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HomeMy WebLinkAbout0165 MARQUAND DRIVE - Health 165 MARQUAND DRIVE, MARS.MILLS A=077.037.003 _ J No._�►" �-�a—Q� Fee-----�'�=----- BOARD OF HEALTH TOWN OF BARNSTABLE M°1 � oa3 Applitat ion for Vell Congtruct ion Permit �— U3�1, Application is hereb made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: L lion — Address Assessors Map and Parcel Owner — — Address Installer — Driller Address Type of _Dwelling- — ------------------------ Other - Type of Building -- No. of Persons---- ------ Type of Well Capacity-------------------- Purpose of Well---- ---- — Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate .of Com 'ance has been issued by the Board of Health.. Signed - -- / ate Application Approved By date Application Disapproved for the following reasons: ---------------- ------------ -- -- ----- ------------- date -- Permit No. �aUO� — oa -- Issued— - -a ----____ ------------ date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f (Compliance THIS IS TO CERTIFY That the Individual Well Constructe Altered ( ), or Repaired ( ) by— 4611-1;W47 Installer at has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated 3-7—X_q2- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE—---- - Inspector-------- __ -- —---- - -- No. _l) r. ,; Fee----•'c--------------- BOARD/OFrHEALTH TOWN OF BARNSTABLE M°1 t 0 0 3 Applicat ion,for Veit �Con5truct ion Vermit - .. J Application is hereby made for a permit to Construct ( ), Alter ( ), or Repairp;.( )an individual Well at: <v Jr "WO Location — Address 1� 3 Assessors Map and Parcel Owner Installer — Driller Type of Building r Dwelling -------------------------------- Other -lTyte oBuilding--= ----------- -- No. of Persons---------------------._—_______ f , 'tl/ Type of Well Capacity--------___—__—___--___--_ ' Purpose of Well--- ---- �. Agreement: , The undersigned agrees to install the aforedescribed individual well in accordance.with the provisions of The Town of Barnstable Board of.Health Private..Well Protection.Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Com lance has been issued by the Board of Health. Signed /��G --- date Application Approved By -- —----------- �' G _______ date Application Disapproved for the following reasons: -------------- --- ---------—_--_ - -- — --- -----------------------__---__—date-- — Permit No.— -a 00 — -�a — Issued - ----------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (i), Altered ( ), or Repaired ( ) t Installer at— / -- —_--— --- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in-the application for Well Construction Permit No.�_4_k9_—Uk_Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL .-SYSTEM WILL FUNCTION SATISFACTORY. DATE--- --- Inspector----- ------ -- ----- --------------- BOARD OF HEALTH TOWN OF_ B.ARN.FSTA,BLE - vell com5truct ion Vermit _ No.— -U 0 ��Q� Fee Permission is hereby granted — y to Construct ( ), Alter ( ), or Repair ( ) an Individual Will at: } No . -- ------ - - - - - as shown on the applicati15 Well onstruction Permit No. W 2 Ud `' f __ Dated— - ____ x ard'of Health :�• DATE �S��=,PU/��� _ ido� A�vA{� �.��� ,q/�s��e 4., I _ No. Fee �It THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Rpplication for lh5pogal *pztem Conotructton 3permit Application for a Permit to Construct X Repair( )Upgrad Abandon( ) El Complete System Individual Components Location Address or Lot No. �(rt OA ner'oame,Addre s d Tel.No. ie v Mt Assessor's Map/Parcel /�m id, Installer's Name,Address,and el. o. 29-679 r) Designer's Name,Address and Tel.No. WM Type of Building: <22�Eb No.of Bedrooms_ Lot Size �J, sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow �� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 e tal Code and not to place the system in operation until a Certifi- cate of Compliance has be ed jaRn Signed Date Application Approved Date —Cl Application Disapproved for the following reasons Permit No. < l"� Date Issued "1 !' d1 l ///(�//(////J//' /�(// (/.��7/.'f////�� __�_ _. -. .•re �^w`yi".`�..r.r _..»F.. �. .I �.I /II IU/ I P ` •.n 19� No. Fee 1040- 0 V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ve, r PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Zipprication for 0igpogar *psstem Construction Permit Application for a Permit to Construct Repair( )Upgrade Abandon( ) El Complete System IfIndividual Components Location�A�dddress or Lot No. rq Twl Oy er's�Name,Address�nd,Tel.No. r 4+�— �j� Assessor's Map/Parcel — Installer's Name,Address,and el. 40. 