Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0030 MIDDLE POND PATH - Health
30 MIDDLE__'PIIND PATH, MARSTONS- MILL` A= 080-003 J TOWN OF BARNSTABLE LOCATION 30 �6I -,j LA; --6' f4l SEWAGE# o>0141� -,4-t "VILLAGE r'J��� °�(CC SESSOR'S MAP&PARCEL rp-3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY.(type) (size) 3-!!C f1•�3`tc�-Q� NO.OF BEDROOMS OWNER- PERMIT DATE: I A-( COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) m rk- Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) /N Feet FURNISHED BY / atd9/ � ci��,�<•.�-�•x L_ le Pooh 'i90 N OF B NS LE LOCA-71011 6 M DNSTALLEWS NAM &PHONE No. . SBP. C�'A.l�i�CAPAC1T�t i ACI11rtG �i +rry i 4 R 0%?. 3(R:..... YfiIL.�►F1� . . . . F�R11�lIT.lD�.T� S jIAlrgtiDtt DiStt1CIGQ BOV ten th% Maxiunum�djus l Grou�dtie+aterT�ble.l tha S ttnmo� chi k c slit' .�..�;..�...------- 1'c °+ at�:r:►iq iy Vlc pt al.d t eacil3ag Facility Of*Malls a c t an eitc.ar witlun.?AO feat of iactiit► fili}�) �cig9 Edge ovet4al d end L,eac�Iti F�$ct�ity:�my'weft&odsc milt n 300 f leaching! ty) C�urnii�d�y U! �` Back ' I f CO) f� 1 �fO A-/-- 39'� " r No. Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplitatlon for Vsposal �6pstem ConstrUttlon permit Application for a Permit to Construct( ) Repair 0� Upgrade( ) Abandon( ) . ❑Complete System Afndividual Components Location Address or Lot No.30 Owp er's Name,Address,and Tel.No 3 - 39 Le-V 310 �� ei►z.Y! �..e-/5�e,'n ���le.�dr�aR•�uKl� Assessor's Map/Parcel W13 Mcite Funfl kd4i Installer's Name,Address,Ld Tel.No. ,508-'VX-$ �° Designer's Name,Address,and Tel.No. 5 19-3�--l'ySy �F�lo( ,Cor czx t'13r,"3r� tlS r�PcC,al'� vn 1 �.�J-,J,44& g3- 111W1yiSt_ rs 016 8 25- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) V. gpd Design flow provided VS gpd Plan Date f�Cr2,D?Irn6 I►'J. ".o19 Number of sheets / Revision Date Title Te' V"~ pj 1.1TdNdZ AI5�p Size of Septic Tank C°)(45�17c) /(al4� Type of S.A.S. /f�Ss�f3 tE>i!� rJrL Description of Soil_1jeo jn&jE AA L f r' Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Cod no o place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date —� Application Disapproved by Date for the following reasons Permit No. Z Date Issued ( — / ------------------------ -------------------------- - - -- -- - - - - --- - _ -_ .. .." .. ,,., y,r. ., _ .. 4.:,,..�,.•_w:-•w,... •-'^•�-,.�`,ro.:.�,.�-.r.,+,`,^i+.d:aw,.+t,..++g'J....;;=i h..�, ..::,1:�-.a.�r"'a''-�-s�..c-'-.,..� r•' arm w a ' 0 i - a� � / No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes , application for Misposal0pstetn Construction 3permit Application for a Permit to Construct( ) Repair O' Upgrades(�.) Abandon( ) ❑Complete System ®Individual Components Location Address or Lot No. _ Owner's Name,Address,and Tel.No.,5'U6-'9 39 U q 30 Assessor'sMap/Parcel 9613 t Yews�cnv, Installer's Name,Address,and Tel.No. ..70�5-4al$-$7�' Designer's Name,Address,and Tel.No.J52N ` V-j y/' C �4IoE£� Ca►�S4 rv� iGm,Zrc �ls cr ,ra "Yt�'P 1'rvr�L�ae ., ,►cc Type of Building: /�f Dwelling No.of Bedrooms Lot Size 7 yi 611 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided '/SS gpd Plan Date D�w. kv, It? 9,01? Number of sheets / Revision Date Title T/�0 5 c�� rlC�m 30 lt'lrf n �z-rf d , Size of Septic Tank �°X��I- t�1g /�a�Y�� Type of S.A.S. •�/�/U)$ or",? /z 3k)X.Vj.s L Description of Soil,-�ge -1_&A�- A// /u �,�r.4111 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: s. �f 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-arid no place the system in operation until a Certificate of Compliance has been issued by this Board of Health. f Signed r; ) Date Application Approved by Date Application Disapproved by ri Date for the following reasons Permit No. I I - d 2 I Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired 4 K Upgraded( ) Abandoned( )by a64613�- 7�oc h�} r at 1jtF JpPb { 61 �,tLte<has been constructed in accordance with the provisions of Title 5 and�the for Disposal System Construction Permit No.�20 r-�G21 dated Installer t�oIOM _L�t�S�1�U�}-/Gry7 111- Designer,(,�lydrr�61-4e. P-04PA1711nn r 4-4. . •L4'tC.- , 1 t #bedrooms `� Approved design flow VY0 gpd The issuance of this perjmitrshall/nort be construed as a guarantee that the system ill-functioaas��H�signeDate �7 P 9 Insp1- - - - - - - - - - - ----- -- --------------- No. / QI /t �� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposar Opstem Construction `-ppermit Permission is hereby granted to Constructt( ) Repair( /� Upgrade( ),� Abandon System located at )(J l'"(Jt'�.- )'/I_x -/ f and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permitT (� ) r Date ( " - / Approved by Ln \— _` 1 2 wa• t U r -25-2019 23:03 From: To:15087906304 Paee:1/1 i R - 1-0 Town of Barnstable Regulatory SeMces Thomas.F'.Gefler,Director MAM� iemasrs�s, � ,ems. ]Pu blic kialltfi Division alb Thomas McKean,Director 200 Watn Street,Hyawis,lam.02601 of,ca: 508*2-4644 Fax: 509-790-6304 I nstailer&Desimer(Certification Form Date:. Sewage PernaitW Assessor's Ma0arcel 8o IIDesipeu: W e 0j— a a4W KU,1 Inst0en. —V es Addrs: Q- - oil►�.