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HomeMy WebLinkAbout1375 OLD POST ROAD (CT & MM) - Health 1375 OLD POST ROAD MARSTONS MILLS A= 057 - 027 i i 1 I i I s• No. �_o Fee 7 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Npfitation for vsposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(4 Upgrade( ) Abandon( ) ❑Complete System [!I/ndividual Components Location Address or Lot No. 13-1 S Ot t) Pc_ey VL'p Owner's Name,Address,and Tel.?Jo. tA k ®Ot-AC4 C—UkECL( Assessor's Map/Parcel S M O &4 1-A-70 M"A:5nbjS k L Installer's Name,Address,and Tel.No. ;D2—147 98 7 �� 1 Designer's Name,Address,and Tel.No. ig—w6va Jt?C46Xx-� Out-�S Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building POST f)G I A+LC No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Le Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) =tt9 7 61,O —10 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of . Signed ealth. Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued ry •t, i No. O � _ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pp4Cation for Misposal *pstent Construction 30EiIttlt rApplication for a Permit to Construct( ) Repair()4 Upgrade( ) Abandon( )"' ❑Complete�System —f tdividual Components Location Address or Lot No. 137 57 00 PO.CT P,-p Owner's Name,Address,and Tel.No. Assessor's Map/Parcel D MM RU t>O L.Ay vkvuli a tvS Installer's Name,Address,and Te.No. J pQ-1471-$1877 + Designer's Name,Address,and Tel.No. w(.-WIDo 1 Ato4e-ex 13 out. to � ��� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building j2gP5,,`� (A L, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 0 4: gpd Design flow provided � gpd Plan Date Number of sheets Revision Date ,. Title Size of Septic Tank Type of S.A.S. Description of Soil x + Nature of Repairs or Alterations(Answer when applicable) =rtJtTnALl bj6u) H_/0 b-13 �0 54':�? Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed A Date ~Application Approved by ( Date Application Disapproved by Date i - for the following reasons Permit No. �. G, _ l/ Date Issued A r � THE COMMONWEALTH OF MASSACHUSETTS (1 boy BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site.Sewage Disposal system Constructed( ) Repaired(X) Upgraded( ) Abandoned( )by t�11 bE .T , 0 LAP- cto at 1375 oLD PaST RLD MM I donjr-f- has been constructed in accordance with'the provisions of Title 5 and the for Disposal System Construction Permit No. 2o If, -U dated ,I/ 19 �i Installer� � �l�p�3ALT6UILd4 Designer 04 #bedrooms / /f Approved design flow gpd The issuance of this pe' it s all not be construed as a guarantee that the system will nctt �designe . Date Z Inspector �// , --------------------------------------------------------------------------------------------------------------------------------------- No. o l ' 1 �O Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS 30isposal 6pstrm Construction i9ermit Permission is'hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at h r ou Paz: AaAz ATu cr_4 MAO-SmaC M I 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 m st be completed within three years of the date of this permit. I Date l ! / Approved by 11/6/2019 ShowAsbuilt(1700X2800) Y '�37 TOWN OF BARNSTABLE LOCATION I 001A) [�nO j SEWAGE # �l VILLAGE '} , y1`� � `-i ASSESSOR'S MAP & LOT �� INSTALLER'S NAME & PHONE NO.VY'% i 'I�w'r _lf SEPTIC TANK CAPACITY_Ija LEACHING FACILITY:(type)?I� (size)6y6 _i5A,'fZ NO. OF BEDROOMS____> `PRIVATE WELL O PUBLIC WATER BUILDER OR OWNER C L t DATE PERMIT ISSUED: 41( S 9 DATE COMPLIANCE ISSUED VARIANCE GRANTED: Yes No L t 0 dab 25 � https://itsqldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=057027&sq=1 1/2 Nov 14 2019 23:48 HP Fax page 20 02 y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1375 Old Post Road Property Address Estate of Rudy Curelli Owner Owner's Name information is required for every Marstons Mills MA 02648 11-13-19 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered In any way. Please see completeness checklist at the end of the form. ����►�uut 0 tF 1 irlriii� Important:When .. s filling opt forms A. Inspector informationyam- `•per'•' •.;�cG' on theoomp,ter, Wig; DAMES s' use only the tab James D.Sears �; r=. key to move your Name of Inspector t A H b � cursor-do not k'• * use the return Capewid Enterprises i �,. c, o ; Company Name r ' ti 1`, key. � Sl 153 Commercial Street ��"'�,s INSPEG o�' �11 Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector In full compliance with Section 16.340 of Title 5 (310 CM 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true,accurate and complete as`of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3, ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 11-13-19 pector'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. l5insp.doc rev.712eW18 Title 5 Official Inspection Form:Subsurface Sewage Dispcsal System•Page 1 of 18 / Nov 14 2019 23:48 HP Fax page 21 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1375 Old Post Road Property Address Estate of Rudy Curelli Owner Owners Name information is required for every Marstons Mills MA 02648 11-13-19 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: The system is a 1000 Gal. Tank D Box and pit. 