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1270 OLD POST ROAD (CT & MM) - Health
1270 Old Post Road Marstons Mills ,f. r®■ Complete items 1;2,and 3.Also complete A. signature item 4 if Restricted Delivery is desired, X ❑Agent 4 Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by 2Printed e) C. Date of Delivery Attach this card to the back of the mailplece, cc/" or on the front if space permits. I D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No qq r Cynthia//H. Costello, Tr`' PO B0� 20 r 3.J.Service Type Orlean, , MA 1:26UZ 590 --, p Certified Mail® ❑Priority Mail Express° --° ❑Registered ❑Return Receipt for Merchandise q ❑Insured Mail ❑Collect on Delivery I 02653 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number "'— `— (Transfer from service labeq '701411200' 0001 0358Y 05296j PS Form 3811,July 2013 Domestic Return Receipt UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4®in this box• it Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 i �r I� p l rru .. • kLn 0 �43 ju7 m Postage $ 17 MA D-- rU �C3 Certified Fee ,�k t3 Retum Receipt Fee(Endorsement Required)p Restricted Delivery Fee O (Endorsement Required) O Total Postage&Fees $ Cynthia H. Costello, Tr i PO Box 20 Orleans, MA Q2653 Certified Mail Provides: o A mailing receipt n A unique identifier for your mailpiece o A record of delivery kept by the Pestal Service for two years Important Reminders: e Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. o Certified Mail is not available for any class of international mail. I e NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece'Return Receipt Requested'.To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. to For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If,a postmark on the Certified Mail t_receipt is not needed,detach and affix label with postage and mail..--.. IMPORTANT.Save this receipt and present it when making an liquiry.- PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 ,ti ''•`t I 1 • Town of Barnstable Barnstable Regulatory Services Department 'gf°"kaCft ? 1ARNWARM1MASS1 Public Health Division 200 Main Street,Hyannis MA 02601 2007 SECOND NOTICE Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7014 1200 0001 0358 0529 March 10, 2015 Cynthia H. Costello, Tr. PO Box 20 Orleans, MA 02653 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 • The septic system located at 1270 Old Post Road,Marstons Mills,MA,was last inspected on 5/20/2014,by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system" Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. • Liquid depth in cesspool is less than 6" below invert or available volume is less than % day flow. 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 OARD OF HEALTH omas McKean, R.S. CHO . Agent of the Board'of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\1270 Old Post Road MM Jun 2014.doc Town of Barnstable Barnstable Regulatory Services Department A*Ameftft MASS � 3ARN8I'ABIE. � I �. .039 Public Health Division 639 �� 200 Main Street, Hyannis MA 02601 200� SECOND NOTICE Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7014 1200 0001 0358 0529 March 10, 2015 Cynthia H. Costello, Tr. PO Box 20 Orleans, MA 02653 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 • The septic system located at 1270 Old Post Road,Marstons Mills,MA, was last inspected on 5/20/2014, by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system" Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. • Liquid depth in cesspool is less than.6" below invert or available volume is less than % day flow. 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 OARD OF HEALTH omas McKean, R.S. CHO . Agent of the Board of Health i Q:\SEPTIC\Letters Septic Inspection Failures or Future EAU270 Old Post Road MM Jun 2014.doc j, Town of Barnstable Barnstable Regulatory Services Department AtAnowamy • sw>uvsr�u.e, • O 1639. Public Health Division 200 Main Street, Hyannis MA 02601 200� SECOND NOTICE Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7012 1010 0000 2851 4013 December 4, 2014 Cynthia H. Costello, Tr. PO Box q0 Orleans, MA 02653 • ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 1270 Old Post Road, Marstons Mills,MA,was last inspected on 5/20/2014, by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system" Fails"under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. • Liquid depth in cesspool is less than 6" below invert or available volume is less than % day flow. 