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Home My WebLink About0053 OLDE HOMESTEAD DRIVE - Health 53 Olde :Homestead Drive Marstons Mills P r A = 043 05200ti, F i 'I I ail ill I IF Bi d III � :� /• �.F e _ � 1 y3.C�,,.;y. Cn 11 nj F I IA L Ln /��+� � co Postage $ rl.l Certified Fee ,�per d 1 PSstmark 0 Return Receipt Fee �� Here p (Endorsement Required) M Restricted Delivery Fee (Endorsement Required) USQ� p Total Postage&Fees Fs rl RJ 'T o William D. & Joanne T. Baker 53 Olde Homestead Drive Marstons Mills, MA 02648 Certified Mail Provides: o A mailing receipt a A unique identifier for your mailpiece a A record of delivery kept by the Postal Service for two years Important Reminders: o_ Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile. o Certified Mail is not available for any class of international mail. o 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. , e 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". - e 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 SENDER- MPLETE:THIS SECTION:'.� . . . ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. X , ❑Agent M Print your name and address on.the reverse Addressee. so that we can return the card to you B. Received..by(Printed Name) C. D of Delivery. 0 Attach this card to the back of.the mailpiece, �� A ie 'Q r 1 or on the front if space permits. - D. Is delivery address different from item 1? ❑Yes 1, Article Addressed to: ` If YES,enter delivery address below: E3 No William'D.A Joanne T. Baker 53 Olde Homestead Drive 3. Service Type Marstons Mills, MA 02648 ❑Certified Mail ❑apress Mail I 0 Registered ❑Return Receipt for Merchandise —�- -: ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) 0 Yes 2. Article Number (Transfer from service tabeo 1 7 012 1010 0000 2851 420 PS Form 3811,February 2004 Domestic.Return Receipt 1.02595-024-15ao fi UNITED STAT!59` � First-gWss Mail ' Postage&Fees Paid USPS . . }:. G R4 Permit No.G-10 'k•Sender: Please print your name, address, and-ZIP+4 in this box • Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 i i r h ` Town of Barnstable Barnstable kriftyi Regulatory Services Department 9� Public Health Division m 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#70.12 1010 0000 2851 4204 August 7, 2014, 2014 William D. & Joanne T. Baker 53 Olde Homestead Drive Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at, 53 Olde Homestead Drive,Marstons Mills, MA was last inspected on 6/20/2014,by Brett Hickey, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Septic system is in hydraulic failure. You are ordered to do one of the following, within one (1)year 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 T omas McKean, R.S., CH�O Agent of the Board of Health Q:\SEPTIC\L.etters Septic Inspection Failures or Future Evl\53 Olde Homestead Dr MM Ju12014.doc I is r _ _ u - __ 1 v ��http)/issgl2rint�ar ':Iprop3 r )P n.c'r'tan.a.p�: L 2aC? I i1X1, • i•e.Search Wp--www:town.barnstable... i Application Certer Suggested Sites- tNeb Slice Gallery- Favorites i Parcel Detail iLfE y *e ieav i# A a 'ai.'' ?� 1 Parcel Info Parcel - Developer ID?043-052-'005 Lot!L0T _ - ............... Location 153 OLDE HOMESTEAD DRIVE Frontage ......Sec ) Sec( Road Frontage "i - — - Village MARSTONS MILLS Fire(C-0•MM ; District' u , Town sewer exists at this ------- _-.. -- -. Road Index 12073 ) ; address No u X� ASbullt Septic Scarf: Interactive 043052005_1 MaP Owner Info Yfi x Ownerl.BAKER,WILLIAM D&JOANNE T _ I Co-Owner Streetl i53 OLDE HOMESTEAD DR I Street2 j City MARSTOdS MILLS State MA Zip j02648 Country � r Land Info a r f.�E I��,>Local intranetsr6� I1:10 AM I�!i,r Parcel Detail=Windows L.. _ - �� Thursday € ell,�161 IZP c P Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 53 Olde Homestead Drive Property Address William Baker Owner Owner's Name required fo is Marstons Mills MA 02648 6/20/14 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Brett Hickey use the return Name of Inspector key. B&B Excavation; Inc. ICCCCCC�t Company Name 14 Teaberry Lane Company Address Forestdale MA 02644 City/Town State Zip Code (508)477-0653 SI-13747 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 6/20/14 Insp Sig ature 1, V, 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. i ****This report only describes conditions at the time of inspection and under the conditions of use i 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 Insp on o :Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 53 Olde Homestead Drive Property Address William Baker Owner Owner's Name information is required for every Marstons Mills MA 02648 6/20/14 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 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the.Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced.with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 53 Olde Homestead Drive Property Address William Baker Owner Owner's Name information Marstons Mills MA 02648 6/20/14 required for every page. Citylrown 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 bordering vegetated wetland or a salt marsh l5ins•3i 13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 a I E Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,.