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1295 RACE LANE - Health
1295 RACE LANE, MARSTONS MILLS A= 064 012 ,F f 0 1� NO.13..3 ... r FEBi....d-fl....[.....o.... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Bar PROVED _ " ConBervatiW DWrtmsnt � -1 ................ ....... ....: . .,T Appliratiou for UiiposFal Works Toaatitror t exuti# Cate `. Application is hereby made for a Permit to Construct ( ) or Repair (V,) an-Individual Sewage Disposal System at: _........_ACE ................. ..---....--•- \J cation-Address r Lot No. `/ _...2 .P�5:....:A��.!�co�..--...ntC.... .! ....X.�....23�.SC� Ow Address W ....................••••................. ........••••-••--•••••...••••-•-•••-•-•-•----•-•-•••••--•••••-••-•-......•........................ Installer Address dType of Building 1 Size Lot...Z.�a�-�...........-Sq. 5 U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder a4 Other—Type of Building No. of persons-----__---_--------------- Showers — Cafeteria Q' Other fixtures ------------------------------------------------------------------ -- W Design Flow...........................................gallons per person per day. Total dailyflow-------\t®.....................-_---_gallons. WSeptic Tank—Liquid capacity.IOM.gallons Length-_�_. ____ Width.-_.✓`. -.. Diameter................ Depth..S.� -. x Disposal Trench—No........t........... Width.....IQ......... Total Length._._ZA....__. Total leaching area_.3M.......sq. ft. Seepage Pit No--------------------- Diameter.................... De h below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (Y� Dosing tank (td aPercolation Test Results Performed by.......................................................................... Date........................................ .a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_.___--.-____---_--__-_. G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil...........................................••-------...---..........------••----------------------------------•-----•-------------------•----------------•-•••......••-• x W UNature of Repairs or Alterations—Answer when applicable............................................................................................... -•------------------------------------------------•------••••--•••-••••--•-•--••---••••••-•••--••-•.•--•••••-•••----------------•----••-••----•--------•----••------------------•--•---.....----•-••-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h been issued by the board of ealt b. Signed ....---- ........ ...........���y . .... Dam Application Approved By --------------I)PA -- - '..<'-'�...--..-.-...--------------------------------------------------------- ..... Dace Application Disapproved for the following reasons: ....................... .. --- ...... --...---............................ ........ . ------.......------........... -------------- -................................---- .....--------....----- -- ..---- . ................... ------.. ------. . -- -- -- .......---------.------------------ �y Dare Permit No. .........< ® Issued ... Dace k,_ THE COMMONWEALTH OF MASSACHUS ARD.C� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l---------------- ........................... Appliration for Disposal Murks Tonstrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at ................_.......................... ............................................... ....------•---......---•------------•--•------•------------------------•----•------• J -�'y j.L catiorn-Address 4 _ \, _ r Lot No. 2 Yr�1� 11C 1`r�• \N ) t��S�Jr,' Ye(L 19i�11e FZ4�1�7 5 tJyl / Jk..5V .....--•-- .................:.....•----••----....-----•--------•--•--......-•••--•-------... ............... ................... .. 1x 1 Owner Address W Installer Address 1Z C�3 �S d Type of Building �,l Size Lot.......:..................Sq-fret U Dwelling—No. of Bedrooms........... ...............................Expansion Attic t�Ca Garbage Grinder ( � Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ............................ . W Design Flow................. 5_....._..............gallons per person per day. Total daily jiow......_ ...........................gallons. P4 Septic Tank—Liquid capacity.).:).gallons Length.. ram..._ Width... _`?.... Diameter---------------- Depth... Disposal Trench—No. ....... ........... Width.....19......... Total Length.....9:�y....... Total leaching area_.SU .......sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (Yxl)> Dosing tank (�o Percolation Test Results Performed by.......................................................................... Date........................................ .Test Pit No. 1......._--------minutes per inch Depth of Test Pit.................... Depth to ground water-____________-_-__---__- Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' •--•----•----------------------•-•••-----------------•-----------•-----...._....._........--•-••---•......................................................... 0 Description of Soil........................................................................................................................................................................ x V ............................................................---•------------------•--------•------•-•••-•------•--•----••--•--------•----------•--------••---•-•--------••--•-----•-•-•---•-----------•. W ---------------------------------------------------------------------------------------•-•-------------------------------------------------------------................................................ U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ----------------------------•---•--....---......------------------•-------------------------------------•---•------------------------------------------•-•-------------------•••••-----••-•-••-••...---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ............................. .---------- -----------"---------------------- ................................................... Dace Application Approved By --""- ........�� -,z_� h:== / = > e... (-� ..................... .. ..................... ...... .. . Application Disapproved for the following reasons: ........................................... .......-------- .....-- ------. -----------.... ----. . -- . --.. --------- -- -- -- - --- ------- ----------------------------------- ------- ----------------------------------------------------------- -----........................................ ------............................... Date PermitNo. --------- ......----� ...C�........................ Issued ................... Date......... ...------------..............---------- THE COMMONWEALTH OF MASSACHUSETTS �_- BOA!I OF HEALTH G�!J►la of --- /fit_?t`1 {. L „---................................... ............................................ (Ile rtifirate of Cfomylianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by .............--------------------- ------------------------------------------------------------------------------"..------------------..........------------------------------------------------------------------------------------- q Ins[aller i at ... �'5 0�-�------- - —4:- ... U 1"t .�Z S ►1� f "1 °-t- -------------------------------------------------------......................... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ......J�...3---3 ------------------- dated............................. .................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-----------------�--------�.7---. ..---...---..."..-----------.----------I--- Inspector ..............------ --------- .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF L�r�.2�i i PLC, oa FEE�3�........... MsVosol Works Tonstrnrtion rrmit Permissionis hereby granted.............................................................................................................................................. to Construct - ) Repair ( ;�j an Individual Sewage DispO�QSosal System at No .............. Street —' -- as shown on the application for Disposal Works Construction Permit No....`':' __- Dated.......................................... ..................................... :::.- ................................................ oard of Health DATE -------•-----------=----'------------------ FORM 1255 HOSES & WARREN. INC., PUBLISHERS d Go P pp THE;p Town of Barnstable Barnstable AD-America RegulatoryServices Department BARNSCABLE, I I 11, � p� MASS, 01 Public Health Division 200 prfD'"''` 200 Main Street, Hyannis MA 02601 email: Barastable.Rental.Re ' tra on@town.barp table.ma.us OFFICE: 508-862-4644 ". .m J3 ' FAX: 508-790-6304 Thomas A.McKean,CHO kPPLICA 109"OR REAV REGISTRATION Date: )-0 2, Fee: $90.00 Per Uni -Plus $25 for ? �v� - a each addtl,unit on the same parcel Property Location: 'col • �2a.cc 0 ICI ag 51-W1g Wtk, 1� 02-(Pq ' UNIT# If Applicable, BUILDING# Assessor's Map and Parcel: 24, er3 1 Number of Rental Units You Own At This Property (including this unit) � s Name: I�lt if a(tr y° VvUol� t If, ! 