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 TIME BOARD OF HEALTH Z� omas McKean, R.S. CHO A Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\1270 Old Post Road MM Jun 2014.doc — _-gym r, iTHE Town of Barnstable Barnstable �pF Tp� Regulatory Services Department e"aC j + BARN-SfABLE, MASS. i63939' Public Health Division �� AIEDMAt° 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7012 1010 0000 2851 3658 June 20, 2014 Cynthia H. Costello, Tr. ;� Cynthia H Costello 2006 Trust . % Cape Cod Five—BT --w PO Box 20 Orleans, MA 02653 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system p syst located at 1270 Old Post Road, Marstons Mills, MA,was last inspected on 5/20/2014, by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system" Fails"under the guidelines of the 1995 TITLE.5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. • Liquid depth in cesspool is less than 6" below invert or available volume is less than %2 day flow. 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 C` omas McKean, R.S. CHO Agent of the Board of Health ' Q:\SEPTIGIetters Septic Inspection Failures or Future Evl\1270 Old Post Road MM Jun 2014.doc f CAPE COD FIVE TRUST AND ASSET MANAGEMENT March. 16, 2015 Town of Barnstable Regulatory Services Department Attn: Thomas McKean, Agent of the Board of Health 200 Main Street Hyannis, MA 02601 Re: 1270 Old Post Rd, Marstons Mill, MA Dear Mr. McKean: Cape God Five Cents Savings Bank is the Trustee of the Cynthia H. Costello Trust. The Trust owns the above mentioned property. We are in receipt of the'Order to Comply with State Environmental Code, Title 5. This property is currently on the market for sale. There is no one occupying the home at this time. We do not want to take action at this time on the replacement of the septic as the size and scope of the design may change depending on the buyer's wishes to upgrade. We would like to give any potential buyer the option to increase the septic system design capacity, tie the garage into the proposed system (no water within the garage at this time) or exercise a new site plan in the event that the existing dwelling should be razed. We believe that with the start of Spring, there will be many more buyers looking at the property and foresee a sale by the end of the year. Please feel free to contact me should you have any questions or concerns. Thank you for taking this under consideration. Sincerely, r Beth Thompson, CTFA Assistant Vice President t 20 WEST ROAD•PO BOX 20•ORLEANS,MA 02653-0020•TEL 508-255-8557•877-409-5600•FAx 508-255-8815• WWW.CAPECODFIVE.COM •.NOT A DEPOSIT • NOT FDIC-INSURED • NOT INSURED BY ANY FEDERAL GOVERNMENT AGENCY • NOT GUARANTEED BY THE BANK •MAY GO DOWN IN VALUE t M / • OFFICIAL u'I co Postage $ fU Certified Fee `N,5 /W.4 O `` O Return Receipt Fee �Q` ost o C3 (Endorsement Required) Here 01 o �Restricted Delivery Fee o O (Endorsement Required) J 32014 ra O Total Postage&Fees $ ra --- -- - -- - .u$PS- f- Cynithia H. Costello Tr r Cynthia H Costello 2006 Trust r %Cape Cod Five — BT PO Box 20 l - Certified Mail Provides: n Amailing receipt o A unique identifier for your mailpiece 0 A record of delivery kept by the Postal Service for two years Important Reminders: • Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. • NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. • For an additional fee, delivery.may be restricted to the addressee or. addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry.' PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 � I V1110119AM • • a e Complete items 1,2,and 3.Also complete A. Sign Ve item 4 if Restricted Delivery is desired. X UJ'agent ® Print your name and address on the reverse ❑Addressee so that we can return the card to'you. B. Rece' (Pnnte ame) C.bat of D livery a Attach this card to the back'of the mailpiece, � or on the front if space permits. D. s delivery address different from item 11 s 1. Article Addressed to: If YES,enter delivery address below: ❑No I Cynithia H. Costello Tr I Cynthia H Costello 2006 Trust i %Cape Cod Five — BT PO BOX 20 1 service Type ❑Certified Mail ❑Express Mail Orleans, MA 02653 ❑Registered ❑Return Receipt for Merchandise i ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes J 2. Article Number (transfer.from service label) i ' [7 012 i,1 D 10 0 0 0 0 ' 2 8 51 401 PS Form 3811.Februarv.2004.-_ Domestic Return Receipt. 102595-02-M-1540 I h UNITED STATES POSTAL SERVICE First-Class Mail _. Postage&Fees Paid USPS I A Permit No.G-10 Sender: Please print your name, address, and ZI15+4 in this box ' j . I I I I I I Town of Barnstable Public Health Division 200 Main Street I Hyannis, MA 02601 I I r Town of Barnstable Barnstable Re ulatorY Services Department ce 1I., KASS • s�uvsr!,s 1 Public Health Division D1A ' 200 Main Street, Hyannis MA 02601 200� SECOND NOTICE Office: 508=862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7012 1010 0000 2851 4013 December 4, 2014 Cynthia H. Costello, Tr. Cynthia H Costello 2006 Trust % Cape Cod Five—BT PO BOX 20 Orleans, MA 02653 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 1270 Old Post Road,Marstons Mills,MA,was last inspected on 5/20/2014,by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system" Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. • Liquid depth in cesspool is less than 6" below invert or available volume is less than V2 day flow. 