•'"r 53 Olde Homestead Drive Property Address William Baker Owner Owner's Name information is required for every Marstons Mills MA 02648 6/20/14 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 Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 4 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal.System Form - Not for Voluntary Assessments 53 Olde Homestead Drive Property Address William Baker Owner Owner's Name required fo is Marstons Mills MA 02648 6/20/14 required for every page. Cityrrown 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: t ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ E 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 ❑ ❑ 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 53 Olde Homestead Drive Property Address William Baker Owner Owner's Name information is required for every Marstons Mills MA 02648 6/20/14 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® El 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 31.0 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 i r i t5ins•313 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 �i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 53 Olde Homestead Drive Property Address William Baker Owner Owner's Name information is required for every Marstons Mills MA 02648 6/20/14 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 5 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection 0 Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date 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•3/13 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 53 Olde Homestead Drive Property Address William Baker Owner Owner's Name information is required for every Marstons Mills MA 02648 6/20/14 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: Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? site glass Reason for pumping: home owner's request Type of System: ® Septic tank, distribution box, soil absorption system El Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other.(describe): t5ins-3113 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 53 Olde Homestead Drive Property Address William Baker Owner Owner's Name information is required for every Marstons Mills MA 02648 6/20/14 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: 1987 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2' 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.): At time of inspection building sewer appears to be in working condition. No sign of leakage Septic Tank(locate on site plan): 1, Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years 3 Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 1000 gallons Dimensions: # Sludge depth: 0 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 53 Olde Homestead Drive Property Address William Baker Owner Owner's Name information is Marstons Mills MA 02648 6/20/14 required for every page. Cityrrown 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 0 Distance from top of scum to top of outlet tee or baffle 0 Distance from bottom of scum to bottom of outlet tee or baffle 0 How were dimensions determined? scour stick Comments (on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appears to be structurally sound. No sign of leakage. 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 53 Olde Homestead Drive Property Address William Baker Owner Owner's Name information is required for every Marstons Mills MA 02648 6/20/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank tank must be pumped at time of inspection) locate on site plan): 9 9 ( P P P ) ( P ) 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•3/13 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 ,.' 53 Olde Homestead Drive Property Address William Baker Owner Owner's Name information is required for every Marstons Mills MA 02648 6/20/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): At time of inspection d-box appears to be structurally sound. No sign of solid carryover or leakage Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: El 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: l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 53 Olde Homestead Drive Property Address William Baker Owner Owner's Name information is required for every Marstons Mills MA 02648 6/20/14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number:" ❑ 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.): At time of inspection leaching is in hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of.cesspool Materials of construction Indication of groundwater inflow ❑' Yes ❑ No t5ins•3113 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 r" ,M 53 Olde Homestead Drive Property Address William Baker Owner Owner's Name information is Marstons Mills MA 02648 6/20/14 required for every — page. City(rown 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.): 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-113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 CoIInMotnwealth of Massachusetts a Title 5: Official Inspection Firm Subsurface.Sewage:bisposal System Form Not for Voluntary Asessrnents y` 5301de,Homestaed Drive. Property Address William:Baker Owner Owner's Name information is required for every Marstons Mills MA 02648 6l20/14 . 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 wittm 100 feet. Locate where public water supply enters he building.Check one of the boxes below: hand-sketch in the-area below ❑ drawing attached separately i A VRONT t A z- a.a 62 30 3 4 ' B3- 35'y,i I1 A4 -53 t5ins•31.13 Title 5 Official Inspection,Form:Subsurface Sewage.Disposal system•Page 15 of 17 I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 53 Olde Homestead Drive Property Address William Baker Owner Owner's Name information is required for every Marstons Mills MA 02648 6/20/14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: > 12 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: previous inspection report 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 1 < Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments y ,..�. 53 Olde Homestead Drive Property Address William Baker Owner Owner's Name information is required for every Marstons Mills MA 02648 6/20/14 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION -5 01 DE AQMC545-01� .SR SEWAGE# ZOIy - ZIS VILLAGE Ar 0,01 S A 05- ASSESSOR'S MAP&PARCEL y3 1 S Z 00S INSTALLER'S NAME&PHONE NO. O.