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1605 RACE LANE - Health
1605 RACE LANE MARSTONS MILLS A = 047 020 r' 00 i -j TOWN OF BARNSTABLE LOCATION ?Gee, Gnl SEWAGE# i90(g 03O VILLAGE /L�(� ��5 &&3 ASSESSOR'SMAP&PARCEL yT INSTALLER'S NAME&PHONE NO. q/4, 1 / :&—. J ): Lc SEPTIC TANK CAPACITY q 1000 Ad LEACHING FACILITY:(type) . I :^ (size) S31,5 AZ NO.OF BEDROOMS OWNER PERMIT DAT : -�-B J H COMPLIANCE DATE: - �/Q Separation Distance Between the: Yvollgk C"F Pok Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BYE, ` f ,�� � - 16 a q5 50 17 l 0 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ' Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Mispo8AY 6pstem Construction Vermlt Application for a Permit to Construct( ) Repair(-,,"Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 16-05 Owner's Name,Address,and Tel.No. A41.iw✓S /t 019 f�/ ION / v Assessor's Map/Parcelo`�� / Y In/st�aller's Name,Address,and Tel.No. ,J Designer's Name,Address`, ,and Tel.No. 'COO �°��-%S�Y/ Type of Building: / Dwelling No.of Bedrooms Lot Size d/6 7411 sq.ft. Garbage Grinder( ) Other Type of Building /'e5/6)t'�/�JGc No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3:�O gpd Design flow provided �/ � 9 gpd Plan Date 1,2 -,90— 7 Number of sheets 2- Revision Date Title 1 Size of Septic Tank � �5//�v�a n)t'vJ 4 Q=jt Yype of S.A.S. ,�00 c G/)G�/ 4 - 2 O (AGE✓/ rrS 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. Signe Date Application Approved by Date _ Application.Disapproved by Date for the following reasons Permit No. C'9LO 1 Date Issued _ �''� t (� No. y Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V PUBLIC HEALTH DIVISION TOWN ;OF BARNSTABLE, MASSACHUSETTS Yes !application for.Misvosal,6pstem Construction Permit Application for a Permit to Construct( ) Repair .. , upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /�5 A6ee-4:,,,,e Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ,�,aQ I/10N / DY le Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. `�sd3/�3 /1 Tjf vr��-�1•v� szo-. vo-�/S3� Type of Building: Dwelling No.of Bedrooms Lot Size1�,7y� sq.ft. Garbage Grinder( ) Other Type of Building /1 ,5/ '�¢!G'� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3:�O gpd Design flow provided ✓ /s�� gpd Plan Date !�^ -�0 (� Number of sheets `L Revision Date Title Size of Septic Tank f gjhv Ole, ti w 1l' ��fype of S.A.S. 5(�p ti G/1�N U 1-�Gi✓I M 5 Description of Soil + s' Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: �x The undersigned agrees,to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed" .�- Date i' °1 l _ Application Approved by � Date Application Disapproved by Date for the following reasons 4 Permit No. .510 ,(4 a 0 Date Issued t ----------------------------------- Z THE COMMONWEALTH OF MASSACHUSETTS . BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(v�Upgraded( ) .Abandoned( )by`l :A-10 Ar at I Gc.�r /(�orgf y,/S M 89- has been constructed in accordance with the provisions of Title 5 and thefor Disposal System Construction Permit No.(9o19-6'0 dated "- Installer�L:/pvf/G'r+ /S l�ryi✓.ri✓� Designer .%;�Nc'f� #bedrooms 3 Approved-design flowt3 Y) and The issuance of this permit shall not be construed as a guarantee that the sys(m will fi�c ionNs designed. Date n4_.��`_e, ( ! Inspect - - - - - - ----------- -_ - _- ------ --------.------- ---------- --------------------------------------- No. U C O ! d a? Fee V THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction 3permit Permission is hereby granted to Construct( ) Repair( l'j� Upgrade( ) Abandon( ) System located at /G(} Gt �.✓P /�/r�G/f�/r �/j��/� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. 1 I Provided:Construction must be completed within three years of the date of this permit. Approved b PP Y M -To Town of Barnstable y� j"E' ti°� Regulatory Services P� ' Richard V. Scali, Interim Director * BARNKABLE. 9 MASS. i639. a Public Health Division `�0 '�futnp�A Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 509-862-4644 Fax: 508-790-6304 Installer_& Designer Certification Form Date: Sewage Permit# 201 = 7Q Assessor's MapTarcel Designer: n�;r►eer WQ,-Lls, 1 Installer: Address: I LQ, C(-css�- e Address: o s3a (.Lfs On -8�-1 c l�C0 ry was issued a permit to install a (date) l-7 (-installer) septic system at ('o('� 2�sr,off 1 / ,�M i based on a design drawn by e+e address) _ ► ine��,"n (aAn:t /'I C , dated 9 -30_1 7 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (Le. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructs nce with the terms of the 11A approval letters (if applicable) tHOF PETER T. + MCENTEE aS CIVIL aller's tgnature) NO.35lo9 �FG/STEp (Designer's Signature) (Affix Designer tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:1Scpti6Dcsigncr Certification Form Rev 8-14-13.doc Town of Barnstable P# ]Department of Regulatory Services > ST,BM Public Health Division Datey /7 200 Main Street,Hyannis MA 02601 P,1 QED MA't� w.,G nn htit Date Scheduled c Time Fee Pd, � � �CJ r-4 P+� Soil Suitability Assessment for Sewage Disposal; Performed By: .f�l C, 1 "�e r --f57-c/ �imessed By: LDCATION & GENERAL INFORMATION Location Address Owner's Name C ki V-4 44 eh Qr3�0's't�J McF�Cs Address gd��riw Assessor's Map/Parcel: !h'%Qr M�- ® l f-7 .—C Z6 Engineer's Name r�s t+41�e'l1� way 1 ETW CONS i RUCTION -t, REPA Z _ Telephone# ,5'6 8-Li Land Use S ttwl - Slopes Surface Stones /lfdnQ Distances from: Open Water Body 7 ft Possible Wet Area 7 3�'/ft Drinking Water Well 7 ft Drainage Way_ + ft Property Line �d ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetland pro 'miiy to holes) l i � r Parent material(geologic) �" Depth to Bedrock YVLA,— T Depth to Groundwater. Standing Water in Hole: N!S M Weeping from Pit Pace 1VCY14 Estimated Seasonal High Groundwater _ > Z DETERMINATION FOR SEASONAL HIGH WATER TABLE Metho:',Used: ._.-._�__,.__.._._. hDepth Observed standing in obs.hole: in. Depth to soil mottles:__....-..._.._,in. Depth to weeping from side of obs.hole: --in. Groundwater Adjustment_ ft. Index Well# Reading Date: _ Index Well level— Adl,factor— Adj.,Groundwater Level PERCOLATION TEST Date- Time....._._ Observation Hole# ����� t�� _ Time at h" Depth of Perc F U/ J 24 3`t Time at 6" Start Pre-soak Time @ I-S_M'i" Time:(9"•6") , End Pre-soak L.2 Rate Min./Inch. _ Site Suitability Assessment: Site Passi;d Site Failed:_ Additional Testing Needed(Y/N) t ' .Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to Ibe conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at Ieast one (1) week prior to beginning. Q:\.S EPTIC\PERCFORM.DOC - ` - DEEP.OBSERVATION HOLE LOG ;,[sole# Te--,jI Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones-Boulders. Consistency.% ravel C'oarSe 5,-.A. 1A .d'L � y 7 ram,.1 DEEP OBSERVATION HOLE LOG Hole#�z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) ' DEEP OBSERVATION HOLE LOG H()le# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Con isle c o Gravel) i DEEP OBSERVATION HOLE LOG Role# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) MotiAing (Structure,Stones,Boulders. - .• -. Consi ten Oravel),._ Flood Insurance Rate Man: F Above 500 year flood boundary No— Yes Within 500 year boundary No—X Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? , `, 5 - -- If not, what is the depth of naturally occurring pervious material?-.-.._._._;.� Certification ��! I certify that on . "�� �' (date)I have passed the soil evaluator examination approved by the: Department of Environmental Protection and that the above analysis was parformed by me consistent with the required trai ' ,expertise and experience described in 310 CMR:15.0!t7. Signature_ Date_16 PA [-7 Q:\SEMC1PERCFORM.DOC /(.C) ��.Li�' ,/'s'r�l.J/�'..D� � I �/.s�i •�l � .." �i�rU"p�..�:._ • !'�cE •6 LTOZ 17T ddU • 1 770 i —Tl:j -77 I 15 17Ao � A Gd NE Ica 0 c f It 1 jvr i i�.._ i • I �i ISM /$,477/ THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR i QUALITY ORIGINAL (S) I M L DATA i Yl ,I ,th xl r • .. 1 I i � %� 1 {j�i'.{�w"�'•i"L.�w;( �• ' rc wax:.., N:. ' +.r - + I Oil I P1 a ! ' f rl .. •'-^ _y�Vi:. _•._ .... �. :xi......... ..... ......... Mi i j''� � ash. ,'*� '.�,, f�• ....�.��t�,Oc,r':-•♦i'�•' ,Sw.4Y1���, . 1: ........_:.__......_:_.............._.., ..,. _ : _.. . _. ,._.._._.•.........,,__._.,_,..:._. •..,.Y., i'+/lei'' v j : • ,r r• i 1 i r F tr i a r � i _3 121 Scale t ' i 5 v •'_yam'- �- 4 �•4,'(. .v• sue" L ud Court.. Pjangop5l I Lot, - _ ` B d 484 - NeWorld Bank of savuss .f+. CERTIFY TMAmot• _:,_ '.r.•i L��.x:f�L.,,. _.,,.