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 enfo-cement action. PER ORDER OF TIME BOARD OF HEALTH omas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\1270 Old Post Road MM Jun 2014.doc . � CO Ln u1 cD Postage $ nj 0&9 O Certified Fee ' Return Receipt Fee aO (Endorsement Required)Restricted Delivery Fee O (Endorsement Required)0 Total Postage&Fees Cynthia H. Costello, TR r Cynthia H Costello 2006 Trust % Cape Cod Five — BT PO Box 20 A 1 _- R A A Certified Mail Provides: o A mailing receipt #I o A unique identifier for your mailpiece e o A record of delivery kept by the Postal Service for two years Important Reminders: e Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail. o Certified Mail is not available for any class of international mail. e NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Reqistered Mail. o For an additional fee,a Return Receipt maybe requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. re For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". 1 a If a postmark on the•Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 I' I COMPLETE,THIS SECTION ON DELIVERY, E Complete items 1,2,and 3.Also complete A. Sig re item 4 if Restricted Delivery is desired. WKgent ® Print your name and address on the reverse ❑Addressee ' so that we can return the card to you. B..Re eived by(Pri ame) C. Date of Delivery p Attach this card to the back of the mailpiece, or on.the front if space permits. ' delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No Cynthia H. Costello.,.TR. Cynthia H Costello 2006 Trust % Cape Cod Five =:BT s. servile type PO BOX 20 0 Certified Mail ❑Express Mail t, rleans, MA 0265 �,at ❑Registered ❑Return Receipt for Merchandise — --- ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?,(Extra Fee) ❑Yes 2. Article Number . . . . . . . = -- (lransferfrom service laben ` ' TO 12'`1'01�d -0 b 0 0 '2 8 51' 3 6 5 8 RS Form 3811 February 2004 Domestic Return Receipt +02595-02-M-1540' UNITED STATES POSTAL SERVICE First-Class Mai{ I LISPS e&Fees Paid Il Permit No.G-10 i • Sender: Please print your name, address, and ZIP+4 in this box • I I i -Town of Barnstable Public Health Division � l 200 Main Street i Hyannis, MA 02601 i i i ,_.._, I lilii Fl}':!t!i�aiiFlFi°i1iiF�.iflFi!ii�`F j;iE�i1S i�Elt�i!Ff�IFFiI r n Town of Barnstable Barnstable OF THE rod Regulatory Services Department AllAme'caCj + -BARNSTABLE, • m 9 MASS. Public Health Division �A ►6gq. bum 2007 DM 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7012 1010 0000 2851 3658 June 20, 2014 Cynthia H. Costello, Tr. Cynthia H Costello 2006 Trust % Cape Cod Five—BT PO Box 20 Orleans, MA 02653 • ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 r The septic system located at 1270 Old Post Road, Marstons Mills, MA, was last inspected on 5/20/2014,by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system" Fails"under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to 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. 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 . omas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Ev1\1270 Old Post Road MM Jun 2014.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetai1.aspx?ID=3613 f77 "N�� Logged In As: Parcel ®�IaII Wednesday, June 18 2014 Parcel Lookup Parcel Info .._..... .._..... _. Parcel 056-003 1 Developeer Ip-ARCECA— I u , Location 11270 OLD POST ROAD(CT&MM)� ' Pn'355 Frontage Sec� _____w_. _ ._ Sec _� -_. Road Frontage it Village[COTUIT _� Fire IC-MM District Town sewer exists at this Road r� address5N0 Indexl1165 Interactive Map E Ei q c Owner Info _ Owner KOSTELLO,CYNTHIA H TR Owner CYNTHIA H COSTELLO 2006 TRUST Streetl!C/O CAPE COD FIVE-ST ------ _.._ _ Street2 1 PO BOX 20 City jORLEANS I State jMA Zip 02653 Country Land Info Acres J2.80 Use Zoning � �010n 5 Topography Above Street Road Paved Utilities!Public Water,Gas,Septic Location Construction Info Building 1 of 1 YerBult Ext 1 1962 S Ruoff Gable/Hip Wall Clapboard Living 1864 � Roof jAsph/F GIs/Cmp AC"None n . Area Cover TypeInt Be Style Modern/Contemp� Wall•Drywall Rooms 13 Bedrooms Int Bath - Model Residential Floor Hardwood Rooms 11 Full+ 1 H d, Heat Total'--— Grade �__ ...__._._..