otherfixtures ....................................................................................................................................................... Design Flow.........5.5..........................gallons per person per day. Total daily flow........ ......_........__._._..gallons. 9 Septic Tank—Liquid capacity.]=.gallons Length!9.=.Q?.... Width4_'-1.9;L_ Diameterff�...... Depth.1G. Disposal Trench—No..................... Width............._...... Total Length.............._.____ Total leaching area................ sq. ft. Seepage Pit No, I .........I---------- Diameter.....I.J......--- Depth below inlet...3AS'.'_' Total leaching areal.08....sq. ft. Z Other Distribution box �� Dosi�] tank j\10 Percolation Test Results Performed by.A.-;:2V.L(_k_QA(Jr Test Pit No. L..,_"._Ze-__minutes per inch Depth of Test Pit_...10.......... Depth to ground water_ %.—V=.-mWQ'wqET_W 4i Test Pit No. 2_4"�-....minutes per inch Depth of Test Pit-----LO--------- Depth to ground water�9.r_.'F&jCa_UTW_-0.0 9 ............................................................................................................................................................. 0 Description of ....... .................................... ...........i i.0....as.-C'.404M.En....6A&lr)............................................................................................................... ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable.............................................................................................. .................................... ......................I........................................................ Agreement:The undersigned in-Zta�Ioredescribed divid il Sew agYe Disposal System in accordance with .1,1 the provisions of TLITA U 5 of the State Sanitary C e un r g ed e ragrees not to place th system in I operation until a. Certificate of Compliance has been iss e y the r o ealth. Signed---. .. ............ .............. .................... .... ............... Z.. ...... ......... .... 4 IF7 Application Approved By.. ....... ... . . ........................... ............... t Dat Application Disapproved for the following .............................................................................................................. ......................................................................................................................................................................................................... Date PermitNo.-. 7== xO------•-••--------------•----•--- Issued....................................................... Date *� ?9�, No.--- •.. �G <o 9 � o U r©G -Pc t,) THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .hl................OF..."l (��Zt` ................................. ApplirFatiou for Disposal Warks Tonstrnrtiutt Frrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: J _....... G S lj t_� Lo fy-Add ess/ //V`/� 1 `^......................................................../y% or Let _ ,r iy.r, �� .._. ----7-J------------- - �-�./..1..... �/(/../`f.'C� O A dress —�^^, a "'T �. ........ ..............."° ..........................•••-..... .....-lam c-KYI//.. �� Y! C>.`�`" --r........... Installer Address UType of Building Size Lot..-.A_a h .j O -------Sq. feet Dwelling—No. of Bedrooms___-.-_-3---------------------------------Expansion Attic (�43 Garbage Grinder (�A)o � e of Building a Other—T yp g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ... w Design Flow.._.........!5.T.........................gallons per person per day. Total daily flow..............................................gallons. WSeptic Tank—Liquid capacity-AM-)gallons Length.`sa�-.4. ... Width 9'-i� _ Diameter---------------- Depth.-S_-".-Pd.-_�r x Disposal Trench—No. .................... Width.................... Total Length_............_._.. Total leaching area....................sq. ft. Seepage Pit No..........I.......... Diameter......'.k.. ._..... Depth below inlet....?:. ------- Total leaching area._S.Qe.