^ ' q,7`)- OG 53 SEPTIC TANK CAPACITY /000 LEACHING FACILITY: (type) `;clot S4oAC (size) x 30 NO.OF BEDROOMS OWNER ;II • allcr PERMIT DATE: $- )I - `/ COMPLIANCE DATE: Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility(If any wells exist on Feet site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist within Feet 300 feet of leaching facility) FURNISHED BY r Al - �g 3 - -z7 AZ, " 2Z 3z 3° A3' B3" ys Fron-� 3 f 4 y TOWN OF BARNSTABLE LOCATION 53 OLJE 14o1ncS4caoL .DR SEWAGE# Z01y - 'Z ?S `VILLAGE /y?gr3gonS Mi S' ASSESSOR'S MAP&PARCEL y3 IS Z 095 INSTALLER'S NAME&PHONE NO. Q�r C3 EXc x%A0,j►0^ q,71- 06 53 SEPTIC TANK CAPACITY /000 LEACHING FACILITY:(type) f;c)a(-,p;Dc * 54oAc (size) I5 X 30 NO. OF BEDROOMS 3 OWNER a tr PERMIT DATE: $-) -I Iq COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY A?.' 2Z t BZ " 30 oG'' A3' S ' , B3- yg � Ay ' Fs'on 3 ; No. 014 c� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS fltlfltatlon for Mispo8Af 6pstrm Construction Permit Application for a Permit to Construct( ) Repair(v� Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.J$ oI.>D E AA csl c .J .Dr Owner's Name,Address,and Tel.No. AX II;*ro amxcr Assessor'sMap/Parcel 4q3 XZ 005MP S.3 040S 1400155iftek .O" Installer's Name,Address,and Tel.No. sue$ q�7. 06 S3 Designer's Name,Address,and Tel.No. SOS 3e Z ys y I .0 4, $. EXcavb.A%o,n mown Cckpc Enl b a crP LN ofc a PMo Type of Building: Dwelling No.of Bedrooms 0 3 Lot Size 14.Sq 9 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 333. gpd Plan Date Zyj a %T. (y Number of sheets '.. Revision Date Title Size of Septic Tank 1000 90,) Type of S.A.S. 6 c la( - pc r-r p i p C ' s4ao%c- Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 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 Date g`S• Iq Application Approved by a Bate, Application Disapproved by Date for the following reasons Permit No. Date Issued Fee No.�t�� Entered in computer: ,,. THE COMMONWEALTH OF MASSACHUSETTS/' Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE"MASSACHUSETTS Zipplicatlon for Mispbsal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(✓) Upgrade( )`,,Abandon( ) E]Complete System ❑Individual Components Location Address or Lot No.,j 3 O L D E }/one e 5 4 cam{ ,D r' Owner's Name,Address,and Tel.No. t.J 1 ;a,r+'N Boy K c r Assessor'sMap/Parcel L/3 SZ 005 S3 0L9E omz5jcaLA JOr Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. SOS 3,,.Z t/S y 1 Excava.AN O^ �Do„ars CaQc CI-J& `. ca scr-r LN orc alaIC In S Yar-OL) % Type of Building: Dwelling No.of Bedrooms 3 Lot Size o96�S 1-1 9 sq.ft. Garbage Grinder( ) Other Type of Buildinglo.of Persons Showers( ) Cafeteria( ) Other Fixtures 4t Design Flow(min.required) 3 3 0 gpd ]Design flow provided 33 gpd Plan Date Zy 1 7-3 1 Number of sheets '., Revision Date I; Title ti Size of Septic Tank /O 00 9 a) Type of S.A.S. F,'c�c�1 - O-C r•-- R P 54 oVN C Description of Soil Nature of Repairs or Alterations(Answer when.applicable) y. x Date last inspected. Agreement: i 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 Corr_pliance has been issued by this Board of Health. Signed Date $- I't Application Approved by Date Application Disapproved by Date for the following reasons Permit No d Date Issued --------------------------------------------------------------------'------------------------ ------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(✓) Upgraded( ) Abandoned( )by B 3 FXL'a Vcx� ; o/\ at .5 3 O LJE Dr has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.ddq_a}s dated Instailer ,Q B gXCa1/a' i oA Designer o n -c d z- #bedrooms 3 Approved des' flow 3 gpd The issuance of this permit sh t e on tru d as guarantee that the system de e C f Date Inspector j' / -cl/ - - ------------- --- ---------_- ---------- -'s- - - - - - ----- ----------,-----__------- ---,-----_ No. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair(wll Upgrade( ) Abandon( ) System located at S3 OL-9E Horne 54coc)( -Dr Ma r54 on.S M 1)S 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 a following local provisions or special conditions. r Provided:Construction must be completed within three years of the date of this perm' . Date f/— /L Approved by 2_eagulat ry Se vices Y�Y � M M 1, Thomas F. GlCler, Director 19AS& �TablIlc Elea rh Di-vision Thomas 1"Y c ewm, Director 200 Main St-eet,Hyzammns,Kk 02601 Office- 508-962-4644 Fax: 509-740-6304 Insitalll<er &De d r Certification Form� Date, Z.Z-- Sewn-e Permit, �-_�-0 ' ^ P �ssessou's MapTarcell .� Desigrn'ere bovjv-- L�e (J? ql!1644 Installer. ��"� �l�L'dL✓ (/L�_ Address- �/,�� MP,t.I Address- ` ( L On was issued a permit to install a (date) (installer) septic system.at '53 U A t4tt,,o based on a design drawn by (address) p D Gt.•^.t �' k ! � 1 dated (desi r) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes suph as lateral relocation of the distribution box and/or_ septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Re-gulatious. plan revision or certified as-built by designer tofollo w. ESN OF o` DANIELA. o� OJ� nstaller's Signature) ClvIL Cn \ No.46502 vim. FSS/O N WEB 1 C�� I-fz-1jiv) _ (Designer's Signature) (An D:signer's Stamp Here) FLLASL F +'TIM_N` 1O BA3.NSTABLEH PUBLIC BEAL4H DIVISION. CE TIFICA -h OF Coy,—r-u A):-dCEE fF1U, NOT UE 6SS-HiM 1TN71'M BOTH THIS FOMU A_ND AS-BUILT CARD ARE( R-ECEF Ei D BY THE BARk4STABLE PUBLIC BTSALTH DIVISION. THANK YOU. 0:}lealtli/5eptic/Desigaer Certification Fon, 3-26-04.doc Town.of Balrnsiable Departitnent of Regulatory.Services Public Health Division Date 7 2 � 200 Main.Street,Hyannis MA 02601 Date Scheduled Pd. )P/00 v " Soil SSW ility Assessment for Sew ' .D"ollPerformed•By: f)A 0 t Q` . �u I ve ? Witnessed By: LOCATION 1�i GENE INFORMATION A.TT0 1v Location Address �� Dior 14 a&v-at� Owner's Name Address ` Assessor's Map/Parcel: r r1 l 13nginecr's Namc i? P✓\ �e NSW CONSTRUCTION REPAIR Telephone# .5�� (COi Land Use Slopes(96) / Surface Stoacs N� ,�•.1�� Distance's from: Open Water Body ft Possible Wet Area > `'��R Drinking Water Well /w ft Drainage Way 7l ft Property Una 7 S ft Other ft SICCITCH:(Street name,dimension f lot,exact locations of test holes&pare tests,locate wetlands in proximity to holes) n z ;IKI �nC= o w eat Z ! -4 tv�cS� \\ ll ()G M Parent material(geologic) /� O� Depth tv Bedrock 1G _ Depth to Groundwater. Standing Water in Bole:/ // ! __ Weeping from Pit Pope Estimated Seasonal High Groundwater /////+ 'TERM WATION FOR SEASONAL kIIG H WATER TABLE Method Used: t a W Depth Observed standing in obs.hole: Ip, Depth to wit mottles. ItL Depth to weeping from side of obs.hole: In, Groundwater Adjugiment ft. Index Weli# Reading Date: Index Well loyal : Adj.Actor r. _Adj.Groutidwater Lavol, , PERCOLATION TEST bate,. T nxa Observation Hole# Tlma at 9" Depth of Perc l Time at G" StLrt Pre-soak Time @ ' Time VI-0) Bad Pre-soak Rate Min.ach Sit^Suitability Assessment: Site Passed V Sitg Failed: Additional Testing Needed(YIN) A 0.6,ginah 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:1.5 BPTICIPER CFOR.M.D O C DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Sol I Texture .Shcl Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, o i to w.