__ ,,a ,gin Grade[Average Plus Type Hot Water Rooms 16 Rooms 5 Stories 1 Story I Heat Oil �,Found-.PoureConc. I 53" Fuel ation� Gross h http://issgl2/irtranet/propdata/ParceiDetail.aspx?ID=3613 6/18/2014 I— Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ;M 1270 Old Post Rd Property Address Judith Knowles Owner Owner's Name information is required for every Marstons Mills MA 02648 5-20-14 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. A. General Information 1. Inspector: V� 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 I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 5-20-14 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 is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspect F r :Subsurface Sewage Disposal System• ge 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1270 Old Post Rd Property Address Judith Knowles Owner Owner's Name information is required for every Marstons Mills MA 02648 5-20-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.308 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑.One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the.replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old" or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 yea'rs old is available. ❑ Y ❑ N ❑ ND (Explain below): k t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 1.270 Old Post Rd Property Address Judith Knowles Owner Cwner's Name information is required for every Marstons Mills MA 02648 5-20-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a boMering'vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1270 Old Post Rd Property Address Judith Knowles Owner Owner's Name information is required for every Marstons Mills MA 02648 5-20-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 ' Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1270 Old Post Rd Property Address Judith Knowles Owner Owner's Name information is required for every Marstons Mills MA 02648 5-20-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 1 ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑e. the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspecfion Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection F rm o _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °,M s 1270 Old Post Rd Property Address Judith Knowles Owner Owner's Name information is required for every Marstons Mills MA 02648 5-20-14 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® El Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 ' Commonwealth of Massachusetts _ Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1270 Old Post Rd ` Property Address Judith Knowles Owner Owner's Name information is required for every Marstons Mills MA 02648 5-20-14 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (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: Ir 5-2014Date 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 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 1270 Old Post Rd Property Address Judith Knowles Owner Owner's Name information is required for every Marstons Mills MA 02648 5-20-14 page. City/Town State Zip Code Date of Inspection D.. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped 2012 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance Type of System: ❑ Septic tank, distribution box, soil absorption system ® Single cesspool r ® Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G1M , 1270 Old Post Rd Prooerty Address Judith Knowles Owner Owner's Name information is required for every Marstons Mills MA 02648 5-20-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1960's Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 24"feet !Material of construction: ® cast iron ❑ 40 PVC Orangeburg ® other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: SEE CESSPOOOLS Pg 13 feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•3113 t Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form _Not for Voluntary Assessments °wM 1270 Old Post Rd Property Address Judith Knowles Owner Owner's Name information is required for every Marstons Mills MA 02648 5-20-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping-. Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 ' Commonwealth of Massachusetts m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 1270 Old Post Rd Property Address Judith Knowles Owner Owner's Name information is required for every Marstons Mills MA 02648 5-20-14 page. Cilyrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface.Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 1270 Old Post Rd Property Address Judith Knowles Owner Owner's Name information is required for every Marstons Mills MA 02648 5-20-14 page. CityTTown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert N/A Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form '^ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1270 Old Post Rd Property Address Judith Knowles Owner Owner's Name information is required for every Marstons Mills MA 02648 5-20-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 1-6x6 ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Overflow cesspool has 12" of water with stain lines at and above inlet invert. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 2-Inline Depth—top of liquid to inlet invert 48" Depth of solids layer 10" Depth of scum layer 1 Dimensions of cesspool 6x6 Materials of construction Block Indication of groundwater inflow ❑ Yes ® No t5ins-3f13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 1270 Old Post Rd Property Address Judith Knowles Owner Owner's Name information is required for every Marstons Mills MA 02648 5-20-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): First cesspool had water above inlet invert because outlet was installed at higher elevation. Second cesspool had 12" of water in it, but had stain lines at and above the inlet invert. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 ' Commonwealth of Massachusetts . = W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1270 Old Post Rd Property Address Judith Knowles Owner Owner's Name information is required for every 1�9arstons Mills MA 02648 5-20-14 page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all-wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately i i o`; se 1 P t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1270 Old Post Rd Property Address Judith Knowles Owner Owner's Name information is required for every Marstons Mills MA 02648 5-20-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water a ❑ 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: USG.S and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 ` Commonwealth of Massachusetts . W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M , 1270 Old Post Rd Property Address Judith Knowles Owner Owner's Name information is required for everyMarstons Mills MA 02648 5-20-14 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I t5ins•X13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN l CIF B STABL E j n �/� ` LOCATION l a 70 _� .: �a s f /CGf SEWA� v At.�� /filar s / s 1;llS ASSESSOWS VIAP�LOT IMAILEWS NAW VP NO SEIzTIC TANK-,Cfel'ACITY. r LEACT:IINGACIL ' f ) Ce 5 J sue) NO.�FBFDf�aUI S -3 BtJI1lFR OR t)�IrIER AbRADATE C©NdPLIt Sepazatian Distst►ce Between'the Ivlax�niuul Adjusted Crraunbri car Table to the Bottom of i,eact cng lzty Fee4 Pnvat SAtatar Supply< eZt and Leaclt3mg Faciltty �Y�reils exisi ota sit$ar zv�tthia 2w feet a€le l scg fa iry) Etlg of 3AlWAR and I eactung}"�aaliry(If any wetlands exist with 3t36€eet a€`teaching facility) %Beet Lc, 1 F/d n�l 1 , r f f i TOWN OF BARNSTABLE LOCATION J 2?D D l D PD.5'TT /�awiQ SEWAGE# VILLAGE 419, ..S?ON.f&&Z1S ASSESSOR'S MAP&PARCEL 656 - 0 03 INSTALLER'S NAME&PHONE NO. SOS �y2 0- 9738 /,is 5 SEPTIC TANK CAPACITY. /sDO LEACHING FACILITY:(type) —.S"00 �'I�s�f12/=�S(size) NO.OF BEDROOMS y OWNER PERMIT DATE: ///—?, —/S 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 1.!',s /J`e.tt.09-1 C �3 4y ant,o dock p/drib No.(]C J� Fee / LJ THE COMMONWEALTH OF MASSACHUSETTS Entered in compute�v� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppliLation for Vslo08aV*pstem ConstCuttion permit Application for a Permit to Construct(A)--Repair( 4-11pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.IA 70 0/y p3r 9,90iOwner's NamS Address and Tel.No. Assessor's Map/Parcel& "19 In taller's Name.Address,and T91.No..r d 8-5'2O"-q73 Desiggn�er's Name Address,and Tel.No..4-08—5�31,2&7a X51-./ k l4'c L3•k+r'r^� ryro�f�s� �Iv, �n��`'r•�y�4 31 eN, .,/ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fiytures Design Flow(min.required) 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 Nature of Repairs or Alterations(Answer when applicable) 2'`l srr4 AVL-Orww a re-, � s7 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. Sig ed Date Application Approved by Date Application Disapproved by Date for the following reasons ` Permit No._ f Date Issued i Fee /� V t THE COMMONWEALTH OF MASSACHUSETTS Entered incompaI I Y,S } ;PUBBLIC HEALTH DIVISION -TOWN°OF'BARNSTABLE, MASSACHUSETTS' 2pplication for Misposar6pBtem Construction permit Application for a Permit to Construct(G .'.'Repair'( 4�%IIpgrade( ) Abandon( ) ❑Complete System ❑Individual Components f Location Address or Lot No./ 7U Old /c%3 7r'��c r?� Owner's Name Address,and Tel.No. ' S r/.5 1?1`1, /S Name, _Address, Map/Parcel C)-5 6-o03/ err T Installer's Name,Address,and Tel.No. 5`6 8' 4'z O-q7-?E Designer's Name,Address,and Tel.No. S`,Z e-i 22-:2 a 72 JrJ� ervGi 41t' Li G�i✓U' �2�CJ1P f% / /r(l i�J�rr�! > l�JSOC, L LE Type of Building: Dwelling No.of Bedrooms Lot Size N sq.ft. Garbage Grinder( ) Other Type of Building r j No.of Persons 'a Showers( ) Cafeteria( ) Other Fixtures Design Flow min.required) gpd Design flow provided gpd Plan Pate,. Number of sheets Revision Date 4s Size of,,Septic Tank � Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) T efl-Ja/1 Date last inspected: i 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. Sided Date i CC Application Approved by lr Date 3 J -Application Disapproved by Date for.the following reasons Permit No. Date Issued 3 b --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS y BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed Repaired( =) Upgraded( ) Abandoned( )by/ ,Ads�f�� IlLe '11A/,�v's at / 7G //c# f ,s ,�c� f.