50�'���'`i3 ^ Designer's Name,Address and Tel.No. p Type of Building: 5 e ling No.of Bedrooms Lot Size sq.eft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow J J t) gallons. Plan Date 1 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 'T'` &A/ d6ijiu)e_` y Description of Soil ;6 a/A ,UP Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenari'c�e`of the afore described on-site sewage disposal system in accordance with the provisions of Title S�efe mental Code and not to place the system in operation until a Certifi- cate of Compliance has beef iss, ed ar of It . Signed Date D Application Approved r Date CS Application Disapproved for the following reaso s Permit No. .0 j2 - Date Issued 4 l THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY that the On-site Sewage Disposal Sy tem Constructed( )Repaired( )Upgraded Abandoned( )by L.C..�t I at 1 has been constructed in accordance with the provisions of TiM 5 and the for Disposal System Construction Pe dated Installer R_1TbLL'_[1!25 Designer `/.kl(l The issuance of this permit shall not be construed as a guarantee that the ste will func_loon�as designed. (} r Date �1 t1 `� Inspector ' Ar C), , `C/`\C CA - ------------------------------------------- No. 4'74,51?' Fee zoo'10 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS! 30isspozal *pgtem Congtruction Permit Permission is hereby ranted to Construct( )Rqpgair( )Upgrade( Abandon ) �q System located at �J / yl t lS M/1— Q / and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date-of this- e t. Date: Approved b THE COMMONWEALTH oFmAssAo*ussrrs BOARD " " " ............ ----0E--� ' ............................. ' � . . or . �� ~ amit Application is hereby made for o Permit to Construct (L�� ur Repair ( ) an Individual Sewage Disposal System at: N� �� L^�------- ---- -u���e�����e��c��� ����-_-'���'��» ----------------'--'���-L----�..�--'-'-'-----'-'-'--- � ' �o=u" AddressmumNu � ---'��'1 --------' ---------------------------'-------------'-'--'---- Aaa�" --_----- .................... '---------------------'�����--------------------_ ` ~ � Type o6Du8diog Size l.ot- � � Z)n/e]l�q�--l�o. o� 8�6,000�a.-----.����--------__-'��oaoa�oo �t �� ( ) Garbage Grinder (u~r � Other—Type of Building ............................ No. of peraoou---.--------'- Sbmrcra ( ) -- Cafeteria ( ) PL4 (}tbec _------_---..._---_--------.------------ '------------' . . D ' ��n�----- ..����----' ��l000 per �ecxoo ��r day. Iotu daily 8o�.----------�����'��---' . Septic Tank—Liquid cayucityl.SX.gdlouo Length................ Width................ Diameter................ Depth................ Z Other Distribution box \~~/ Dosing tank ( ) ~~ Percolation Test Ileonita Performed ��'-------- Date......kn4 A-Y-7---- Tey Pit No. l.....~L-.-minuutco per inch Depth of Teat Pit--.VO--- Depth to ground water................... �Z4 Test Pit No. 2__�Z., .-mioutespcc inch Depth of Test Pit.......1.0...... Depth to ground wuter--................ ~~ -'__-------_-__._----_-__---___-_______'_-_-'-----_--'------'-_'--_- 0 Description ofSoil- � -__.---.-_----.----------'--------------'--'----'-..-_'-_-----'--- -------._'-----'-------'--'_'--'------ ----_------'-_--_---__-.--_------__--_--'-_----''-'___'__--_-----_---'---'----- L) Nature of Repairs ur Alterations--Answer when applicable.............................................................. ................................ ....................................................................................................................................................................................................... ' Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of�ZTl� 5 of the State Sanitary Code The o��u�o�further agrees not to place the system in operation until a Certificate of Compliance has een issued i _�by the hard ---._'-----' - ------- k-- Aoo1�o600 Bv � �0w' ----------'/-------------' - �» ------- � � Z) for rouxomx�---.-.-----------_--_--_.-------.----------'-..--'�------- � '' -- � ............................. .. .............. .............................'...........'.....'......'......'....................................'............ Date � Permit '70 � ` Date 7- �,Y 3-7 3 t No.. ...r�. FEs.... l...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TO kv.I1�............OF........ r`��Zi��l��8L .................. Allpliratiun for Disposal Works Tontnution ramit Application is hereby made for a Permit to Construct (Lll�or Repair ( ) an Individual Sewage Disposal System at: ................