`%'Craven toyfi F5 10YR 0/9" DEEP OBSERVATION HOLY LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. •�� i� � ------------------ Consistmoy,9n Gravel) >0 FS DEEP OBSERVATION HOVE LOG Hole P. Depthfrom Soil Horizon Soil Texture Soil Color Soil Other' Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,.Boulders. QoTjs1qtmry,.Yd c IDEEP OBSERVATION HOVE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Casitn Flood Insurance Rate_Mgp- Above 500 year flood boundary No. Yes .v____ —Within 500 ear boundary No 1 Yes Y r3' - - WIthin 100 year flood boundary No. Yds , Depth of 1Vatttrally Occurring)Pervious Material Does at least four feet of naf urally occurring pervious material exist in all areas observed thrpughout the area proposed for the soil absorption system' y_,_ S If not,what is the depth of naturally occurring pervious material? Certification /l� - 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 requited training,expertise and experience described in�10 CUR 15.017./ / (� Signature � Datb ' Q:�s.�rTlc�rrncnoRM.Doc . TOWN OF BARNST LE ,LOCATION QF�-� SEW�G�fE?#� ,VILLAGE (Y1 S C r �l•t(.S ASSESSOR'S MAP &I.Op a INSTALLER'S NAME&PHONE iVO. SEPTIC TANK CAPACITY M O O LEACHING FACILITY: (type) elf= (size) !r 0()b NO. OF BEDROOMS BUILDER OR OWNER �� N PERMITDATE: 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) Io—� Feet Furnished by Grc g ca 7 -------------------- EJ4 g AA ® A635 Ac 3Y &A 30 d 35 TOWN OF BARNSTABLE .00ATION L Z8 lb 1, SIeoU J+ .SEWAGE # VILLAGE �/�lar5�ds ►�li4I,S ASSESSOR'S MAP & LOT �l3-SZ INSTALLER'S NAME & PHONE NO. ZSCa�` 77 Z-le)Li4 SEPTIC TANK CAPACITY ,ydd 11615 ti LEACHING FACILITY:(type) C-e�� (size) cry 6��►s -NO. OF BEDROOMS. PRIVATE WELL O PUBLIC WATER r BUILDER OR OWNER ^a/i DATE PERMIT ISSUED: p�-�� c t O q g6 DATE .COISPLIANCE ISSUED- VARIANCE GRANTED: Yes No 1 � �`� �� -� r�• Lti a ,N f � i _ .J': L •. ,> ASSESSORS MAP N0: _P"j 113=sue- PARCEL NO.: -� No...�..v��.J�.. Fps.. ....7..5cQ THE COMMONWEALTH OF MASSACHUSETTS g 3 BOAR® OF HEALTH ----------- 720U,0._�,'-- ......OF..... �.1 Ile Applira#ion for Uispwi ai Works Tomiummin Frrmit Application is hereby made for a Permit to Construct ()C) or Repair ( ) an Individual Sewage Disposal System at: ...0 .......... --•-- 1r L?l1�.................................................... Location-Address No. klotv�.a-- ----------------------------------------------- ....1.1u- bolo.------ ----------------------------------------- Owner Address .....-_.-•------------------------------- -•--- r.A-t' . Installer Address Type of Building Size Lot__a_�ir_� �•---_-•Sq. feet Dwelling—No. of Bedrooms....... ___________________Expansion Attic ( ) Garbage Grinder ( } a Other—T e of Building No. of persons ..................: Showers aOther YP g ---------------------------- p ---- ( ) — Cafeteria ( ) WDesign Flow.Othe.55...es.................gallons per person per,day. Total daily flow- _---•��.........................gallons. WSeptic Tank—Liquid*capacity./00D.gallons Length----- Width.......(a..... Diameter________________ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. � $Seepage Pit No----------l---------- Diameter...... ..`......... Depth below inlet_.__._._k?__...... Total leaching area__a,tOO.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by----10.01 t..._..WAJtW-Ct ,�................... Date........5hi/8-'lo--•.--•.-_-- Test Pit No. 1.....�-_-___-minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ........•------------------••••-,•••--••••--••-••-•••••--•-•:......••-•---•----------....-•-.--............................................................. 0 Description of Soil--------� ..i ._.7-10 ..g....Sig./J.-dat-L............................................................................................ Wx ........................................ ......Ja.........141 Ard............................................................................................ UNature of Repairs or Alterations—Answer when applicable............................................................................................... --- ---------- r.. `� A eer_zent: , The undersigned agrees to install the aforedescribe ndividua wage Disposal System in accordance ith the prcvisions of TTTILE 5 of the State Sanitary C e he s* ed further agrees not to place e s ern in operation until a Certificate of Compliance has bee i ed b ' o r of health. Signed•. . .....••-•_•-- ... •• ---••........ ...... . o - D e Application Approved By-••-•......1.1 -----------------•-•-•-•---•--- ..._....../ � -----•--- ate Application Disapproved for the following asons:........................................•--•-••••-•••--•-•-•--••-----•-•-•••-•--•••-•........................- --•-••-..............•-•-••-•-•-••-----....••-•-•----•-•--•-•--•--••-••••------•..........................._.....••---•-•-•-•-•-••-•••••-•••-••••--••••-••••-••••-••-•.....•-----••-••----•-•••-•_..•••--- Date PermitNo......................................................... Issued_....................................................... Date 1 _ . qq Ob- 7� ._._.. Fns .7: Inr N .--•----•----•----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ ---------------OF.... Appliration for Diipn- l Worko Tnnitrur#inn ramit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: M_ .1at6-n. a ------------------------------------••••- Location-Address or t No- r��1 ► .��1 __.........-•••••••-•••................••-•------- ..- t_ rz�......_.1' r. .- ~ Owner Address Insta:ier Address Type of Building Size Lot.,J.k.,�2 ._y_q---•--.