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HomeMy WebLinkAbout0024 PRINCE AVENUE - Health F =2eue s ti I I Commonwealth of Massachusetts N u Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 24 Prince Ave. l Property Address Sylvan Lane Realty Trust Owner Owner's Name J information is Marston's Mills Ma. 02648 06-18-2018 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 inf 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 Michael T Bisienere use the return Name of Inspector key. Cape Septic Inspections ,Q Company Name 624 Old Barnstable Road Company Address Mashpee Ma. 02649 City/Town State Zip Code 508-280-3356 S13938 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 06-19-2018 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6116 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 zo o Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Prince Ave. Property Address Sylvan Lane Realty Trust Owner Owner's Name information is required for every Marston's Mills Ma. 02648 06-18-2018 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: ® 1 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: This 3 bedroom home has a H-10 1500 gallon septic tank and a H-10 D-Box feeding 4 flowdifusors. At the time of the inspection the leaching was dry and there were no visible signs of past hydraulic failure. NOTE the bathroom in the garage is plumbed to the septic 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. 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 24 Prince Ave. Property Address Sylvan Lane Realty Trust Owner Owner's Name information is required for every Marston s Mills Ma. 02648 06-18-2018 page. Cityrrown 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 t5ins.cloc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 24 Prince Ave. Property Address Sylvan Lane Realty Trust Owner Owner's Name information is required for every Marston s Mills Ma. 02648 06-18-2018 page. Cityrrown 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 %day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 24 Prince Ave. Property Address Sylvan Lane Realty Trust Owner Owner's Name information is required for every Marston s Mills Ma. 02648 06-18-2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Prince Ave. Property Address Sylvan Lane Realty Trust Owner Owner's Name information is required for every Marston s Mills Ma. 02648 06-18-2018 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. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 plus GPD t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Prince Ave. Property Address Sylvan Lane Realty Trust Owner Owner's Name information is required for every Marston s Mills Ma. 02648 06-18-2018 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Fall 2016Date 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 24 Prince Ave. Property Address Sylvan Lane Realty Trust Owner Owner's Name information is required for every Marston s Mills Ma. 02648 06-18-2018 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: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 24 Prince Ave. Property Address Sylvan Lane Realty Trust Owner Owner's Name information is required for every Marston s Mills Ma. 02648 06-18-2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 02-21-2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 36"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.): Septic Tank(locate on site plan): Depth below grade: 24"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Standard H-10 1500 gallon septic tank Sludge depth: 1" t5ins.doc-rev.6/16 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 GSM 24 Prince Ave. Property Address Sylvan Lane Realty Trust Owner Owner's Name information is required for every Marston s Mills Ma. 02648 06-18-2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 36" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I would recommend the new owner put the tank on a maint. plan with a local septic pumping co.The Barnstable Health Dept. has a list of local septic pumping co. 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 24 Prince Ave. M Property Address Sylvan Lane Realty Trust Owner Owner's Name information is required for every Marston s Mills Ma. 02648 06-18-2018 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.): i Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form K Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 24 Prince Ave. Property Address Sylvan Lane Realty Trust Owner Owner's Name information is required for every Marston s Mills Ma. 02648 06-18-2018 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.): The H-10 D-Box had no visible signs of leakage or evidence of past hydraulic failure. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Prince Ave. Property Address Sylvan Lane Realty Trust Owner Owner's Name information is required for every Marston s Mills Ma. 02648 06-18-2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4 Flows ❑ 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 the time of the inspection the leaching was dry and there were no visible signs of past 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 24 Prince Ave. Property Address Sylvan Lane Realty Trust Owner Owner's Name information is required for every Marston s Mills Ma. 02648 06-18-2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (ncte 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 24 Prince Ave. Property Address Sylvan Lane Realty Trust Owner Owner's Name information is required for every Marston s Mills Ma. 02648 06-18-2018 page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Af- L/I-14- o/J ,AJ-e-�f t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 -� TOWN OF BARNSTABLE LOCATION. j! 5//Mince i SEWAGE N 4,004-0j(,2 VII LAGE._((t ///i&L_ ASSESSOR'S MAP,@ LOY617 ONI INSTALLER'S NAME&PHONE NO, > 6ep4 fret.,! S/ flWe SEPTIC TANK CAPACffY /nv GQL LEACHING FACI.ITY:(type) )t:,-/se a.,,r LyI (Silt)//� 3l k,'NO.OF BEDROOMS--,I_ BUILDER OiL4WN6R �- PERMIT DATE: A21-06 COMPLIANCE DATE: Separation Distance Between dw.. MaximumAdji WGrouadwaterTebletothellommofLeachingFacility St Feet Private Water SuWy Well and Leaeh)ng Facility (If any wells exist on site or vwihin'200 feet of leaching facility) ' Feu Edge of Wetlaad sad Leaching Facility(if any wetlands exist w)titin 300 reet of leaching facih ) Feet Furnished by G/.a �.,.,tl�e✓. RJ i J -12 di_ 7t, EF- Lit ► 00 a v 6!]5/201 R.2:30 PM Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Prince Ave. Property Address Sylvan Lane Realty Trust Owner Owner's Name information is required for every Marston s Mills Ma. 02648 06-18-2018 page. City/Town 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: 10 plus feet 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: I augered a hole at a lower elevation to show four plus feet of seperation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. Lt5ins.d,c-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Prince Ave. Property Address Sylvan Lane Realty Trust Owner Owner's Name information is required for every Marston s Mills Ma. 02648 06-18-2018 page. CityTTown 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 J ® System Information- Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 •P i ,' ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Prince Ave Property Address Sears Owner Owner's Name information is Marstons Mills MA 02648 May 16, 2014 required for Y 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 A. General Information_ forms the C � computer, r,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Company Name r� PO Box 1487 Company Address Marstons Mills MA 02648 'eN!" City/Town State Zip Code 508-776-4186 Sl 12855 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 May 16, 2014 Job# 14-37 Insp tor's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 ��'I�� ( Title 5 Official Inspection Form:Subsur:....e Sewage Disposal System•Page 1 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G7M 24 Prince Ave Property Address Sears Owner Owner's Name information is Marstons Mills MA 02648 May 16, 2014 required for Y every 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--valuated are indicated below. Comments.- Recommend pumping tank, leaching system showed no evidence of saturation or surcharge. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Prince Ave M Property Address Sears Owner Owner's Name information is Marstons Mills MA 02648 May 16, 2014 required for y every page. CityFrown 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 ❑ f:D (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 Lt5s•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Prince Ave Property Address Sears Owner Owner's Name information is Marstons Mills MA 02648 May 16, 2014 required for y every 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: �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 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 felt 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 day flow l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Prince Ave Property Address Sears Owner Owner's Name information