�T"i? T THAT - TOW -__ - - 'e ZONING REGULATIONS, 1 FURTHER CERTIFY !yam.. WIMP THE _ - P. =f_- .. __._. Gtii _ Office: 508-8624644 Barnstable FAX: 508-790-6304 Town of Barnstable ahN A&AnwdcaCiW Board of Health i I F 200 Main Street, Hyannis MA 02601 2007 August 10,2010 Revised March 9,2016 Public and Environmental Health Program Policies, Procedures, and Guidelines Enforcement of 310 CMR 15.223, Septic Tanks/ Properly Sized Septic Tank and Two Compartment Tank Enforcement No. 2010-007 Septic Tank Size When/if an applicant requests a local or State Code variance involving a setback distance to wetlands, high groundwater, or any other environmental type of variance to the Board of Health to be reviewed at a public meeting of the Board (not a variance request involving a setback distance to a foundation or property line), the Board of Health will require full compliance with Section 310 CMR 15.223 of the State Environmental Code, Title V. Specifically, when an environmental variance of any type is requested, a properly sized septic tank will be required by the Board. Two Compartment Tank or Two Tanks in Series When a design involves facilities other than a single family dwelling unit or whenever the calculated design flow is 1,000 gallons per day or greater, a two compartment septic tank or two tanks in series will be required. This requirement shall be enforced during the construction, repair and/or upgrade of a septic system, regardless of whether the repair or upgrade is proposed for the leaching facility only. (See back of page for clarification and examples regarding the requirement for two compartment tanks at dwelling units.) However, this policy does not apply to minor component repairs such as replacement of a distribution box, tee, piping, or component lid. Wayne Miller, M.D. Paul Canniff, DMD Junichi Sawayanagi Q:TOLICIES\Dual Compartment Tank Enforcement.doc 0 WJ No'p3..—V...« aFES...y ............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �f.�..- (N.......OF.........3ARA. --5.7413-4.&................ Appliration for Uiipniia1 Works Tnnitrnrtiun Frrmit Application is hereby made for a Permit to Construct ( -,/Or Repair ( } an Individual Sewage Disposal System at: �U .....RAUT......L.A...j............................................ .... -. ' . :.. .................................. Location-Address or Lot No. .......................s.iv.je.......... .11ll s Own r ` Address a ..........wz......�� W..---, � .-� ------ ail.... '• Pq Installer Address d Type of Building Size Lot..5_/._®0A7......Sq. f t Dwelling—No. of Bedrooms___._ ................................Expansion Attic ( ) Garbage Grinder Other—T" e of Building �'h^�:!4z QNo. of ersons-_-_-_-�--.....--.--.. Showers — Cafeteria Ga YP g P ( ) ) Q' Other fixtures ................................. W Design Flow...........� ........................gallons per personpfr day. Total daily flow........�.�__�.�....................gallons. WSeptic Tank—Liquid capacity/12...gallons Length_...:Q..... Width..' -L. Diameter................ Depth. ..-7.-. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area..............:.....sq. ft. Seepage Pit No---------I-..-_-.__._ iameter.._�D_� Depth below inlet.... f—_ ..� Total leaching area._�'�_7sq. ft.1GPO Z Other Distribution box ( � Dosingptank�, ~' Percolation Test Results Performed b. .I.ldc . -�--- ------------••-. --..... s__..._.... Date.,)l1*r.�.--. Y �! ��_.. ,4 Test Pit No. 1................minutes per inch Depth of Test Pit.___ .l�____- Depth to ground water.._..._...___�G_. Test Pit No. .2L....minutes per inch Pe th of Test Pit-------/C�... Depth to ground water.___ s 0 Description of Soil..!�" IA?15-.. .,X� .-.....J--'`'� J --------....•----•-------•---•-------•--------------•-................................ y� .�.....F Mgssq�y W --•-------------------------•---•---•-•---•--•-•-•----------- --------------------------------•----------------------------•---------------------•••.......... TER V Nature of Repairs or Alterations—Answer when applicable.......................................................................... . ......VVAE. o E. -•-----•••--•--------------••-------••••••-•---••----•----•---••--••-....._......_...........-•--•---•--•----.._....-----•------•-•-•-•-•-•-•-••-•-----•---------........•-----.-- -`.. ... !TH, JR: rn Agreement: #15128 I A The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accor �e q t TE�``� the provisions of iITL% 5 of the State Sanitary Code The undersigned further agrees not to place the s FS UAL ECG\ operation until a Certificate of Compliance has been is ed by the bwrd of health. o� j Dat Application Approved By.......... ---- -- -------------------•--•---••-----..._.....---------•-•--•----•--•---••-- ------------------ ----------------•-- Date Application Disapproved for he llowing reasons:-----•---•-------------------•------•---------------------------•--------------------------•--•-._......-------- ----•........--••-••-------------------------------------------------------------------------•------------•-•••--------------------- Date PermitNo......................................................... Issued....................................................... Date t .............. .. Fxs....