-- - — Add ess: .D'SOX— d --- —- � On �/9 'val4 l s r r was issued a permit to iiostall a (date) (der) septic system at 30 ft,OU o PaTti based on a design ftwn by (address) �ar•,e( 0,LL PE, ea dated. . / signer) - V I certify that the septic system referenced above was installed substw alYy according to the design,which may include.m mor approved changes such as lateral relocation of the distribution box and/or septic tank. J certify that the septic system referenced above was installed with major changes (i.e. - gmatex them 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 cerd:ded goer to follow. IA0YSAS� DANIEL A. o OJALA ^� CIrA VIL No.40502 ssIONl1L ECG (Designer's Sigoatme) (Affix Desiga&s.Stamp Hare) PLEASE SE RMIMN TO AARN3TA8LE rMIC WALM D M. CERTNICATE_ �P CON&L ANCE WML NOT BE x4WkD UNM% F®TH N BX AND AS-IBUI T-CARD ACE RAID BY THE AA➢.NffAEI.E UC NTH IDXVXS ON. TI3f AXK Y'CYJ. Q:ffcdltWSeptie/Da9fV r CerdficahonFmm 3-26-04.doc J Town of Barnstable Barnstable o��l�t� Inspectional Services j Ic , K BARNbCABIX 639 Public Health Division x639 ,� m b 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL47015 1730 0001 4988 0039 November 30, 2018 FINKELSTEIN, GLENN A & CATHERINE A 30 MIDDLE POND PATH MARSTONS MILLS, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 30 Middle Pond Path, Marstons Mills, MA was inspected on 11/12/2018 by Shawn Mcelroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Backup of sewage into the house due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\30 Middle Pond Path Marstons Mills.doc Town of Barnstable BARNST"9� " �,� Regulatory Services Department rED MA'l� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A-McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. 'Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe,relocation of a 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) OTHER Repair deadline: d Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc 090-003 / Commonwealth of Massachusetts ✓ ��l'I Title 5 Official Inspection Form ci Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Middle Pond Path Property Address *' Glen Finkelstein Owner Owner's Name information is required for every Marstons Mills MA 02648 11-12-18 :: page. City/Town State Zip Code Date of Inspection P9 Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. Inspector Information Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that:l 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 theproperty 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 11-12-18 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 . s Commonwealth of Massachusetts 'y� Title 5 Official Inspection Form , i� ws ,� i,l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments IV. 30 Middle Pond Path Property Address Glen Finkelstein Owner Owner's Name information is required for every Marstons Mills MA 02648 11-12-18 page. City/Town 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 "ConditionalPass" 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): . II t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 5 Commonwealth of Massachusetts ,w Title 5 Official Inspection Form MI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Middle Pond Path Property Address Glen Finkelstein Owner Owner's Name information is required for every Marstons Mills MA 02648 11-12-18 page. City/Town 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): ❑ 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 El ❑ ND (Explain below): ❑ obstruction is removed ❑Y ON ❑ 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 30 Middle Pond Path Property Address Glen Finkelstein Owner Owner's Name information is required for every Marstons Mills MA 02648 11-12-18 page. City/Town 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 I� w' 1 lI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Middle Pond Path Property Address Glen Finkelstein Owner Owner's Name information is required for every Marstons Mills MA 02648 11-12-18 page. City/Town 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 1/2 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 16,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section.C.4: 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 Commonwealth of Massachusetts r� Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Middle Pond Path Property Address Glen Finkelstein Owner Owner's Name information is required for every Marstons Mills MA 02648 11-12-18 page. City/Town 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? ® ❑ Wasthe 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,7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Ili Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Middle