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0271 OLDE HOMESTEAD DRIVE - Health
271 OLDE HOMESTEAD';, GMARSTON MILLS f TOWN OF BARNSTABLE LOCATION �� �� +yag SEWAGE# VILLAGE e � ASSESSOR'S MAP&PARCEL 0 Y(r/00-9-009 INSTALLER'S NAME&PHONE NO. /4D, � SEPTIC TANK CAPACITY LEACHING FACILITY: (type) *76 (size) NO.OF BEDROOMS OWNER -e e— PERMIT DATE: /� COMPLIANCE DATE: Z 2 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 D v l d-e K r �1 Town of Barnstable Barnstable P` a Inspectional Services Department m-ArnmticaCity1 t t BARNfiTABLE, 63 Public Health Division a ArF� �a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 7558 August 12, 2019 NELSON, ROBERT & PATRICIA C TRS, 271 OLDE HOMESTEAD DR MARSTONS MILLS, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 271 Olde Homestead Drive, Marstons Mills, MA was inspected on 07/10/201.9 by Michael T Bisiencre, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2) years 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 BO RD OF HEALTH a , S., C Agent of the Board of Health Q:\SEP'I IUl'itle V Inspection Report Letters Mailing\Failed or Needs Further EValUatlo❑Letters\271 Olde Homestead Drive Mars-ons Mills.doc b �P��THE 10h�,n Town of Barnstable • .nRrisraec.e. 6 q Inspectional Services Department .or fD MA'S A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts of$ -oo/ Das Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary.Assessments 271 Olde Homestead Drive Property Address it 111 Robert& Patricia Nelson, TTEE Owner Owner's Name r , i I information is Marstons Mills MA 02648 07-10-2019 ;w I required for every `a t page. City/Town State Zip Code Date of Inspection 1 Inspection results must be submitted on this form.Inspection forms may not be altered in any i way. Please see completeness checklist at the end of the forma I 1. Important.When filling out forms A. Inspector Information 5/ rl */j}00� i on the computer, ? use only the tab Michael T Bisienere key to move your Name of Inspector cursor do not Cape Septic Inspections use the return Company Name l t i key.I i 52 Rivers End Road Company Address i I Teaticket Ma. 02536 i � i Cityrrown State Zip Code I. I 508-280-3356 S13938 Telephone Number License Number I, B. Certification I F'i tf i Ill i I I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5;! i 1 I (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address! j listed above; the information reported below is true, accurate and complete as of the time of my ' I inspection; and the inspection was performed based on my training and experience in the proper function 1 and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: ' El1. Passes i 2. ❑ Conditionally Passes l ; 3. ❑ Needs Further Evaluation by the Local Approving Authority 1 4. ® Fails 1 i 07-14-2019 r i Inspector Signature Date fI The system inspector shall submit a copy of this inspection report to the Approving Authority (Board I'I i of Health or DEP)within 30 days of completing this inspection. If the system has a design flow ofl. , 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate I I';I i regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. 10, Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform i i"! in the future under the same or different conditions of use. i �! t5in5p.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 I ;1 : I 1 Commonwealth of Massachusetts Title 5 Official Inspectionform . All. �- 7. a Subsurface Sewage Disposal-System Form - Not for Voluntary Assessments . ;E j ` V 271 Olde Homestead Drive Property Address ; i Robert& Patricia Nelson, TTEE , { Owner Owner's Name information is a i required for every Marstons Mills MIA 02648 07-10-2019 { page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary i p rY �„ Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. I 1) System Passes: I ❑ 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: i I ii ;} E 2) System Conditionally Passes: l I IA f ❑ One or more system components as described.in the"Conditional Pass" section need to be ' I i 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. i determined," please explain. i ,1 t* 1 I ' The septic tank is metal and over 20 years old or the septic tank(whether metal or not) is structu, all i unsound, exhibits substantial infiltration or exfiltration or tank failure its imminent. System will pa,'ss I j inspection if the existing tank is replaced withla complying septic tank,as approved by the Boar gof { F Health. s ( I *A metal septic tank will pass inspection if it is structurally sound not,leaking and if a Cetficate of 4 F Compliance indicating that the tank is less thanQ0 years old is available. I ) l+ a i ❑ Y ❑ N' ❑ ND (Ezplaintbelow): it � i •si t I �il t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 . i Commonwealth of Massachusetts } ,�o Title 5 Official Inspection form I a Subsurface Sewage Disposal System Form-Not for Voluntary,Assessments i 271 Olde Homestead Drive V Property Address Robert& Patricia Nelson, TTEE q I ' Owner Owner's Name information is require d for every Marstons Mills MA 02648_ 07-10-2019 page. City/Town State Zip Code Date of Inspection ( , C. Inspection Summary.(cont.) 9 2) System Conditionally Passes (cont.): i ❑ Pump Chamber pumps/alarms not operational._System will pass with Board of Health approval ifl pumps/alarms are repaired. l i El Observation of sewage backup or break out or high static water level:in the distribution box due i 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): rr ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): I ,i. ❑ obstruction is removed ❑ Y ❑ N. ❑ ND (Explain below): l ❑ 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): j ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): I�' F. i 3) Further Evaluation is Required by the Board of Health: E I + El Conditions exist which require further evaluation by the Board of Health in order to determine If the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,, safety and the environment: I I t5insp.doc-rev 7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 I rl i i i fi Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary.Assessments 1 271 Olde Homestead Drive i Property Address Robert& Patricia Nelson, TTEE r Owner Owner's Name information is Marstons Mills MA . 02648 07-10-2019 required for every i page. Cityrrown State Zip Code Date of Inspection i C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water 1, ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh ` b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, t � l safety and environment: {I ❑ 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 ' fj supply. a ? ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water ; . supply well. ly ❑ 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: + i II **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. i1 i c. Other: ! i r � fE I ! I 33 ry I f j E I 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: I i Yes No 1� ® ElBackup of sewage into facility_ or system component due to overloaded or , clogged SAS or cesspool ' El ® Discharge or ponding of effluent to the surface of the ground or surface waters; j due to an overloaded or clogged SAS or cesspool { !' t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 i rl li ;I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments '; + ! I 271 Olde Homestead Drive !i f Property Address ! Robert& Patricia Nelson, TTEE Owner Owner's Name + informaticn is required for every Marstons Mills MA 02648 07-10-2019 ,I I page. City/Town State Zip Code Date of Inspection ' C. Inspection Summary cont. p rY (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) l Yes No El ® Static liquid level in the distribution box above_ outlet invert due to an overloaded) or clogged SAS.or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less' than '/2 day flow I 4 I Required pumping more than 4 times in the last year NOT due to clogged or E ❑ ® obstructed pipe(s). Number of times:pumped ; ! ' fI ❑ ® Any portion of the.SAS, cesspool or privy is below high ground water elevation 1. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or b tributary to a surface water supply. '- Any portion of a cesspool or privy is within a Zone 1.of a public water supply I ❑ ® well. ❑ ® Any portion of a cesspool or privy is within 50,feet of a private water supply,wel.i { ❑ ® Any portion of a cesspool or privy is less than 1.00 feet but greater than 50 feet'CI 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,i laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, 4 i f provided that no other failure criteria are triggered. A copy of the analysis; and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be P , ' necessary to correct the failure. I i 5) Large Systems: To be considered a large system the system must serve a facility with a "t 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:,i questions in Section CA, Yes No j ❑ ❑ 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 El Elthe system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone.II of a public water supply well I a t5insp.doc•rea.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 ; Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 271 Olde Homestead Drive Property Address 1 Ii Robert& Patricia Nelson, TTEE , Owner Owner's Name I information is required`or every Marstons Mills MA 02648 07-10-2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) i ► If you have answered "yes" to an ,i y y y question in C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The if owner or operator of any large system considered a significant threat under.Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. I 6. You must indicate"yes" or"no"for each of the following for all inspections:_ I I y ` Yes No !; ' ® ❑ Pumping information was provided by the owner, occupant, or Board of Health F , ❑ ® 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? : l 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? t. ® ❑ Were all system components, excluding the SAS, located on site? ( a j ' ® ❑ 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? I ; � 1 Was the facility owner(and occupants if different from owner) provided with i I ® El .information on the proper maintenance of subsurface sewage disposal s stems. - p P 9 p Y ,. The size and location of the Soil Absorption System (SAS) on the site hash I! been determined based on: l f � I ® ❑ Existing information. For example, a plan at the Board of Health. i ® ElDetermined 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)] l ' I i a t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 tj �• ! � I 'i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments A , j 271 Olde Homestead Drive Property Address Robert& Patricia Nelson, TTEE , { Owner Owner's Name I information is required for every Marstons Mills MA 02648 07-10-2019 page. Citylrown State Zip Code Date of Inspection k D. System Information ' y 11 1. Residential Flow Conditions: li. li 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): 33 p lu kGP i i Description: i I I' Number fcur rent 3 i I e o residents: , 4 ,r Does residence have a garbage grinder? # � 9 9 9 ❑ Yes ® i � Does residence have a water treatment unit? El Yes ® No; �I 3 If yes, discharges to: i Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) El Yes ®; No � ' Laundry system inspected? ❑ Yes ®F No t Seasonal use? ❑ Yes ® No G ( i Water meter readings, if available (last 2 years usage (gpd)): i Il I Detail: p� 101 ITV) A0la- '7%,000 mdlCos trier-e (A :Z)G � Od0 QC3Tt� It{gt�i l {' S ? 0 Yes ®i No �I Last date of occupancy: occupiedDate t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts + I �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 271 Olde Homestead Drive ! Property Address - Robert& Patricia Nelson, TTEE Owner Owner's Name information is required for every Marstons Mills MA 02648 07-10-2019 + i page. City/Town State Zip Code Date of Inspection € t. D. System Information (cont.) t 2. Commercial/Industrial Flow Conditions: k I Type of Establishment: I � E Design flow(based on 310 CMR 15.203): �i Gallons per day(gpd) f' ! Basis of design flow(seats/persons/sq.ft., etc.): I i� t Grease trap present? ❑ Yes ❑ , No , Water treatment unit resent? I. P ❑ Yes. ❑� No: i r If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ i No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑t No. I j Water meter readings, if available: Last date of occupancy/use: Date ° ; tti i I Other(describe below): 4 3. Pumping Records:Source of information: r I1 j Was system pumped as part of the inspection? ElYes ZNo i If yes, volume pumped: gallonsI How was quantity pumped determined? T1 t Reason for pumping: ,i ! r a I i I' t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 r 6 i � I r Commonwealth of Massachusetts Title 5 Official Inspection . Form i - Subsurface Sewage Disposal System Form- Not for Voluntary Assessments pl jj C. V - �s\. 271 Olde Homestead Drive ;I Property Address e + Robert& Patricia Nelson TTEE + Owner Owner's Name t information is } required for every Marstons Mills MA 0264.8 07-10-2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) k ! 4. Type of System: i t ® Septic tank, distribution box, soil absorption system ❑ Single cesspool I t ❑ Overflow cesspool i ❑ Privy ❑ Shared system (yes or no) (if yes, attach.previous. inspection records, if any) ` II ' ; ❑ 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 ElTight tank. Attach a copy of the DEP approval, ❑ Other,(describe): + I 1 Approximate age of all components, date installed (if known)and source of information,; Were g at the site?sewage odors detected when arriving �g ❑ Yes ® 'lNo . 5. Building Sewer(locate on site plan): Depth below grade: 3611 p 9 feet Material of construction: �' t ❑ cast iron ®40 PVC ❑ other(explain): I i Town water Distance from private water supply well or suction line: feet , i r Comments(on condition of joints, venting, evidence of leakage, etc.): # �t t I � l t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18I + Commonwealth of Massachusetts Title 5 Official inspectionform I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3� 271 Olde Homestead Drive i 44 tly'y Property Address f Robert& Patricia Nelson, TTEE Owner Owner's Name informal-ion is 1. ' requirec for every Marstons Mills MA 02648 07-10-2019 page. City/Town State Zip Code Date of Inspection i. D. System Information (cont.) I 6. Septic Tank(locate on site plan): Depth below grade: 24" p 9 feet . E Material of construction: � . t I � ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) I i, { ,I j I� If tank is metal, list age: years. ; li• t { Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No II ' H-10 1000 gallon s i I ; Dimensions: x la �i i 4 { Sludge depth: 32" r Distance from top of sludge to bottom of outlet tee or baffle r ee O ►, 1r, Scum thickness q 4,e , lS Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 12 i ! . sludge judge ( � How were dimensions determined? rI77I' +. li Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,' i liquid levels as related to outlet invert evidence of leakage,etc. : l recommend the new owner put the septic tank on.a maint. plan with a local septic pumping co. a; based on the future use of the home. i I � t r,t t e k l i t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 