__.........!. �j/� W O A at......�nek .......aim....... t`O - = ......................... Location•Address or•Lot No. •--....a.l.lr! � .. .......... .... .......................... ••......... ................ -----•----------........- -------- Owyer ................•---•--........ Address .................. -- Installer Address j Type of Building Size Lot....-_�--.". ...f c..:SSq-feet- U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( U Other—T e of Building No. of persons............................ Showers — Cafeteria PaOther fi,xt4ps --••-------•-----------------------•------•------- . W Design Flow.............. .....................gallons per person per day. Total daily flow...................... �1..1�......gallons. WSeptic Tank—Liquid capacity. :`' .).gallons Length................ Width................ Diameter--------..---_ Depth................ x Disposal Trench—No. •--------- -------- Width................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No............I......... Diameter.......i.4.... Depth below inlet.........62...... Total leaching area.... l ?...sq. ft. Z Other Distribution box (V)� Dosing tank ( ) ~" Percolation Test Results Performed by.. .� ?......f? -•i....JY ......... ............... Date..........- _Z....M......... Test Pit No. 1......---....minutes per inch Depth of Test Pit------- C)....._ Depth to ground water........ ""-......-. Test Pit No. 2....... --r...minutes per inch Depth of Test Pit........l.f?...... Depth to ground water-------" ---.-..-.--- P1 -•----•---•-------------•----•-------------••••-----••....-------•------._...............--•-.•-•-••......................................................... 0 Description of Soil........................................................................................................................................................................ V -------------- ------------•------•---•----------- -/� =�-------- h5---�.......... +.....a...l... ..•...................•......................................--...... W ........................................................................................................................................................................................................ UNature of Repairs or Alterations—Answer when applicable............................................................................................... -•------------------------------------------------•----........................---............----•----•-•---------------------------••-----...-----------------------------------------•---.......----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL- 5 of the State Sanitary Code— The undersigned further agre s not to place the system in operation until a Certificate of-Compliance h been issued,by the and of 1 Signed •. .......................... �! / Date Application Approved By.&... �t�2� �.......----•--.------ --•-•-•---••--•--•-•-------. /_f .51" e Application Disapproved for the following reasons:-............................................................................................................. .................................•-•--------•--------------------•---•----•---•••-•-••••••-•--------•-•-.--•--••--•.....••••-••-••----•---••----••••---••-•-•-----•--•-•----------......--•••-....-•-•-- p Date PermitNo.-6--�.... f _.... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............!! L ✓.i`11. .....OF........ ~.(4.(.(..+7Gr��./�::! :....... ........................................ Trrtifiratr of Tomplittnrr THIS IS/ 0 C RTIF , Thal the I ;vidual Sewage Disposal System constructed or Repaired ( ) by.................c yF�{ �I,$ � �/" c��;...---•--••-------•---•-•-----------------•.----------------------Z.2.................................... / ry. nstaller at......... ?^ ........ Q- -U4 ---P >, - /!l is �/i 1�. .r -•;----•--•-------------------------------------------- has been installed in accordance with the provisions of TIT 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..�!_... .0...... dated--....-f,...-�' _e...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE ONSTRUE® AS A GUARANTEE THA�THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 ................ n e 1 — OF..................��..�.... . ...... -� .............................. N FEE Disposal Ivor g Ton/s�tr in Vamit Permission is hereby ranted_..__.. .. to Construct or Repair ( ) an Individual Sewage Disposal System atNo..