Pond Path Property Address Glen Finkelstein Owner Owner's Name information is required for every Marstons Mills MA 02648 11-12-18 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: Number of current residents: 3 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: 11-2018 Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 c Commonwealth of Massachusetts s' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Middle Pond Path Property Address Glen Finkelstein Owner Owner's Name information is required for every Marstons Mills MA 02648 11-12-18 page. City/Town 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): r 3. Pumping Records: Source of information: N/A 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form w_, �i Subsurface Sewage Disposal System Form Not for Voluntary Assessments 30 Middle Pond Path Property Address Glen Finkelstein Owner Owner's Name information is required for every Marstons Mills MA 02648 11-12-18 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 l/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: 1986 & 1995 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 1811 Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ! i41 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 p Y rY 30 Middle Pond Path Property Address Glen Finkelstein Owner Owner's Name information is required for every Marstons Mills MA 02648 11-12-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1211 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 J Commonwealth of.Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Middle Pond Path Property Address Glen Finkelstein Owner Owner's Name information is Marstons Mills MA 02648 11-12-18 required for every 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: 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 Commonwealth of Massachusetts 3 Title 5 Official Inspection Form l�J ia�• , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Middle Pond Path `r• Property Address Glen Finkelstein Owner Owner's Name information is required for every Marstons Mills MA 02648 11-12-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ElYes ElNo 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.): D-box in poor condition with signs of decay and crumbling. t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 1 Commonwealth of Massachusetts tiro Title 5 Official Inspection Form 0 it Subsurface Sewage Disposal System Form Not for Voluntary Assessments 30 Middle Pond Path Property Address Glen Finkelstein Owner Owner's Name information is required for every Marstons Mills MA 02648 11-12-18 page. City/Town 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: 2 ❑ leaching chambers number: ❑ leaching 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Middle Pond Path Property Address Glen Finkelstein Owner Owner's Name information is required for every Marstons Mills MA 02648 11-12-18 page. Cityfrown 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.): Both leach pits had stain lines above inlet inverts and into riser. 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts rill ,3 Title 5 Official Inspection Form .I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Middle Pond Path Property Address Glen Finkelstein Owner Owner's Name information is required for every Marstons Mills MA 02648 11-12-18 page. City/Town 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.): 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 [�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Middle Pond Path Property Address Glen Finkelstein Owner Owner's Name information is required for every Marstons Mills MA 02648 11-12-18 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 U. .� J , . TILJ all- Oft r �— ' 6 .7 Zo. t5insp.doc-rev.7/26/2018 ° Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 II Commonwealth of Massachusetts Title 5 Official Inspection Form r-Il Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a -- >" 30 Middle Pond Path Property Address Glen Finkelstein Owner Owner's Name information is required for every Marstons Mills MA 02648 11-12-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 e�" Commonwealth of Massachusetts ,w Title 5 Official Inspection Form i-i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Middle Pond Path Property Address Glen Finkelstein Owner Owner's Name information is required for every Marstons Mills MA 02648 11-12-18 page. City/Town 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Town of Barnstable P# /SO5 �oF� Two Department of Regulatory Services , BABNSTABLE, " Public Health Division Date y MASS. Q� 039. 