y i , k Commonwealth of Massachusetts E j Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11. G, 271 Cilde Homestead Drive f ;! Property Address t 1 Robert& Patricia Nelson, TTEE Owner Owner's Name i information is required for every Marstons Mills MA 02648 07-10-2019 page. Cityrrown State Zip Code Date.of Inspection �} j D. System Information (cont.) jl 7. Grease Trap (locate on site_plan): Depth below grade: feet a Material of construction: ❑ concrete ❑ metal ❑fiberglass. ❑ polyethylene ❑ other(explain). f. Dimensions: ° I Scum thickness { Distance from top of scum to top of outlet tee or baffle I j Distance from bottom of scum to bottom of outlet tee or baffle ' Date of last pumping: Date + �f Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I � 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: , :{ Material of construction: I ; l I,j, ❑ concrete ❑ metal El fiberglass El polyethylene El other(explal ) i �. r Dimensions: i Capacity: p ry' gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 I sic 1. i� I,l i Commonwealth of Massachusetts i I Title 5 Official Inspection Form I o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ) 271 Olde Homestead Drive Property Address ( I Robert& Patricia Nelson, TTEE Owner I Owner's Name ` I information is arsonsMillsA 02648 07-10-2019 required for every C Mt Mill 41, page. ° Cityrrown State Zip Code Date of Inspection D. System Information (cont.) j 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No I Alarm level: Alarm in working order: ❑ Yes ❑ No II Date of last pumping: Date j:i :I} ' Comments(condition of alarm and float switches, etc.): Ei , l {f It . I li 1, � C I ,• i .t i 111 �I• � II I, Attach copy of current pumping contract(required). Is.copy attached?. ❑ Yes ❑ No � ,I I i 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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 the time of the inspection there were no visible signs of leakage. f+ IF i s� • } ll ,� litlit • � 1 I�I � �' �,ji; i �.j 6' !I � •I. is 1 t5insp.docj rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 11. : A'1 Commonwealth of Massachusetts i i it Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 271 Olde Homestead Drive l Property Address I Robert& Patricia Nelson, TTEE Owner; Owner's Name information is I required for every Marstons Mills MA 02648 07-10-2019 C j it page. Cityrrown State Zip Code Date of Inspection i D. System Information (cont.) t "' PIS { 10. Pump Chamber(locate on site plan): Pumps in working order: El .Yes ❑ No* I , � ylt! R1 I ii j Alarms in working order: ❑ Yes ❑ No*' i Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): lip ilt I I , � I " If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan,excavation not required): I If SAS not located, explain why: 6i l i{ t Type: one i ® leaching pits number: ,+ l Elleaching chambers number. it Y Elleaching galleries number: ; I I ❑ leaching trenches number, length: u i I i �li ❑ leaching fields number, dimensions: h '{ ❑ overflow cesspool number: ,' I I Elinnovative/alternative system J i; � 11li it I: Type/name of technology: t5insp.do c•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 k l yi G) it•I i Commonwealth of Massachusetts i. Title 5 Official Inspection Form ; I o Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 271 Olde Homestead Drive E Property Address Robert& Patricia Nelson TTEE Owner Owner's Name I �' information is f Ali required for every Marstons Mills MA 02648. 07-10-2019 page. I Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 111. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition i vegetation, etc.): ' At the time of the inspection the liquid level in the leaching pit was up into the riser. €I ' i f ' ,� 12. Cesspools (cesspool must be pumped as.part of inspection) (locate on site plan): Number and configuration I I is Depth top of liquid to Inlet Invert Depth of solids layer ii 1 Depth of scum layer l Dimensions of cesspool I li I Materials of construction F Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil; signs of hydraulic failure, level of ponding, condition of vegetation, etc.): lip k I �I � II {{i IW�� I I 1I f; t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 IfN C ' I i. Commonwealth of Massachusetts j Ili Title 5 Official Inspection F rm I i o i ► ,1 I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �� 271 Olde Homestead Drive I u� Property Address i Robert& Patricia Nelson, TTEE "�; ►� j� Owner Owner's Name i ► �F j� requir required is Marstons Mills MA 02648 07-10-2019 required for every page. f Cityrrown State Zip Code Date of Inspection k E il+ D. System Information (cont.) `3 13. Privy(locate on site plan): t Materials of construction: Dimensions Depth of solids i Comments(note condition of soil, signs of.hydraulic failure,.level of ponding, condition of vegetation, , I etc.): rl of li} IIu r 11� kr ,+� ii•1�! , � f • t, ,� i' II t f f I � � t5insp.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 + , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 271 Olde Homestead Drive i! Property Address N Robert& Patricia Nelson, TTEE Owner Owner's Name I information is , required for every Marstons Mills MA 02648 07-10-2019 r Cit /Town State Zip Code Date of Inspection a e. r P 9 y p P D. System Information (cont.) t ' 14. Sketch Of Sewage Disposal System: ; Provide a view of the sewage disposal system, including ties to at least two permanent reference i landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply ente',rs 1, I the building. Check one of the boxes below: ❑ hand-sketch in the area below f i ® drawing attached separately } l F ei 1 t P + i� If I I1 I I I I '( t5insp.do c'•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 j TOWN OF BARNSTABLE LOCATION La j a i'l± Old.e s Rs« �c.,1 SEWAGE# 'Z?6-itM r< VILLAGE ASSESSOR'S MAP& LOT i� � G1 INSTALLER'S NAME&PHONE NO. 5C6l� Svc 7�l"O`65 t N SEPTIC TANK CAPACITY 'LEACHING FACILITY:(type) LCtic�, (size) 1v00 ga�dh5 �' i �NO.OF BEDROOMS PRIVATE WELL O PUBLIC WATER �s BUILDER OR OWNER_ DATE PERMIT ISSUED: e , (Q IWO DATE COEiPLIANCE ISSUED: VARIANCE GRANTED: Yes No 0 I } , Commonwealth of Massachusetts I ► ! . Title 5 Official Inspection Form �f - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I I � 271 Olde Homestead Drive Property Address f +! Robert& Patricia Nelsori, TTEE Owner Owner's Name info,mation is i required for every Marstons Mills MA 02648 07-10-2019 page. City/Town State Zip Code Date.of Inspection I r I i ! D. System Information (cont.) ; i 15. Site Exam: i ® Check Sloe I . p i 1 i ® Surface water l Itt � I ® Check cellar Shallow wells I 1 10 plus feet ;P ', Estimated depth to high ground water: feet i Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record G t ii If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) i ! '�l L ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers- (attach documentation) I ❑ Accessed USGS database-explain: ' You must describe how you established the high ground water elevation: I� augered a hole •� I�! . I Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 I i Commonwealth of Massachusetts . f I Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I i {{ 271 Olde Homestead Drive Ii i II Property Address i Robert& Patricia Nelson, TTEE Owner I Owner's Name I III information is Marstons Mills MA 02648 07-10-2019 required for every page. CitylTown State Zip Code Date of Inspection E. Re ort,Com leteness Checklist P P i Complete all applicable sections of this form inclusive of: i l ® A. Inspector Information: Complete all fields in this section. fi 1 ® B. Certification: Signed & Dated and 1; 2, 3, or 4 checked i; ® C. Inspection Summary: IfJ 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completedr II ,E ® D. System Information: - , Ali ��f I i For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included li r f iiil iI I' Ii s i I t5insp.doc'.rev. e Official Form:Subsurface Sewage Disposal System°Page 18 of 18 1 , 7/26/2018 Title 5 O l Inspection F Sb �t it i TOWN OF BARNSTABLE 4!,GOCATION,3e-7 g toLjb%E jkg6t„Ga�,&,' tk,SSEWAGE# VILLAGE Q'PtZUL_ASSESSOR'S MAP&PARCEL 0 Q1. INSTALLER'S NAME&PH NO. O. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) �—�JC Imo-• �' NO.OF BEDROOMS ,.OWNER '-J Q PERMIT DATE: 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 206 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) M/A;� Feet FURNISHED BY , k� �-?I O de t�m e S ec. .. r . .3 aB I . ' r , � - No. 2 j3 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:—�� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9lpflLation for Disposal *pstrm Construction permit Application for a Permit to Construct( ) Repair V Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No.on Okk Dr, Own is Nate,�d¢ress and Tel.No.,,$—og-937`e/b30 Assessor's Map/Parcel �1,3 �d M4mkoos 041 lls YqA = �� bb-k`J56�7 awo4 1+YYw.(=4 A 0XwEr Installer's Nam Address,and Tel.No. 130'B 28-161�R<p Designer�N�a"me,Address,and Tel.No.�G$-�(oa-�ISVL mat-latr�i.�,�Et�►, �c u5����dJc(• ���-�2..�1 n�i^i°r�j,inc S'��g�Cv'h SF Type of Building: Q �y Dwelling No.of Bedrooms Lot Size $ /(0 7 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 30 gpd Design flow provided c/9 gpd Plan Date AUG �ar-,,:;Lv I ri' Number of sheets ' n�e iRevisiion Date Title Si ®�dnmp5�� s Mills 9 M// Size of Septic Tank tik � " Type of S.A.S.Q5 'X!us'a'.dlet Jjd Description of Soil g� Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maint ce of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmen ode not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. gned Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued ---------------------------------------------------------------------- No.=,V/q 33 Fee .16THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISidN`_-DOWN OF BARNSTABLE, MASSACHUSETTS Yes 4 9pplication for Misposal *pstrm Construction Permit Application for a Permit to Construct Repair V Upgrade Abandon Complete System ndividual Components PF ( ) P (� Pam' ( ) ( ) ❑ P Y � P Location Address or LosNo./��l Owner's Name,Address,and Tel.No.,f'o8_�37- yo 30 Assessor's Map/Parcel tj�/ -v 11,Ar%lb rs N,��� ;Y�Ad/ i/i, � i /`a �/C 'c /�raYh�h � a u Installer's Name,Address,and Tel.No. �,�.4��,$-�g a{p Designer's Name,Address,iand Tel.No._5o$-� j�-</yy/ lc(3ooic�vrvc�icy, 1.�., �t c �15 r►cc� �r R� Ci7 �ij jrj 'r'i ,ir,c 9�� irj Sl a f Aur A a L/#n f, n,/ �_-4- AAA / Type of Building: v r v _ - r Dwelling No.of Bedrooms -3 Lot Size ��5�� sq.ft. Garbage Grinder( )' Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) '3 30 gpd Design flow provided gpd Plan Date A�J ��pX X. A j I I Number of sheets l Revision Date All 1/ Title—, / O Ml s n', Pin". s 1 �,1/ 1i l� !'�.rv*v.• �t�v.1 ��1't'tF i ,11 i Gahvgc A !!S b�7 A -vr- I ..,. r E -r-E - . �1 Size of Septic Tank j g,,,V �,.m j , y,,p Type of S.A.S.aS Y C4 /� Description of Soil `i�� gi �„l Li Nature of Repairs or Alterations(Answer when applicable) 1 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 Environmentgl odE" e d'not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. f 1 ed Date �I/ Applicationn Approved by Date Application Disapproved by Date for the following reasons f Permit No.--)cD, of—5 -3 :2 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance � f, THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X Upgraded( ) Abandoned( )by f�-t,�, s r. -4`c1 0 v� at z2l has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. / /dated Installer 1, Designer t 1 #bedrooms '� Approved d HIM flow 2 v• 1 gpd The issuance of this pe it sh 11 not be construed as a guarantee that the system w 1 fun tion s designed f Date Inspector A / _ R r No. -' , Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at 'r � and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction mu t be co pl ted within three years of the date of this pe it. Date Approved by / down cape engineering, inc. SIEVE SOILS ANALYSIS 271 OLDE HOMESTEAD DR., M. MILLS DATE OF REPORT: 8129/19 .JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 271 OLDE HOMESTEAD DRIVE, MARSTONS MILLS LOCATION: DCE TEST HOLE SIEVE ANALYSIS Weight Sample(Grams): 126.9 SIZE WEIGHT RETAINED % RETAINED I % PASSED (sum) -------------:...............................................0.......0::---------------0---0-%- ........................100.....0%........ 1" . . € 0.0 0.0% 100.0% --------------:......................................................:---------------------=------------------ 1/2" 0.0: 0.0%€ 100.0% 3/8" 0.0: 0.0%: 100.0% 0.0%: 100.0% -------------......................................................>---------------------..................................... #10 9.7 7.6% 92.4% --------------:......................................................:---------------------:..................................... #20 42.5: 33.5%i 66.5% --------------......................................................>---------------------..................................... #40 92.5i 72.9%i 27.1% ------------- .....................................................:---------------------:..................................... #50 109.7: 86.4%: 13.6% --------------......................................................>---------------------..................................... #80 120.1: 94.6% 5.4% --------------:.......................................................---------------------..................................... #100 121.5: 95.7%: 4.3% --------------i......................................................>---------------------------------------- #200 124.0 i 97.7% 2.3% -------------:......................................................:---------------------=------------------ PAN: 126.2: 100.0%: 0.0% -------------- --------------------------•--------------------- ------------------ SAMPLE: 126.9i NOTE:TEST ON PASSING#4 ONLY, 5.7% RETAINED ON#4 <45% O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-1-b (GRAVEL&SAND) (UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING #4 SIEVE : #4 100% (TEST ONLY MATERIAL PASSING #4) OK #5010%-100% OK #100 0%-20% OK #200 0%-5% OK SAMPLE MEETS TITLE 5 FILL SPECIFICATION >97%SAND RESULTS: PERMEABLE MATERIAL-CLASS 1 <2 MIN./IN. MATERIAL NONCOMPACTED SOIL DESCRIPTION: MEDIUM/COARSE SAND �NOFMAs11 DANIELA. yes o OJALA CIVIL No.46502 GlST RHO NAL EN / C zxp-1 l - 4 { 0o r SEP-20-2019 03:14 From: To:15087906304 Pa9e:1,'1 Town of Barnstable -y Services Regulatoz Thomas F.Geller,Director 6M. ]Public Health Division �uaw '• homis McKean,llDixrct'or 200 A6in Street,Hvs+Joxds,Mtn 02603l Office: 548-iQ-4644 Fax: 508-790-6304 ITAstalleA&j Desiper Ceriffication 1FOrAn. )[Date: q le sewage>Peraimit# -�019-33 2 Assessor's Maip\arceA IIDesigmer•: DA 0 lut0hr: 'CO' (?AWUCTTOf4 AalduKss: Nlhl�.°1.��UT .I.� Address: . � [Nbtl R-y,-�'� On 1— C -was issued a pepX it to install a ff�•(date) (mstallcr) septic system at Z?l OF J§Mrqw DrL YWMO muri based.on a design drawn'by (address) �ErNJ�(o�A� f clated�uc�,, o / desi r V I certify that the septic system referenced above was iustalled;.4.stantially according to the design, which may include minor approved cbatges such as laxeral relocation of t]ae distaibution box and/ox septic tank. I certify that the septic system zeferenced above was installed with major ebanges (i.e. • greater than 1 0'lateral relocation of the SAS or any vertical relocation of any component of the septic system)but iu accordance with State&Local Regnlalions. Pfau.revision or ee:rtified as� signer to follow. �N Of A}qs DWEL A. OJALA —Kinstaller'sSignature) CIVIL o No.46502 4 FOI s T sSIONA �21 (Designer'signatme) (Affixcsigmer's Stamp here)WEASR MTURN TO BAx&ld'b'"CABX,E PUS dC :t9•la' TH D7C6 SLON. CEMMCA7:E Of Ct,':'�Z]ft�IVGE WILE. 07' BD'� ISSUF�ID UNA']Y, EOTEE T1Tls POYLM A J� A'��p1l,T C.AXd1A ARE D2ECErw!1)E-Y THL;,.BA :[tgs'TA,.sLr,,�'TjiijAf'EifjgA LTH DTMSO �U Q:Bca181/Septic/Desigua CeMiculionllorm 3 26-04,due ' .