7x/Telephone Numbers (Daytime) (o f - 2-1-3 3�6 _ (Home Phone) k'q B SI (Cellular) -y 11-3 3 GO Owner s Address: 1115- e U,c-e- , M dii,$ VU 5 i a Mailing Address: (if different than above) Email: MA,Ao"gCowzGg• nek Owner's Representative's Name (if Applicable): Address: I Telephone Number: r ay lX Occupant's Name: ' \P��Cu uG� 04-4 VlflDifU Daytime Phone Number: Cellular U I Number of Bedrooms: t Check One: Is-this a single family dwelling unit? {✓]� an apartment building? [ ] or an accessory apartment? [ ]. /Private Drinking Well? [ ] Do You Have Zoning/Building Division Approval for an accessory apartment? Will there be any children under the age of six who will be occupying the gee l unit? (circle one) No Was the dwelling constructed prior to 1979? No 'W ee4l deV9?J- I certify that the information provided above is true: *Inspections Done Annually. Applicant's Signature C:Oocuments and Settings\herrandk\Desktop\RentalRegistAppFbrm w 25 fee May 2012.doc PAGE 1 OF 2 INSTRUCTIONS ON PAGE 2. Town of Barnstable ���; ��� �F1HE roy, Regulatory Services Barnstable / do Thomas F. Geiler,Director AMmericacfl9 1 Public Health Division * B"RN,K ss"B Thomas McKean' Director I I y f �Ai i639' a`e 200 Main Street 2007 ED Mp`l Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 � O ...._ tag Sent Via Certified Mail: 7006 0810 0000 3524 7137 December 7, 2012 .,., Margaret Nash R{ rn 1295 Race Lane r- Marstons Mills, MA 02648 As of October 1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register their rental units with the Town of Barnstable Health Division. . According to our records, you own the rental property at 1295 Race Lane, Marstons Mills, MA. Enclosed is an application_. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at • www.town.bamstable.ma.us. Go to the Health Division page by looking in.the Department Menu. There is a link to the Rental Registration information on the Health Division page. You g Pg may print out as many as you need, and return them to the Health Division with the appropriate 2012 fees included. This must be completed within (14) fourteen days of your receipt of this letter. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of$100. Each day of non-compliance is considered a separate offense. Should you have any questions, please feel free to call 508-862-4644. Thank you in advance for your cooperation. Karen Herrand J Division Assistant �,1 Public Health Division 0)v Direct#508-862-4072 3 J��N ti— CP t t:C Uj,. 6 v _ c SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. S' n item 4 if Restricted Delivery is desired. X ❑Agent ` ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by(Printed Name) Date of Delivery Aftach this card to the back of the mailpiece, d EZ qW on the.front if space permits. AAM4 a,� 2012- D. Is delive address different from Rem 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No V r I Z'r,4Vn V r I t `.5 i I� 3. Service Type nrtified Mail ❑Express Mail �a 6u ❑Registered 9_;d%Wm Receipt for Merchandise ❑Insured Mail "U C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes I 2. Article Number _ '. '' << 3 1 (Transfer from service labe/) ' it 7 0 0 Ei 10 810 0M }3 5 2-4 71371 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE ' ,. a mit No.G-16 ! • Sender: Please print your name, address, and ZIP+4 in this box • I I t � I I f � 1 �., Town of Barnstable Health Division 2.00 Main Street I Hyannis,MA 02601 i I ! l u,w..— 1�lalfiflflfltlf�lt!fJi'.)1.fiffiii!fiill;!l11!{ilflallff:f�flft m m Postage $ p Certieed Fee p p 6ostma►k Return Receipt Fee p (Endorsement Required) Here O Restricted Delivery'Fee (Endorsement Required) CO p Total Postage&Fees p Sena N Street Apt, of or PO Box No. �Q_ L�-f .Pity,Staff zP+41 Yti'1 °lCs !m ►�- oab� 77, Certified Mail Provides: - ta A mailing receipt (as enay)3003 eun��0o -oJ sd, Is A unique identifier for your mailpiece s A record of delivery kept by the Postal Service for two years I mportant Reminders: m Certified Mail may ONLY be combined with First-Class Mail®or PH ' Mail®. ■ Certified Mail is not available for any class of international mail. s NO INSURANCE COVERAGE IS PROVIDED with Certified For valuables,please consider Insured or Registered Mail. • For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811 to the article and add applicable postage to cover the fee.Endorse mailpiece'.Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. - a For an additional fee, delivery may be restricted to the addressee:or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Delivery". ® tf a postmark on the Certified Mail_receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. _IMPORTANT:Save this receipt and present It when making an inquiry. 