10� 200 Main Street,Hyannis MA 02601 f,;Y ArFp Mp't A •€� Date Scheduled Time l Fee Pd. Foil Suitability Assessment for Sewa e Disposals Performed By: CQ I� �C�a�i Witnessed By: VN� L-O.CATION &.;GENERAL-INFORMATION Location Address 7 0 M; _�/1_ 10., /A Owner's Name �] Address. ' Assessor's Map/Parcel: S�/3 Engineer's Name NEW CONSTRUCTION REPAIR ✓ Telephone Land Use ,( Slopes(%) 7 ,Z 5 Surface Stones Distances from: Open Water Body—��—`��ft Possible Wet Area�J�ft Drinking Water Well ft Drainage Way- V -ft Property Line tn Lot ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) + A. ao Parent material(geologic7)Y e 6 k -tr.. Depth to Bedrock t + Depth to Groundwater: Standing Water in Hole: 1V(j!�L000 Weeping from Pit Face -f Estimated Seasonal High Groundwater —� DETERMINATIONYOR SEASONAL HIGH WATER TABLE Method Used: --� Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST, Date \Z11V Ti., 10 Observation Hole# Time at 9" Ir Depth of Perc � Time at G" Start Pre-soak Time cr 6Q Time(9"-6") / End Pre-soak Rate Min./inch Site Suitability Assessment: Site Passed Site.Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of-wetland,you must;rst notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTICCPERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from - Soil Horizon,' Soil Texture Soil Color' ;t " `, Soilf,J .: ` Other Surface(in.) (USDA) (Munsell) Mottling' (Structure,Stones,Boulders. T' Corisistency.%Gravel) IZo C 14S tollm DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) Flood Insurance Rate Man: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes Within 100 year flood boundary No `� Yes Depth of Naturally Occurrin!Pervious Material Does at least four feet of naturally occurring pervious�Ilaterial exist in all areas observed throughout the area proposed for the soil absorptionsystem?y stem? S .� If not,what is the depth of naturally occurring pervious material? Certification / I certify that on !�i (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection.and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. • Z i t� Signature Date Q:\SEPTIC\PERCFORM.DOC l r V, TOWN OF BARNSTABLE UDCATION `mod �dOL� �� OAF SEWAGE # L _ VILLAGE /'V/VU_tVP'AS k"I"J ASSESSOR'S MAP & LOT O —410.3 INSTALLER'S NAME&PHONE NO. �1��Iro�7 � SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �/%_ �� tj6W(size) NO.OF BEDROOMS v'? BUILDER O O II, WNE PERMTTDATE: 7//,7/A COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) / Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) 4 Feet Furnished by Lt- of qc ieA Loo r ,017k i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratuan for Di-lipw3al Works Tnnitrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair A an Individual Sewage Disposal System at: Location..`ddress C r.�t_NYv r`�Yu� 7v►��f ((lJ irCL� s i .�n.1 r'h 140 ,04�► avi✓1 V I.YJ // LNO�ery J .e.��/1 ��N dress �^ a 1✓(mil Installer Add,L Type of Building Size Lot............................Sq. feet i—t Dwelling— No. of Bedrooms...._.--_---� ------------------------Expansion Attic ( ) Garbage Grinder ('—T,01J0 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ---------------------------------- W Design Flow............. -.-..--.._-___-__..gallons per person per day. Total daily flow-.-----.---..� d-_.............---gallons. W Septic Tank—Liquid capacity/9*_.gallons Length---------------- Width-----.---------- Diameter....._...--.... Depth................ x Disposal Trench—No. .................... Width_..--.i------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........../-...... Diameter-----/0..-..... Depth below inlet........(A._(...... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit---.--.-.-.-..-.---- Depth to ground water...--.......----...--... fr Test Pit No. 2----------------minutes per inch Depth of Test Pit--............--.--. Depth to ground water..----.................. P4 •-•-•---•-••----•--------------•---••••---•--••--••-••••-•-••--•---••-••-•-•••--•-•--•---._...•-•••.....••--------•••--••-•-••••......--•--•-•......---..••-- 0 Description of Soil........................................................................................................................................................................ x V ....---••••-••••-•-•--•••••----•••••--•----••••-••--•-•-•-••--••--••••••-•----••••-•••-••-••••••-••--••--•--------------•-------••-••-••---•-•-•--.....•-•-•-•------••-•-••-•-•......•-•-•-•-•••----•••. W --- ----------------------------------------------------------------------------------------------------------------------------------------------- ----- ........................... U Nature of Rep rs or Alterations—AnsyVer,when applicable..--- - - ,Q.-..---..lOLY4-- .. ........... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environment 1 Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliant aVbten u b the board.of health. _..._ Signed ------- - -- Date Application,Approved B _....:.:... �'� `------ ------- Application, . - ------ -------------- ----- i Date Application Disapproved for the following reasons: ..................... ...................... ............................ . . ........................ ...................... ����/�...._................. Permit No. / . . ...................._ - - ...Issued -....-�............. . Date 1 t No.._1.. ...... FEa....-7d............. THE COMMONWEALTH OF MASSACHUSETTS k BOARD OF HEALTH TOWN OF BARNSTABLE Appfiratiun for Divjipimal Works Tomitrurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair (/<) an Individual Sewage Disposal System at: n ........................................................ ••-•--•----••-•---•-•-•---•••--•----•----------•-•---....--.-•--- Lo�catiOonw.-.n)cAddress l. U1 71 �tJ � or Lot No. ......•-- .--••- ? 61 rf�NC_ � `-' ................................................. s v►'l tC � ... . .. ddress ..l ... - Installer Address U Type of Building Size Lot...........................Sq. feet 13 �. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder () /JD Other—Type of Building ---------------------------- No. of persons._.._ --_--__--_____--.-.-.- Showers ( ) — Cafeteria a ( ) d ,t Other fixtures ------------------------------------------------------------------------------ ----- W" Design Flow................................____gallons per person per day. Total daily flow--------------7-7d..................gallons. WSeptic Tank—Liquid capacitvl9..0®_.gallons Length---------------- Width---------------- Diameter_--..----.--_- Depth................ x Disposal Trench—No. .................... Width___..._---.__--_-_ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.------_._/....... Diameter------/0.--..... Depth below inlet.__..._��......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by---------------------------- ............................................. Date.................................... Test Pit No. 1................minutes per inch Depth of Test Pit-.--.--______--.._-_ Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W �� ----------------------------•-•--------.................................................................................................................... 0 Description of Soil........................................................................................................................................................................ x U •-•------------------------------------••-----------------------------------------•--------------------------------------------------------...--------------------------•---------...........------•---- W x . U I Nature of Repa'rs or Alterations—Anse.er when applicable.___/Q.�._.._.._fl!.4__� ....................................................1 w f=7-s: L`�..... 7-a ;&✓� fx -_ 1a.s��.n -=��.... ........................... .....................�' sue►... Agreement. 0 - The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complianceilias b en issu by the board of health. Signed ...........•,.. f 7/7�5�-� ���I'Il✓: Da�..... . ...APPlication Approved B . -Y........ - - re _�'47 +� Dace Application Disapproved for the following reafonr: ...................... .... . ..... . . ................... . ............------- ------ - -------------- - ---y,.. . ..... - - i Permit No. 3 ---------------------- Issued ...................................��------Dace Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�extitira e of TIImplianre THIS IS TO CERTIFY, T�h,au, e Individual Sewage Disposal System constructed ( ) or Repaired by ....._._._ - - - ----------C V,v-sTX,,..r6-zu^J �--h1 f A 7 r _.... ------------- ........................................ . has been installed in accordance with the provisions of Tl"fI� aL he,State Environmental Code as described.i-n— the application for Disposal Works Construction Permit No. ....�... ...6_.......~, ......... dated �'"1�-�`..�� �... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------l .....R..._. ..J� ' .. G ......_ ...... Inspector --.�__ ..�...............���......... THE COMMONWEALTH OF MASSACHUSETTS �j rRj 603 BOARD OF HEALTH v C� TOWN OF BARNSTABLE No t.,✓..../.. FEE.--- �-f b -- Rupuunl lVighq Tumitrudiun rrrmit Permission is hereby granted.....................:25_�,66��/f__......_.�/J--57/�l C --•----•-•--------•••-•-••........... to Construct ( ) or Repair an Individual�ewage Disposal System atNo... - � ! L �-G-'J...--..... 1..... t I 1 1 ................................... Strc f as shown on the application for Disposal Works Construction Perini _ 3--__ D �_---/�.",�'�.�_. , �'/� DATE..... -•------•--•-•--•-------------•---•-----•--•---- Board of Health FORM 36508 HOBBS&WARREN.INC..PUBLISHERS LOCATION SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME i ADDRESS F, Vo lcprft uft,�r> ca�( 2:� PM"yk ny-e v fN� BUILDER OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED 'd�s�wLV�i� C-ttscut�w'�l�> yu M' Y s ' I � :4 F�$. 0..... .... tl• � THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH /. G /1.................._0 F........4J..r�.