-;�,- ✓'.ice • /!� SITE PLAN SHEET l of 2 SCALE: 1„= _ Q iR 9GO C�a c?' z9a 27� 2� ,•� /� ci nl 't lavliw 1 p 1 tt SIN / p .(( �-/oM� WILLIAi1A M.• WAmiCY I N0. 19771 a REGISTERED LAND SURVEYOR FOR A ., SON E M A ,( r MIL. ,,S. ANA , PLAN ,REF, MA F> 4-� DATE t3fe-<e BENCH MARK DATUM I°)257 M 6 L- VA-rL)AA WM. M. WARWICK 8 ASSOC., INC. DOMESTIC WATER SOURCE-` OV.)L u�/ -1` - 80X 80/ - NORTH FAL MOUTH FLOOD ZONE.- N off' H A--7,A7-P ' � MASS. 02556 - (617) 563 -26 38 I�r 1 LEACHING QAS/N SECT/ON NOT TO SCALE Sheep 2 of Z a:,c;y;•y s: 24"C.L MH COVER ;,. EARTH F/L L BRICK AND MORTAR COURSES AS REO'D• TO-BRING `- `•r:' 4,, i 4" COVER TO GRADE • INLET 1B FLOW L/NE 2' "TO " WASHED PEA STONE- FREE Of IRONS, P/pE FINES AND DUST IN PLACE ' OPENING W%TH 4%8" ''L 414 TO I%2 WASHED CRUSHED STONE FREE OF i • '• OUTER DIAMETER IRONS, FINES AND OUST /N PLACE AND 1414"INS/DE DIAMETER I. CONCRETE TO BE 4000 PSI 28 DAYS ,. ' .•- 2. REINFORCED WITH 6%6" NO. 6 GA. W,W.M. 3. 2"AND 4' SECTIONS•ARE AVAILABLE FOR II " GREATER DEPTH REQUIREMENTS 40%- I� ��----6'0"' 3'—� 4. NUMBER OF PITS REQUIRED0'J� MIN. 1 I Z EFFECTIVE DIAMETER NOTE: EXCAVATE TO ELEVATION OR ' � (NOT TO EXCEED 3 TIMES EFFECTIVE DEPTH) LOWER AS REQUIRED TO REMOVE ALL WATER TABLE - LOAM AND CLAY BENEATH PIT. REPLACE EXCAVATED MATERIAL WITH CLEAN I TYPICAL PRORLE GRAVEL TO DESIGNED GRADE. 0 /8"STD. LT. WGT. C.I.MH COVER 9"C.I.PIPE 4"B/T.FIBER PIPE =` ' TIGHT JOINT OUTLET LEVEL iDWELLING r LOW LINE _ o TO FIRST JOINT —— — s ,._s';_• 0a l4 vp 0 0 110 �00 it S C./. TEE 7 1 11 44. I I o I O O I P�7 Oj6f D PRECAST CONC. : D/ST. BOX TO BE ( 0 0 0 00 to i i —1 _UAL.SEPTIC TANK. 1 100 0 0 51 1 INSTALLED ON LEVEL I . j 111600 00 1,11 STABLE BA SE � \SEPT/C TANK TO BE 1 if 000 0 0 1 11 1 ; INSTALLED ON LEVEL 1 if 1001 0 0 1 ► ; STABLE BASE. 1 1 1 6 0 0 0 0 1 1 1 1 i 1 1 100 0 0 1 11 1 LEACHING BASIN Qp i BASE TO BE LEVEL i l 0 0 l 0 0 1 1 , 1 .. SOIL AND PERC. DATA PERC.RATE z MIN. /IN. � � TEST PIT NO. I TEST PITAO. 2 0 O WfkI21.c��G ► -rap, !su Pyha I V ..TEST BY - !� A�i�oG • �t WITNESSED. BY: -7• AA G �A-kj AA p L OM j TEST PIT GR. EL. sli >>3� DATE:--- � +Z 1, �•7-�?o DESIGN DATA GENERAL NOTES I BEDROOMS NO HEAVY EQUIPMENT TO RUN OVER SYSTEM. DISPOSAL �� SEPTIC TANK, DIST. BOX AN LEACHING BASINS TO BE STANDARD I EST. TOTAL DAILY EFFL. PD. PRECAST REINFORCED CONCRETE UNITS. loav ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE SEPTIC. TANK -. GAL. Z S TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE, SIDEWALL AREA—GAL./SQ.FT. MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF BOTTOM AREA l"o GAL./SQ.FT. SANITARY SEWAGE EFFECTIVE ON JULY 1 ,'1977. `LEACHING REQUIRED 7f SQ.FT. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD r.: .".. : ACTUAL.LEACHING AREA OF HEALTH. 0*FT. AT -COMPLETION OF CONSTRUCTION, PRIOR TO BACKFILLING, THE BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. PITCH ALL SEWER LINES I/a'� / FT UNLESS INDICATED OTHERWISE. . . + o s SEWAGE DISPOSAL SYSTEM o MARTIN yak E. fOR I��� SI >7L1�La• G� , cgs MORAN y(,-D oM.�� .D �.p f23417�Q � - ' /st��G��`�`` SS/QUAl SCALE AS INDICATED DATE 1�;A( ;,4C' . • WM. M. WARWICK 8 ASSOC., INC. ' BOX 801 - -NORTH fAL MOUTH ` MASS. 02556 (617) 565 -26J8 PROFESSIONAL• EN6/NEER SENDER: COMPLETE THIS SECTION mi COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3. A. ture ■ Print your name and address on the reverse X `t-Ct� so that we can return the card to you. U Addressee ■ Attach this card to the back of the mailpiece, Received by(P' ted Nam C. Date of Delivery or on the front if space permits. 'r>'�z-+ Ndv 8'2e'1 ry 1 ----- - _D__Is delivery-address different from item 1? ❑Yes delivery address below: ❑No Ar NELSON, ROBERT&PATRICIA C TRS 271 OLDE HOMESTEAD D `MARSTONS MILLS, MA 02 I)I'III�I I III II II'll)II II I �I II II I I�'ll ❑Adult Signature ❑0 Priority Mail Reg ��e MailTM Mai M ❑,(ldult Signature Restricted Delivery 0 Registered Mall Restricted 9590 9402 5225 9122 7022 43 ertified Mail® Delivery Certified Mail Restricted Delivery etum Receipt for ❑Collect on Delivery Merchandise 2._ArtlCle_Number?ransfpr�inro_— iati���- �� n r" :,Delivery Restricted Delivery Signature ConfirmationTM I11 al ❑Signature Conf! atiore . 7 015 17 3 01'00 0-1 4 98 ll 17 5 5 8 ° I Restricted Delivery Restricted Delivery over ) PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return;Receipt USP$TRACKING ' "1'4,wE First-Class Mail . r. Postage&Fees Paid USPS..- . — Permit No.G-10 C 9590 94( 2 5225 9122 7022 43 United States •Sender:Please print your name,address,and ZIP+4®in this box• Postal Service Town.of Barnstable, Health Division 11P 200 Main Street I Hyannis, MA 02601 I I u,�ll►:llli�ll�alrl�ili� ll,l�,�l1�,i~II,1„111�1i�i„1�i11i,:ill,l �03 IN •. • ram-. Er Certified Mail Fee "y =I- $ _ � ,Extra Services&Fees(check box,add fee ats appropriate) r.q ❑Return Receipt(hardoopy) $1- NNI 1` ❑Return Receipt(electronic) ,$-.. S'Me 0 .•�P.Stmark`a 1 Q ❑Certified Mail Reshlcted.Delivery $] 2019Here, C3 []Adult Signature Required $ i ❑Adult Signature Restricted Delivery$ NELSON, ROBERTT&PATRICIXC'TRS 271 OLDE HOMESTEAD"R� C3 MARSTONS MILLS-MA 02648 Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this j delivery. USPSO-postmarked Certified Mail receipt to the ■A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service"" Restricted delivery service,Which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent. Important Reminders: Adult signature service,which requires the •You may purchase Certified Mail service with signee to be at least 21 years of age(not Rrst-Class Mail®,First-Class Package Service®, available at retail). - or Priority Mail®service. Adult signature restricted delivery service,which n Certified Mail service is notavailable for requires the signee to be at least 21 years of age international mail. c and provides delivery to the addressee specified ■Insurance coverage is notavallable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). 0 of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is Insurance coverage automati6i.y;iricldded with accepted as legal proof of mailing,it should bear a" certain Priority Mail items."r:. '* USPS postmark.If you would like a postmark on-r ■For an additional fee,and W*a proper this,Certified Mail receipt,please present your �; endorsement on the mailpiece,you may request Certified Main item at a Post Office'for the following services: postmarking.If you don't need a postmark on thisry, -Return receipt service,whicWprovides a record Certified Mail receipt,detach the barcoded portion.. of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply --, You can request a hardcopy return receipt or,an . appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, r complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records. Ps Form 3800,April 2015(Reverse)PSN 7530-02-000.9047 V(W Alfl) 1_,0CATlON q b6 ccNo , VILLAGE DATE /-L -7-96 APPLICANT F E Laf�� ADDRESS 6. NO. (Non-refundable ) E'NGINEL'J?Jk,)�-k (91�.