1 Internet access to delivery information is not available on mail addressed to APOs and FPOs. Town of Barnstable CF I l� Regulatory Services Barnstable fig`' o Thomas F. Geiler, Director A"mericaCity snxxsrnst.E, Public Health Division I I * 9 MASS. Thomas McKean, Director . i639. `0 2007 Argo , a 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 y Sent Via Certified Mail: 7006 0810 0000 3524 7137 December 7, 2012 Margaret Nash 1295 Race Lane Marstons Mills, MA 02648 As of October 1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register their rental units with the Town of Barnstable Health Division. , According to our records, you own the rental property at 1295 Race Lane, Marstons Mills, MA. Enclosed is an application. Please use a separate application for'each • rental unit you own. Should you need more applications, they are available online at www.town.bamstable.ma.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information.on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2012 fees included. This must be completed within (14) fourteen days of your receipt of this letter. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of$100. Each day of non-compliance is considered a separate offense. Ii Should you have any questions, please feel free to call 508-862-4644. Thank you-in advance for your cooperation. Karen Herrand Division Assistant Public Health Division Direct#508-862-4072 Map Page 1 of 1 • Town of Barnstable Geographic Information System New Search Home Help Parcel Viewer Custom Map Abutters t"I°=5°, Zoom Out j j j�j j 11� El JPG Map: 064 Parcel: 012 Full Property 4 ' 08400800e Location: 1295 RACE LANE Info s Owner: NASH,MARGARET R 054638 .Location Information a 1323_. Map&Parcel 064012 Location 1295 RACE LANE 4 ). Acreage 2.83 acres 084013 p 1317 .Current Owner Mailing Address NASH,MARGARET R 1295 RACE LN E MARSTONS MILLS,MA 02648 �7 089012 � I Appraised Value(FY 2012) Extra Features $47,800 r Out Buildings $0 _ Land $148,400 0540 330""' Buildings $143,600 au �6 Total Appraised $339,800 �e Assessed Value(FY 2012) Extra Features $47,800 t' Out Buildings $0 054007 Land $148,400 M15 a Y Buildings $143,600 Set Scale 1" _�ti5 � I April 2008 I MAP DISCLAIMER Total Assessed $339,800 _:j • Copyright 2005-2010 Town of Barnstable.MA All rights reserved Send questions or winments to GIS 1 r ' http://66.203.95.236/arcims/appgeoapp/map.aspx'?propertyID=064012&mapparback=O640... 12/6/2012 r Town of Barnstable �.�,, '„ Page 1 of 1 —Back B[H,T[540]1 Building � Pine/Soft Style Conventional Interior Floors Wood ` Model Residential Interior Walls Plastered gJPj Y Grade Average Heat Fuel OilHot rn' Stories 1 Story F A Heat Type Air Exterior Walls Wood Shingle AC Type None , Roof Structure Gable/Hip Bedrooms 2 8 Bedrooms30 Roof Cover Wood Shingle Bathrooms Full �t 1 H Replacement Cost $147151 living area 1506 Depreciation 25Year Built 1780 Total Rooms Rooms Building Style Ranch Interior Floors Pine/Soft WoodVinyl/Asphalt �ER AT , Model Residential Interior Walls Knotty _ .. Pine Grade Average Minus Heat Fuel Oil g '• TA Stories 1 Story Heat Type Aot Exterior Walls Wood Shingle AC Type None Roof Structure Gable/Hip Bedrooms 1 Bedroom Roof Cover Asph/F GIs/Cmp Bathrooms 1 Full Replacement Cost $51010 living area 520 Depreciation 35Year Built 1950 Total Rooms Rooms 0o s http://www.town.bamstable.ma.us/Assessing/print06.asp?mappar=064012 12/6/2012 II i + DATE:_-9'/27195 . PROPERTY ADDRESS:-1295 Race "Lane Marstons Mills ,Mass On the above date; I Inspected the septic system at the above address. This system consists of the following: 1 . '1-1000 gallon leaching' pit packed in stone. 2. 1-Distribution box. 3. I-1000 gallon septic ..tank. Based do my Inszoaction, I certify the following conditions: 1 . This is a .title five septic system. ' ( 78. Code' ) 2. The peptic system is in proper worki-irg order-,at • the' present time:- SIGNATURE: Name:_J_P_Macomber Jr_.. Company: J.P_Macor4ber & Son-_Inc , p r A d d.re s s:_-&;_c-bb-----= -= -- �Cr �cr1V Cente L,M_rvilleass__02.632 ' 4 1995 Phone:---SQ87-5a3338_-___-- 1 e S � THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY • JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachf fields Pumped & Installed Town Sewer Connectlons P.O. Box 66' Centerville, MA 02632-0066 773-3338 77"412 Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection William F.Weld Governor Trudy Coxe Secre,. ,ECEA • David B. Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 1 295 Race Lane Marstons Mills Address of Owner: Margo NashESQ Date of Inspection: 9/25/95 (If different) 330 Brodway Name of Inspector: ,Tose�Y� P Mae�m�er Jr. Cambrid e Mass . 