< .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH A � .�., j� ........ :-.. -WA(......OF..........1RIB/... .. �'.4.4.. :............... Appliration for, Uhipaaal 10orkii Tom4rnrtinn ramit , Application is hereby made for a Permit to Construct ( &,or Repair ( ) an Individual Sewage Disposal System at: C, E .. - ,�� �. hems;, •- -••-••-- ................•----•------............... :........................... ................................ Location_Address or Lot No. • — .......... . .±��° ` , . .............. .... 7•-- c! t .„. .: . ....... Owner Address W Installer Address r Q Type of Building Size Lot... . __:__ .....Sq. feet U Dwelling—No. of Bedrooms-__.._ .............. .. .....Expansion Attic ( ') Garbage Grinder ( )U aa �-� 4......------. Showers — Other—Type of Building �.._ ..____...�4_�.�To. of persons................ ( ) Cafeteria ( ) QOther fixtures -•------•---------------------------------- --------------------------------------•----. ..----------... Design Flow.............�. ........................gallons per person�er day. Total; dailyflow ��.�-ems................gallons. 6I WSeptic Tank—Liquid capacity_10 ..gallons Length.__--__" ... Width__'`'°/.0 Diameter................ Depth...°' .. .. x Disposal Trench—No..................... Width.................... Total Length.............'....... Total leaching area....................sq. ft. 3 Seepage Pit No........../--------- iameter..../IZ-Q.. Depth below inlet..... .'...-..Total leaching area...05 7..sq. ft.AL-, z Other Distribution box ( Dosing ank Percolation Test Results Performed by- _ ......... ....... ......... Date.. .. ... ,a Test Pit No. 1......:''�- .minutes per inch Depth of Test Pit...... . .Q� Depth to ground water.....! ? . f1 Test Pit No. 2. 1- minutes per inch eprh of Test Pit..... '.... -`Depth to•grou water----- d A.00°.4 O Description of Soil.... . �."'../ ".:tom�' �, . At w •---•••••. ti �.__ _ x WALTER V Nature of Repairs or Alterations—Answer when applicable._.___................................................................... . ............E ..;....-•-•--•-----•--•--•--------•----•..............•---.............---•-•-----•-----------.....------........._...-----••--------•--......_...._._......-Sm!I- JR. `�" Agreement: A #15128 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accor the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the s operation until a Certificate of Compliance has been'issued by the board of health. Slier ----- -... - ... Application Approved B ....... ` -P R ,,s`� ate Application Disapproved for�tle fol owing reasons:.... s ..............•--•-----------•---..........---------------••----•----•---....----•--------•-•-------....----------•----•------•-••-•-------•----•--•--•-•------•--•---••-•----------•- ..._.._. Date PermitNo.......................................................... Issue_d....................................................... Date . THE COMMONWEALTH OF MASSACHUSETTS BOARD OFF HEAL „ ....................OF ............................ Trr#ifiratr of Tumphanrr T I IERTIFY, at th . ndividual Sewage Disposal System constructed' Repaired ( ) by... �� r. _ •• Installer - has been:mstalled;in,accordance with the provisions of TImLE 5 of The State Sanitary-Code des - c�in the application for Disposal Works Construction Permit No.._ ."._. 4............. . dated-.-. .: THE ISSUANC OF THIS CERTIFICATE SHALL NOT BE CONST AS GUARANTEE THAT THE SYSTEM WI TION SATISFACTORY. ; DATE-_.../.l ------------------ --- Inspector-- _...-- ------. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH S3 ..........................................OF..................................................................................... No..................::.... FEE.. � rrntt� Permission is reby granted.... .. f°c'41kf.. =' '��' j ...............•---.••---- to Construct ( or Repair ( �,,�"n In teal Se�Nr erpispo�ystem Street as shown on the application for Disposal Works Construction Permit No..................... ..... ✓" ". ............................... fi d o ealth FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ' '2 7-10 VA Ae f OIL g ® DEnt ol`cS TEST r +T I (C1006AL, �DiS7,$ 1 \ /St yr i c TAN t I / I Reo pose p N 1 k 2 8E De oom P / 9WCLL S Cx L_fiti tJ •No Ells 14G ut'I LS \A tfilhl BA4� V�5 i A 8L � R 55 Wig/H OF t' L VVALTEP SV11T1 JR �� eV 1 L©CAS 5 -8 5cAL-E �- 40 FED. -3, Y ,p. q. B4 Sl,ooC� + 15"v . .483 03 i l w 3r- / IL LAVhCRENCE E. HUGHES �����A OF��Ss9c Ft1EGis,rEREf3 LAND SURVEYOR o` t_AINRENCG 66 MAIN STREET.. REAR 747-0232 � EDWARD `, KINGGTON, MA. 02364 HUGHES � A No.22+n54 O 1 4��i/ or /'� v'li csoa S F , f ® �^�OTcS TES'i^ f i i I 10006AL. QiST.Bv- /SFot'icT'AN 1 I � I 1�2oPox'D N ��� I e i 9S / �o ��fisTiN6 WLL-5 W% T►ilN �y5-rEN► BAR M 5 i A &LC- V A--5'5 Or -•'�` WALTER Yl `� I c E. 1.r SMITH, JR. E AS I D E dr15128 L�JU I L[)G: .