- cc' 11%LEP1101414, NO.66 3., DATE SCH-l"DULED 47 . pplicaiiLls signatVe ) SOIL LUG "UB DATE: -v I m L. 67 aulvt .j -DlVlf;1O1'J NAME EXPANSION AREA: YF;sv,/ 11(l) 4.1 Walwtck,4 45,oC. ENGINEER - 'DOWN WATiER VPRIVATE T, AA c, V-e A'N BOARD Or HEALTH J, SGo I EXCAVATOR SKETCH : (Street Of ] ()(: , exact IOC,-It-joll Of Lost holes and percolation lucaLe wetlorid.. in proximiLy to Lest holes ) NOTE'S : v Of .PERCOLATION RATL : C', mttk TEST HOLE NO: Tl:,ST HOLE 1,10: ELEVATION : 2 2 3 3 ------- -- 5 5 6 I G ..7 7 9 12 12 13 . u W46- 13 14 14 15 15 16 16 SUITABLE FOR SUB-SURFACI; S FMAG I' : U'ACHING FIELD LEACIMIG PITS LLACHRIG 'TRENCHES UNSUITAIIIA: FOR SUB-SUkl-'1(.,1..: S1,11WAGE . REASOU.13) : 140TE : MUST Sll0W, llUflBl:'R tl,`;.")lGNl_,D ON PE'RC Tl;',ST APPLICATION IMIG1.1.1p.l.: (7011PIJ."I'l71) 'It! PN'PTQM'Y PY il . F . :"J') P17TUMN-1) Tr-) 11-7M) (-)P TIT-77\T,Tl] COPY: RF"TAINY"D 13Y APPLICANT -�'-� TOWN OF BARNSTABLE Y LOCATION O tke a-Gv w 5 tJ 01 ,vt SEWAGE # '36- W9 VILLAGE Wl�cti-la� 5 +�t5 ASSESSOR'S MAP & LOT } INSTALLER'S NAME & PHONE NO. (13 SEPTIC TANK CAPACITY l ,06o 5..Alav 5 LEACHING FACILITY:(type) Le�,cL A (size) ( 00 q-lldh5 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER R7 ,j 4,c ee DATE PERMIT ISSUED: 0 J Z7 L rS�i DATE .COMPLIANCE ISSUED: p VARIANCE GRANTED: Yes No � 6PoT �g/ Gar ,, S � � '� �� o .��° 33 y7' y� �. _.... _..—. 'e ASSESSORS MAP NO- Y 6 ' No...+�... .....�.�.}q PARCEL NO.: Pl9 if 7- D F / Fes$......... .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ----- 4cU ........O F......... ------------...................... Ap iratiun for Diuvuutti Vorkg Tunutrurtiun Daum Application is hereby made for a Permit to Construct ( ✓1 or Repair ( ) an Individual Sewage Disposal System at: LLS -- ---•--••-••-------•...........•.......... . ............................ _ Locat on- d ss or Lot - . .Ys% .... L� -CG•--•-------- ......................................................� sip/ W �!!ZL 5!T Instal ler Address Q Type of Building Size Lot.... &'7161......Sq. feet Dwelling—No. of Bedrooms.......................:....................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ...../(JoQ v No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures .... . W Design Flow........................... .........gallons per person er day. Total daily flow_._..._...a��?....._....................gallons. WSeptic Tank—Liquid*capacity/.0 ..gallons Length___ ... Width................ Diameter____-__---__.._- Depth................ x Seepage Pit No--------- - Width./..,...�..�.............. Total Length_._. . .._... Total leaching area....................sq. ft. Disposal Trench— Diameter.......IV..... Depth below inlet... iv Total leaching area..................sq. ft. z Other Distribution box (�) Dosing tank ( ) aPercolation Test Results Performed by_W44t-"AVh)4-.. r .. Date......511LvItle................ a Test Pit No. 1.._....�_..minutes per inch Depth of Test Pit.........1..2 .. Depth to ground water.......... -......... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -- ----- - O Description of Soil------•--------•--..... �......G.�.� S U_PISd-���=-.A.. ------ktD(V•_.4&.J b W •---•-••--••-------••----•-...-•-•••••••--••••---•-••--•••----•-•••----•-••••-••-•-•-•----------•---•-•-•••-•-•-•---•••-•----------••----•••--••----....••--•-•-•-•------------------------••--•-.-•---- VNature of Repairs or Alterations—Answer when applicable............................................................................................... •---------------------------------••-----------------------------•-• --------------•-------------•-----•----------------------------------------------•-•-------•----------------------.............--- Agreement: The undersigned agrees to install t aforedescribed Individual Sewage Disposal System in accordance with the provisions of ITLL 5 of the Stat nitary Code—.The undersigned further agrees not to place the system in e tion until a rti' e \Com e has been issued�thhe d of health. Signe - --.. . ---•------•......•-•-------------..._--••- �f ... Xplication proved BY ---------------------------• r a 3�� ..... ------------•. Date Application Disapproved for the following r ons:.............................................................................................................. .....................••------•--•--•-----•--•--------•-•--••--••••-•--•--••--•-•--------•------•-----••--•--•.......................---------•--------•---•------•---•---••----••-•-----•-------••-••••- Date PermitNo....................................................... Issued.------••-•----------- Date ` / f` • ! ^ y No......................._ fi9 h'!` 0 F 1 Fps_....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........� !.�J......----....oF......... /)A..0 Apphration for Biopmal Works Tons#.rurtion Frrutir Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: -- •- --.. ... .............. .....� � . '.: /.�.=.r..-.L..o..c9 n s..... -. G1 . : ..o r ......-- ........._....:. ..... ..... Lot Nf:o_� Owner_ drgss.... Installer Address Type of Building Size Lot.......... ....... ......Sq. feet aDwelling—No. of Bedrooms._..........—''` ____________________________Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ..... �....... No. of persons............................ Showers ( ) — Cafeteria ( ) P4Other fixtures ...•...............•---•--••----=-..........---•••-•-...•-•-••-------•-••-...-----•--------...---.---•-�•--.._.......-------•-••----••-........_... d W Design Flow.............................3 .........gallons per personger day. Total daily flow..........33. ........................gallons. WSeptic Tank=Liquid capacity lg1)-.gallons Length________________ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width �'...-----..... Total Length•._--�,�._.... Total leaching area...................sq. ft. 3 Seepage Pit No.........�.......... Diameter................... Depth below inlet.._................ Total leaching area--...............sq. ft. Z Other Distribution box (/) Dosing tank ( ) aPercolation Test Results Performed by-Wa.. 1���L�r.. 1 `...................... Date.....§P& P................ ,..1 Test Pit No. 1-------l...minutes per inch Depth of Test Pit........1._2_..... Depth to ground water.........---.......... fi Test Pit No. 2................minutes per inch Depth of Test Pit...........::....... Depth to ground water........................ a ------••--•---..-•.............•`•---.....----•....�---••-----j----•-•......_......-----.----.-,{.--.................. �. � " -1 M p.1.11! .,.S 00 Description of Soil.......................-7. ..... ...... t /S U_ ••.-•-- •••................. V ------------- •------------------- ----------- -------------- •-------------------- ----------- •------------ -----•------------------ ------------ ----------- .....------- .. -.--•------ W UNature of Repairs or Alterations—Answer when applicable........................:-..................................................................... -•-•------------------------•--•----•----...--•--•--•-••-•-•--------......--.....-•---•---------.....---•---•---•--...-------• ----•-•-•-••----...........--•---............--•------•-••----.......... Agreement: The undersigned agrees to install t aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLS 5 of the St at nitary Code—.The undersigned further agrees not to place the system in ;pplication tion until a erti a of Co a e has been issued b the board of health. ...... ....... �ZN Signedr.....� ... ^ '.`, _ ...................'�' rate J Proved By__..._.._ . . Application Disapproved for the following reasons:...................................................................•.............._____._..I nace............----- ......................................•--••-.......--•-------• ........