-- j....... -...... -•---- tr � ------------------------------------------------ as shown on the a plication for Disposal Works Constructiot* ,eet t I/�/!J�) /�/� D d _{ ..._.. ....... ........."'. ...... ..0._... _ ..41............... .. __•_ o d of ea DATE. -----••-•------••........................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS DATE•_1/14/00____ PROPERTY ADDRESS:-.fra_Ma.LQ.UZ d.-UX.i-v�__--- -- 02648 ---------------- On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 1-1500 gallon septic tank. / �7 7 4 O 2. 1-Distribution box . 3. 1-1000 gallon precast leaching pit . Based on my Inspection, I certify the following conditions: 4. This is a title five septic system. ( 78 Code ) 5. The septic system is in .proper working order at the present time . 6. Waste water is 46" below the invert pipe to the leaching pit . 7 . Pumped septic tank at time of inspection . 8. The septic tank has been pumped annually since 999 . This is for maintenance purpose only. SIGNATURE:,f _ N a m e:_,1 �1t0s.smb q-r--Ir------- Company: Joseph P. Macomber & Son, Inc . Address:_ Box—66_------------ Centerville L Ma —02632-0066 Phone:_ 508 775_3338_______ THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY MOM JOSEPH P. MACOMBER & SON, INC. Tan ks•Cesspools-Cesspools Is Ids Pumped & Installed Town sewer Connections titi 2 P.O. Box 66 Centerville, MA 02632-0066 775.3338 775.6412 �1 =17ATTij f JA N 2 5 2000 'ftOF� �\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY CC Secre• ARGEO PAUL CELLUCCI DAVM B. STRL Governor Com m i—lc SUBSURFACE SEWAGE DISPOSAL SYSTEM.WSPECTION FORM PART A CERTIFICATION Property Address:165 Marquand Drive N.,a,fOw ar John B. Cotton M a r s t o n s M i s . 02648 Address of owner: Date of Inspectkm: I i 7 4785 Name of Inspector:(Please Print) Joseph P.Macomber J r . I am a DEP awoved system 4upector to Section 15.340 of TWe 5(310 CMR 15.000) Co panyName: J.P.Macomber & Son Inc . MaaingAddress: Box 66 Centerville .Mass . 02632 Talephons Number: 5 n R_7 7 5_'1 R R 8 CERTIFICATION STATEMENT I certify that I have personally Inspected the sewage disposal system at this address and that the Information reported below Is true, accurate and complete as of the time of inspection. The Inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes _ Needs Further Evaluation By the local Approving Authority _ Falls Inspectors Signature: Darts: The System Inspector shall submit a copy of this Inspection report to the Approving Authority(Board of Health or DEP)whNn thirty(30) days o completing this Inspection.*It the system is a shared system or has a design flow of 10,000 gpd or greater,the Inspector and the system own, shall submit the report to the appropriate regional office of the Department of Environmenta0 Protection. The original should be•sent toVm system owner and copies sent to the buyer,If applicable, and the approving authority. . NOTES AND COMMENTS revised 9/2/98 Page Iof11 �,Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 165 Marquand Drive Marstons Mi11s ,Mass. Owner: John B. Cotton Data of Inspecd= 1/14/0 0 INSPECTION SUMMARY: check A, B, C, or A A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 16.303 exist. Any failure criteria not evaluated are Indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: A/v_ 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. Indicate yes,no,or not determined(Y,N,or ND).:Describe basis of daterminadon In all Instances. If'not determined',explain why not. The septic tank is metal,unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was Installed within twenty(20)years prior to the date of the Inspection;or the septic tank,whether or not metal,Is cracked,structurally unsound,shows substantial infiltration or exfiltration, or tank failure is Imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box Is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. The system will pass Inspection if(with approval of the Board of Health). broken pipes)are replaced obstruction is removed distribution box is levelled or replaced - The system required pumpMg-more than'fourZhnes myeardue to broken or obstructed pipe(s). Theeystem willpass-- Inspection if(with approval of the Board of Health): broken pipes)are replaced obstruction is removed revised 9/2/98 Page 2of11 t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 165 Marquand Drive Marstons Mi11s ,Mass . owner. John B. Cotton Date of Inspection: 1/14/0 0 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _4 Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICKWILLPRQTECT THE PUBLIC HEALTH-AND SAFETY AND.THE 8WHONMENL• Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. z) 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 AND SAFETY AND THE 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 soil absorption.system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS Is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds Indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid).- 3) OTHER illy A revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropartyAddresa: 165 Marqund Drive Marstons Mi11s ,Mass. Owner. John B. Cotton Date of Inspection: 1/14/0 0 D. SYSTEM FAILS: You must indicate either"Yes" or"No" to each of the following: 1 have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backupof•sewageintofacNity"er-eretemoomponent•dneKoanoverloadedor•cleggsdSASor-ceaspod. 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 disNibu���box above outlet invert due to an overloaded or clogged SAS or cesspool. I&KAol r Liquid depth in casspeelds less than 6" below invert or available volume Is less than 1/2 day flow. Required pumping more than 4 times in the lest year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a Cesspool or privy Is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is-within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. - Any potion of a cesspool or privy Is lost-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for •coliform bacteria,volatile organio-compounds,ammonia nitrogen•and nitrate nitrogen. - E: LARGE SYSTEM FAILS: You must indicate either"Yes" or"No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or-greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes N,l� the system is within 400 feet of a surface drinking water supply the system•is-within 200 tootofa-tributary toa4urfao"4nkkV-w&1w--supply• the system is located In a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 16.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4orn SUBSURFACE SEWAGE DISPOSAL SYSTBA INSPECTION FORM PART B CHECKLIST Property Address: 165 Marquand Drive 'Marstons Mi11s ,Mass. 0iw"Or John B. Cotton Dace of inspection:1/14/0 0 Check if the following have been done:You must indicate either'Yes'or'No' as to each of the following: Yes Nb-� Pumping Information was provided by the owner,occupant,or Board of Health. _ None of the systemcomposents.iwwbean pumpedJapatleast-4wo•aweakeaadthe'systam h&s.Jm"vacaitiay mammal Aow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. j1 The system does not receive non-sanitary or Industrial waste flow. The site was Inspected for signs of breakout. _ All system components,Acluding the Soll Absorption System,have been located on the site. _ The septic tank manholes were uncovered,opened,and the Interior of the septic tank was Inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on,the site has been determined based on:-- Existing Information. For example,Plan at B.O.H. Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 115.302(3)(b)) _ The facility owner.land. a-t-,.if did-raat fra&n ownarL&uar$pgauLd&d..wI:h 1nfnrmAtIoaOn*hA pjnpar n+.int f SubSurface Disposal Systems. I t revised 9/2/98 Page Sof11 ` r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:165 Marquand Drive Marstons Mi11s ,Mass. Owns John B. Cotton Date of hsp.ction: 1/14/0 0 FLOW CONDITIONS RESIDENTIAL: Design flow: lJl_ a.p.d./bedro m. Number of bedrooms(des ggI. Number of bedrooms(actuaU� Total DESIGN flow ,� Number of current residents• Garbage grinder(yes or no): Laundry(separate system) s oro_, If yes,sepau"Inspection.required -- Laundry system Inspected r no)yes Seasonal use(yes or no): Water meter readings,if available(last two year's usage(gpd): /1�����lli���AUerl�• d' at Sump Pump(yes or no) l9. —All A0 � 6 • Last date of occupancy: �0/`/RJ,�,j�, l n %,4 D/►Q SG,µ ' COMMERCIALIINDUSTRUAL• / Type of establishment: Design flow: ,_,jZd and (Based ogq)6.203) Basis of design flow Al Grease trap present:(yes or no) Industrial Waste Holding Tank present:(yes or no)A& Non-sanitary waste discharged to the Title 6 system:(yes pr nowy Water meter readings,If aval able: Last date of occupancy: OTHER:(Describe) 4 Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: See pa a 6A System pumped as part MAVI�WAA& n:(yes or no) S If yes,volume pumped: gallons JJ Reason for pumping: JSI.Urf/!