✓.MJdq.blt ...... Applira#ion for Elhipmal Works Tonotrurtion rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual ,Sewage Disposal System at .... 26 5 ._.... Lo ation-Address / or Lot n.....---•-•••-••---...--•-•--••---•.......... •--....7..`f..,t'�v.,�r,�t f/.��.�. - - An nAs caner_ Address ; .© ..----••--------------------•-.................._.. Installer Address Type of Building/ Size Lot............................Sq. feet U Dwelling `—/No. of Bedrooms.......... .... ..:. ....__....Expansion Attic (AIA Garbage Grinder 7 - 4 a Other—Type of Building ...../V _ No. of persons...,, ............... Showers �(/� — Cafeteria�((/ ) -------------- d Other fixtures & ......................................... WDesign Flow.............J&......................gallons per er/day. Total daily flow___.......3'w......................gallons. WSeptic Tank—Liquid cap,acJity./jOW.gallons Length__ _'_fir.... Width_'4�:�a��. Diameter .... De th__.21__7.N. x Disposal Trench—No. .../.Ik........ Width...JVA....... Total Length...*/A....... Total leaching area./ ..........sq. ft. Seepage Pit No--------f---------- Diameter.................... Depth below inlet.................... Total leaching area._ 44......sq. ft. Z Other Distribution box Dosing tank ( ) 11 aPercolation Test Results Performed by._...Elll4_...*..T{aL(1!1�._.LhC..................... Date.._ . �.7 BJr.......... Test Pit No. 1.4r.Z....minutes per inch Depth of Test Pit.......8........ Depth to ground water.... _._....... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.....1?.......... Depth to ground water....�.tk.......... ----------------------------------•-------------.........-----.....------------......-----.._....--......................................................... 0 Description of Soil...... '.. ........... _Z.S..__ cAJ�1Y.__ C !!.�.......Z=S.'__. 1I.......MED-.�Spa'A ........... vTom. Z ME L...........................•--------------------....-................-----------------..._.........-•----•-- W U Nature of Repairs or Alterations—Answer when applicable..........................................................................0......_.........._.. ------------------------------------------•-•-•-•-•-••-•---•-•-•••--••••••....-••••--•••...---•..........-----•--••------......•••-------•-......................................................... Agreement: The undersigned agrees install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of th State Sanitar.. o e The u e si n urther agrees not to lace the syst in operation until a Certificate of Com iance s b en ' su b e f ealth. ne� ........ Application Approved By........... ....... ............... Date Application Disapproved for th ollowing reasons-..............................................................-...............................................- -•-••.............•-••••-----•-••--•.......-••--•--•-• •.......................................................... %!. Date Permit No. •.---• ....`�Z-c`�-------- Issued---------------------------•---...----•-----........--- Date No.....2—-. F$a ..� ' 1. R ,., s THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -ram l 16 b 9.. . . . Appliratilan fur Disposal Works Tons#rudian Vrrum Application is hereby made for Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at• !!/ ...................................... ....... or._. d....... _ _ _ Lo tion•Address or Lot- •-------------.. ...... _ in ar. ......... ................................ . ....... ..�'Lvr� ., h a�,� .._....... ........... • ner Address......................... - -- M Installer Address Q7i Type of Building/ Size Lot............... :............Sq• fe4t. U Dwelling—No. of Bedrooms................3......................Expansion Attic ( Garbage.Grinder (,(/ 1 No. of .&A.............. Showers a Other—Type of Building __._. ............. persons... f�,/,(�;,'r'",„Cafeteria Other fixtures .*". gin............................................................ .--;...........•••............_... WDesign Flow..............11b......................gallons per �e�se� ear day, Total daily flow_._..__....-:----.--•-.--_------------...... lonsN. WSeptic Tank—Liquid capac't .lA ?gallons Length._.P._..1 .... Width_'9.':10��- Diameter... ^^.... D th_.. .I x Disposal Trench—No._._. ._.__.. Width_...t' !4_...... Total Length.._. :..... Total leaching areaAh... _....sq. ft. Seepage Pit No.........I......... Diameter.................... Depth below inlet.................... Total leaching area.....Z. sq. ft. z Other Distribution box ( Dosing tank ( -) W Percolation Test Results Performed by..... _E15... .. h+�!►?. _..�.!'L................... Date__. . : .. �... ,-a Test Pit No. 1__�'f._»_l...minutes per inch Depth of Test Pit........6....... Depth to ground water....... .......... f� Test Pit No. 2................minutes per inch Depth of Test Pit.......M....... Depth to ground water.... . ......