`.sq. ft. Z Other Distribution box NQj Dosin�,g._t,a�nk (W '-' Percolation Test Results Performed by.-_F'Yt:�Pd'-J,. . :_-(`i`(_i •�r.1CAate.. °�. `g �_ Test Pit No. 1.../-.Z...minutes per inch Depth of Test Pit..... ......... Depth to ground water..N..... 44 Test Pit No. 2__G Z...minutes per inch Depth of Test Pit......1.0__...... Depth to ground water A.?:...k...... O Description of Soil..•-- ', ` i z f C. r -Lc*, d. S 3 SO t(__ - - ------------------------------------ v .---•---••--t-'".Q.._G���k�..�±.>"sly....�l��.iD.-------•--------------------------------------------- w UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement The undersigneThe undersigned a insta oredescribed ivid 1 Se wag Disposal System in accordance with the provisions of TIT!Z- 5 of the State Sanitary Co e e and ed ther agrees not to plac/thn system in operation until a Certificate of Compliance has been ss d y the r o alth. Signed---•- . -----.._.. Z ._ ---- ..�.- --- Application Approved By............... •1�-==p -`�, - ---------------=. a d at Application Disapproved for the following s-.....................................................................-.......................................... ...............................•-•--•-----...._....-----•....------........----•-•--•-•••••••-----------•---•--------••........•-------•--•••------------••--------.-•---••-------•................... Date PermitNo.... ...t t ................................. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS •A�_�� //` BOARD L HE4LT � f / 1 .........OF....... ...... ................................................... Trrtifiratr of Tuntpliattrr THIS IS TO CERT F , That the d; idual S age Disposal System constructed ( or Repaired ( ) b ........................ '�_.� ................................. . ..................... °� Instal at �........ .. . . . ---` .. ..... j ..... has been installed in accordance with the provisions of TITST� 5 ppf The State Sanitary Code as de ribi�d in the application for Disposal Works Construction Permit No..___?1 :'._. .0............... dated------ ._.'" t _ - ---------- THE' ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � DATE... - ......1�... ..7..................................•------ Inspector........ .:'r'v:"`� ....................... J/+ THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTFj1 Sr `.....t�. ^ t..........OF............ ... ... ........ ................... No.......................•• FEE. ........... Disposal Works T �r ion rrntit . . to.r Permission ><s h y granted..... �� .......................•-..----.......----••---..................-- to Construct ( LTor Repair ( an Indio ual .wage Dispov System at No.. .74 ---- ------ .. Street ^V . as shown on the application for Disposal Works Construction Permit Date .._ ..._ ..". . 00 . .................... �/oard of Health DATE-----.3................ ---�: r FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Ste* 2/z --vim S A" -en, 1987 I`c rT ? Lu E G2 11 P - - / PITFR t 29733 y J CT r7 0 N r' EX,t6T I Al l Y `-E,&e-kA 7'tT i i r, G9 �� Lt.,•f "" ----------------- �-Da 1 u(`�i.e�•-t' , 3 X 110 X ��4�T1G E aK 3k. 11 0.1C ?-aO90 = Co<o0 6?D L16S 1SCO 154 Z.s = 385 CVr,.> ke=1.1�,,: pl-�AT►O►J �p,T�. ', 2 M 11..1' Z 1►�LH Q �a�» oSULLIVAN No. 29733 " 4,,:; 10 e 3.1 g•SG, �G�1;� .. (4 — L4, ;a V41� yq _. _,, °" wv I NV 1 Nv it Hv -T�►aK I NV z>=)_co.o A4'6 towM -na-rP ZAJA27,I OK ��o�/�Tt'�. �i2ct.iM1►.AAe.'� �L_A,I,�, dF LAdJlt7 -rvkA-T Tj�E.-ToL>j"-?fYPWS}{W�ll�l Q�.�s IM Ass 5�` LK REQC..1 t� t,tlE'1�Ct�j OF ETt � G-ti1 >Z 1 ►-� Sowi=foes t ����t.