--Sq. feet Dwelling—No. of Bedrooms.....-3.._l3sR....................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) p-' Other fixtures ................................. W Design Flow...........5:5................ti.t.--_.gallons per person per day. Total daily flow-------3 0....._.._...............__gallons. 9 Septic Tank—Liquid capacitvt 'Ov_...gallons Length---9...._..... Width.....(n......_ Diameter________________ Depth................ Disposal Trench—No..................... Width........._..._.... Total Length...._........•._.. Total leaching area--------------------sq. ft. Seepage Pit No........I........... Diameter...._.'-- --------- Depth below inlet.......k....._.__ Total leaching areal ?U-•-___-sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by...�m!.......LAC-1 ?xt:??f.�......._•......_.... Date.......K_ AJ5tn.............. a Test Pit No. I....r;�........minutes per inch Depth of Test Pit.................... Depth to ground water........................ L=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 .............................................-•-•••-••••--.........•-•-••-•-•---•••••..............•........................................................ Description of Soil . `L......54 .r�,•---- x ff /` V '•--•-•--•-•••.......................�:.••....9.........---• G'/r .f_Ja-a't_1......,� 51 .....-•.•....------..------....--•---•-•-.--•.--........__...--....._..............••------•..-- UW -------------------------------------------------------------fU!t---L.!_)a_J r------••------•--------•--••----•-•---•-•------•-----•-------••---------••----•--•-•-------------------------- Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: C/�j , The undersigned agrees to install the aforedescrib Individu Sewage Disposal System in accordanc with the provisions of T� I� ;or the State Sanitary C d The n rs. ed further agrees not to piac the stem in operation until a Certificate of Compliance has bee sued by 0 of health. �� Signed. . ............. =•-----------.......---••-•--•••............•-- _ Application Approved By.. .. -----'�-�°t•--......- ....................... ........ ---------- �' Date Application Disapproved for the f ollowin- easons:---...•••-•-•-••••-•••••••-••-•••-•........--•-•-------•---••••-•••---•-•--••---•-•-••-••--••--••--•-.....••-•-- ....••--••-•--•••.............•-•---•••••••-•••••--•--••--••••••-••••••••-•--•••................•--...•-•-•-•---••-••---•-----•--••-•-••••-••••---•------------............-•-••----••-••...•-••-•-•--•- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 710-�......... _ A1................OF........... ?r.:t '2M..Atb............................................ Trrtif iratr of Tuntphaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed Oe ) or Repaired ( } by....... ......................•----------------.....----------•-. Installer at.•r � � � _ ?L� M� l.!_lft'� has been installed in accordance with the provisions of T IT 1E j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATA. .6;. ................................... Inspector-••• _: ......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Nol - ......... ...n4,n................OF.....13./.I�...Zll..?:I.A.!1"�-tom J ........................................... FE - �i��rr,s�1 nrk� ��an��rnr�uan rruti� Permission is hereby granted......K:4L [ .,A--------14i:ckA�± ....--•----------------•----•--------•----•---------•-•-•-••-------........•-•---....--- to Corslru� VC )for Repair ( ) an Individual eve*a e Dislosal Syst ----•-• , at No. -•-----•0=--------..40L§ I`_� ........ L0 C.C_ -al-.....)5A.4._.k+`�--•-I••--•-- ��. .f t1. F•"�^a +.......-•--.-•-------•--- Str eet as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... C(� �T` ( ------•--------•-------------- D - • -�--------•------' -------•• Board t `P'V ATE-\Dd-, -..- ---•-- -n- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS UJ t MZ mz r , r C MIS Low � sg PETER �19.SC�t�t ; U:_t IVAN �•is 29733 �G?sT¢RF. W A.U, ems. 1 •�F �ss�;rr�A E"aG\ pGmf: 1 Sq'�° 2.5 385 G�r'D "�rToul � f_�ZE�• A�5�4 5� • T'a-rA.t_-7 �E5�N�Y"k;2 1,�-f-�pt,,1"d�A'�. ', 2 M i►.t Z1hia\ T I BAX i Eli N.G. 2404a cy I 1 7 f t . I r, $a 5 Bg.? a1< ez.9 eA,t -6E.xmc. 8 1'S 1 AT2 btA ErST�/irl { L1=1ZTt'F`t; ;`C�RATTt•�� .i-�U`LCDAt+OY+� S}{f�ll� -T�AT�.Oi �Z`q•0S ftzQla1EME'1SC�j UFETa'vcL1AC-YtS'f��7 � SV2�lF'(OeS a� a►�2>J S'i Ax1 c7 \5 tSCSr. C+v I t- Zz_7 6 Lzk E zs .1.tx 'r'�-•tom Wl-r4•l(r l't'+VM It_tY�`�'"� =Iws� Lus= t Lor f I� 0 L` r 71 Cl ci I I i r � {•s, ' to. 1\'�"� > x.,l-oPROr COPT. AU Ms I , q (e UANENe(P GUIDE IIHC 10 5641 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS _ DEPARTMENT OF ENVIRONMENTAL PROTECTION F � } d t y�s TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 53-OLDE HOMESTEAD DR MARSTONS MILLS 02648 M43 P52-2 Owner's Name: DINIS BALTAZAR Owner's Address: 18 MARIAN CIRCLE LUDLOW MA. 01056 Date of Inspection: 2/21/03 Name of Inspector: (please print) JOHN GRACI, INC. Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of 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: X Passes _ Conditionally asses _ Needs Furth Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 2/21/03 The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within ,30 days of completing this inspect n. 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. Notes and Comments THE SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO MAINTAIN SYSTEM. ""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. Title 5 incnPrtinn Fnrm F/I 5/,)M(1 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 53 OLDE HOMESTEAD DR MARSTONS MILLS 02648 M43 P52-2 Owner: DINIS BALTAZAR Date of Inspection: 2/21/03 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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 PASSES TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO MAINTAIN SYSTEM. 