is Marstons Mills MA 02648 May 16, 2014 required for y every page. City/Town State Zip Code Date of Inspection B. Certification (Cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 cf 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 CM 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 tl-e Department. L15,ns3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts u vo Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Prince Ave Property Address Sears Owner Owner's Name information is Marstons Mills MA 02648 May 16, 2014 required for y every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, matei lal of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CM 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 24 Prince Ave Property Address Sears Owner Owner's Name information is Marstons Mills MA 02648 May 16, 2014 required for y every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Two weeks prior to inspection. 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 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form - Not for Voluntary Assessments ,. 24 Prince Ave Property Address Sears Owner Owner's Name information is Marstons Mills MA 02648 May 16, 2014 required for y every 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: None Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons I How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsur+_ace Sewage Disposal System•Page 8 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Prince Ave Property Address Sears Owner Owner's Name information is required for Marstons Mills MA 02648 May 16, 2014 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1 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.): Septic Tank (locate on site plan): ' Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 10.5' long x 5.8'wide- 1500 gal. Dimensions: , Sludge depth: 3" L15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 I Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Prince Ave Property Address Sears Owner Owner's Name information is required for Marstons Mills MA 02648 May 16, 2014 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28 Scum thickness 3" 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 12" 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.): Liquid level was at bottom of outlet invert and tees were intact. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: - Scum thickness Distance from top of Scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Prince Ave M Property Address Sears Owner Owner's Name information is Marstons Mills MA 02648 May 16, 2014 required for y every 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): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethy,ene ❑ 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 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Prince Ave Property Address Sears Owner Owner's Name information is required for Marstons Mills MA 02648 May 16, 2014 every 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located„ explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth. of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments sy0'. 24 Prince Ave Property Address Sears Owner Owner's Name information is Marstons Mills MA 02648 May 16, 2014 required for y every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4 flowdifussors. ❑ 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.): Stone and soils surrounding SAS were probed with no signs of saturation found. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Prince Ave Property Address Sears Owner Owner's Name information is required for Marstons Mills MA 02648 May 16, 2014 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of pondinr, 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Prince Ave Property Address - ----- - -- ------ Sears Owner -----------... ... ..._.__._......... .... _....._..------- Owner's Name ---- — information is required for Marstons Mills_ MA_ 02648 May 16, 2014 every page. City/Town State Zip Code Date of Inspection ___ D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes bek ✓v: ® hand-sketch in the area below ❑ drawing attached separately ! Front 68 7 66 8 g rt.ir���...•Lv.r.rest 2. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Prince Ave Property Address Sears Owner Owner's Name information is Marstons Mills MA 02648 May 16, 2014 required for y every page. CityFrown 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: 10+ 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: River at rear of property is considerably lower in elevation than SAS. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments <C�M 24 Prince Ave Property Address Sears Owner Owner's Name information is Marstons Mills MA 02648 May 16, 2014 required for Y every page. City/Town State Zip Code Dat.,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" 7��r�hcc 1ri-e SEWAGE #ocOO(o- D� V11-LACE // l f ASSESSOR'S MAP & LOTS/9 0"/ INSTALLER'S NAME&PHONE NO. f,Od SEPTIC TANK CAPACITY /S`Od CkL l LEACHING FACILITY: (type) (size) NO. OF BEDROOMS 3 BUILDER O WNER��_ PERMIT DATE: A-2I-d 6 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility s¢ 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 q7 within 300 feet of leaching facility) Feet Furnished by i33- AY- 10;2 'G O00 a 3 y ' O O No... Fee C C) THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for MIS oal �bpgt m Con!6truction Permit Application for a Permit to Construct( ) Repair(4 Upgrade( ) Abandon( ) LJ Complete System ❑Individual Components Location Address or Lot No. 2- 191-Mee-1S 61e- Owner's Name,Address,and Tel No. npl Assessor's Map/parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. � ell G '7 71 Type of Building: Dwelling No.of Bedrooms 0 Lot Size 76�©P sq.ft. Garbage Grinder ( lam Other Type of Building g NweAlC& No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -3 3t0 gpd Design flow provided 3r V 7 gpd Plan Date Z h✓``TO J Number of sheets Revision Date _ Title cSLr' `� ill Size of Septic Tank ype of S.A.S. — ' 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. f Sign - Date Z� < Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. .CD Date Issued 1 � No. "0 � ' ,�`� Fee 0 C) 4 , .THE COMMONWEALTH OF MASSAUS TS Entered in computer: Ye ` PUBLIC 1,414- HEALTH DIVISION - TOWN OF BARNSTABLE; MASSACHUSETTS ZIPpritatidn for Th5pont 6pgtem Con9truction permit Application for a Permit to Construct( )"'Repair( Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. Z l� ��>!hG �/�, Owner's N e,Address,and Tel.No. / ol If lee- Assessor's Map/Parcel �'1la�jr�D0S t Installer's Name,Addres ,and Tel.No. Designer's Name,Address and Tel.No. 7 7 Type of Building: Dwelling No.of Bedrooms Lot Size-7 sq. ft. Garbage Grinder (101� Other Type of Building 1'e5/ elllCe No.of Persons Showers( ),"Cafeteria( ) Other Fixtures q Design Flow(min.required) 3 30 gpd Design flow provided 3 7// 7 gpd Plan Date Z A —D Number of sheets / Revisiongj7 Title / ` Size of Septic Tank 1 0!� f Type of S.A.S. Description of Soil ✓` Nature of Repairs or Alterations(Answer when applicable) f i 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. Signe Date 2-1 pA Application Approved by Date �`J Application Disapproved by: Date for the following reasons Permit No. °kC'D�CD "�6 Date Issued -------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ii�Upgraded ( ) Abandoned( )by ©1, 7`O d �!//I , at 1 / `I-- e Q' *M�W A/. a been constructed in accordance r with the provis' ns of Title 5+and � e%for Disposal System Construction Permit No. c G o)—dated a I 'a`1 InstallerU-�� LC� Designer #bedrooms Approved design flow U336 gpd The issuance of this permit sh ll not be construed as a guarantee that the system ill f d signed. Date N Inspector --------------------------------------------- No. V ­rj(0.}- Fee �0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Migpo$AY,6pztem Con6tructiou Permit Permission is hereby granted to Construct ( ) Repair ( Vj . Upgrade ( ) Abandon ( ) System located at Z q Ar /h C li qllte "', // S and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of is pe i, Date Approved by .v r Town of Barnstable Regulatory Services Thomas F. Geiler, Director * s�wsrAe�. M^S Public Health Division %634, Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 3 0 Sewage Permit# l76 Z- Assessor's Map\Parcel Designer: 6(tk fi Installer: (30✓-'E0(0#; 66n1 r(1C,+ly&J, 71kc, Address: 9 L&dam Ut L-&,% Address: 04 r!/"Ib hV o Z6 w d Am$ On Z` Z1` ��/��1D o?�V C�o�) was issued a permit to install a (date) (installer) septic system at #'14-1 pielVCE ff y'siyyE My► based on a design drawn by (address) -Eon, P.S• dated. Tyr' , is, zoos--. (designer <certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. 