� �?, \`Cr v!ST;Qi` T � . _ _. .. .. �,'� s• fir: �°, �. r • .. ... _ . .. 3 � .4': `• Uh��,• ?. f y; � . [ «t >, ,,it• ,, t .a•}.. • 71 f 93', Q 4 r r+• ... _ ,t t tad -*�_•—;-- � � a A4. Co�1C:'L; A�'NN.I t 4ma x T kt jf r.,• . .. 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Board of Health 9 MAS9. g' qj s6gq ♦� ArFD"A0rA 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. October 18, 2004 Mr. Joseph Chretien ,1605 Race Lane Marstons Mills, MA Dear Mr.Chretien, We received correspondence from Ms. Lee McConnell dated August 25, 2004 and laboratory test results which indicated that your private well contained"trace amounts " 0.8 ug/l of perchlorate. This level fell below the recommended limit of 1.0 ug/1 and is not considered to be failed or contaminated at this time. During the public meeting of the Board of Health held on September 7, 2004,the Board voted to recommend that you test your well bi-annually in the future. At this time,the County laboratory is not EPA certified for the analysis of perchlorate; however they are planning to obtain the certifications in the near future. You may call Ms. Lee McConnell at the Barnstable County Department of Health and the Environment at(508) 375-6620 to discuss plans for conducting the recommended testing of your private well in the future. VeMiller, M.D. ChretienWell Of Bs BARNSTABLE COUNTY DEPARTMENT OF HEALTH AND ENVIRONMENT SUPERIOR COURT HOUSE POST OFFICE BOX 427 h BARNSTABLE, MASSACHUSETTS 02630 9SSACHU ��� Phone:(508)375-6613 S FAX(508)362-2603 TDD(508)362-5885 August 25, 2004 Thomas McKean Barnstable Health Department 200 Main St. Hyannis, MA 02601 Dear Mr. McKean: Enclosed is the report of samples collected by the Barnstable County Department of Health and Environment (BCDHE) for the preliminary screening of perchlorate contamination of residential wells in Marstons Mills. On July 20, 2004 Mary Garvey of 1645 Race Lane, Marstons Mills, tested her well water for perchlorate in response to a recent article in the newspaper regarding perchlorate contamination in Bourne. Unexpectedly, the sample contained what we determined to be trace amounts of perchlorate. The sample was first analyzed at an EPA certified laboratory, Alpha Lab results were 0.6 ug/l, and subsequently confirmed using similar methodology at our lab, Barnstable Health Lab results were 0.8 ug/l. To further investigate the situation we contacted twenty residents within a quarter mile radius from Ms. Garvey's home. Most homes in the area had town water available, however we were able to collect four samples from potable wells. Two of the five wells sampled collectively contained detectable levels of perchlorate, Mary Garvey's well at 1645 Race lane and Joseph Chretien's well at 1605 Race Lane, Marston Mills. Barnstable County Health and Environment and the Health Laboratory conducted this survey as a preliminary assessment of the water quality in this area. All samples were analyzed at no cost to the town or homeowner. It should be further understood that the BCDHE laboratory is presently not EPA-certified for the analysis of perchlorate. It should also be understood that presently there is no state or federal regulation for this chemical. The Massachusetts Department of the Environment (DEP) and the U.S Environmental Protection Agency(EPA) are working towards drinking water standards and cleanup standards. However, EPA does have a recommended limit of 1.0 parts per billion(ppb), or micrograms per liter(ug/1). We have enclosed the locations of all the wells sampled and neighbors who were contacted. We have also notified both the Barnstable Water Department and the Sandwich Water Department of our findings. Craig Crocker, COMM Water Department, informed us that the most recent round of sampling collected in April in accordance with the regulations, did not detect any perchlorate. Please feel free to contact us with any questions or concerns. We will gladly assist you in any further testing/monitoring your Board of Health may request. Sincerely, Lee A. McConnell Environmental Project Assistant Barnstable County Department of Health and Environment 508-375-6620 Enc: Perchlorate Fact Sheet Sample Reports from BCDHE Laboratory Correspondents to homeowners from BCDHE P. 1 COMMUNICATION RESULT REPORT ( SEP. 8.2004 2:21PM ) TTI BARNSTABLE BOARD OF HEALTH FILE MODE OPTION ADDRESS (GROUP) RESULT PAGE — ------------------------------------------------------------------------------------------------ 911 MEMORY TX 95083622603 OK P. 2/2 — — ------------------------------------------------------------------------------- REASON FOR ERROR E-1) HANG UP OR LINE FAIL E-2) BUSY E-3) NO ANSWER E-4) NO FACSIMILE CONNECTION Page: IFI�ATE OF ANALYSIS Barnstable County Health Laboratory Report Dated: 9/17/2004 Re part Papgred For: € AP-RtMAMS CiLDEUNTY Order No.: G0427093 5 EPA P7M ENTtkA>i<.Pf,51EALTH&El;IWIRON{E ENT SARN2TAOLE SUPERIOR COI11t'R HousE 8:0. SBUX 46713295 MAIN STREET GAE;3NSTABLE,MA 02630 Labors g w#: 0427093-01 Description; Water,Drinking Water Sample#: 100 Sampling Location 15 Drumble Ln Marstons]Mills MA Collected; 8)412004 Collected by; Lee McConne Received; 814/2004 .Test Parameters ITEM RESULT UNITS RL ACL Method Anslvst Tested Note LAB: IC Lab Perchlorate RRL ug/L 1.0 0 BPA 3I4.0 DCB 8/4/2004 � Laboratory IDS_ 0427093-02 Description: Water-DrinkingWAter Sample#: 101 Sampling Location 1605 Raee Ln Marstens Mills MA Collected; 814/2004 Collected by; Lee McConno Received: 814M04 Test Parameters ITEM RESULT UNITS RL MCL Mathod 0 A.nalvst Band Nate . E Page: � CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory Report Dated: 8/17/2004 Report Prepared For: PAPNb7,Af@LE CUQIN7Y Order No.: G0427093 r y1 R�T I£E1,1T 0 F H EAUFH IENVIR0NMENT BA,R.NS T,A—.DLE S PE&UOR COURTHOUSE P.G. BOX 427,0195 R"WN STREET BAR NIS AAOLE,AMA"02630 Laboratory ID#: 0427093-01 Description: Water-Drinking Water Sample#: 100 Sampling Location 15 Drumble Ln Marstons Mills MA Collected: 8/4/2004 Collected by: Lee McConne Received: 8/4/2004 Test Parameters ITEM RESULT UNITS RL MCL Method# Analvst Tested Note LAB: IC Lab Perchlorate BRL ug/L 1.0 0 EPA 314.0 DCB 8/4/2004 Laboratory ID#: 0427093-02 Description: Water-Drinking Water i Sample#: 101 Sampling Location 1605 Race Ln Marstons Mills MA Collected: 8/4/2004 Collected by: Lee McConne Received: 8/4/2004 I Test Parameters >_ ITEM RESULT UNITS RL MCL Method# Analvst Tested Note LAB: IC Lab Perchlorate 0.90 J ug/L 1.0 '0 EPA 314.0 DCB 8/112004 "J"flag means that the result is lower than the reporting limit and higher than the method detection limit. Laboratory ID#: 0427093-03 Description: Water-Drinking Water Sample#: 1.02 Sampling Location 47 Norway Marstons Mills MA Collected: 8/4/2004 Collected by: Lee McConne Received: 8/4/2004 Test Parameters ITEM RESULT UNITS RL MCL Method# Analvst Tested Note LAB: IC Lab Perchlorate BRL ug/L 1.0 0 EPA 314.0 DCB 8/4/2004 Approved By: Director) RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, ]VIA 02630 Ph: 505-375-6605 f CERTIFICATE Page: 1 OF ANALYSIS Barnstable County Health Laboratory Report Dated: 07/22/2004 Report Prepared For: Order No.: G0425433 Mary Garvey 1645.Race Lane Marston Mills, MA 02648 Laboratory ID#: 0425433-01 Description: Water-Drinking Water Sample 4: 25433 Sampling Location 1645 Race Lane Marstons Mills MA Collected: 06/07/2004 Collected by: M Garvey 047-010-004 Received: 06/07/2004 -Test Parameters ITEM RESULT UNITS RL MCL Method# Tested LAB: IC Lab Perchlorate 0.61 J ug/L 1.0 0 EPA 314.0 06/14/2004 Routine+Ammonia ITEM RESULT UNITS RL MCL Method# Tested LAB: IC Lab Ammonia BRL mg/L 0.1 EPA 350.1 06/09/2004 Nitrates 4.6 mg/L 0.1 10 EPA 300.0 06/07/2004 LAB: Metals Copper 0.1 mg/L 0.1 1.3 SM 3111B 06/14/2004 Iron BRL mg/L 0.1 0.3 SM 311113 06/14/2004 Sodium 19 mg/L 1.0 20 SM 311113 06/14/2004 LAB: Microbiology Total Coliform Absent P/A 0 Absent 307 06/07/2004 LAB: Physical Chemistry Conductance 170 umohs/cm 1 EPA 120.1 06/07/2004 pH 6.2 pH-units 0 EPA 150.1 06/07/2004 J means lower than the RL higher than the MDL(minimum detection limit). Sample has higher than average levels of Nitrates. Monitoring is recommended(2-3 times per year)to establish any upward trends. Approved By: (Lab Director) RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 CERTIFICATE OF ANALYSIS Page: 'f to - i Barnstable County health Laboratory Report Dated: 07/22/2004 Report Prepared For: Order No.: G0426639 Mary Garvey 1645 Race Lane s"? ���( G � — �Z G 67 Marston Mills, MA 02648 / Laboratory ID#: 0426639-01 Description: Water-Drinking Water Sample#: 26639 Sampling Location 1645 Race Lane Marstons Mills MA Collected: 07/20/2004 Collected by: M Garvey Received: 07/20l2004 Test Parameters ITEM RESULT UNITS RL MCL Method# Tested LAB: IC Lab Perchlorate 0.80 ug/L 0.5 0 EPA 314.0 07/20/2004 Retesting is recommended. f Approved By: (Lab Director) C1 waacc u3cm RL = Reporting Limit \ MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Barnstable :County ,Department` o.f S.uperor Court :House Hea`ltb _and ,the Environment P.;. 