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health. will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old'or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): I 15insp.doc-rev.7/28/2016 Ti11e 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 or 18 Nov 14 2019 23:49 HP Fax page 22 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface� Sewage Disposal System Form Not for Voluntary Assessments Vv 1375 Old Post Road Property Address Estate of Rudy Curelli Owner Owner's Name information is required for every Marstons Mills MA 02648 11-13-19 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 i❑ a times a year due to broken or obstructedpipe(s). The Y q P P 9 Y system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: a ❑ 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.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Oisposal System-Page 3 of 18 Nov 14 2019 23:49 HP Fax page 23 Commonwealth of Massachusetts p Title 5 Official Inspection Form i1� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments e.! 1375 Old Post Road Property Address Estate of Rudy Curelli Owner owner's Name information is required for every Marstons Mills MA 02648 11-13-19 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 l5insp.doc•re+.7/26/2016 Title 5 official Inspection Form:5l 11$Urface Sewage Disposal System•Page 4 of 18 Nov 14 2019 23:50 HP Fax page 24 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ., 1375 Old Post Road Property Address Estate of Rudy Curelli Owner Owners Name Information is required for every Marstons Mills MA 02648 11-13-19 page, Cityrrown 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 pjppppW is less than 6" below invert or available volume is less 'than '/2 day flow Pi-r ❑ ® 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 ails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area —IWPA)or a mapped Zone II of a public water supply well l5insp.doc-rev.7/26/2018 Title 5 Official Impection Form:&bsurrace Sewage Disposal System-Page 5 or 18 Nov 14 2019 23:50 HP Fax page 25 li Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments k�,,w — 1375 Old Post Road Property Address Estate of Rudy Curelli Owner Owners Name information is Marstons Mills required for every MA 02648 11-13-19 page. Cityrrown 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 NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? f ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example,a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7l2el2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page a of 18 Nov 14 2019 23:50 HP Fax page 26 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4� 1375 Old Post Road Property Address Estate of Rudy Curelli Owner Owner's Name information is MarStons Mills required for every MA 02648 11-13-19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms): 330 Description: 1000 Gal.Tank D Box and pit. Number of current residents: 0 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 El Yes No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonai use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 2017-17,000Gals 2018.17,000 Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date t5insp.doc•rev.7/26018 Title 5 Otkial Inspection Form:subsurface Sewage Disposal System•Page 7 of 18 Nov 14 2019 23:51 HP Fax page 27 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1375 Old Post Road Property Address Estate of Rudy Curelli Owner Owner's Name information is required for every Marstons Mills MA 02648 11-13-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercialllndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow(seats/personslsq.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: c Last date of occupancy/use: Hate Other(describe below): 3. Pumping Records: Source of information: NA 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.72612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 16 I Nov 14 2019 23:51 HP Fax page 28 Commonwealth of Massachusetts I Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1375 Old Post Road Property Address Estate of Rudy Curelli Owner Owner's Name information is every Marstons Mills required for eve MA 02648 11-13-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 1993 Permit # 93- 17A / 11-2019 New D Box. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 28"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.): Pipeing is 4" PVC SCH -40. 151nsp.doc•rev.7/25/2018 Title 5 oBicial inspection Form:Subsurface Sewage Disposal System•Page 9 of t8 Nov 14 2019 23:51 HP Fax page 29 commonwealth of Massachusetts 6; Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /0 1375 Old Post Road Property Address Estate of Rudy Curelli Omer Owner's Name information is Marstons Mills required for every MA 02648 11-13-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 18" feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene El 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.Precast Sludge depth: 1 ll Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Asbuilt-Plan-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level.Tank and covers at 18", In and outlet tee's. No sign of leakage or over loading. t5msp.doc-rev'7/26/2010 Title 501ricial Inspection form;Subsurface Sewage Disposal system•Page 10 011a Nov 14 2019 23:51 HP Fax page 30 Commonwealth of Massachusetts Title 5 Official e c ai Inspection Form r: p Subsurface Sewage Disposal System Form -Not for Vol untaryAssessments •/ 1375 Old Post Road Property Address Estate of Rudy Curelli owner Owner's Name mation Is every Marstons Mills required for eve MA 02648 11-13-19 page. Gtyrrown 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 t5lnsp.doc rev.7126I2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page I!of 18 Nov 14 2019 23:52 HP Fax page 31 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1375 Old Post Road Property Address Estate of Rudy Curelli Owner Owner's Name information is Marstons Mills required for r every MA 02648 11-13-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of Fast 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 is H-20 16"xl 6'-1' Below grade w/one line out Box is new 11-2019 w/cover at 6" 19insp.doc•rev.7/2612018 Title 5 Official lnspaction Fom:Subsurface Sewage pieposel System•Page 12 of 18 Nov 14 2019 23:52 HP Fax page 32 Commonwealth of Massachusetts t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments >4 1375 Old Post Road Property Address Estate of Rudy Curelli Owner Owners Name information is required for every Marstons Mills MA 02648 11-13-19 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. 