� 6ttiac-4L1D N►OT"�1+ t-ls'�DTZ� c rerro The Town of Barnstable Health Department { """A" 367 Main Street, Hyannis, MA 02601 Office 508-790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health June 11, 1993 James & Margaret Miller 115 Lovells Lane Marstons Mills, MA 02648 RE: Underground Fuel Storage System located at 115 Lovells Lane, Marstons Mills and listed as Assessor's Map 078, Parcel 069-008 Dear Mr. and Mrs. Miller: Our records indicate that you have a #2 fuel oil underground storage tank that is presently unregistered with the Health Department. You are now required by the "Health Regulation Regarding Fuel and Chemical Storage Systems" published in the December 17, 1987 issue of the Barnstable Patriot, to register your underground tank(s) with the Board of Health. Please complete the enclosed Registration card(s) . Include any evidence of the date of purchase and installation, a copy of the permit from the Fire Chief, and a sketch map showing the location of such tank(s) on the property. Upon entire completion of the Registration card(s) , you will be issued a brass valve tag(s) by the Board of Health. These valve tags shall be picked up by you or your representative at the Health Department located in the Barnstable Town Hall. The tag(s) shall then be attached to the filler pipe/cap of the underground tank(s) . Please return completed Registration card(s) to: Town of Barnstable Health Department, P.O. Box 534, Hyannis, MA 02601, as soon as possible. You are required to comply with this regulation by June 21, 1993. If you have any questions, please telephone (508) 790-6265 for Donna Miorandi or myself during office hours. Office hours are Monday through Friday from 8:30 - 9:30 a.m. and 1 :00 - 2:00 p.m. PER ORDER OF THE BOARD OF HEALTH T omas A. McKean Director of Public Health 4 , 51 DIAM. ACCESS MANHOLES 2-18 10, m, *NOTE: ALL PIPES ARE TO BE 4* SCHEDULE 40 P.V.C. —A ho n. from SECTION A 8, Existing Foundation house to septic tank f 0 BOX cover miu Septic tank covers must be st be PROFILE VIEW OF ADDITION TO LEACHING SYSTEM ELEV. 100,00 (Assumed) lw� I TOP OF FOUNDATION 6 In. of finished grade within 6 in. of firgehed grade J Grade over Septic Tank 99.00 Grade over D-Box 99.00 a over SAS 99,00 3' of 1/8* - 1/2' Washed Peastone ad 0 14' to 1 1/2 ' Washed Crushed Stone _Z 4- PVC (CAPPED)INSPECTION PORT TO BE 3 HOLE H-10 0 INLET .02 INSTAUXD AND TO BE WITHIN 6'OF GRADE 3' Maximum Cover T1.LT zi [ST. BOX Top OF System- Elov. -97.25 Ou 10 LWQU4'LO 7'. 15, EXIST. S'0,01 or Greater U, EXIST, PIPE 1,000 GAL. S. 0.01,P A THE ACCESS COVERS FOR THE SEPTIC TANK, 06 1`1 0 or foot Or greater FROM EXIST. F13UNDATI , 1 0) r� : U� . 0" Effective Depth Uarn'tre SEPTIC TANK DISTRIBUTION BOX AND LEACHING COMPONENT \ILI mi. C) H-10 SET DEEPER THAN 6 INCHES BELOW FINISHED 7 "7,Ir7 �7r _ 4 Units @ 625' 25' CONCRETE FULL FOUNDAT a) I FINISHED GRADE. 10' GRADE SHALL BE RAISED TO WITHIN 0' OF > H C� (o > r, 0.83' (10 inches) STEEL REINFO RCED PRECAST CONCRETE 03 4' 31 STONE IN BETWEEN 4' 81 '5 11 .- I - I — INSTALL TuF-TITE GAS BAFFLES OREQUALS 6 ln.of 3/4"-1 112` --, 'P PLAN VIEW SYSTEM PROFILE compacted stone 5 2 0) U-) —36 Noi to Scale S Effective Length 3-24' OEMOVABLE COVERS qt tANsfy#�CehVrT,6 2&4 N4,TE0 2001 RAMW 5' PROVIDED 4' 4' C 4- SOIL ABSORPTION SYSTEM (SAS) r1r—fr- 6 In.of 3/4*-1 1/2" Effective WIdIth INFILTATROR HIGH CAPACITY (H-20 LOADING)/ GEORGE O'BRIEN 3- min. clearance compacted stone < [ '.1 1 i r GENERAL NOTES 0 INLET mK-F 12- min. init to Outlet ..i _f INLET NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE 0 8'mi (OR EQUIVALENT) Not to Scale OUTLET actor is responsible for Digsafe notification Z LLJ NOTE: OVI"RALL HEIGHT OF INFILTRATOR IS 18' /EFFECTIVE HEIGHT IS.10" and protection of all underground utilities and pipes. Bottom of Test Hole 1 Elov.-8&00 Adjusted ESHWT ELETVATICN - No Adjustment Required 5- -7- 5' -7' 1. Contr 2. The septic tank and distribution box shall be set E 4'-0" min. level on 6" of 3/4"-1 1/2" stone. wObs. Groundwater Test Hole 1 Elev.= None Observed 0 132" oft Dam. Liquid depth 3. Backfill should be clean sand or gravel with no stones over 3" in size. 4. This system is subject to inspection during installation by Carmen E. Shay — Environmental Servicies, Inc. 4' -10�-- 8'-0* 5. The contractor shall install this system in accordance CROSS SECTION END-SECTION with Title V of the Massachusetts state code, the approved plan and Local Regulations. 