---•------...-........ � - ..s--- •......_ .. .....................•.... ........... Date _ Permit No. ._...... Issued.:...... :...........:......•-•-•-•. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD ,�2!�.OF HEALTH .............7P.� 1 IV.........OF..........: fI� C.✓. ........................................ (Intifutttr of faoutpltttnrr TYS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (#f) or Repaired ( ) by------<l:-J..--��.�5 CU---�=-•---••---•------------•------------------••--------- ------------------.--..... .........................................LL.....--.... ...... Insta15A )�l�a l tJf� , m f/u 5 has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Codq as described in the application for Disposal Works Construction Permit No.__.A1..1 I j................. dated___..!'::!.1 - r _<:............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUPTION------•---•------- -.AT.. FACTORY. � DATE.................. /................... Inspector.................•-------•--.....................----.....-•----................... J l v E t 1 if THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �.., ✓fit ..........OF..........�... �✓.0 No......................... FEE......... Rapouttl Works Tonu#rudtun Frruti# Permission is hereby granted. d. •= =- fi'15C ��-`..•--•-••---•-...-------•-•••............................................................---.. to Construct or Repair (� ) an Individual Sewage Disposal System _ at No._.4:AZ.......-`/-�....... L&2--...1,416or �j ,t1� .,-•-- r ✓ ? f�':`.--{�:U�v_S ....../�'P�G;!5............... .•-- Street 1 e as shown on the application for Disposal Works Construction Permit No. G: `.)./ Dated.........: �_........:.................. t ,- 1 .:............................ - -7 •t r � Board of Health' i G DATE.................... ........--...---•j••f-------•-...•...................... FORM 1255 A. M. SULKIN. INC.. BOSTON " TOWN OF BARNSTABLE r Y- LOCATKIN _�"1 © L��f��5� SEWAGE # VILLAGE 9 \�5� �S ����� • ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 't oi') LEACHING FACILITY: (type) ea� (size) to7� NO.OF BEDROOMS 7 BUILDER OR OWNER PERMITDATE: � COMPLIANCE DATE: Separation Distance Between the: 1 Maximum Adjusted Groundwater Table to the Be�t€achng Facile 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) � . z Feet Furnished by 1kb-ex,krL i v .�� .�� � �� � � � 0 ® � 3 l �2.-�tb� `�2' 33 l CO\I\ION\\r_ALTH OF ?\L-�SSACHt'SETTS EXECL'TI\T- OFFICE OF E\v IRONNIENT.�I :�� - - DEPARTMENT OF ENviRONMENTAL PROTECTION =i- 0\E n1\TER ST'.=L BOS"O\ eta 0210c 6:- 292- :; . -R-DY COXK Secretan ARGEO PALL CELLL-CC DA%-D S STRUHS Governor Co-.:nissic�e: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t-V('? QLI'7� PART A CERTIFICATION L�, ��Uc�S p\�yy Property Address: o\6_'L, '1 �` Name of Ownef C1ftv2 tvi�f� ( 1 (-Lttkiddress of Owner: ('t o 1\i1(Av 14-N-WN \Date of Inspection: G`� ,�+ / , // '�l�!10���l►4l L �v:�` 2 Name of Inspector:(Please Pnnt)! [ •C4 a,I 'l� EC_.KO lR �J , I am a DEP approved system inspector pursuant to Section 15.(340 of Title 5(310 CMR 1 .000 ( C.�L r. Company Name: ,`c E k L- 42r�c, A... e r.'tau F Marring Address: /L, a _ 24-- b f�P F-t= 1�'� �1-�4-� Telephone Number: !S:C2 _C E 3 -;z. /Lr • Zco CERTIFICATION STATEMENT I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true. accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspectors Signature: SIL Date: The System Inspector shall submit a copy 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 ��12 ri 1999 co t � g 9 revised 9/2/98 Page Iof11 `. Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) `roperty Address: I Jwner: Date of Inspection: INSPECTION SUMMARY: Check A, 8, C, or D: A.�/SYSTEM PASSES: 1l 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: �— - !T rC I`t' 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. Indicate yes, no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ 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 revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: 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 15.303(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 ' (approximation not valid). 3) OTHER j revised 9/ /98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date,of Inspection: D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: 1 have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ Backup of sewage into facility or system component due to an overloaded or cogged 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 112 day flow. _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. _ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ Any portion of a cesspool or privy is within a Zone 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. If the well has been.enalyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition,o 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 _ the system is within 400 feet of a urface drinking water supply the system is within 200 feet a tributary to a surface drinking water supply the system is located in a ni rogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply well) The owner or operator of any such syste shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further info ation. revised 9/2 98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No k _ Pumping information was provided by the owner, occupant, or Board of Health. 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. As built plans have been obtained and examined. Note if they are not available with N:A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: Existing information. For example, Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 411 (15.302(3)(b)1 XThe facility owner(and occupants,if different from owner) were provided with information on the Wopermaintanance of SubSurface Disposal Systems. N I revised 9/2/98 P2ge5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION 'roperty Address: Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flo�ai:�j�(1 g.o.d. bedroom. Number of bedrooms (design): Number of bedrooms (actuall:63D Total DESIGN flowQ_ D Number of current residents:Q Garbage grinder (yes or no):_ Q/� Laundry(separate system) l s orl�igY t,L; If yes, separate inspection required Laundry system inspected kyevor no) Seasonal use (yes or no):L Water meter readings.if available (last two year's usage(gpd): IJ� " Sump Pump (yes or noi: tJ` Last date of occupancy: 154lb COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gpd ( Based on 15.203) Basis of design flow Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings.if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: PU , System pumped as part of inspection: (yes or no— If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tankidistribution 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 APPROXIMATE AGE of all components, date installed Af known)and source of information: Sewage odors detected when arriving at the site:(yes or no)_J12-0 revised 9/2/96 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'roperry Address:.2'� /i�it ( F�t1r:' �'C4d , Owner': Date of Inspection: BUILDING SEWER: (Locate on site plant Depth below grade: Mater.al of construction: _cast iron X 40 PVC_ other (explain! Distance from private water supply well or suction line lcs y/4( Diameter 4.1 Comments: (condition of joints, venting, evidence of leakage, etc.) r 1 .