/iQ�i(y TYPE OF YSTEM 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) UA Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank _Copy of DEP Approval Other AN APPROXIMATE AGE of all components,date installed4if known)-end source ot4nformation: Sewage odors detected when arriving at the site:(yes or no) 6V revised 9/2/98 Page 6of11 � Macomber Customer History 6�6reen 1114/20'00 Customer number JobAddress Pind Customer JobState MA. Add Billing Address Fax Customel List Billing Address BOX 68 Print BiffingState MA 6129193 � __________ ^ _______________ _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddress: 165 Marquand Drive Marstons Mi11s ,Mass . Owner: John B. Cotton Dew of InSP*"d0n:1/14/0 0 BUILDING SEWER: (Locate on site plan) Depth below grade:-- Material of construction:49 cast iron/40 PVC jyothor(explain) Distance from w1vate water supply well or suction line Diameter Jv Comments:(condition of joints,venting,evidence of leakageeetc.) Joints a StPTIC TANK: (locate on site plan) Depth below graden�rMaterial of constructioete LmetaI4 Fiberglas&VjQ lyethylene_other(explain) If tank Is Enetal,list age" Js.age•confirmed by Certificate of Compliance (Yes/No) Dimensions: r n • Sludge depth: Distance from top of Judge to bottom of outlet tee orbaffie: Scum thickness:_ Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bolt,Vn of ou et tee or baffle: _ How dimensions were determined: Comments: (recommendation for pumping,condition of inlet and outlet tees or-baffles,depth of liquid level in relation to outlet invert,atructureFintegrity, evidence of leakage,etc.) is 2 resent h evidence . GREASE TRAP: D (locate on site plan) Depth below grade: Material of construction- concrete.metalfAFiberglassd/APolyethylene..LOother(explain) Dimensions* Scum thickness: Distance from top of scum to top of outlet tee or baffle: 4-Y Distance from bottom of scum to bottom of outlet tee or baffle:. Date of last pumping: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet Invert,structural integrity, evidence of leakage,etc.) -Grease trap is not prpspnt* revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C i; SYSTEM INFORMATION(continued) ProWgAddress: 165 Marquand Drive Marstons Mills ,Mass . Owner John B. Cotton Date of Inspection: 1/14/0 0 TIGHT OR HOLDING TANK(Tank must be pumped prior to, or at time of,Inspection) (locate on she plan) Depth below grade:-A-14 Material of constructionLQ concrete,ie&mstal4IFlberglas4VAPolyethylentaother(explain) Dimensions• A1 Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Afar int n working order:Ysy� No/�//, A Date of previous pumping: _ Comments: (condition of Wet tee,condition of alarm and float switches,stc.) DISTRIBUTION BOX:-k-� (locate on site plan) Depth of liquid level above outlet Invert:_ Comments: (note-if level and distribution is equal,evidence of solids carryover,evidence of leakage Into or out of box, etc.) — — Distribution box has one lateral . No evidence of solids carry oVPr Nn Pvi ((PnrP of 1 Paka$P i ntn nr niit of tha hnir PUMP CHAMBER:. (locate on site plan) Pumps In working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) umD chamber is not nrPG nr I revised 9/2/98 Page 8of11 I r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATiON(continued) Property Address: 165 Marquand Drive Marstons Mills . Owner: John B. Cotton Daft of kwec*m:1/14/0 0 SOIL ABSORPTION SYSTEM(SAS)2 (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits,number: leaching chambers,numbar-_L leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Alternative system: /e Name of Technology: Comments: (note condition of soil,signs of hydraulic failure,level of ponding, damp soil,condition of vegetation, etc.) CESSPOOLS: (locate on site plan) Number and configuration: Q Depth-top of liquid to Inlet invert: Depth of solids layer:P Y Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: Inflow(cesspool must be pumped as part of Inspection) esspoo s are not present Comments: (note condition of soil, signs of hydraulic failurs..level of pending,condition of.vegetation, etc.) esspoo s are not present PRIVY:Ahte , (locate on site plan) Materals of construction: /Y� Dimensions: Depth of solids:1/9 Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation;etc.) Privy is not =racant revised 9/2/98 Page 9or11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contirwed) PropeetyAddress: 165 Marquand Drive Marstons Mills Mass . owner: John B. Cotton Data of Inspection:1/14/0 0 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes Into house) J onIr VA 5�j l A revised 9/2/98 Page)oof11 r • M � J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(c"Mnued) Property Address:165 Marquand Drive Marstons Mills ,Mass . Ownw. John B. Cotton Date of kwpectioo: 1/14/0 0 NRCS Report name Soll Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater Feet Please Indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record !