0.. Box.:-A2=7 Barnstable, MA 02630 (,508,). 37.5=6605"•.661-2 . o.:3 - CHAIN ;O"F CUSTODY'' w 4 N f CLIENT NAME: �r`i4- �" ADDRESS:: PROJECT NAME PROJECT NUMBER . .PROJECT; SITE SAMPLER ; .A <.DATE% 'SAMPLE SAMPLE NO QFx ANALYSES- COMMENTS ° T:IME: . NUMBER, LO:CATION" ESAMP.LESt REQUIRED Na V. ti r f r REL�NG:U4{ IS'HED .B.:Y DAT'E/T:T?ME, RE'CE:IVED -BY--: :DATE'/T:IME: � ! A`hir RELI•N.GUI-SHED -B:Y:." DAT'E/'T'T' E: . RECEIVED B:Y.� ''DATE:/T.IME CERTIFICATE OF ANALYSIS Page: 4 O i Barnstable County Health Laboratory y'sSRCFIL%5*'�� Report Dated: 8/17/2004 Report Preuared For: BARNSTi°ABLE CID QJ,147V Order No.: G0427188 &ENVIRONMENT -DARNSTiAB E 5U?-E J0R C0ZJRTII0kJSE ¢aoQy DON 42713c135 1AA2N STREET BARI'NSTh 13LE,MA 02630 Laboratory ID#L 0427188-01 Description: Water-Drinking Water Sample 9: 27188 Sampling Location 29 Drumble Lane Marstons Mills MA Collected: 8/6/2004 Collected by: McConnell Received: 8/6/2004 i Test Parameters ITEM RESULT UNITS RL MCL Method 4 Tested LAB: IC Lab Perchlorate BRL, ug/L 1.0 0 EPA 314.0 8/11/2004 Approved By: (L hector) RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Bar-ns:table =County :Department ,of `Superior Court House Health ,and the Environment P:. 0. Box ,-4.27 'Barn stable;; _MA 0 2 6 3"0 -37.5'-6:6.05 66.12 ?CHAIN yOF CUSTODY { CLIENT 'NAME. .:`ADDRESS .;PROJEC:T .NAME: #£�('� €_i la PROJECT ;NUMBER': ` :P.ROJECS' ;SITE gadSAMP"LER DATE.[ "SAMP:LE SAMPLE : NO OF' YS ANALYSES COMMENTS 'TIME;: :NUMBER 2` .I�OGAT.IO'N -_SAMPLES . REQUIREDJ. ` i F II a a t RELINGU.I(f;SHED BBY,:; DATE/'TI':ME..,. RECEIVED BY DATE/TIME G'"•'.ds!• RELIN.GUISHED-,BY :DATE/T:II?IE°: ,. R 'C=EIVED :B,:Y.:, ' DA.TE/TIME.. BARNSTABLE COUNTY Of BA A, DEPARTMENT OF HEALTH AND THE ENVIRONMENT SUPERIOR COURTHOUSE UPOST OFFICE BOX 427 BARNSTABLE,MASSACHUSETTS 02630 s July 22, 2004 Dear Homeowner: Recently, a resident in your area tested their well water for perchlorate in response to an article in the newspaper regarding an alleged groundwater plume in Bourne. Unexpectedly, the sample contained what we believe to be trace amounts of perchlorate. The test was first performed at an EPA certified laboratory, and subsequently confirmed using similar methodology at our laboratory. In order to further assess the situation, we would like to sample a number of wells in the general area of the well where perchlorate was found. Accordingly, I am hereby inquiring whether you would allow a test of your well water, if indeed you have a well. The test will be performed at the Barnstable County Department of Health and the Environment Laboratory at no cost to you, and the results will be returned to you. You should understand however, that at present,the County Laboratory is not EPA-certified for this analysis. Hence, any result you obtain will have a statement to this effect. Our main intent on sampling your well is to obtain further screening information regarding any source of perchlorate in the area that might be contaminating wells. If you would like to avail yourself of this free test,please contact me at 508-375-6616. If I am not at my desk,please leave a message containing the telephone number where you can be reached. You do not have to be present when the sample is drawn if you have an outside faucet. We will merely run the water for approximately 5 minutes and withdraw a sample for analysis. If you have any question about our request, please do not hesitate to call me. Thank You. // 7" rge H eld wector of B '�� BARNSTABLE COUNTY DEPARTMENT OF HEALTH AND ENVIRONMENT x t_ SUPERIOR COURT HOUSE >� POST OFFICE BOX 427 BARNSTABLE, MASSACHUSETTS 02630 9s`sACHUs�� Phone:(508)375-6613 FAX(508)362-2603 TDD(508)362-5885 August 25, 2004 Dear Homeowner: Enclosed is the result of the water sample collected from your private well. The sample was analyzed for the compound perchlorate, which was found in a neighboring well on Race Lane. At this time, we found two wells out of five sampled contaminated with the compound. Although, the Barnstable County Health Laboratory is trained and equipped to test for perchlorate, at this time it is not EPA-certified for this analysis. If perchlorate was not found in your well, we thank you for your