02139 Company Name, Ad ress a d elephone um er: g Box 66 Cent,erville ,Mass . 02632 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 Inspector's Signature, . Date: 9-7T The System Inspector shall submit a copy of this inspection report to the Approving Authority 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. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) i4 The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is 14 imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) 1 One Winter Street 0 Boston,Massachusetts 02108 0 FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1 295 Race Lane Marstons Mills ,Mass . Owner: Margo Nash,ESQ Date of Inspection: 9/2 5/9 5 B] SYSTEM CONDITIONALLY PASSES (continued) 'T 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 . Ze 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 C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: �d 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 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 a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: 1J The system nas a septic tonic anei suii absorption system and is withir. 100 feet to a surface: water supply or tributary to a surface water supply. JZj The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. ,LW The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. .LO The system has a septic tank and soil absorption system and 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. D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined 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. Backup of sewage into facility or-system component due to an 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. (revised 8/15/.95) 2 r , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1 295 Race Lane Marstons Mills Mass . Owner: Margo Nash,ESQ Date of Inspection: 9/2 5/9 5 D] SYSTEM FAILS (continued): �! 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 1/2 day flow. Required pumping more than 4 times i the last year NOT due to clogged or obstructed pipe(s). Number of times pumped�e,4 �ur'2��. Ar Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. dN Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 1� Any portion of a cesspool or privy is within a Zone I of.a public well. &b 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 analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 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: 40 the system is within 400 feet of a surface drinking water supply A4 the system is within 200 feet of a tributary to a surface drinking water supply 40 the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1295 Race Lane Marston Mills ,Mass . Owner: Margo Nash,ESQ ' Date of Inspection: 9/2 5/9 5 Check if the following have been done: lumping information was requested of the owner, occupant, and 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. L/ As built plans have been obtained and examined. Note if they are not available with N/A. X/The facility or dwelling was inspected for signs of sewage back-up. the system does not receive non-sanitary or industrial waste flow ,L//The site was inspected for signs of breakout. ✓ All system components, excluding the Soil Absorption System, have been.located on the site. YThe 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 or approximated by non-intrusive methods. _The facility ov.ner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. Recommendations 1 . Covers on the distribution box should be raised. 2. Cover on the leaching pit should be raised. 3. Septic tank covers should be raised. (revised 8/15/95) 4 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1295 Race Lane Marstons Mi11s ,Mass . Owner: . Margo Nash,ESQ Date of Inspection: 9/2 5/9 5 FLOW CONDITIONS RESIDENTIAL: Design flow: • D all ns Number of bedrooms: Number of current residents: Garbage grinder(yes or no):_ALP Laundry connected to syst m (yes or no):,D Seasonal use (yes or no):in Water meter readings, if available: Q�J " / e4iMIS, e✓ �P�►Q• o. Last date of occupancy: COMMERCIAUINDUSTRIAL: Type of establishment:" �� Design flow: gallons/day 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 an�j source of information: YU ✓JPi' &P d)44 OGC1�t�ifd System pumped as pan of inspe ion: (yes or no)/L If yes, volume pumped. gallons. Reason for pumping: TYPE OSTEM _L,-1 Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Y. Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other(explain) API 1�-!XIMATE AGE of all components, date installed (if known) and source of information: fet4-�2 S Sewage odors detected when arriving at the site: (yes or no) IVY (revised 8/15/95) $ • r. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION (continued) Property Address: 1295 Race Lane Marstons Mills ,Mass. - Owner: Margo Nash,ESQ Date of Inspection: 9/2 5/9 5 SEPTIC TANK:.L" (locate on site plan) ��/ Depth below grader � Material of construction: !/concrete _metal _FRP—other(explain) Dimensions: 0 Zwo {� g� Sludge depth: z- 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:iA P Comments: (recommendation for pumping, conditi n of inlet and'outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) S q'v -4-1 - GREASE TRAP:40 (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP_other(explain) . Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom nl scum to bottom of outlet tee or baffle: 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.i (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1295 Race Lane Marstons Mills ,Mass . Owner: Margo Nash,ESQ Date of Inspection: 9/2 5/9 5 TIGHT OR HOLDING TANK:0 (locate on site plan) Depth below grade: Material of construction: _concrete_metal _FRP—other(explain) Dimensions: Capacity: allons Design flow:_ allons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and floa: switches, etc.) DISTRIBUTION BOX:Z (locate on site plan) Depth of liquid level above outlet invert:/ Comments: (note if lev I and distributiui, is equal, evidence of sglids carryover, evidence of leakage into or out of box, etc.) r LA-rt� U r 6 U ti O - r PUMP CHAMBER:AZO (locate on site plan) Pumps in working order.(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 t SUBSURFACE SEWAGE DISPOSAL;SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1295 Race Lane Marstons Mills ,Mass . Owner: Margo Nash,ESQ Date of Inspection: 9/2 5/9 5 SOIL ABSORPTION SYSTEM(SAS):2 ' (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) ' If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: i Comments- (notA condition of soil, sins of hydraulic failure, level of ponding, condition of vegetation,etc.) V YET 'i�w.T AN LZ.S �AK �"1� CESSPOOLS: (locate on site pan) 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 (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:&0 e (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 8/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1295 Race Lane Marstons MI11s ,Mass . Owner: Margo Nash,ESQ Date of Inspection: 9/2 5/9 5 SKETCH OF SEWAGE DISPOSAL SYSTEM: • include ties to at least two permanent references landmarks or.benchmarks locate all wells within 100' O jo �okC DEPTH TO GROUNDWATER Depth to groundwater: feet method of_dyer 'nation or approx' ation: �. (revised 8/15/95) 9 .rrn�rrf•rr••rt1�-r..:rr.�r•Tr..r...-.r.::r...rrr:-rr�.--rs-s-tr:—rc.r.....- ...-. -.. -.- .-.... --.rrr..-r-.r.rt-.r..-r.- TOWN OF Ba rn s to hl a BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D .- CERTIFICATION F•••t!•:-T"•-::.��,11.:�.-•.�T1.T.�TRT.:Trt�T.—...'TT.:TTCt'T�•it�:.�'T.ZiTSJ—`f':�f.Ct:a= fit .— .. . itt7tRTeTlrT:T'eTTlT'ITt'tRt�ri•T'r•-1 '—. -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 1295 Rara Tine Marstons Mills .Mass . ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAMEMargo Nagh ,'FqQ� PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P. Macomber Jr. . COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Street Town or City State LIP COMPANY TELEPHONE ( �(�Q 1775 3338 FAX ( 508 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate, and complete as of the time o'f :inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one: XXXXXSystem PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which,' I have conducted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 310 CMR 15 , 30.3, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . ,le . Inspector Signature ' Date 9/27/95 One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or operator shall upgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 310 CMR 15 . 305 . partd.doc " C �^mnn� 1 r� CI zC=".;serS v.I�I, cnNercm v, I w Exec,rve Gf,ice C. cE^vircrlr—,en a s ®enartment of Environmental Protection ' Water Pollution CcnTrol Tecnniccl Asswcnce and Training SecTions MUL= F.wow GO—Mr Trudy Cos• 5•cwary,ECCA Thomas &Pow«s :4'q Com+r.crr . 06/12/95 ATTN: Joseph P. Macomber, Jr. Joseph Macomber and Scut PO Box 66 Centerville, MA 02632- Dear Joseph P. Macomber, Jr . , _ I am pleased to inform you that you have attended training, met the experience qualifications , and have passed the Title 5 System Inspector exam, pursuant to 310 CMR 15 . 