��r 6'�TG'�`>> 1>. 1 5' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Nq�/J 3 dated P P Y Installer 1/1lf C/-X/ /�2�j/-j a Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will nation esigried. Date 12 / ir Inspector R --------------------------------------------------------------------------------------------------------------------------------------- G �21� Fee 5 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal .pstem Construction Vrrmit P,< Permission is hereby granted to Construct(L) Repair(G)' Upgrade i ) Abandon( ) ' System located at / 7U l/'/c/ �c SJ" /�r'/4c� 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 pe i' t. Date ( ` 13 h `j Approved by Town of Barnstable P a I • Department of Regulatory Services .> Public Health Division Date am 200 Mam Street,H MUM MA 02601 r E Date Scheduled Time .I Fee Pd. S nit ility Assessment for Sewage Disposal Performed By.�IG11l�t D�A:ID Witnessed By: €LOCX ION:&`GENERA INFORMATION Location Address n,a G�0 GOSTrUOIz-`7o or-o posy eo.4D e MA'R.STOAK M I1-L$ vro,6 201 o4c�uS, AM Assessor' MaplParal: Engineer'sName)Wr."AN61AASMAN C NSTRUCTR)N REPAIR Telephone N Land Use gggDeQT/14L Slopes(°lo) 2—!_ SmieceSion. ")A s Distances froru Opm Water Body )")CO fl P.-ble we,Area�fi Drinking Water well>)�fl DrainageWay,>2<1 fl PropertyLmte �fi Other fl SKETCH:(Street mane,dimensions of K exact locations of tat holes&pert tests,locate wetlands m proximity to holes) 42,6 ,g170 t�q X N l 4 Q a33 t ;' J �7► 44 CO , . 1 . O( r- .� M so°t< Parent material(geologic) �flv r N1 51 f Depth to Bedrock 7 200t Depth to Grmadwater. Standing Warer in Hole: MIA 6 Wit Weeping from Pit Face W A C Estimated seasonal High Groundwater S U MMCC E L . M i Nv5 y Rt7VOV)dA vMTeUf—15L r I�-_ ,ZE) DETERMWATION:F.OR SEASONAL HIGHMATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Deptb to weeping from side of obs.bole: in. Groundwater Adjusnuent fl. Index Well 9 Reading Date: lade.-Well level Adj.factor Adj.Groundwater level_ TERCOLATION TEST Date Time Observation Hole p ! Time at 9" Depth of Perc ?M Time of 6" Scar Pre-soak Time C 00•PD Time(9"-6") End Pre-soak RateMin./lacb Site Suitability Assessment: Site Passed� Site Failed: Additional Testing Needed(YrN) 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 first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPnC\PERCFORMDOC s DEEP OBSERVATION HOLE.LOG Hole# I Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) , 9j n p bPA401 NIA NO PW, "DECOME �I� 5 IMP, Nb Qa�,%vLAf— I-S I b`(R 3S4 Np MVF r SA13 4. 5 Z5`( NO DEEP.OBSERVATION HOLE:LOG Hole# - Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones,Boulders. Consistency.°.b GraveD Z'1 0 OR"MIL N14 NQ PART P ULAR.- ►� s 54-_ n -M. 5 2,5 0/ NO LSej DEEP OBSERVATION HOLE LOG. Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(m,) (USDA) (Munsell) Mottling (Structure.Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Sire(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) Flood Insurance Rate bias: T Above 500 year flood boundary No_ Yes Within 500 year boundary No V. Yes_ Within 100 year flood boundary No V/Yes Depth orNaturaliv Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? �� If not,what is the depth of naturally occurring pervious material? Certification I certify that on (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 ex enence described in 310 CMR 15.017. Signature �' it �� Ftd/� Date 4 �� Y Q:\SEMC\PERCFORMDOC Town of Barnstable , tKE ' " Regulatory Services o� Richard V. Scali,Interim Director * ■ARNSTABLE, MASS.�� ��� Public Health Division i0rf1639. Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Sewage Permit# `(j/ -3� Assessor's Map\Parcel W3 -149INDesigner: r' z Ylna Installer: S Gl�� t /�i4yvvs' Address: 941 W1 i J Address: On / }rOe;<J has issued a permit to install a ( at (installer) � septic system at 021 y t)(tj f b& &f 11 e"A l based on a design drawn by (address) MUA-r i j, W 6 dated lb 131 () X (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constru liance with the terms of the I\A approval letters (if applicable) �k OF REPS M ( staller s igna re) - M .. 