/ Obaerved.Site(Abutting property, bservation hole,basemeat sump etc.) _ZDatermined from local conditions Checked with local Board of health I Checked FEMA Maps Checked pumping records _zchecked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Used Water Contours Map . Gahrety & Miller Model 12/16/94 revised 9/2/98 Page 11of11 a•wl....•..—w.TTTr �nrJnr•1.1wflTwaw��lraprRw++.-.►/Tl.Rwn n�rslY/A'�rAnlw • .. 'I'UHN OF Barnstable DOARD OF HEALTH •_T11�_SUtISUttFACR SEWAGE�I)I fUSALSY�9TFM IN9PFCTION FORM PART D•- CERTIFICATION � -TYPE Olt PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRES$ 165 Marquand Drive Marstons Mills ,Mass . ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME John B. Cotton PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. , COMPANY NAME J. P.Macomber & S-oeh' Inc. COMPANY ADDRESS Box 66 Centerville ,Mass. 02632 Street Town or City state LIP COMPANY TELEPHONE ( 50.8 ) 775 - 3338 FAX ( 508 1 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at ®recommendations his address and that the information reported is true , accurate, and omplete as of the time of .inspection . The inspection was performed and any regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one: ysteri PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which I have con ted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature DatejV ne copy of this c rtification must be provided to the OWNER, the BUYER (where applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or operatorshall upgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 3,10 CMR 16 . 305 , partd.doc v' TOWN OF BARNSTABLE LOCAU,'-3N SEWAGE # 'W©\ VILLAGE f,Y'`J�IYNI 1 161��� M ft ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.�,I)M ��i I/)11f 6 SD '-11 l 3dej SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS ld BUILDER OR R` Dr. Pan-u—cP. � PERMPI'DATE: COMPLIANCE DATE: 1 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �® Feet Private Water Supply Well and Leaching Facility (If any wells exist n on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by W�M k� ; `� ` 1 t �✓ 75 1. 'D Sao ���� 47" ,`. TOWN OF BARNSTABLE LOCATION Lot 3 1.65 Marquand.Dr.' SEWAGE # 87=722 V;3A`.�3 VILLAGEMa.rstons Mills,-- ASSESSO S MAY &'Lo-f INSTALLER'S NAME & PHONE NO.Denis ' Colbath • .420-3538 SEPTIC TANK CAPACITY 1,500 gal. LEACHING FACIL ITY:(type) 1,000 gal: (si�.e), -.-r'NC-. OF BEDROOMS PRI4�Aq{'E—M'4E'LL OR PUBLIC WATER BUILDER OR OWNER David Barnicoat,Builder DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED; VARIANCE GRANTED: Yes_ I°Io. "��'f► a n�� P P P �+ I , r f r' g: has i rb.� Al d John B. Cotton 165 Marquand Drive Marstons Mills ,Mass . 02648 1-1500 gallon tank. 1-Distribution box 1-1000 gallon pit . '. - , €"{fi3 -A. w, P m TOWN OF BARNSTABLE LOCATION SEWAGE # \ `I VILLAGE1.�('`j'�T�/1 m ft ASSESSOR'S MAP & LOT _.3 } INSTALLER'S NAME&PHONE NO, I)M ,���f,{ ( Dt�s !�G�_-�-t I•�I3Dc-j SEPTIC TANK CAPACITY - LEACHING FACILITY: (type). (size) - F BEDKOOMS BLTIL.DER OR R•. 1 PERMITDATE COMPLIANCE DATE: '. . r -. l .Separation Dis'tance.Between he: Maxtmurri:`Adjusted Groundwater Table to the Bottom of Leaching'Factlity �.LJ Feet ' Private Water Supply Welland Leachin Facility". 8. (If any wells:ezist. 4 on site;or wttlun 2 .0 feet of leaching facility). fleet k Edge of Wetland and I eactung Fa6lity(If any wetlands:ezist . within 300 feet of leaching facility) { Feet Ftimished.by: r r ---- t -7 SUM 'f Z}, 2 m T t. ,SG o F v C s � I 00 I °0 v � a6ld,la A-rA N i m st Q&LC PA AA t L�f t StTlc. Ti�N�L ='3x� = 460 Ll S /IGOO I—AL TAM9— f VPWO-:�,AL prr - via I lcro SAL ¢"qT rJ&- "2S G��SF ' GGa L UoT' XA At7iA = 154 SF T�T'A(. -DA(i t FwwK- i INfj fZM14 pt� p i i Q2- 1 R-A to \A Mv� 1 - -------- Tim- 39-3s•i� •i` s,may, d SC 40 ..- a �, 1� � � � .. �• ;,�"' low _ t�Sr w! I+�� F: , ��� e 33.0 el F R GoArzS P Tta w =L=3d,00 3s�3c t \�\� , 3n S�IJD -Ulf-'r�t� a r \$Ica 4 � �,' \ (lop - P'T N 55 f a► L 5Y9S*MAA - iii V �i - f c-L-3Coo � • _-- - +1 i -•-t _ - f _ s w .y. No tl O N GDltn���5 Wt Tbf °fifd s 14-1 N -awct.0 Qe. 16 NOT' - to 9 ... r � I x Ci1a +STet.