1 certify that;the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. (M OF Mq�s90 - off GLEN tiG ERIC , (InstP-s` ature) o, HARRING1 N No. 1070 0 i qI/TAa\� (Designer's Sig ture) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc r 4 9 Town of Barnstable Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. April 28, 2005 Mr. Glen Harrington, R.S. 9 Leda Rose Lane Marstons Mills, MA 02648 Dear Mr. Harrington, You are granted conditional variances, on behalf of your client, Shirlee Burd, to construct an onsite sewage disposal system at 24 Prince Avenue, Marstons Mills. The variances granted are as follows: SECTION 360-1: The soil absorption system will be located 97 feet away from a bank, in lieu of the one-hundred (100) feet minimum separation distance required. SECTION 360-1: The septic tank will be located 83 feet away from a wetland, in lieu of the one-hundred (100) feet minimum separation distance required. This variances are granted with the following conditions: (1) No more than three (3) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property; at the Barnstable County Registry of Deeds restricting the property to three (3) bedrooms maximum. A copy of the recorded deed restriction shall.be submitted to the Health Agent prior to obtaining a disposal works construction ;permit. HarringBurd65 (3) The septic system plans shall be revised by the designer showing a listing of the variances requested. (4) The designing sanitarian shall supervise the construction of the onsite sewage disposal'system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the revised plans. These variances are granted because they physical constraints at the site severely restrict the location of theseptic tank and soil absorption system due to the close proximity of the river. It its the opinion of this Board that the proposed new septic system is 'designed to .meet tlje maximum feasible compliance standards contained within the State Environmental Code, Title V. Sin rely yours, J � yn A. filler, M.D. C air an HarringBur005 r FEB-12-2006 22:37 ARDITO' ' P.02/03 Bk 20071 Rs 55 �5i�304 07-21-2005 a 03 = lap DEED RESTRICTION WHEREAS, SHIRLEE G. BURD of 24 Prince Avenue, Barnstable (Marstons. Mills) , Barnstable County, Massachusetts, is the owner of 24 Prince Avenue located in Barnstable (Marstons Mills) , Barnstable County, Massachusetts, duly recorded in Barnstable County Registry of Deeds in Plan Book 2784, Page 248 ; and WHEREAS, SH.IRLEE G. BURD as the owner of said land has agreed with the Town of Barnstable, Board of Health to a restriction as ua a 1—,: , �- �.0 iLic iuuwL.ci of tiicuivvuo nLiiL can be , i aiuL i % j iav�uc a,uii. on said land as a pre-condition to obtaining a variance from the 310 CMR 15 . 214 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and to obtaining a building permit for this lot; and WHEREAS, the Town of Barnstable Board of Health, as a pre- condition to granting the variance from 310 CMR 15 .214, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on this lot is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable county Registry of Deeds by recording this document . NOW, THEREFORE, SHIRLEE G. BURD does hereby place the following restriction on her above-referenced land in accordance with her agreement with the Town of Barnstable, Board of Health, which restriction shall run with the land and be binding upon all successors in title : RAIVISEY&HANESIAN.L.L.P. .V FORNEY5 AT LAW 700 ATTUC S LANE.SUITE IC HYANNI5,MA 02601 TEL.508 790-J 177 1,^ FEB-12-2006 22.39 Af<DITU P.03iO3 w> 1 . 24 Prince Avenue, Barnstable (Marstons Mills) may have constructed upon the lot a house containing no more than THREE (3) bedrooms . SHIRLEE G. BURD agrees that this shall be permanent deed restriction affecting 24 Prince Avenue located in Barnstable (Marstons Mills) , Barnstable County, Massachusetts . For title of SHIRLEE G. BURD see the following deed: Book 2784, Page 248, Robert D. Burd deceased January 15, 2002, late of Barnstable (Marstons Mills) , Barnstable County, Massachusetts . . Executed as a sealed instrument this 8th day of July, 2005 . Shirlee G. Burd COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, ss . On this 8th day of July, 2005, before me, the undersigned notary public, personally appeared SHIRLEE G. BURD, personally known to me, to be the person whose name is signed on the preceding or .attached document, and acknowledged to me that she signed it voluntarily for its stated purpose. �c�.. Z�0. tq Notary Public MARTHA T. RAMSEY = NOTARY PUBLIC (:ammonweal(h oP Massachusells My Commission Expires July 8, 2012 RAMSEY 6 HANESIAN,L L.P. A11*01tNb'S Af LAW 700.-\TTUCKS LANE.SUITE IC HYANNIS.MA 02601 T EL.!iOB 790.117 7 T1TAI P_17173 t t V' Town of Barnstable sn>isrr�xa�a ; Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,KS. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. Mr. Glen Harrington, R.S. April 28, 2005 9 Leda Rose Lane Marstons Mills, MA 02648 Dear Mr. Harrington, You are granted conditional variances, on behalf of your client, Shirlee Burd, to construct an onsite sewage disposal system at 24 Prince Avenue, Marstons Mills. The variances granted are as follows: SECTION 360-1: The soil absorption system will be located 97 feet away from a bank, in lieu of the one-hundred (100) feet minimum separation distance required. SECTION 360-1: The septic tank will be located 83 feet away from a wetland, in lieu of the one-hundred (100) feet minimum separation distance required. This variances are granted with the following conditions: (1) No more than three (3) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to three (3) bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. HarringBurd05 (3) The septic system plans shall be revised by the designer showing a listing of the variances requested. (4) The designing sanitarian shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the revised plans. These variances are granted because the physical constraints at the site severely restrict the location of the septic tank and soil absorption system due to the close proximity of the river. It is the opinion of this Board that the proposed new septic system is designed to meet the maximum feasible compliance standards contained within the State Environmental Code, Title V. Sin rely yours, yn A. iller, M.D. C air an HarringBW05 r � DATE: FBS: I=. BY Town of Barnstable. DATE: Board of Health 200 Main Street,Hyamlis MA 02601 Old so&862-4644 FAX 50&79"Xg Susan G.Rask,R.S. Sumer Ka ffinx,MS.P.K Wayne A Miller,M.D. VARIANCE REQUEST FORM LOCATIOPY _ Property Address: ` j (•add'i � �` ' " Assessor's Map and Parcel Number. ' �° r Size of Lot Wetlands Within 300 Ft Yes 1/ Business Name: < N No Subdivision Name: cn APPLICANTS NAME: d e e- 13 L/ � Photo` a'�I �" :-z-�i:�� cx, Did the owner of the property authorize you m represent him or her? Yes No -- c.� PROPERTY OWNER'S NAME _CONTACT PERSON Co rn Name: �, co- (e e l v r d Name: C'(e v t �� r �' Vt, 1O �. VA (�y�ems— i,3 Pc.Ce F 11 T - _ Address: ? d;�r�- :. a 9 •�« mot o e�t t-k take k e ,. .r � Phone: ` 7 AV Phone: VARIANCE FROM RFGOLATION(i�caeg) REASON FOR VARIAlYFC (May2ttach if mare spade waded) g g tkA NATURE OF WORE: House Addition 0 House Renovation O Repair of Failed Septic System (to be cornpteted by ofice Alaff 'wehft warimrce regum Four(4)copies of theO0 UW variance appslrc4tion) Four(4)copies of r regoest fog P�subsided(eg. systeanplaos) Pow(4)c*08oflsbeleddimeoeomalfloarplans (e4.h0uwPhworrestauraotkitc=plaos) SWed lefter datmg*a thepzq)4dy Ormor au&o ized Yon to reg►rewa hnni or far"requat —_ Applicant nnderwandi;&A he abutkon mt be notified by cati6ednwR i it leaetten days priorto nie ing date at apphcoW.asps. (for Y"Q1e V andler local wwW rewdadan wsioncrs may) Fnllmenu maandted(fa'weaae tp variance regoeets only) Valiance m4ued ipplicabon fee collected (no fee fee YeWNd moffic9bon rena nk Weaw trgp varunce renewals [same awe dipiog variance rawwals[same ownedie"M oaly),and vat swatorgmorfailed sewage dupes sygem [mlyifno eVandca tothe;bu&tingpmposedl) Vaimca raqua t submitted at leant 15 dayspriartomeetimg date VARIANCE APPROVED NOTAPPROVED Saean G.Rs*,R.S.,Chairmw RFASONFOR DISAPPROVAL Snnmer Kin man,ALS.P.IL Wayne A M Mk,MD C.:\Documents and Settings\deCollik\Local Settings\Temporary Internet Files\OLKFB\vARIR$Q.DOC 'l TOWN OF BARNSTABLE LOCATION o�7 /�� t//nC �X/d C SEWAGE ' VU LAGE -Ad //I/ /�j ASSESSOR'S MAP & LOTY1'2 0"/ INSTALLER'S.NAME&PHONE.NO. � r�S�ir.Gf�J�. SEPTIC TANK CAPACITY /S'�Ja 4;4 LEACHING FACILITY: (type) �cr�/ ,-J 61 (size).//)c Ir A i NO. OF BEDROOMS 3 BUU DER 0 PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 5 � 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) / 7 Feet Furnished by 61,n crrri»��a•✓, J z 133_ -7/ 7- 0 3 y O O Lovell's Rd. N BARNSTABLE CONSERVATION FOUNDATION, INC. o, »-No �. Desl4n Calculations GENERAL NOTES 93't Number of Bedrooms: 3 Existing Garbage Grinder: NO, GRINDER NOT ALLOWED WITH THIS DESIGN 1, ADDRESS: #24 PRINCE AVENUE • 2. ASSESSORS NUMBER: 077-041 Septic Tank Capacity Required: 330 9Pd X 200% 1,100 gPd O 3. DEVELOPER'S LOT: � Septic Tank Provided: 1,500 gallon (PROPOSED) 4. TOPOGRAPHIC INFORMATION WAS COMPILED FROM AN Leaching Capacity Required: 330 Gal./Day ON THE GROUND INSTRUMENT SURVEY. 5. TOWN WATER IS PROVIDED TO SITE & SURROUNDING PROPERTIES. Leaching Area Required: 330 Gal./(0.74 Gal./Sq.Ft.)=446 Sq.Ft. 6. REFERENCE PLAN: DEED BOOK 2784 PAGE 248 .a Proposed Leaching Area Provided: 35'. X 11 X 0.92' = 469 sq. ft. REFERENCE PLAN: PLAN BOOK 37. OAGE 127 r o Total Leaching Capacity. 