340 . The passing grade for the exam was 39/52 or 75% . This is an official notification that you are a Certified Department of Environmental Protection System Inspector pursuant to 310 CMR 15 . 340 . You will receive a System Inspector certificate at a later date. If you have any futher questions, please write to me at the following address: Kimball Simpson D. E. P. Training Center 50 Route 20 Millbury, MA 01527 Thank you very much for yoir time and consideration in this matter. Sincerely, Kimball T. S:moson, DEP Training C ur Director 2405� „ .. Routs .4 9 Millbury, MA � FAX 58-755.9253 • �� �n• 508-756-770' ........ _ Water Conservation SAVE Tips . * . ME. i , CHECK FOR LEAKS Water Loss in Gallons Due to Leaks Leak this Loss Per Day Loss Per Month Size • 120 3,600 • 360 10,800 • 693 20,790 • 1,200 36,000 • 1,920 57,600 3,096 92,880 ® 4,296 128,980 ® 6,640 199,200. 6,984 200,520 8;424 252,720 9,888 296,640 11,324 339,720 12,720 381,600 14,952 448,560 `� I (a y-3/4y L Yam'0 C T: A ION S E W A G PPERMIT4140. VILLA G E �Grs)�>n ,S As INSTA LLER'S NAME i ADDRESS JOHN A, AALTo mcmm SERVID9 West ,Barnstable,:MassJD2668 B U I L D E R OR OWNER CA Tho_I s► © DATE PERMIT ISSUED _ �0 e DATE COMPLIANCE ' ISSUED �� S,•%`� o, f, � THE COMMONWEALTH OF MASSACHUSETTS BOAR® ®OF HEALTH .........,r8.W A -*.------..OF... -RN.S.l,V,0,:4�................................ Allp irattion for Dhip a al Works Tonstrnrtion ranfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: --------------------------------------------- ..--- ----.-...•------•.....-- Location-Address or Lot No ...1�vIN SJOR------------------•----- rr �9P YJ /E'. . ......t,111 1 1 11?61t.!!1A. 15® Owner Address% ---------------------------------- 'W1P17_7•_,Xt_9_R1VS.7"i- .8.��--------------------------------- ----- Installer Address Type of Buildin Size Lot............................Sq. feet U Dwelling No. of Bedrooms........4..............................Expansion Attic (r o Garbage Grinder (A!j) Other—T e of Building No. of persons............................ Showers. a YP g ------•-•-----•-----------•- P ( ) — Cafeteria ( ) dOther fixtures --------------- -------•-•----•-•••--••-------••-••-•.-••---------•-••-•-•---•--------------•-••••••••-•-.....•••••--•••--•••••--•--•-••.........---- W Design Flow........../1,6...................a_..gallons per person per day. Total daily flow-------- .......................gallons. WSeptic Tank—Liquid'capacity V-__sQgallons Length................ Width................ Diameter--.-----........ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.........---.--..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test ResultsNAPerformed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..---................--. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---.__...-.----_._....-- 9 ----•--------•------------------------------------------------------------------------•----•---_............................................---- •------------ 0 Description of Soil....................................................................................................................................................• •....---•-••----- W U --------------- ------------------------------------------------------------------ ------------------------------------- .-------------- ------------- -------------------••-•------_---••-•-••---••--- W U Nature of Repairs or Alterations—Answer when applicable-A-Z4464.�1'f®/v_..__ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bSp issued by th board of health. Signed ---/-D ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons---------------••---------------•--------------------------------------------•-----......................... -•--.................................................................................................................................................................................................... Date PermitNo......................................................... Issued........................................................ Date --> THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . /V..........oF...RA./3.1!5 L,.--------------------------------- Appliratiou for lliipnsal aarko-Tint ,itrnr#ion rantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Addressf or Lo N Owner a .44.47= -------------------------------------•--------------- ........................................... Installer Address U Type of Buildog Size`Lot............................Sq. feet 1.117 I•-. Dwelling No. of Bedrooms..................................