_ . .. ................................ '.. . •..�1.." ....... Description of Soil.....".......:.... MV 1. . ^ ...... ...-� � l�_rV CPVa .-----...... .--------•• . •------•----•................. . ......•----•--------•-•----•-------•----.......--•------...... !� ... ... W UNature of Repairs or Alterations—Answer when applicable.............................:...................•-----.•:•-:•-•--.........-:.--.......--...... ••--•---•==-------------•-•••----••••-------•----------...................•---.........••••-•.....-----•-•••-•---------••••----- " Agreement: The undersigned agrees t install the aforedescribed Individual Sewage Disposal System,in accordance with the provisions of TIT11r 5 of th tate Sanitar e . he u er i ne rther agrees not to lace the syst i operation until a Certificate of om 'ance b n ' u b e d lth. ..--•_..... Application Approved BY ....._.. . `� ......... - ... l ... ....... Date Application Disapproved for the f llowing reasons:.............. ....................................................... ...........__- ..----...............---------------•-----------.... ..... .....•..... Date .._ Permit No......... .. ....--------- Issued......................... te ,. Da THE COMMONWEALTH OF MASSACHUSETTS-`-- ' - BOARD OF HEALTH ..........................................OF................................ f,0rr#ifirate of Tomphaurr THIS IS TO CERTIF`, That the4ndividual Sewage Diposal System constructed ( or Repaired by------------------------------ -�= ..............s ....................................•-•--...................---.......... (- ) Installer at............ ...........(4!.-l.D.lD e........PC2-Nvh---------P-A---1-14............................................................................. has been installed in accordance with the provisions of TITIEF 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........0 7.31:-........ dated......... ........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIL FUNCTION SATISFACTORY. DATE••-•-••-• ---•---------------------------------•-•-•------- Inspector•--•-•�- ....--•---------.......------....-----.....---...........-•-------•--. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �iu�outtl�-forks �onu#r�r#iun �rrutit Permission ji!jkereby granted......... Latls.. --- to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No.-......... o.............�.1'J - ..�t3....._.... .L� L ...._... ..........1� �- �• .................-•---....................----............ Street as shown on the application for Disposal Works Construction Permit No. ated ....P. 7 —P� ...-•--••-- al - 1. d DATE........./ --.----2.. --�` ,6...............•-•--•-•---..................... f He •� s FORM 1255 A. M. SULKIN, INC., BOSTON f DESIGN DATA Lo, 3`l• 9 _ � / /� STRUCTURE 9 A ~Ac'4ti�. \-RD DESIGN FLOW P�1:)(2-r\A % rJv C-t'cig SEPTIC TANK LEACHING RATES, SIDE AREA 2+--:, GPD/SF BOTTOM AREA I.OGPD/SF LEACHING FACILITY rSM NAIL FND IN PQIMAQ- 9 / I P&D ELE VA-now = 1 00.0 3 / / / / _ @ I \ / / / / / / �B -EA 77 Q I II ., / % / / , // . / ✓ / // �I f 1=A 2 x x Co k 4 = I S I F 00 / 0 x I . c> + NISI r 'L.Si = 4-iOGPD PLAN REFERENCE: / />7 LvT 4-c �A, A �L Q Q / �/ 4 � � h° -�''„ / / �> r/ i � � � a1= Dt=cD� P� (3K 20=•, fJ•,�c:3 a nm J i' m I4 ,fI 0,°�0 D d/�L�ZPZI / / /' I I ASSESSORS LOT NO. -----._ . J� e z6o 3 1 /� I �" 1 /f / � I i / NOTE- I. ALL MATERIALS AND CONSTRUCTION METHODS ?S' ® I I /8 / j t TO CONFORM WITH COMM. OF MASS. TITLE SC ENVIRONMENTAL CODE el� � / � �l/Nj /e /� �� / 1 / I a j � T�1= 4.'„ �, ��r-4�C ��� C=-•�:,--- C/1 / / r� i� m /e r/ / � 1� : -- ]Q If / / 1 f _ S --'•— X1sT f1 Imo, �c�a� rooL � 1 9R 1:Z11 IJ l ! l n }Z' / I l A --Z Lr�T 'Lo A t2-- ! , . cp sI --;=uD EL S �f / �P��11 Mqs aAR AVI �� DD.. a�� 21 C. 1HULIN a o. 29976 n��/I .fQ 'N [d PLAN. /<0i- f i s C 90,o SCALE I"=4o TEST PIT N 0.e I TEST PIT .NO. +` �.� ELEV. �14, ELEV. 89.E E�cI ,- EN"v `� 29c37d . qo c- 90 ; l 9EGIST CSC .L• `' B9.o D.5. s Lt�aa-n 1 SU��tt_ ToP P-t s so,c_ 1.5 SOIL OBSERVATION PITS l 000. s7.5 87.s a' DATE OF TEST S •22 , 4 l '- '`'=�� vALLoI 1 e — EL. = Q,� o ENGINEER 65 - BS B.O.H.AGENT � :F-;- TA�K (1) �' x 4.' G t_1J�N ME=l] EXCAVATOR 4.o S w / 3 sTt�l SA.1-110 PERC RATE IN T.P. NO. I AT 4- FT._ 2 MIN./IN. . r o• _ e' '� ��_ P,4.2 . ,�y M1=DiUM -['IZ ! — — 1 O r D i. 20 r T- BoTT• L.P. 80 IUDIA" LA LE— E-aTA 11=-:5 MA L---l:DQS M'I L_IS ELLIS & THULIN, INC. LAND SURVEYORS AND CIVIL ENGINEERS AAA lot- I,.lo w a're(Z �o r-+.w wA-rcrz. No F�I�Q >=l_ 77 o 75 EAST SANDWICH, MASS. 75 P��vR�1=� �Lr�T ►P2-A" �/CQ-T 1 '�= S 2E:V, g �.17185 f••`L�D SOtC.. T�S`ZC' P•�#-�5� SECTION THRU SEPTIC SYSTEM DIv '. .3eE- o�� -1 k=. r`�T 8 . 2a i i ALL SYSTEM COMPONENTS SHALL BE NOTES LEGEND SYSTEM PROFILE MARKED WITH MAGNETIC TAPE OR NOTES COMPARABLE MEANS FOR FUTURE LOCATION. 