347 gpd > 330 gpd, req'd. BBYYBBENNETt' &&o'REILLLLY,PIN' s�I1 20 AVENUE, 8/200MILLS, 11 REV.' M� 00 SITE DATE 7/25/2001. o REFERENCE PLAN: rTOPOGRAPHISAL PLAN IN BARNSTABLf, MASS.' FOR ; ROBERT SURD ET UX, SCALE i =20', DATED OCT. I B. 1�79 BY KINGSBURY SURVEYING COMPANY, INC. a 7. RESOURCE AREAS LOCATED BY GLEN E. HARRINGTON, R.S. ' e�94• 8. NO POTABLE WELLS ARE LOCATED WITHIN 150 FEET OF SAS. „ 9. PROPERTY LINE DISTANCES SHOWN ARE DEED DISTANCES. LOCUS 10. SUBSURFACE UTILITIES LOCATED PER DIGSAFE NOTIFICATION #20044504212. NO SCALE CONSTRUCTION NOTES 1. Contractor is responsible for Digsafe notification QpS, I sand protection of all underground utilities and pipes. Now"ow tQ 2. The septic tanka l distribution box shall be set qpP ns Revel on 6 of 34 -11/2 stone. W �5, 3. Backfill should be clean sand or gravel with no Q stones over 3r in size. D .me ER 'rj 4. This system is sub'ect to inspection during installation Z ,3 TOP OF (/Lot" by Glen E. Harting?on, R.S. W BqN To ER 5. The contractor shall install this system in accordance 7r with Title V of the Massachusetts Environmental Code and the Regulations of the Town of Barnstable. 2 �• 6. Provide an Acme Precast H-10, 1,500 gal. septic tank. 1-5-hole W 22W H eai• H-10 D-Box and 4-H-20 flowdiffusors or equal. 1440 Tat 7. No vehicle or heavy machinery shall drive over the U ZU7. 2Lsr Tas septic system unless noted as H-20 septic components. _Z 8. Install os baffle or equal on se tic tonic outlet tee end. by contr PCV*d 10. Existing leachvpii9. All exi n tt and cesspool(s) to a site conditionsbe pumpedeanldshall be vrifedbackfilled.actor. dryri AREA 26,000t SQ:FT. 11. Main sewer to be replumbed to exit to front yard and to proposed septic tank. 12. Sewer line to be encased 10 feet on either side of intersection of water line. -- - - - - - - - - - - +I • dlot 'owr{ryoietor er Day+u� c _ 0 4'd(�. 8C8 40 PiC ifirs O bs M}u�° i°� sd >�1949'END TDD PERK TEST 8c SO,L EVALUATION EXISTING r�' ,S Date of Perc. Test & So!I Eval.: Novembbr 12, 2004 e4z ME•• J T 83r. Veronica A. Warden N' - ue13t SSE BY. R.S...- PERK • ////////// .ATN_...._0 _Y: Qnvid Stanton.. ten . NO.: P10,852 ., m 4r - B co PERK RATE: LESS THAN 2 MPI (ASSUMEO) s 1H ei Test Hole No. 1 8EA0" '► ' O d o t,tiliUes EP SOILS ELEV. e a Q A i �� 10" • 74"'Ls/2 sold STEEL REINFORCED PRECAST CONCRETE O LW ''""n2= PLAN VIEW n7F. loony WWI X Raw 9 t16'TDI O 60 .M. 4' �- 5r14M/s 97 s'P' C2 FROM TOP OF BANK k MOM..w 1o>'n/s �pQ I R P� 7.98' GROUNDWATER ENCOUNTERED O 122' (11.46' MSL) 0 0 C2 n2 ELi2•TDi 0 0 0 0 iO 11 uP<Ic setbadt 1 J EEC�iPPA �C COMPANY EASEMENT 4 H-20 FLOWDIFFUSORS zao9• I END-SECTION PROPOSED SAC 187't e ? H-20 FLOWDIFFUSOR 1 leaching X 11'trench Xing. D DANIEL P. SULLIVAN ear NOT TO SCALE leachingg trench using.4 H-20 USE ACME PRECAST OR EQUAL flowdiffusors with 3.5' of stone #42 PRINCE AVENUE on sides & 1.5' on ends. on-M i 2161• ! OFlv1A PROPOSED SEPTIC SYSTEM UPGRADE ' =ya :V ti PREPARED MR SITE PLAN �+ SHIRLEE G. BURD SCALE: 1 "=20' R T AT 13ENCH MARK ON FIRST FLOOR OF #24 PRINCE. AVF_ 07�O #24 PRINCE AVENUE FRONT DOOR THRESHOLD. ELEV. 24.72' MSL gMGFA �P BARNSTABLE (MARSTONS MILLS), MA 10' min. from *NOTE: ALL PIPES ARE TO BE 4' DUI. SCHEDULE 40 P.V.C. LEGEND house to septic tank Existing House Fried gto" over''hn-='�' awW O PROPOSEDS 15TIC00 GAL PREPARED BY: FF�.-1ooes' EX/SA'N OWE a".� UIUM fly. GLEN E. HARRINGTON, R.S. full cellar s.aoz, Mh 2�-1/e'-1rr_ x104 SPOT GRADDMOTES E 9 LEDA ROSE LANE Moh Hoes•saw to Low for 2• douElrsashad steno _I t968 to mb 1500 GAL D aSTING CONTOUR MAR STO N S MILLS, MA 02648 aAR�►cE-sl' i3 SEPTIC iTTANK 22 .16' OAS o 0 M E ammmisem I!R DEEP TEST HOLE TEL: 508-428-3862 3S• Yr2ou,9 do' V FAX: 508-428-3862 LEACH TRENCH Wr(s mh.met) Approx. location r of 31e-11/r SWWW yStending GW elev=11.46' existing water line SCALE: 1"=20' DRAWN BY: GEH FEB. 15, 2005 SYSTEM PROFILE V OF 31e-111r star FILE: BURD SHEET 1 OF 1 Not to Some a DATUM: NGVD I Laveia's Rd. N BARNSTABLE CONSERVATION FOUNDATION, INC. n Calculations � on-o4o Q e s I C, GENERAL NOTES s3' Number of Bedrooms: 3 Existing Garbage Grinder: NO, GRINDER NOT ALLOWED WITH THIS DESIGN 1. ADDRESS: #24 PRINCE AVENUE er,p 2. ASSESSORS NUMBER: 077-041 Septic Tank Capacity Required: 330 gpd X 200% = 1,100 gpd 3. DEVELOPERS LOT: Septic Tank Provided: 1,500 gallon (PROPOSED) 4. TOPOGRAPHIC INFORMATION WAS COMPILED FROM AN Leaching Capacity Required: 330 Gal./Day ON THE GROUND INSTRUMENT SURVEY. 