1.1. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: J ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields / number, dimensions; ❑ overflow cesspool number: ❑ inn ovative/altemative system Type/name of technology: t5lnsp.ccc•rev,7fW2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 13 or 10 Nov 14 2019 23:52 HP Fax page 33 ti Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ••` 1375 Old Post Road Property Address Estate of Rudy Curelli Owner Owner's Name information is required for every Marstons Mills MA 02648 11-13-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cunt,) Comments (note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is a 1000 Gal. precast pit w/3'stone. Pit at 3'below grade w/cover at 1'. Pit is dry wl clean walls. Stain line at 1'off Bottom. No sign of over loading or solid carry over. No high stain line. r 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.) .5insp.doc-rev.712612018 Title 5 of6cial Inspection Form:Subsurface Sewage oisposai System-Page 14 of 18 Nov 14 2019 23:52 HP Fax page 34 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1375 Old Post Road Property Address Estate of Rudy Curelli Owner Owners Name information is every Marstons Mills required for eve MA 02648 11-13-19 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.cloc•rev,7/26/2018 Title 5 01PIcial Inspection Form:Subsurface sewage oispossl System•Page 15 of 1s _ Nov 14 2019 23:52 HP Fax page 35 Commonwealth of Massachusetts Ti Sewage tle 5Official Inspection Form Susurface p System Form -Not for Voluntary Assessments l_., 9w, 1375 Old Post Road Property Address Estate of Rudy Curelli Owner Owner's Name information is every Marstons Mills required for eve MA 02648 11-13-19 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 0 drawing attached separately I 15insp.coc-rev.P2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Nov 14 2019 23:53 HP Fax page 36 ° 3 = 3; -3 �S r /� f Nov 14 2019 23:53 HP Fax page 37 °y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 1375 Old Post Road Property Address Estate of Rudy Curelli Owner Owner's Name reformation is every Marstons Mills quired far eve MA 02648 11-13-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Na Estimated depth t high ground water: 12 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record I If checked,date of design plan reviewed: 1993 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: T.H.on Design plan 1993 12'no G.W.. Bottom of pit at 9'below grade. Bottom of pit at 3'above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5lnsp.doc•rev,7/2612018 Title 5 Official Inspectlon Form:Subsurface Sewage Dlsposai Syslem•Page 17 of 18 r Nov 14 Z019 23:53 HP Fax page 38 Commonwealth of Massachusetts Title 5 Official Inspection Form ,�I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments h P 1375 Old Post Road Property Address Estate of Rudy Curelli _ Owner Owner's Name information is required for every Marstons Mills MA 02648 11-13-19 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.Ilnspection Summary: 1, 2, 3,or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed I ® 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 G Air- 3, t5insp.coc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage orisposao system•Page 18 of 18 TOWN OF BARNSTABLE LOCATION/:f t Q -� PO 1T - SEWAGE #9 -L VILLAGE i`�..` ASSESSOR,S MAP & LOT 6-6 0�7 INSTALLER'S NAME PHONE NO.iY-v SEPTIC TANK CAPACITY (9 C r— LEACHING FACILITY:(type)FIT (size) J_ NO. OF BEDROOMS-PRIVATE WELL O PUBLIC WATER BUILDER OR OWNER ( i wlC DATE PERMIT ISSUED: ( S DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No J �L \ ` 1 tl 4 � `�� �`� 25 0 \ �1, � ... . . ..!. Fxa. D ......._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH " ...T_o.u�..,1.............OF.......h.�Gir.eJ.S.TA..c 4./ ................................... Appilration for Disposal Workti Tnnitxnr#tnn rrrmit Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal System at: rr aL� Pi�T Poo.oY .........._... __.............. . ....... ............. nor i� ......���.................... ......... ..... v .......... :............. Location.Address or Lot No. �.... Owner Address W Installer Address UType of Building Size Lot..:i�a_V&..........Sq. feet Dwelling—No. of Bedrooms..............S.........................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons............................ Showers — Cafeteria 04 Other fixtures ......................... -------------------- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. �� W Septic Tank—Liquid capacity./41.d4?gallons Length..f's.._.4.:...._ Width. '_.ice... ________________ Depth..5..-.-If-.. x Disposal Trench—No. .................... Width................'_.. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area....C.f' . Z Other Distribution box ( ) Dosing tank ( ) _ Percolation Test Results Performed by......... 6. ! ....J, ?.s.oa&,ODate.... :.