___________Expansion Attic,0) Garbage Grinder 40) W'4 Other—T e of Building No. of ersons___________________________ Showers —Type g ---------------•---•-------- P - ( ) — Cafeteria ( ) dOthg 6xtures --- -•-•-•••-•-•--•------=--••--------------------•--•-----•••••••----•-------••---••------••------...------------------ ...---•---- W Design FloVgallons per person per day. Total daily flow.-_-�7 .0_________________________•gallons. WSeptic Tank—Liquid capacit�............gallons Length................ Width................ Diameter----............ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth.. below inlet-----............... Total leaching area..................sq. ft. Z Other Distribution box (,� g tank ( ' '—' Percolation Test Resul�s� Y.. �, _ _ a Date....................................... . 'Test Pit No. 1............:...minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4o Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x -------------------------.................................................................................................................................... 0 Description of Soil........................................................................................................................................................................ U - ----------------------------- W ----------------------------------•----- -------•-••----•----•-•••----•............................... ,,� U Nature of Repairs or Alterations—Answer when applicable .. --4 • ------------------•--- ------------------------------------•-----------•----------•------••--•------------•--•-----........'----------•--------------------------------------------........................................... Agreement: The undersigned agrees to ,install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITU 5 of thee;State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha en issued byR°t,�ie board of health. Signe�� :. ,tea........................................... d .................. 0 sl... /ate Application Approved By-- Date Application Disapproved for the following reasons:.......... =`........=--•......... ------------ •---------------------------------------------------•---•------•--------...-------.._....--•------------------••-----•----------........................................... Date PermitNo........................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' ................O F 4,�-9t 4e................................ %rrfifiratr of TlantpliFanrr (0" OEZTI�That the Individual Sewage Disposal System constructed ( )"or-Repaired ( ) y-•��------•--••-•-------•---o•,r-'.-•'-.=---•------•--•--•--------------------------•-•------------•----- -•..---•--•--------------•-----.....-------------------••-----......._.:-----------------• has been installed in accordance with the provisions of UT Y 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit N -_•'�,. � ______________ dated------------------------------------------------ THE ISSUA CE- F THIS CERTIFICATE SHALL NOT BE CONSTRUED AS.A GUARANTEE THAT THE SYSTEM 1NIL ION SATISFACTORY. DATf. ................................................ Inspector--- ,-- ---------------------------- ........................................ III2V7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH NP I- 1 ........OF,��..A j 3(74.8 ? -•--- --- --- FED' ..... Works %-Conn#rnrtion- rrntit Permission is hereby granted -•-�-- L� ................--............................................................................... to Construct ( ), rp >r Individu ear > p sal S st at No. r - .- i - � -- Street as shown on the application for Disposal Works Construction Permit __ _______________ Dated.......................................... Board of Health DATE._--•-----••--•-•--• - ......................................... FORM 1255 A. M. SULKIN, INC., BOSTON .F �,r TOWN OF BARNSTAB_LE LOCATION Ge- Q, SEWAGE f VILLAGE,e,LZ'C, ASSESSOR'S MAP Ci LOT INSTALLER'S NAME & PHONE.NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No O ' \ \ q� a /2 9S` / A L .4•ve o •JC A sPo � --z� w �I I )CZIfj,6 lot Oqr u � �' � 1�►I�"� I ►����� ,�- Viz,o rn _... _..._....- _�.....__..�_.. - ��.. ,�''�`�- _ �3 � »1 pro` 1, ' > � 151,2 41 NO. 29733 µ 1 l-L5, ' I 11 f Ai GZ, 1 �2�P ► Y \JJ N A r�7 � � t ,. � 1 e r�l C�yU 11 lga tS r 41 1 IJ )i ` 1 V us, —�........... Itug iNvWMIAM NY iu� t�� � ►uY - v�C No. 1% _ 12 41 PE.T7 •y , LC L °.r.. VU►�Sit- 51v � VAN suil Aw— ' IL 41 .6— A-Ij F!tom:L-L) f -t-)o C I U I 4EU I u