1140 ( gne s ignature) L S�,� (Affix tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc i w BR-1 a- 0 LND BR-3 nd FLOOR BR-2 BA UTILITY ROOMS 7 BA LIVING ROOM DINING 1st FLOOR KITCH Room HALF—/ WALL Dwelling is on slab foundation FLOOR PLANS MORAN ENGINEERING ASSOCIATES, LLC 941 Main Street, S. Harwich,MA LOCUS: 1270 Old Post Road PO Box 183, S. Harwich,MA 02661 Marstons Mills, MA 508-432-2878 ` PREPARED FOR: Costello 2006 Trust MAP:056 PARCEL:003 P.O. BOX 20 JOB NUMBER: 14-147 SCALE: not to scale Orleans, MA DATE: 12/19/14 SHEET: 1 of 1 ©2014 Moran Engineering Associates, LLC Wells not shown exceed 150'from the proposed SAS LOCUS s82•08'46"E �1 BENCHMARK: EL. 61.11 m G 338.92' 1 - ASSUMED DATUM _ y' "o 6 i o • '� � d M T.O. MAG NAIL SET EXISTING ORANGEBURG LINE LOCATION: R2pp/�,/. 11 �Pec`I � THE DESIGNER AND CONTRACTOR SHALL TRACE BACK THE COrr` J' s'I`u c���' 5�^ 7 0Vc CO / / o C, 1 Z CENTER CATCH BASIN rn ORANGEBURG LINE FOUND TO THE CAST IRON LINE AT THE / l (� �� 1r'l T VI1 r / / 1 1 EL, 50.39 ( SECONDARY) SLAB FOUNDATION. 4' PVC SCH. 40 PIPING SHALL BE GT Pnd ��" ��°` LN w�,of�,,d U l / WATER INSTALLED FROM THE SLAB FOUNDATION TO THE PROPOSED 1 db 7 u METER SEPTIC TANK. A TWO WAY CLEAN OUT CAP SHALL BE 60"tr J` � Iu {�e(or� l l (D PIT INSTALLED BETWEEN THE DWELLING & SEPTIC TANK. 50.46 I I..,,. I o �9�A TOWN WATER LINE / (2 (r/ ( S w ATFRFORD PER PRIVATE 1 ' ' i O I R LOCATION MARK OUT (V / I I UTILITY N CEDAR TREE APPROXIMATE WATER �/ I I Ste,I i' S \� OH I POLE '4 NECK RD LINE LOCATION /� / I xX J� �4 g'f I 1 Q 0 1 / UTILITY OHS 5(� e 49.53,'1 r / POLE I ,,'R� m LEGEND GUY SPIKE ° 1 i��� ,' 3 O 6� \W SET 7 ° 1 �� 50 6 I 2 TEST HOLE 87,189 S.F. t sew P'r1O ' ° 57.1.15 / (Q/� Z.00 AC. t sHE° Arlo 107.g 0 :.:::.;: R25.0' CATCH ti HA: HAND AUGER ° .7 BASIN Q 50.39 p STING 6.9 ° �1.3 '. :1 ' ; \ ���� EXISTING CESSPOOL(S) T wE17L "EX/STING 56.7 s Q .O S. 9g q�0 / ORANGEBURG ` , .:; 50.3 "D" BOX .3 T/0 L/NE L OCA T/ON ::"• 25.2'f PROPOSED SEPTIC TANK W r ° CLEANOUT --so EXISTING CONTOUR / \ I 43 0, o 57.5 5& ° --_1 0.3 sn PROPOSED CONTOUR \ o / % 57.4 57.2 55.4 / ` \ OH OVER—HEAD UTILITIES J � I 50• HA� W WATER LINE \ VED ° o ! I \ PROPOSED LEACH/NG AREA SITE AND SEWAGE PLAN DYER 58.3 33.5'X /2.8'X 2.0' (H /0) Locus:.l \ � GARAGE PAVED . 57.2 52:5 : � � 1270 Old Post Road DR/vEWAYZ59.5 pR VE UY LIT,IITY/G Marstons Mills MA ! 55.6 . \ Po 57:4 PAVED WIRE PREPARED FOR: Peggy Freitas � PARKING I I � � P.O. BOX 195 / AREA PUMPS FILL Marstons Mills, MA 02648 0 EXISTING CESSPOOLS Deed Ref.: Bk 22647 & Pg 90 (Costello) I I I INSPECT/ON REQUIRED I38j MORAN ENGINEERING A550C, LLC . Ng I 48.5� A, BENCHNARK' s I MA NAIL SET 1 N h tH OF 941 Main Street, Harwich, MA I EL. �� No.o. 6/.1/ 1 I �, m �., ' s-7 to Z S. PO Box 183, S. Harwich, MA 02661 jN O OFM� �o MICHAEL 508-432-2878 1m � 0o � r^ ® RIC J. I I � M1o, ` I-i DUE �l MAP:056 PARCEL:003 SCALE: 1 n c 30� Jll I O N �O6 =I Qp P f SHEET: JOB NUMBER: 1 Sg. 3S. FFss�o� 14-147 1 of 2 I \ S G AR pa I S9'�Y 1 DArE:12/19/14, 6/1/15, 9/24 & 9/25/15 ©Moron Engineering Totes, LLC 10/31/15: 4—bedroom INSTALL ACCESS PORT OVER LEACH SEPTIC TANK "D" BOX. LEACH FACILITY CHAMBERS GH��THIN 20 DM Loawc COVEIR AT GRADE 500 GALLON DRY WELLS 3' (MIN.) OF FINAL GRADE EL. 57.40 ACCESS PORTS (2) . EL. 63.95 TOP OF COVER TO BE WITHIN b OF GRADE MIN.9'COVER EL. 50.60 MIN 2%SLOPE Stag 20'DULAOCIESS PORI MAX 36'COVER TO T MIN.9'COVER a•sc}L ao P.V.C. s MIN OF FNAL GRADE MAX 31S'COYER Y' LAYER OF 1/8' s= .oz x TO 1/2 DOUBLE t EL.49.83 WASHED STONEEL 61.1O t CH.40 P.V.C.N. MIN. .. _�{.- �_ EFFECTIVE LM EL 54.75 EL. 49.30 EL 49.10 EL• 49.00 s�=> O O O 0 O '4;c-c,�,-< . ... 2 0'EL. 55.00500 � s; ,r �� `-3. . DEPTH '~` __ ... a: ...... _ .... ....-::::::.-:-:::::::.: n ._ :� :.-:.:::::. EL. 47.00 . 3/4" TO 1-1/2" DOUBLE WASHED STONE b 0F ONE BED ST ONE 4.0 4.0 x Ir'� - N .BO �J............ UNDER DIS -.......-. - T TO BOTTOM SEPTIC TANK ON A STABLE COMPACT BASE Ip� * STONE 25.5'LENGTH INSTALLED STONE 43' t b OF STONE UNDER TANK 76 * DB.D4 OF D.O.H. 2 1. INSTALL A CLEAN-OUT CAP "D" BOX NOTES SEPTIC TANK NOTES TO GRADE BETWEEN SEPTIC 1.CONTRACTOR:SEE CONSTRUCTION NOTE#3. 1. Extend inlet tee 10'min.below flow line;extend TANK AND DIST.BOX 1. When system is dosed or slope of inlet pipe EL 38.96 outlet tee'14"below flow line. exceeds 0.06/ft.install inlet tee cut-off one inch above outlet invert. INSTALL INLET TEE. NO WATER ENCOUNTERED AT TEST HOLE 2 2. Provide 20"manholes over center of tank, inlet and outlet with readily removable impermeable covers. 2. Install outlet pipes level 2 feet minimum. APPROXIMATE USGS SURF.EL 35 t 2. Provide a two way dean out port,to grade,between SURFACE 20't 3. Provide a minimum sump of 6"below outlet invert. GROUNDWATER CON EL.ISt ESTIMATED DEPTH To GROUND WATER FROMS the dwelling and proposed septic tank. Clean out 3. Seperation distance between inlet and outlet tees not to be less 4. Install access port over"D"Box with precast concrete or equivalent URF requires an irrigation control box cover set at grade. than liquid depth(310 CMR 15.227(2)) watertight riser within6'min.of final grade. 