5. TOWN WATER IS PROVIDED TO SITE & SURROUNDING PROPERTIES. Leaching Area Required: 330 Gal./(0.74 Gal./Sq.Ft.)f 446 Sq.Ft. 6. REFERENCE PLAN: DEED BOOK 2784, PAGE 248 4 Proposed Leaching Area Provided: 35 X 11 X 0.92 = 469 sq. ft. REFERENCE PLAN: PLAN BOOK 37, PAGE 127 O REFERENCE PLAN: SITE PLAN, 42 PRINCE AVENUE, MARSTONS MILLS, MA." a Total Leaching Capacity. 347 gpd > 330 gpd. req d. BY BENNETT & O'REILLY, INC. SCALE 1 =20, DATED 5/28/2001, REV. w SITE DATE 7/25/2001. o -74 2&92' REFERENCE PLAN: "TOPOGRAPHICAL FLAN IN BARNSTABLE, MASS." FOR 0 ROBERT BURD ET UX, SCALE 1"=20, DATED OCT. 18, 1979 BY KINGSBURY SURVEYING COMPANY, INC. P- 7. RESOURCE AREAS LOCATED BY GLEN E. HARRINGTON, R.S. 249W 8. NO POTABLE WELLS ARE LOCATED WITHIN 150 FEET OF SAS. 9. PROPERTY LINE DISTANCES SHOWN ARE DEED DISTANCES. LOCUS 10. SUBSURFACE UTILITIES LOCATED PER DIGSAFE NOTIFICATION #20044504212. Na SCALE CONSTRUCTION NOTES 1. Contractor is responsible for Digsafe notification i Mprs,C and protection of all underground utilities and pipes. (� 2. The septic tank on j distribution box shall be set APp �S level on 6" of 3/4 -11/2" stone. 3. Backfill should be clean sand or gravel with no LLJ To 4stones over 3" in size. °t RSV . This system is subject to inspection during installation Z ,3, TOP 0 �C- by Glen E. Harrington, R.S. LLJ e QAN To5. The contractor shall install this system in accordance ER with Title V of the Massachusetts Environmental Code LL QBMW and the Regulations of the Town of Barnstable. 6. Provide an Acme Precast H-10, 1,500 gal. septic tank, 1-5-hole E&We , H-10 D-Box and 4-H-20 flowdiffusors or equal. LLJH D 1410 Toe 7. No vehicle or heavy machinery shall drive over the U 2e8r eftlzr T® septic system unless noted as H-20 septic components. z 8. Install gas baffle or equal on septic tank outlet tee end. 9. All existing inverts and site conditions shall be verified by contractor. Of Paftd dr►ye 10. Existing leach pit and cesspools) to be pumped and bockfiiled. 0- AREA 26,000t SQ.FT. 11. Main sewer to be replumbed to exit to front yard and to proposed septic tank. 12. Sewer line to be encased 10 feet on either side of intersection of water line. A'Loo�`Mo"w*41'�r►rYa � -li _eXs, 4-4ra. SM 40 Pre rills 0 to be� •) lA4911M TIM PERK TEST & SOIL EVALUATION EXISTING ) Date of Perc. Test & Soil Evol.: November 12, 2004 4.7• DWELLING Test Performed By- Veronica A. Warden WITNESSED BY: David Stanton, R.S. CLEAH "won"com PERK NO.: P10,852 EL4r �— B� C0 PERK RATE: LESS THAN 2 MPI (ASSUMED) s� TN Test Hale No. 1 O Gj DEPTH SaLS ELEV. -u- D o A O O a EL � EC O T s fi srm REnoRcm vREAsr CONCRETE e3 LSPu�os - �,.aa PLAN VIEW x ea-W 9ss"1Tis 4' 0 000M aw p�.� lorxe/e `Q � a2 97' FROM TOP OF BANK .wa toxn/e 25 ® ® ® C3 1 1" 18" ��Q N �PqR GROUNDWATER ENCOUNTERED O 122" (11.46' MSL) ® ® 0 2L12'T[M HPtk utb*,Ck ri` ee2• APPROX. LOCATION 33' WIDE 4 H-20 FLOWDIFFUSORS +--1 ELECTRIC COMPANY EASEMENT END-SECTIQN PROPOSED SAS 187' 9" H-20 FLOWDIFFUSOR 1 NOT TO SCALE X X 0.92' D s13' leaching trench using,4 H-20 DAME!- P. SUUNAN USE ACME PRECAST OR EQUAL flowdiffusors with 3.5 of stone #42 PRINCE AVENUE REVISED 5 19 2005: PER i30H COMMENTS on sides & 1.5' on ends. 077-042 • OF M PROPOSED SEPTIC SYSTEM UPGRADE SITE PLAN PREPARED SCALE; 1 LA LOCAL VARIANCES REQUESTED• E C SHIRLEE G. BURD SECTION 360-1 - SETBACK. A variance is requested to install a �? RRI o AT BENCH MARK ON FIRST FLOOR OF #24 PRINCE AVE septic tank 83 feet from the BVW in lieu of the required 100 feet. d• 7024 PRINCE AVENUE FRONT DOOR THRESHOLD, ELEV. = 24,72' MSL SECTION 360-1 - SETBACK. A variance is requested to Install a leaching field 97 feet from the coastal bank in lieu of the required 100 feet. gtVIT 5B\P BARNSTABLE MARSTONS MILLS), MA b�Ta� C ) 10' min. from *NOTE. ALL PIPES ARE TO BE 4" DIA. SCHEDULE 40 P V.C. house to septic tank Existing House Finishede� ove5 2% slope oway arose LEGEND PREPARED BY: HOLE F.ELE,,,_1�5. 0017,G OR40E �BOX o GLEN E. HARRINGTON, R.S. r»Min. PROPOSED 1500 GAL 9 LEQA ROSE LAN E full cellar o 0 0 ' s a G02' Min. Y-t/e"-t/2'_ mmc. H-10 SEPTIC TANK Ma h House sewer to 1500 GAL iewl for 2' s..,af double—w ohed,tone m19.86' MARSTONS MILLS, MA 02648 be rephxnbed to rnh. WQUSE.80' elw-213d } 9 flARACE-3Y SEPTIC TANK 22 .� .16' X 104.46 DENOTES EXISTING o 9 H-10 SPOT GRALIE � ! AS ,� ' a ca 24•e� rench lev.� 1 .24' ---95 EXISTING CONTOUR TEL: 508-428-3862 01 LEACH TRENCH &7W(s mh. reed.) FAX: 5og-428-3862 e•of 3/4'-117r STONEY s n DEEP TEST HOLE >stona�,a Gw elev.�11.46' SCALE: 1"=20' DRAWN BY: GEH FEB. 15, 2005 e,OF 3/4_1t/2..STONE FILE: BURD SHEET 1 OF 1 Approx. location SYSTEM PROFILE Not to scale __ — ^�! existing Water line DATUM: NGVD