0� (NOT TO SCALE) 1. DATUM IS NAVD 88 PROVIDE MIN. 20" DIAM. WATERTIGHT 99- EXISTING CONTOUR ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE Ley 2" PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS EXISTING o X 99•1 EXIST. SPOT ELEV. \ TOP FOUND. EL. 68.4 FILTER FABRIC OVER STONE -[99]- PROPOSED CONTOUR MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 59.0 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. NOTE: 2" MIN. WALL 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS BLOCKS OR 198•4] PROPOSED SPOT EL. THICKNESS REQUIRED PRECAST RISERS TO BE AASHO H-10 Locus TH1 59 5' 4"0SCH40 PVC MORTAR ALL H-10 .. s" MIN. SUMP PIPES LEVEL 1ST 2' COMPONENTS5. PIPE JOINTS TO BE MADE WATERTIGHT.INV'S E 5.24'TEST HOLE t2" MIN. INT. DIM. �4D NS (NP) L. 5 SIDES 56.03' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITHqj *THE INSTALLER SHALL VERIFY THE to~ t4" :y EE Po�o�oo� o 00000 2% SLOPE OF GROUND "EXISTING TEE ° ®BOO� OO�o�o Do ���� ��Do�o >000�oogo 310 CMR 15.000 (TITLE 5.) TEE *58 23 > o 0 0 0 > o 0 0 0 LOCATIONS OF ALL UTILITIES AND ALL SEPTIC TANK °o°°°o°° �I��mmmmm OM 0EI���®�00�0 °°°°°°°° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO 00000 ° ° ° ° ° ° ° ° �oa000c000aoo WATERTEST D'BOX o >°°°°°°°° o o 0 0 o 0 0 0 '°°°°°°°° BUILDING SEWER OUTLETS AND GAS BAFFLE : 000,0000000 °°°°°°°° I��O��D��OO® ®®�®®®®®0�® '°°° °°°° C-O ) UTILITY POLE 0..0• FOR LEVELNESS N ° ° o ° ° ° ° ° ELEVATIONS PRIOR TO INSTALLING ANY °°°°°°°° ��O�D����O00 Do���QOQOOODoDo oDo� °°°°°° BE USED FOR LOT LINE STAKING OR ANY OTHER �o g°o °o°o°o° PURPOSE. oa I ° ° ° ° ° ° ° ° 53.2' FIRE HYDRANT PORTION OF SEPTIC SYSTEM ':,'.. 55.47 55.30 NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAw�Nc H-10 500 GAL LEACHING CHAMBER BY ACME PRECAST OR EQIUAL. 8• PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. Wo{ershed ALL 3/4"A 1 AROUND DOUBLE WASHED STONE 4' MIN. (3) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED ALL AROUND PRECAST STRUCTURES WITHOUT INSPECTION BY BOARD OF HEALTH AND \ **INSTALLER SHALL CONFIRM MINIMUM SEPTIC 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 33.50' X 12.83' iv PERMISSION OBTAINED FROM BOARD OF HEALTH. Q TANK SIZE AT 1000 GALLONS AND ITS SUITABILITY COMPACTION. (15.221 [2]) (6 V FOR RE-USE. REPLACE WITH 1500 GALLON 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING SEPTIC TANK APPROPRIATE TO SITE CONDITIONS IF DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCUS MAP NOT SUITABLE LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES 47.0' BOTTOM TH-2 PRIOR TO COMMENCEMENT OF WORK. ( 9 % SLOPE) ( 1 % SLOPE) NO GROUNDWATER FOUMD SCALE 1"=2000'f 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED BENEATH AND 5' AROUND THE PROPOSED FOUNDATION FACILITY EXIST. SEPTIC TANK 30' D' BOX 12' LEACHING LEACHING FACILITY. ASSESSORS MAP 80 PARCEL 3 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. SYSTEM DESIGN: TEST HOLE LOGS GARBAGE DISPOSER IS NOT ALLOWED 49 s� CRAIG J. FERRARI, SE #13871 EXISTING 4 BEDROOM DWELLING EMGINEER: DESIGN FLOW: 4 BEDROOMS © 110 GPD = 440 GPD - DONALD DESMARAIS 46 S 3'29'50"E 52 WIITN'ESS: USE A 440 GPD DESIGN FLOW 18 71 DATE: 12-14-2018 47 PERC. RATE _ < 2 MIN/INCH SEPTIC TANK: 440 GPD (2) = 880 g8 �9 \ **USE EXISTING 1000 GAL. SEPTIC TANK 50 h' CL-ASS I SOILS P# 15854 I so J I LEACHING: s6 s� 51 s ELEV. ELEV. SIDES. 2(33.5 + 12.83 2 .74 - 137 GPD � s �, � 1 z 71 g a 52 53 0„ 4 59 0„ 57, BOTTOM 33.5 x 12.83 (.74) = 318 GPD - - - c�, s \ � q TOTAL: 615 S.F. 455 GPD 55 sg ' RE OVA OF UNSUITAB LE UIRED s� FILL FILL A OF LEACHING FA 22 0 WINT TA LE L LAYER. REPLACE 10YR 4/2 USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) TO WITH 4' STONE ALL AROUND 6O Q 56 TH2 H EAN SPECF*AWN E O -- CMR�15.55(3) A 36" LS 10YR 3/3 C 1 a X X 25 S L QD g SL 52» 4 J 52.7' F TH 0 \ 22 �' 58 40" MA � ' 2.5Y 5/4 55.7' APPROVED DATE BOARD OF HEALTH 5 l c' C2 REMO T E �-\ POOL C RO T ARE EN I 6j _ 0' oEP N 63 62 00� �____ x PATIO PERc MS r7 DO 64 �- t _- �- Ql scll MS C7 _J 65 \ � ��_ _c, 10YR 7/4 �o N 66 ��\ x 10YR 7/4 0 cn BENC ARK: \ 132" 48' 120" 47' PATIO TOP NCRETE I rh =60. NAVD88 OW° No NO GROUNDWATER ENCOUNTERED i I DECK� I II I I PAVED I DRIVE I EXISTIING J DWELLING ss TOF =I 68.4 6 6TITLE 5 SITE PLAN l PORCH \ a OF 70 I I < WALKMARSTONS MILLS, MA ou MIDDLE 'OND PATH 66 68 \ LOT 20 I 68 D 44,541 S.F.f j 6� PREPARED FOR 69 BORTc�TL GLENN F�INKELSTEIN C) ��� CAT TV �6'8 66 J 6� L 2108.00' 6g carv----CA DATE: DECEMBER 17, 2018 _ R=2543.90 6 Scale: 1 20' 70 MI LE PONDPATH - _ \ - _ 1 A 1T H 0 10 20 30 40 50 FEET off 508 s -362-4541 -�N OF A'ASS9Cy fax 508-362-9880 DANlELA. DANIEL Gym ( downcope.com to OJALA ,o A U CIVIL U No.LA down cape engineeM7,f, ®nc. 46502 P �o �� oF�ss� civil engineers ,a SSosTE� G�e SURD �t land surveyors 939 Main Street ( Rte 6A) DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 ' LICE # >8-439 18-439 i I it ......- __. - - .. --- - ---- ----- -- --- -_ -