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., Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. n/a 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. ND explain: n/a n/a 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 _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a 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 _obstruction is removed ND explain: n/a Ptige 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 53 OLDE HOMESTEAD DR MARSTONS MILLS 02648 M43 P52-2 Owner: DINIS BALTAZAR Date of Inspection: 2/21/03 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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 n/a "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a r Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 53 OLDE HOMESTEAD DR MARSTONS MILLS 02648 M43 P52-2 Owner: DINIS BALTAZAR Date of Inspection: 2/21/03 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool - X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than'/2 day flow _ X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped PUMPED iN JULY OF 99. X Any portion of the SAS,cesspool or privy is below high ground water elevation. - X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. - X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _ (Yes/No)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: Y To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no - X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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. a Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 53 OLDE HOMESTEAD DR MARSTONS MILLS 02648 M43 P52-2 Owner: DINIS BALTAZAR Date or Inspection: 2/21/03 Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health _ X Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site? X - 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? X _ 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: Yes no X _ Existing information. For example,a plan at the Board of Health. X _ 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(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 53 OLDE HOMESTEAD DR MARSTONS MILLS 02648 M43 P52-2 Owner: DINIS BALTAZAR Date of Inspection: 2/21/03 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents: 0 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): tt*.a Sump pump(yes or no): NO _ ^'� Last date of occupancy:2/15/03 �co LA t vim`-' COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design.flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings,if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: PUMPED IN JULY OF 99 Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X 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) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1987 INFO FROM LISTING SHEET Were sewage odors detected when arriving at the site(yes or no): NO Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 53 OLDE HOMESTEAD DR MARSTONS MILLS 02648 M43 P52-2 Owner: DINIS BALTAZAR Date of Inspection: 2/21/03 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 12" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: L 8' 6"H 5' 7" W 4' 10"" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle:33" Scum.hickness: 2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 16" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL SEPTIC TANK COMPONENTS ARE STRCTURALLY SOUND AND FUNCTIONING PROPERLY.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP: _(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 53 OLDE HOMESTEAD DR MARSTONS MILLS 02648 M43 P52-2 Owner: DINIS BALTAZAR Date of Inspection: 2/21/03 TIGHT or HOLDING TANK:: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no):NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX: X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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 STRUCTURALLY SOUND. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a I Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 53 OLDE HOMESTEAD DR MARSTONS MILLS 02648 M43 P52-2 Owner: DINIS BALTAZAR Date of Inspection: 2/21/03 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a. n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.THE PIT WAS VIDEO INSPECTED AND SHOWS NO SIGNS OF FAILURE. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a A f Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 53 OLDE HOMESTEAD DR MARSTONS MILLS 02648 M43 P52-2 Owner: D1NIS BALTAZAR Date of Inspection: 2/21/03 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. W a C- AP '� as 31 AD �h in Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 53 OLDE HOMESTEAD DR MARSTONS MILLS 02648 M43 P52-2 Owner: DINIS BALTAZAR Date of Inspection: 2/21/03 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimat.-d depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: GROUNDWATER DETERMINED FROM HAND AUGER-NO WATER AT 12' 11 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS John Graci DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAULCELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION f f Property Address: 53 OLDE HOMESTEAD DR. MARSTONS MILLS Oc>;), Name of Owner PRISCILLA GIRVAN 9 Address of Owner: SAME Date of Inspection: 9/14/99 Name of Inspector:(Please Print)JOHN GRACI pph� I am a DEP approved system inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000) VED � S Company Name: n/a EP2 4 Mailing Address: n/a 1 Telephone Number: n/a 10WN0'. ��9 9 DEPT A ti CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below isAt de,accura and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes The Inpection Is based on criteria defined in Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system Is Needs FurthgEn By the Local Approving Authority performing at the time of the Inspection.My inspection does _ Fails not imply any warranty or guarantee of the longgevity of the septic system and any of its components useful life. Inspector's Signature: Date:9/14/99 The System Inspector shaopy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 53 OLDE HOMESTEAD DR.MARSTONS MILLS Owner: PRISCILLA GIRVAN Date of Inspection:9114199 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: nta One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. nLa The septic tank is metal,unless the owner or operator has provided the systern inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20).years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. nLa Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed _ distribution box is levelled or replaced nta The system required pumping more than four 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 obstruction is removed SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 53 OLDE HOMESTEAD DR.MARSTONS MILLS Owner: PRISCILLA GIRVAN Date of Inspection:9/14199 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 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 AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nLa_(approximation not valid). 