`!_..' ._-�'lP............. Test Pit No. 1.......z.....minutes per inch Depth of Test Pit......!z.�..... Depth to ground water.._._ti_�w ._. Test Pit No. 2........z-...minutes per inch Depth of Test Pit......./.z Depth to ground water.... TEs W,r ...... -------------------------------•..............-•--....--------------••-............•..........-...-----------------..---......•-•••-------------- Descriptionof Soil............0-...----1-..-...-•------..P---ff-a-1-A-.............................................................................................................. U ---------------•--•---••......--------•-... -•3• -• s ° ------•-----.....------------------------------------........................------•-•--..........-----•-------- W -------------------------------------- ...... ..........Av..n ...sMjO.7" .R... 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliant been is ued b the board of health. SignedY---- -- ........................ b ................... ......... .......... .. .. .. : ApplicationApproved BY --............. . ---D -- ...................-- ------............................... e Application Disapproved for the following reaso s: ................................................................... ------------------------ � Dale Permit No. ................ Issued ..... ..� ��� Or 4 Ss9 No..........-'... Fims........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ f Apphratiun for 14spusal Works Tonstrur#iun ranfit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: .:.4p_7.': ...... ..... jpj .................. 7 Location Address or Lot No. J,- ' .................. 5. Owner Address a . . .t ln-� ------------------------------------------- ...................... Installer Address Type of Building Size Lot_?,_•-T.r...............Sq. feet �-t Dwelling—No. of Bedrooms.............. _..........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a d Other fixtures -----•------------------------------•------•-----------------------------•-------------------------------••---------•-•--...-------------...--------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............galroftg�6 Length.'..4 " Width:/-re!®.'.444 peter................ Depth- '_Y. x Disposal Trench—No. .................... Width..................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........./.......... Diameter....../..�Z ..... Depth below inlet........ ....... Total leaching area... Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by..............:..: '. :� l •t:-'...__!�:.._ r _ !_:..fi Date----•--.--: - ,f_y=-- w-_-- Test Pit No. 1.......�:.....minutes per inch Depth of Test Pit-___--L......... Depth to ground water--__ fs, Test Pit No. 2........Z-.--_minutes per inch Depth of Test Pit-----4:-4......... Depth to ground water----- . f.:� ... O T 1, , : ................................................................................................................. Description of Soil.......................... ' .................:''_/ _ = U --•---•-••••-•-•••••-•--•••-••••••••-••..............•..... ...........-••-•--••-•-------.....--•••--•-------- •--•-•..... U Nature of Repairs or Alterations—Answer when applicable................................................................................................ Agrreeee--- ment:---- ':"*.--•-----•---••-----------------------------------------------•.-.--•-----------------------------------.----.-•----------------•-------•-------.-_.----------.-- 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 Compliance-has been issued by the board of health. (� c _, S>gned s'"� 4- .w. �... r ,... '�. ;. - h� / � � ,ti..� ��.. Dare`. '� t Appllcauon Approved BY • " ' •� f f ,< `�' = l'�.`t;zz_te t ............ 1 Application Disapproved for the following ream ........................................................................................ .................................. . L. c �( Date Permit No. .... --.: -----------== //� Issued {J ova �P�tNP MA�s9 WILLIAM F. �y Q MORANCIVIL cGn THE COMMONWEALTH OF MASSACHUSETTS O N0 13899 u~, BOARD OF HEALTH -!W.A.-'------------ OF -F-f� rcJ.. .�'�/. ,,.G:/ ,:.. ...... ......... ... A CIler#ifira e of Q1,omytianre T IS IS TO CERTIFY, That tha Individual Sewage Disposal System constructed ( ) or Re aired ( ) b 1/4' , _ �� ✓ ... ----- >S..........0..L .........P0- has been installed in accordance with the provisions of IT E of he S tpAS ronmental Code as described in the application for Disposal Works Construction Permit No. ... ... r ..'".. ....... . .. dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT E CONS RUA A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE -------------------------------------- Inspector ----------- :. ,.. - - ddd THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r / NO. C_ .....IJA........................... FEEA��,�.. ..... a Permissio a hereby g ...._ , : :...___,1. ,..1..?/f:r I ............................................................... to Construct Y ,o �Repai ( ) an Individual Sew e Disposalstem ._ .. ._�. ..----..•.j-•--•----•� ` - --7-..---=•Street _..• '. .._.�,r.. ..`-� �'"' =e.. `may. as shown on the application for Disposal Works Construction Permit No ; �Aated.......................................... ••-•--•------------------------------------------------------------------------•---•--------••- Board of Health DATE............................................................................... FORM 1255 HOBBS & WARREN. INC.. 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