✓ 5 Vt C (+ C c SEPTJC TANK: (locate -- site p nl 1 Depth below grade: Material of construction: concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: - Sludge depth: - Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: " Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: ;omments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert. structural" tegrity, evidence of leakage,etc.) 41& u GREASE TRAP: 'v"t.: (locate on site plan) Depth below grade:_ 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: 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.) revised 9/2/98 Page 7of11 L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) +roperty Address: :3�1 6 iA 6,0<,;1 t� f Owner: Date of Inspection: TIGIa;T OR HOLDING TANK: 0i 3 (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ etal _Fiberglass_Polyethylene_other(explain) Material of construction: _concrete_m Dimensions: Capacity: gallons Design flow: gallons day Alarm present Alarm level: Alarm in working order: Yes _ No_ Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: ,S (locate on site plan) �— �.�Lt Depth of liquid level above outlet invert: Comments: if level and distribution is,equS, evid nce of solids carryover, evidence of leakage into or out of boxetc.)- (note \ / - PUMP CHAMBER: (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,-condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �( r SYSTEM INFORMATION (continued) 'roperty Address: , Owner: Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):_ (locate on site plan, if possible: excavation not required, location may be approximated by non-intrusive methods If not located, explain: Type: leaching pits, number:���� leaching chambers, number:_ leaching galleries, number:_ leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of pondin damp soil, con ),tipn of ve etati etc.) j IV CESSPOOLS:111: (Locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: )epth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) 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.) revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) n 'rope"Address: -�Z-7 1 G!C&z �aLus�t�t�l- )wner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at leas, two permanent reference landmarks or benchmarks locate all wells within 100 (Locate where public water suppi� comes into housel 2- ' n i r�tJc � y L I LO Page revised 9/2/9 $ R , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C L'- 1 SYSTEM INFORMATION (continued) rope-ty Address: .�1( � ,� (Aa-1 s3 1 Owner: Date of Inspection: NRCS Report name - Soil Type_ — — --- Typical depth to groundwater _ ___ USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE:EXAM Slope f-k% Surface water Check Cellar OC,'1 Shallow wells + Estimated Depth to Groundwater j Z PFeet 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 Used USGS Data Describe how you estabnlishe he High Groundwater dElevation. (Must be completed),- �SIc`- � �VLo 1 C- -S 11 S�ol�ic coY i revised 9/2/_98 Page 11of11 SYSTE SYSTEM PROFILE ALL MARK D WITHCMANETICTTAPSHALL E OR BE NOTES PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS NAVD 88 4� �' �'� Aso ei ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE �qt� 2. MUNICIPAL WATER IS EXISTING \ TOP FOUND. EL. 87.2' FILTER FABRIC OVER STONE aS' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 85.9 / Q_ PRECAST H-10 NOTE: 2" MIN. WALL BLOCKS OR 4. DESIGN LOADING FOR ALL PROPOSED PRECAST o Ri�e�Rd THICKNESS REQUIRED UNITS TO BE AASHO H—LQ RISERS (TYP.) PRECAST RISERS 3 2'0 83 8' 4"�SCH40 PVC MORTAR ALL H-10 z s" MIN. SUMP PIPES LEVEL 1ST 2' COMPONENTS 4, 5. PIPE JOINTS TO BE MADE WATERTIGHT. 12" MIN. INT. DIM. ENDS (T�') SIDES 82.96' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE o 10. "EXISTING jT1EE �o�o�oo�^ o°°o°°°°°TEE SEPTIC TANK *82.5' ° ° ° ° ®®®® �®® ® ®®®® ®®® WITH 310 CMR 15.000 (TITLE 5.) WATERTEST D'BOX °°° ° ®®®®®®®`�.�-•• ® ® ®®®®®®®®®®® >°o°o°o°o M °°°°°°° �ppyyqq °°°°°°°° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND Muddy °io >°O°O°O°O ®®®®®®®IJ® ® ®®®®®®®®®®® °O°°°°°° Pon GAS BAFFLE;; _o,o,o,o,o_ FOR LEVELNESS o0000000 ®®®®®®®®® ® ®®®®®®®®®®® ;00000000 NOT TO BE USED FOR LOT LINE STAKING OR ANY �o °o °o°o °o°o°o "�`•: 4 LIQ. LEVEL (ACME OR EQUAL) 82.40 .23 80.13 OTHER PURPOSE. plde Homestead 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 6 o,°,o°,o,°,o?0000000i°,o o�o�o�oo,o�00000? `H-10 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. 1 Qoo Locus akeb R 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. (2) UNITS REQUIRED o ALL AROUND PRECAST STRUCTURES 9. COMPONENTS NOT TO BE BACKFILLED OR 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12.83' CONCEALED WITHOUT INSPECTION BY BOARD OF COMPACTION. (15.221 [2]) M HEALTH AND PERMISSION OBTAINED FROM BOARD o� Q 6 OF HEALTH. ( 1 % SLOPE) ( 1 % SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING DIGSAFE (1-888-344-7233) AND FOUNDATION EXIST. SEPTIC TANK 10' D' BOX 12' LEACHING 74.0' BOTTOM TH-1 VERIFYING THE LOCATION OF ALL UNDERGROUND & LOCUS MAP FACILITY NO GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF WORK. SCALE 1"=2000't 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL ASSESSORS MAP 43 PARCEL 1-25 *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL BE REMOVED BENEATH AND 5' AROUND THE UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS PROPOSED LEACHING FACILITY. LOCUS IS WITHIN FEMA FLOOD ZONE X PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM 12. EXISTING LEACHING FACILITY SHALL BE PUMPED (AREA OF MINIMAL FLOOD HAZARD) AS R=192.82' AND REMOVED OR PUMPED AND FILLED WITH CLEAN SHOWN ON COMMUNITY PANEL 25001 CO541 J **INSTALLER SHALL CONFIRM MINIMUM SEPTIC L=4o.o0' i SAND. V DATED 7/16/2014 # LEGEND TANK SIZE AT 1000 GALLONS AND ITS SUITABILITY \ �\ 99_ EXISTING CONTOUR FOR RE-USE. REPLACE WITH 1500 GALLON � 0 ' SEPTIC TANK APPROPRIATE TO SITE CONDITIONS IF SITE IS LOCATED WITHIN A ZONE II X 99.1 EXIST. SPOT ELEV. NOT SUITABLE d V� 0�1 —[99]-- PROPOSED CONTOUR !1 1. 198•41 PROPOSED SPOT EL. � s TH1 / TEST HOLE G ° \ SYSTEM DESIGN: \ d 20% SLOPE OF GROUND 0' GARBAGE DISPOSER IS NOT ALLOWED UTILITY POLE \ `r \ FIRE HYDRANT DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD sY �c ` USE A33`J GAD ^ESIG^: FL'J4"J NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAM!Ej SEPTIC TANK: 330 GPD (2) = 660 5' REMOVAL OF UNSUITABLE SOIL REQUIRED \ **RE-USE EXISTING 1000 GAL. SEPTIC TANK TEST HOLE LOGS �•� AROUND PERIMETER O LEACHING EPLACEFACILITY, DOWN TO SUITABLE Dc6 N2 IL LAYER. WITH CLEAN MED. SAND, TO MEEREPLACE 86J LEACHING: SPECIFICATIONS OF 310 CMR 15.255(3) l2 9\ SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD ENGINEER: CRAIG J. FERRARI, SE #13871 \ 9J DAVID W. STANTON RS O g7 BOTTOM 25 x 12.83 (.74) = 237 GPD WITNESS: \ � ' .o• DATE: 8/23/2019 ELECTRIC - METER 166 TOTAL: 472 S.F. 349 GPD PERC. RATE _ < 2 MIN/INCH e�� �� / USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) CLASS I SOILS P# 19-120 �q(,I'FcTJ ',i 2 / WITH 4' STONE ALL AROUND L T AREA / "� TH1�� ELEV. ELEV. 18, 69 F. GAS BENCHMARK: 0" 86' 0" 86' METER , TOP OF STEP A A EXISTING =86.8' NAVD88 MA DWELLING a ^ APPROVED DATE BOARD OF HEALTH LS LS BH I TOF=87.2 4„ 10YR 3/2 4» 10YR 3/2 II FFLR-88.1 B B TITLE 5 SITE PLAN LS LS OF 26" 10YR 6/6 83 $, 24" 10YR 6/6 84, DECK 271 OLDE HOMESTEAD DRIVE 86 c1 c1 MARSTONS MILLS, MA /SIL /SIL ems, BALCONY RY 65 PREPARED FOR 96„ 1OYR 6/3 78, 84„ 1OYR 6/3 79' BORTOLOTTI CONSTRUCTION, INC. �oF��� C2 C2 ;,�" s'�yc �,IF� \\ DATE: AUGUST 26, 2019 SIEVE \` CANIELA \� ,, 1 c, MS MS ® UNSUITABLE SOIL O A A 0 I> off 508-362-4541 CIVIL � fax 508-362-9880 4e502 10YR 7/4 10YR 7/4 _ ho_ ,� gown cage 07 h7fering, hac 144" 74' 144" 74' civil engineers Scale: 1"= 20' o _ _ ,�� Lc_ /crud Su/'veyo/'S NO GROUNDWATER ENCOUNTERED �S Z6 \`� I 939 Main Street ( Rte 6A) n c�y , DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 DICE # / 9-2U / 0 10 20 30 40 50 FEET 19-267 BORTO—NELSON.DWG i