3) OTHER nLa revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 53 OLDE HOMESTEAD DR.MARSTONS MILLS Owner: PRISCILLA GIRVAN Date of Inspection:9/14/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Wa. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 53 OLDE HOMESTEAD DR.MARSTONS MILLS Owner: PRISCILLA GIRVAN Date of Inspection:9114/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal Flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [1 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 53 OLDE HOMESTEAD DR.MARSTONS MILLS Owner: PRISCILLA GIRVAN Date of Inspection:9/14/99 FLOW CONDITIONS RESIDENTIAL: Design flow:-M g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):. Total DESIGN flow: = Number of current residents:A Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no):M Seasonal use(yes or no):M Water meter readings,if available(last two year's usage(gpd): nLa Sump Pump(yes or no): NO Last date of occupancy: Wa COMMERCIAL/INDUSTRIAL Type of establishment: nta Design flow: nLa gpd(Based on 15.203) Basis of design flow: n& Grease trap present:(yes or no):�LQ Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):MQ Water meter readings.if available:n& Last date of occupancy: n& OTHER: (Describe) Wit Last date of occupancy: n& GENERAL INFORMATION PUMPING RECORDS and source of information: JULY 99 System pumped as part of inspection:(yes or no):NQ If yes,volume pumped n(a_ gallons Reason for pumping: Wit TYPE OF SYSTEM XSeptic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: nta APPROXIMATE AGE of all components,date installed(if known)and source of information: THE SYSTEM IS 12 YEARS OLD. Sewage odors detected when arriving at the site:(yes or no): NQ revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 53 OLDE HOMESTEAD DR.MARSTONS MILLS Owner: PRISCILLA GIRVAN Date of Inspection:9/14/99 BUILDING SEWER: (Locate on site plan) Depth below grade: 1 6" Material of construction:_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: TOWN Diameter: nta Comments: (condition of joints,venting,evidence of leakage,etc.) Wa SEPTIC TANK: X (locate on site plan) Depth below grade: V Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) n& If tank is metal,list age Is age confirmed ay Certificate of Compliance(Yes/No): No Wa Dimensions: L 8'6"H 5'7"W 4'10" Sludge depth: n& Distance from top of sludge to bottom of outlet tee or baffle: nta Scum thickness:-nLa Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: nLa How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC 7ANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING EVERY TWO YEARS GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) nta Dimensions: nLa Scum thickness: Wa Distance from top of scum to top of outlet tee or baffle:_Va Distance from bottom of scum to bottom of outlet tee,or baffle nta Date of last pumping: Wa Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) Wa revised 9/2/98 Page 7 of 11 " SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 53 OLDE HOMESTEAD DR.MARSTONS MILLS Owner: PRISCILLA GIRVAN Date of Inspection:9/14/99 TIGHT OR HOLDING TANK: NQ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: nLa Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) nLa Dimensions: nLa Capacity: nLa gallons Design flow: nta gallons/day Alarm present: NQ Alarm level:jita- Alarm in working order:Yes_No_ NQ Date of previous pumping: n& Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nla DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert:LIQUID LEVEL WITH BOTTOM OF PIPE Comments: (note if level!and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) DISTRIBUTION BOX IS STRUCTURALLY SOUND PUMP CHAMBER: NQ (locate on site plan) Pumps in working order:(Yes or No): NQ Alarms in working order(Yes or No): NQ Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n& revised 9/2/98 Page 8 of I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 53 OLDE HOMESTEAD DR.MARSTONS MILLS Owner: PRISCILLA GIRVAN Date of Inspection:9/14/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: nLa Type: leaching pits,number: 1000 GALLON LEACH PIT leaching chambers,number: jVA leaching galleries,number: jita leaching trenches,number,length: n& leaching fields,number,dimensions: n& overflow cesspool,number: n& Alternative system: n& Name of Technology: _nLa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT APPEARS TO BE FUNCTIONING PROPERLY,SYSTEM SHOWS NO SIGNS OF FAILURE. . CESSPOOLS: _ (locate on s to plan) Number and configuration: n& Depth-top of liquid to inlet invert: n& Depth of solids layer: nLa Depth of scim layer. nLa Dimensions of cesspool: n& Materials of construction: n& Indication o-groundwater: n& inflow(cesspool must be pumped as part of inspection)n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nLa PRIVY: _ (locate on site plan) Materials of construction:n& Dimensions:n& Depth of solids: n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n1A revised 9/198 Page 9 of 11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 53 OLDE HOMESTEAD DR.MARSTONS MILLS Owner: PRISCILLA GIRVAN Date of Inspection:9/14/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a a �A l� BA revised 9/2/98 Page 10 of 11 e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 53 OLDE HOMESTEAD DR.MARSTONS MILLS Owner: PRISCILLA GIRVAN Date of Inspection:9114/99 NRCS Report name: nLa Soil'Type: nta Typical depth to