5. Inside minimum dimension 12"X 12" DEEP HOLE LOGS DESIGN GENERAL NOTES DEEP OBSERVATION HOLE # 1 1.) ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE W/ITTLE 5 OF THE SANITARY CODE& 14442 DATE: 7/28/14 1.REQUIRED FLOW:'4-BEDROOMS X 110-GPD/B.R=440-GPD ANY APPLICABLE REGULATIONS. R BARNSTABLE P SHALL BE NOTIFIED FO �` TEST BY RICK JUDO TIME: 10:00 2J PRIOR TO BACK FILLING THE INSTALLATION,THE DESIGNER&HEALTH AGENT 'EXISTING DWELLING CONTAINS 3-BEDROOMS. SYSTEM DESIGNED TO ELEV. From COLOR SOIL STRUCTURE ACCOMMODATE FUTURE 4TH BEDROOM INSPECTION. TEXTURE NG CONSISTENCY, OTHER 3. ANY ALTERATIONS OF THIS DESIGN MUST BE APPROVED BY THE DESIGNER&BOARD OF HEALTH,IN rig 32 Surloee HOR. (MUNSELL) M0T7U ) 50.07 3 0 Organic WA NO Partly decomposed organic WRITING. 49.49 10" AtE Loamy Sand 7.5YR 4/2 NO Granular 2.SEPTIC TANK CAPACITY:440-GPD X 2= 880-GPD 4.) SYSTEM IS NOT DESIGNED FOR A GARBAGE GRINDER. 46.99 40 Bw Loamy Medium Sand 10YR 3/4 NO Very liable,sabk USE(1)1500-GALLON(H-10)SEPTIC TANK 5.) THE INSTALLER IS TO VERIFY THE LOCATION(S)OF UTILITIES,CESSPOOL(S)AND SEWER INVERTS PRIOR 39.82 126" C Fine to Medium Sand 2.5Y 614 NO Loose,single grain TO CONSTRUCTION. 3.LEACH FACILITY DESIGN:33.5'X 12.8'X 2.0' 6.) ALL UNSUITABLE MATERIAL WITHIN 5 FT.IN ALL DIRECTIONS FROM THE SOIL,ABSORPTION SYSTEM &REPLACED W CLEAN COARSE SAND. r : horizon) SHALL BE REMOVED / Bait. of Pe c 24" (Bw ho z ) SIDE WALL AREA:2 33.5+12.8 X 2.0 X 0.74 GPD/SF=137.04 RATE: < 2 MIN/INCH (24-Gallons in 6:47) Class I soil. Loading Rote: 0.74 gpd/sf ( ) 7.)ALL FILL MATERIAL UTIIIZED FOR THE SOII.ABSORPTION SYSTEM SHALL BE CLEAN,COARSE SAND FREE WITNESS: Don Desmarais, Barnstable Health Department BOTTOM AREA: 33.5 X 12.8 X 0.74 GPD/SF=317.12 FROM DELETERIOUS MATERIAL AND SHALL HAVE A PERCOLATION RATE OF LESS THAT 2 MIN./IN.BEFORE& TOTAL: 454.35 AFTER PLACEMENT. 8.) EXISTING CESSPOOL(S)TO BE PUMPED AND BACK FILLED PER TITLE 5 ABANDONMENT PROCEDURES. DEEP OBSERVATION HOLE #2 DATE: 7 28 14 9.) DURING INSTALLATION,THE CONTRACTOR IS RESPONSIBLE TO PROVIDE A SAFE EXCAVATION AREA. / / 454 GPD PROVIDED>440 GPD REQUIRED BARNSTABLE P1 14442 TEST BY. RICK JUDO TIME: 10:00 10.) GROUND COVER OVER SEPTIC SYSTEM COMPONENTS SHALL NOT EXCEED 36". ELEV From co�oR SOIL s7RucTURE USE: 3 8.5'L X 4.8'W X 2.0'D CHAMBERS WITH 4:0'OF 3/4"TO 1-1/2" 11.) ALL GRAVITY SEWER PIPE SHALL BE 4"DIA.SCH 40 PVC UNLESS OTHERWISE NOTED. THE MINIMUM - 49 53 Sur/ace HOR. TEXTURE (MUNSELL) MOTTLING CONSISTENCY, 07HER O SLOPE OF 4"DIA.SCH 40 PVC SHALL NOT BE LESS THEN 0.01 FT/FT. 49.53 2" 0 Organic NIA NO Party decomposed organs DOUBLE WASHED STONE ALONG ENDS AND SIDES. 12.)WHEREVER SEPTIC LINES CROSS WATER SERVICE LINES OR WHEN WATER SERVICE LINES COME WITHIN 48 86 g 0 Loamy Sand 10YR 3/2 NO Granular 10'OF THE PROPOSED S.A.S.-PIPES SHALL BE CLASS 150 PRESSURE PIPE&SHOULD BE PRESSURE TESTED TO 48.86 36' Bw Loamy Medium Sand 1OYR 312 NO Very triable,sabk RESERVE AREA:33.5' X 12.8' X 2.0' ASSURE WATER TIGHTNESS. COORDINATE WITH LOCAL WATER DEPARTMENT. 38.96 130 C Fine to Medium Sand 1OY 44 NO Lome,single grain 13.) PLACE MAGNETIC MARKING TAPE OVER ALL COMPONENTS. Bot. of Perc: N/A: see test hole 1 results CONSTRUCTION NOTES RATE:< 2 MIN/INCH-assumed at Bw Horizon suRrEcr: 1270 Old Post Road WITNESS: Don Desmarais, Barnstable Health Department I. CONTACT OFFICE A MINIMUM OF 48-HOURS PRIOR TO START OF PROJECT. 2. CONTRACTOR IS RESPONSIBLE FOR ALL UTILITY & WATER LINE MARK-OUTS PRIOR TO START OF CONSTRUCTION. Marston Mills, MA 3. EXISTING ORANGEBURG LINE IS TO BE TRACED BACK TO DWELLING FOUNDATION. ALL EXIT LINES ARE TO BE LOCATED AND PREPARED FOR: HAND BORING TEST BY. RICK JUDD DATE: 11/7/14 CONNECTED TO THE PROPOSED SEPTIC TANK. THE INSTALLER AND DESIGNER SHALL CONFIRM ALL EXIT LINE LOCATIONS. Peggy FreitaS A TWO WAY CLEAN-OUT SHALL BE INSTALLED, WITH A CLEAN OUT CAP TO GRADE,WITH AN IRRIGATION CONTROL BOX ELEV. From COLOR SOIL STRUCTURE COVER, BETWEEN THE DWELLING AND PROPOSED SEPTIC TANK. AssessoRS scwT.E: Sur/ace HOR. TEXTURE (MUNSELL) MOTTLING CONSISTENCY OTHER MAP: 056 4. PUMP AND FILL EXISTING CESSPOOLS. y Not to Scale r� PARCEL: 003 56.67 10" HTM Fill WA NO Mixed fill 5. RAISE SEPTIC TANK INLET ACCESS TO GRADE WITH LOCKING COVER AND OUTLET COVERS TO WITHIN 6' OF GRADE. RAISE 54 3B• Bwb Loamy Medium Sand IOYR416 NO Very friable DISTRIBUTION BOX COVER TO WITHIN 6' OF GRADE. RAISE TWO LEACHING CHAMBER COVERS TO WITHIN 3' OF FINISHED DATE: 12/19/14 & 6/1./15 47600 126' C Medium to Fine Sand 10YR 614 NO Loose,single grain GRADE. SHEET '•2 of 2 6. A FINAL INSPECTION IS REQUIRED PRIOR TO BACKFILLING OF SEPTIC SYSTEM. 9/24-9/25 & 10/31?/15 r 7. ALL LANDSCAPE AND PATIO REPAIRS ARE TO BE IN WRITING BETWEEN THE CONTRACTOR AND TRUST. Moran Engineering Associates; LLC South Harwich;MA �02661 508-43&287- �" O 2015 Moron Engineering Associates, LLC