� L"r.:) Svr �yarr, 1-� - -- -ot4Tt ntJ M AP-G'rCS MILL-4 I " fro �� xr Z4,Rsl \cs � -_- l=rr a, (�aa C.ovr� PL-AN 2311) � tZ (1JC ^ _ 0 r t;►J ��iC UCrh 1t Cj— /�1Ct"1r a Y1.3 L •1' \ �/� J I1�...t.;�„+-+i...°."t t.� I�LI��§i+�..�'-1 �� ^3�� _ 1 -CSC/�.5 1 ! -•� �W D J J FAY a j[�ri7 25ro / o� .ut L4-4!% o Ali A� 1 QPPLICAWT ; 'SILVIA 1 5IILVIA .1W-, T-R s S�„ � '- r sYA6J, MCHARO �* No.,29733 "�3?j�_ �Ax7ER , V vJ 167 l a �Zq/g"� } 9 + LEGEND TOP FNDN. AT EL, 33.9' SYSTEM_ PROFILE TEST HOLE LOGS SEPTIC DESIGN: NOT ALLOWED ' --ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT T 1 SCALE) 100.0 PROPOSED SPOT ELEVATION (GARBAGE DISPOSER IS_- ) (WATERTIGHT) TO BAXTER & NYE ACCESS (OVER WATERTIGHT ENGINEER: DESIGN FLOW: 5_ BEDROOMS ( 110 .4,PD) = 550 GPD MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE 32.1' WITNESS: " �;, ---•..� 2% SLOPE REQUIRED OVER SYSTEM 100xO EXISTING SPOT ELEVATION USE A 550 GPD DESIGN FLOW : 27 87 I. 100 SEPTIC TANK: 550 GPD 2 = 1 1 �0 f RUN P PE LEVEL 2" DOUBLE WASHED PEASTONE DATE: / PROPOSED CONTOUR (�) -.� 30.39 FOR FI3ST Z' ROUTE 2s ' USE A 1500 GALLON SEPTIC TANK (EXIST) EXIST. EXISTING 1500 / + -- PTI / 3' MAX. PERC. RATE _ < 2 MIN/INCH 100 EXISTING CONTOUR C4LLON SE C ** 6771 !, LEACHING: TANK (H- 10 ) cns 29.1' CLASS I SOILS P# N� SIDES: 2(47.5 + 10.83) 2 (.74) = 172 -- BAFFLE 28.32' �"� 28.15 C-1 C3 � ED O C I� O 0 MARa,PNO OR. 0�� _?.7.96' f� 0 CI 0 M Q CD 0 �3' AT SIDES LOCUS-�T 47.5 x 10.83 (.74) = 380 ----- ELEV. BOTTOM: --- 6" CRUSHED STONE OR MECHANICAL 0 0 0 M � F 2:5 AT ENDS o TOTAL: 748 S.F. Sat GPD COMPACTION. (15.221 [21) �$ 2' C7 a CO C� C7 CJ Cl 0 CI bo 251.96' p�� �'� 32.0' DEPTH OF FLOW = 4' 1 1 0 USE (5) 500 GAL. LEACHING CHAMBERS ACME OR TEE SIZES: 10 ( o SLOPE) ( q sLo"'E> 3/4" TO 1 1/2" DOUBLE WASHED STONE LOAM & _EQUAL) WITH 3 INLET DEPTH =STONE AT SIDES AHD 2.5' AT ENDS _ SUBSOIL OUTLET DEPTH 14„ 24" LOCATION MAP NOT TO SCALE LEACHING 4' FOUNDATION- EXIST. SEPTIC TANK - 93' -- D' BOX. 21' FACILITY 22'f ASSESSORS MAP 77 PARCEL_ 37-3 BOARD OF HEALTH I **UNK DOWN INVERT - VERIFY PRIOR TO COARSE SAND h0`L' INSTA, LING ANY PORTION OF SEPTIC AND GRAVEL MA SYSTE v1 22 APPROVED DATE I / GROUNDWATER EXPECTED AT ELEV. 4.0'f _--4 MARQUAND Df ;IVE \ 45.77 UTILITY j 5.67 -`` 120" 2 2.0' CLUSTER i 4 7 4 09 �~ --- EL!=C TEL.CATV4 69 NO WATER ENCOUNTERED 5.54 i 461 R%s �45,55 ma3 GATE 45,1P LOT 3 LL `� 4 0$i, 45.03 3.8f ACRES g� ° 3.06 NOTES: �3 `''� 4 f 1 1. DATUM IS NGVD ao. N�C) ,� 2. MUNICIPAL WATER IS EXISTING 44.80 39,4 , �� 4 . ELEc 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. \\ �`O 1 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 20 +3y.0 i (� �'01 39 87 " VL METER I �1 5. PIPE JOINTS TO BE MADE WATERTIGHT. BENCHMARK + 9. �rl? 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. CONCRETE BOUND � O � ti ENVIRONMENTAL CODE TITLE V. ELEV = 34.0' F-E �4.4 M r:+29.34 NGVD -31 ° 3 ,'s R� `' 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE _. F LOT F STAK M 34.00 � / ;<% 31i.73 USED LINE ._ G. , I ry _ _ _ _ __ R (zinc_ "CIP S TIL c\i4Tc-t,AI �_ ---- • a _ I 38.24 9 COM TS "JIj f 0 B^'� 33 ti ,4R POI`•=EN I - `i_ - � K3$.50 INSPECTION BY BOARD OF HEALTH AND PERMISSION OP7 AWED + act f/38.33 ' FROM BOARD OF HEALTH, l ` +27,86 LOT 2 3 a6. •77 10, CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE 37.36 LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIE.\ F,fti'IOR TO COMMENCEMENT OF WORK, ' - LOT 4 q 9 + 9. 5 t�35. 1 TITLE 5 SITE PLAN 4ee 4.39 34. 7 35,08 OF #165 MARQUAND DRIVE -4 38.70 N _ +32 434.32 '1 IN THE TOWN OF: - r 35.11�, 36.02 ro SL EVE SE _R LINE FOR 0 31 ,O' ITER IDE OF D (MARSTONS MILLS) BARNSTABI-E f34.29 CROS tN NTH TH WATERLINE 4.7 +36. 6 +38.69 `. +3 .7 r_ PREPARED FOR: DR. ARTHUR BERNSTEIN Z 2� 34.31 i 7.8 33\+33.18 r \ 30 3�\ 0 30 60 90 irr 34_.-4-33. P s +r 33.76 LP --- "- 3�\ � SCALE: 1" = 30' DATE: JULY 31, 2001 -�;33. TH + 7.5 38' 32 33,02 0 ST LL 39 '1 ,a RET. AL 40 r/ it 32.46 5. +39,86 2.7.1 3.1. i 39 `ZH Of M \ i +38.59 3?,6 INV OUT 32. �8-- �� '"y �N __-- � AFiNE N. cyGJ, ���P` A11NE ELEV = 30.39' 37 aF OJALA c� 30 Z i 36 f c! CIVIL o _n A �• �� 3S� +35.14 EXIST, SEPTIC o. 30792 0 26 04 O ' LOCATION FROM EXIST. DWELL. INSTALLER'S ASBUILT SS �SQ� 7 PZ / �\ TF=33.9' A JALA, P. .S. DAT32-45 PROP. VENT (FINAL `, 31.73 PLACEMENT BY CONTRACTOR WITH HOMEOWNER) , LOT 3 off 508-362-4541 fox 508 362-9880 ry down cape engineering, Inc. CIVIL ENGINEERS EW2 EW3 LAND SURVEYORS -- +1 3 939 main st. yarmouth, ma 02675 0 1- 138 EW, T - -