groundwater: n& USGS Date website visited: n(a Observation Wells checked: N4 Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated'Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions _ Checked with local Board of health Checked FEMA Maps Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHART revised 9/2/98 Page 11 of 11 i i SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES MARKED WITH MAGNETIC TAPE OR PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS ASSUMED ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS EXISTING \ TOP FOUND. EL. 82.8' FILTER FABRIC OVER STONE MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 81 .0' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. NOTE: 2" MIN. WALL PROVIDE INSPECTION PORT TO WITHIN 3" OF NAL GRADE 4. DESIGN LOADING FOR ALL PROPOSED PRECAST a PRECAST H-10 THICKNESS REQUIRED UNITS TO BE AASHO H-14 o es{e RASTERS (TYP.) 80 7' 4"OSCH40 PVCZ I PIPES LEVEL 1ST 2' 2" DOUBLE-WASHED PEASTON 5. PIPE JOINTS TO BE MADE WATERTIGHT. R u ' OR GEOTEXTILE FABRIC akeb EXISTING 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE 10' 14" WITH 310 CMR 15.000 (TITLE 5.) '.V TEE SEPTIC TANK** TEE [1 3t�* ; ..q o =000.0000 0 0 0 0 0 0 0 0 0 0'0 0 0 o p p o°o°o° o°o°o°o°ooJ o 00 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 o0000 0 o 0 0 00 0 0 0 0 0 0;0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 76.69 0000000000 ° 00000 ° 0000000000 ° 007. THIS PLAN IS FOR PROPOSED WORK ONLY AND 5hgd ° ° ° ° ° ° o 00 0 0 0 0 0 0 0 0 , o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00000°°°°°°°° - o 0 0 0 ° ° o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 GAS BAFFLE ° ° °�°�° ono0°0°0000°000000°00 °oo°oo o°o° 0 0°00 000°°oo°o0e0°00000o00°0 76.0' NOT TO BE USED FOR LOT LINE STAKING OR ANY VQoon o 00 0 0 0 0 0 0 o c o 0 0 0 0 0 0 0 0 0 0 0 0 o V cn {er5 76.96' 76.79' 4" PVC SET AT .005'/' SLOPE OTHER PURPOSE. +' ON 6" DOUBLE WASHED 3/4"- 1 1/2" STONE " � 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC. Pond EI o P 5' 9. COMPONENTS NOT TO BE BACKFILLED OR ng5 o 6" CRUSHED STONE OR MECHANICAL CONCEALED WITHOUT INSPECTION BY BOARD OF o � COMPACTION. (15.221 [2]) HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. ( 8 % SLOPE) ( 1 % SLOPE) BOTTOM TEST HOLES 1 & 2 EL 71.0' 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP CALLING DIGSAFE (1-888-344-7233) AND LEACH 'NG - VERIFYING THE LOCATION OF ALL UNDERGROUND & NOT TO SCALE FOUNDATION EXIST. SEPTIC TANK 29 D' BOX 12' ti OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF FAC I LfiY WORK. *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL ASSESSORS MAP 43 PARCEL 52 005 UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 11. ANY UNSUITABLE MATERIAL,ENCOUNTERED PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. /. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT / AND REMOVED OR PUMPED AND FILLED WITH CLEAN 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE SAND. WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE 82 . CONFIRM WATERLINE SEPARATION AT CONDITIONS IF NOT SUITABLE 8288 MINIMUM 10' (IF LESS, WATERLINE MUST BE 8 7 SLEEVED) O / i VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE G11 41 82 8 Jco 83.37 IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR BY HEALTH INSPECTOR G ( .38 83.01 PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED x , ,8 14 83,39 SYSTEM DESIGN. BY THE BOARD OF HEALTH REVISED DURING A PUBLIC �O / HEARING HELD ON AUG. 4, 2009 / O 83.1 4g�/ GARBAGE DISPOSER IS NOT ALLOWED x 83.31 3) FAILED SYSTEMS ONLY : SOIL ABSORPTION SYSTEM �8a��0 O :GARDEN AN / 82.61 DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GPD INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW �O i �� PLANTIN, S g2.7g GRADE WITH PROPER VENTING (PIPED TO THE ATMOSPHERE) Q co row'' 30' USE A 330 GPD DESIGN FLOW AND WITH H-20 LOADING, BUT IN NO CASE SHALL THE SAS 12" BE LOCATED MORE THAN SIX FEET BELOW GRADE. YIN/ 85.02 I BEE �;� .i SEPTIC TANK: 330 GPD (2) = 660 83. 3 TWIN 6" AK I 82. 8,0 81.00 -� **RE-USE EXISTING 1000 GAL. SEPTIC TANK 16 N 8.0" 1.65 .37 �O6 ro •09, � TEST HOLE LOGS 83.33 83 4 ' 1 TWIN 12" 81 21 14 3 4 LEACHING: " OAKi _ OAK 81.40 LEACH FIELD DETAIL SIDES: N/A 81.53 1" = 20' ENGINEER: DANIEL E. GONSALVES, SE #13587 / 85.98 `3� / �p 0 PAVED DRIVE BOTTOM 30 x 15 (.74) = 333 GPD �5 R 82.22 81.76 8167 . WITNESS: DONNA MIORANDI, RS 82 w 81.78 TOTAL: 450 S.F. 333 GPD 7 23 14 97 / DATE: / / % s w�81.66 '81Io86 USE 30' x 15' x 0.5' DEEP LEACH FIELD WITH (3) 4" 7,1 87 ro 80.7 `2 O PX LOCATION R1.75 0 PERF. PVC IN DOUBLE WASHED STONE. SEE DETAIL PERC. RATE _ < 2 MIN/INCH 81.00 � OFPI� (NOTIES) .88 lbI . CLASS I SOILS P# 14436 � 1 O � � 9�18 ELEV. ELEV. WOODS 1. � x 80.8 8- .. 4 81 7 d .85 Opp4 81.0' Opp 81 .0' 87 -� CO111 18" A`Tt■ 9` T 2 LAWN CO n , 0 8 / BENCHI MARK - CORNER CONC. MA FILL FILL ' � �� 81 .80 GARAGE APRON. ELEV. = 82.3' APPROVED DATE BOARD OF HEALTH ' I EXISTING cn .86 DWELLING 1.40 ,\ C'q 0.66 3 z TITLE 5 SITE PLAN B B 44" 42 <7^,F c 8• 8 - 0.85 �80.25� \ EL. 82.8' OF CAUTION: GASLINE T c"�-'`'� DECK LS LS 6 0 44 81.19 NOTE: POOL AND STRUCTURES IN r6� � \/ REAR YARD NOT SHOWN. rJ3 OLDE HOMESTEAD DR. 48" 1 OYR 5/6 77 0 48„ 1 OYR 5/6 77 0 PROP. VENT WITH CHARCOAL FILTER 85 AND BUGSCREEN (FINAL PLACEMENT BY �� MARSTONS MILLS CONTRACTOR WITH HOMEOWNER 80.75 CONSULTATION) � AREA DRAIN C C UNDERGROUND ELEC. 7. PREPARED FOR PERC PROBABLY IN THIS AREA 6`3 LOT 28 B&B EXCAVATION/BAKER FS FS 26,549 Sq. Ft. JULY 28, 2014 AUGUST 8, 2014 (DESIGN FLOW) 1 OYR 6/8 10YR 6/8 �,�' ` r ., g . . .. o aGp`(N Of bigSi� 4�A 0F A1g5S� Z1�OF h9p�ssln. �r11�U \ ' �/� off 508-362-4841 DAi J.ELA. u w:, �° DANIELA. ° DANIEL , DANIEL fax 508-362-9880 i I JAI A. A. , I I CIVIL OJALA � �` GJ, L,; I downcape.com o No.45502 a-: � No. 6502 No.40980 v.. \�N'e. f1h1_1 down cape ellfkeefk f, nc. 120 w Cc 0SS GISTE civil engineers y0. >, ,-;o,NA Ewa QSUR 4 Scale: 1 = 20, land surveyors NO GROUNDWATER ENCOUNTERED y '_ 939 Main Street ( Rte 6A) 4- 163 DATE DANIEL A. OJALA, P.E., P.L.S/ 0 10 20 30 40 50 FEET YARMOUTHPORT MA 02675