6. If, during installation the contractor encounters any TYPICAL 1000 GALLOW SEPTIC TANK soil conditions or site conditions that are different NOT TO SCALE from those shown on the Soil log or in our design R 25.00' installation must halt & immediate notification be mode to Carmen E. Shay — Environmental Services, Inc. 7. No vehicle or heavy machinery shall drive over the' septic system unless noted as H-20 septic com ERCOLATIONf TEST ponents. P r L 4 9.15' 8. Install Tuf—Tite gas baffles or equals on all outlet tee ends, ipes. Date of Percolation Test: M AY 9, 2005 9. All Distribution Lines shall be 4" diameter Sch, 40 NSF PVC p Test Performed By CARMEN E. SHAY, R.S., C.S.E. solid piping, tees & fittings shall be 4" diameter 10. All Results Witnessed By. WAIVER,( per BARNSTABLE B.O.H.) CO Schedule 40 NSF PVC pipes with water tight joints. EXCAVATOR: Shay Environmental Services, Inc. Percolation Rate: Less Than�2 MPI 0 30" 11. Municipal Water is Connected to ALL OF The Residence and Abut...., Properties Within 150 Feet. Test Hole CO No. I DEPTH SOILS ELEV. 0 99,00 THE PROPERTY LINES ARE APPROXIMATE AND A� Loamy COMPILED FROM THE PLAN BY BAXTER & NYE, INC. ENTITLED " CERTIFIED PLOT PLAN — 115 LOVELL'S LANE Sand 10 Y 3/2 MARSTONS MILLS, MA" DATED JANUARY 27, 1987 0"-10' A. AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN 1�O Loamy IT SHOULD BE USED FOR NO PURPOSE OTHER THAN Sand THE SEPTIC SYSTEM INSTALLATION. ? 10 YR 7/1 50! 10,- 30" 96., A 0 Medium 0 NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE A Sand J 2.5 Y 7/4 FROM THE EXISTING SEPTIC SYSTEM TO BE DISPOSED 1-4) -J, / —1 1 OF AS PER BOARD OF HEALTH SPECIRCATIONS. 30*-132" C, 88.00. 0 EXISTING LEACH PIT TO BE PUMPED DRY & FILLED WITH CLEAN FILL MATERIAL. Q) Q� ———————— 20NING RESIDENTIAL FLOOD ZONE C e J _,i Perc VITHIK�, 'In,-R( Depth, to Per Perc Rate= Less Than 2 M!"i 7 EJ�,R E K, 0 v5_rLkN�S�_LOC'�T]K! c. 30" to 48"; THE 7 77 41 �77 4 _4 _7 ALL OUTLET PIPES FROM 74E D'STRIBUTION BOX SHALL BE SET LEVEL FOR AT LEAST 2 FT. 12* CONCRETE COVER LEG P 3 - 5*OUTLET PROJECT BENCH MARK KNOCKOUTS DENOTES PROPOSED TOP OF FOUNDATION T F8 X70 12' fNLET SPOT GRADE T ELEV. 100.00 (Assumed) OUTLE Lai DENOTES EXISTING �t2 X 104.46 SPOT GRADE _�J ,L4 4* SCH. 40 Tee---. -SECTION EXrSTING PLAN SECTION CROS5 PL PROPERTY LINE 3 BEDROOM �Z 1000 �GALLO N HOUSE 3 HULL DIStRIBUTION BOX -- H TO LOADING PROPOSED CONTOUR EPTIC� TANK S NOT TO SCALE #f 15 �-o 97— — —�-97 EXISTING CONTOUR 0 DEEP TEST HOLE & DECK 2 (Des an CdIculation PERCOLATION TEST LOCATION �330 Gal./Day Min. per Title V) Number of Bedrooms:31 Equivalent to 330 Got./Day FENCE Garbage Gritinder: No Cb D—Box ity Proposed: 330 Gal./Doy Minimum (Min—Per Title V) Cb Leaching Cccpac Septic Tank< 2 x 330 GaL/Day = 660 USE EXI�T. 1,000 GAL. Septic Tank. L PRIVATE DRINKING WATER WEL SOIL ABSORPTION AREA� Using percolation rate of <i min,/inch :W, 293.04 allons F3ited Bottom ,Area: 0.74�gal/sq. ft. x 396 Sq. ft., 9 REVISIONS Pit Sidewall Area, 0.74 gat./sq. ft. x 7802 sq., ft. 58 gallons Providing: ='351.04 gallons L ach NO. DATE: DEFINITION 6 i i Use: (4) INFILTRA' —20 UNITS,iHAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, TOR HIGH CAPACITY H TO BE USECD WITH 4.0' OF WASHED STONE ON TH E SIDES,, AND 4' OF WASHED STONE ON THE ENIDS, 3' STONE IN BETWEEN, NO STONE UNDER,. LOT #7 TEST HOLE #1 ELEV.= 99.00 43,608 Square Feet +/- 36. ———————————- PROPOSED PR EPA", RED Fo' R : SUBSURFACE SEWAGE DISPOSAL SYSTEM OF JAMES 01. MILLER 115 LOVELL S LANE MARSTONS MILLS, MA CO 115 1� OVELL' S LANE _7 PREPARED BY: MARSTONS MILLS, MA ' 02648 OF 7A PHTY E. SHA Y E E ENVIROXNENTAL SERVICES, INC SH NIF HENRY,HANLEY P.O. BOX 627 40 50 0 20 EAST FALMOUTH, MA 02536 ANIT TEL/FAX 508-539-7966 % SCALE: 1"=20' DRAWN BY: CES DATE: MAY 9, 20 PROJECT#SD-736 FILENAME: SD736PP.DWG SHEET 1 OF 1 3 1��E BH�XIO 11,02 4-SI Mox'�_ Cover To A S O.D1 per foot _ 9" _te, 10, 0 T