participation in this preliminary screening and recommend having your water sampled periodically to ensure good water quality for you and your family. If perchlorate was found in your well, we have enclosed information regarding health concerns associated with this compound. You might want to further assess the use of this well and have it tested periodically. As you may know, presently there is no state or federal regulation for this compound. The Massachusetts Department of the Environment (DEP) and the U.S Environmental Protection Agency(EPA) are working towards drinking water standards and cleanup standards for perchlorate. However, EPA does have a recommended limit for drinking water of 1.0 parts per billion(ppb), or micrograms per liter (ug/1). Thank you again for your cooperation in this investigation. We have notified your local Board of Health regarding the situation. Please feel free to contact Tom McKean, Director of Barnstable Health Department at 508-862-4644 or Lee A. McConnell at Barnstable County Department of Health and Environment (BCDHE) with any questions or concerns you might have. Sincerely, Lee A. McConnell Environmental Project Assistant Barnstable County Department of Health and Environment 508-375-6620 4 oF_B BARNSTABLE COUNTY a_,_..`_ r; y� DEPARTMENT OF HEALTH AND ENVIRONMENT UO SUPERIOR COURT HOUSE POST OFFICE BOX 427 _ �54 BARNSTABLE, MASSACHUSETTS 02630 SAone:(508)375-6613 CH(JS�� PhFAX(508)362-2603 TDD(508)362-5885 Date Location Sampled Date 7/29/04 1629 Race Ln, MM Left Info. at door 7/29/04 1605 Race Ln, MM Sampled 8/4 7/29/04 1593 Race Lane, MM Town Water- No Well 7/29/04 1579 Race Ln, MM Town Water- No Well 7/29/04 1567 Race Ln, MM Town Water- No Well 7/29/04 1690 Race Ln, MM Town Water-No Well 7/29/04 1710 Race Ln, MM Town Water- No Well 7/29104 5 Drumble Ln, MM Left Info. at door 7129/04 15 Drumble Ln, MM Sampled 8/4 7/29/04 29 Drumble Ln, MM Sampled 8/6 7/29/04 225 Jones Rd, MM Town Water- No Well 7/29/04 262 Jones Rd, MM Town Water-No Well 7/29/04 103 Jasper Rd, MM Town Water- No Well 7/29/04 91 Jasper Rd, MM Town Water- No Well 7/29/04 8 Redberry Way, MM Left Info. at door 7/29/04 9 Redberry way, MM Town Water- No Well 7/29/04 6 Cinderellla Tr, MM Town Water- No Well 7/29/04 15 Cinderella Tr, MM Town Water- No Well 7/29/04 28 Cinderella Tr, MM Town Water- No Well 7/29/04 7 Norway Rd, MM ISampled 8/4 TABLE .00tTION S C t (�vi SI;W t3E ' ASSESSOR'S. MAP L07 VILLAGC IN5TA3rL 1�'S D1AI &P CAME NO SEPTIC xANI CAPACrN 1 kr Teh c S (size). r� 3 a I.,Ci�►C1�It1 d-FA.CILrrY's.(type) a rro `oral'-DROOMS -3`M PERMITOA;TE CnL 1 Maximumla.rJ}ust�;tlGt'putgciwtttet'! bleEailleBittorn.ufLJ 9(;hinSlRari{ity ,_.. .�.•-�� °+ Iv 4 'JVnt�r,Suppl is leBl anti Lewhiis 1?acitity �y vlat9s exist Fool a�a<oite acwltk�snQA feet of I4actur► fstciiity) -.-�-�-+ Ecl�ri:iyf WetlsnaE!acid I.eaelEintt I~acaiiey(its uriy wFtl nd asf fee t4tP{liil�QQ�l�j�,p �(%i1C�11A PUC�{Kty) a � � �< _ o � �._ _ � � � � t t G � ' I - A a -�� �v ' �a ��� G , Sb 'Y`' C-� e �8`Cry j � TOWN OF BARNSTABLE /� L_O Aknb''i/ 12Y4-CC— LA-� SEWAGE #2 000—4f/l VILLAGE bl Ma)"TGni e ryY t 1 FS ASSESSOR'S MAP & LOT- 0 INSTALLER'S NAME&PHONE NO.C�.►V1 t� �- ��' Y ?=� SEPTIC TANK CAPACITY ' LEACHING FACILITY: (type) (size) 1-Y 44 KID NO.OF BEDROOMS-3 BUILDER O W E PERMTTDATE: 7 e COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by - '�' ��ccqq P P v AA Y h a Qf pQef l 30 ^°Lots° 48 48 Race Lane 83-86 Installer - Frank A W.i,newic.z I' Old—Town—Landscape Contract_o_r_s_,_Inc.. 75 Dale Street, Abington, MA 02351 Builder - Seaside Associates P_.o-._Box._29 Monument_Beach_,,_MA02-553 C:h reToEK Rice 4stie- do's" B5'a'� L,,e c. No. Fee l THE COMMONWEALTH OF MASSACHUSETTS Entered in cor n PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS OfppYication for �Bigpogar *pgtem Con!5truction Perron Application for a Permit to Construct( )Repair( —1'U__pgrade( )Abandon( ) ❑Complete System dividual Components Location Address or rLot/'No./60 5-01r .� L4u� m I- L-CST- Owner's Name,Address and Tel.No. ep r A` Z)-36P14 C kKE77 Assessor's �v 0 5 A4C.te-_ C �vlE Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. C t2-1 155 �&.R0��"4 � Wk C <3--C TG1,4 6 Y kDu-ccd Lr3-Grp6 141_ YAI-Pu. Type of Building: Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �� gallons per day. Calculated daily flow -� gallons. Plan Date 7�l /!� Number of sheets Revision Date Title 5�1'fC �S6r?" i�'I i2.Fi--.PAR /6® .� Size of Septic Tank /C-50 O mil! 9Q!el S i 7,�f ZZ- Type of S.A.S. T.?16X-e , 2 X y)[Z Description of Soil ��—/Z oe'7?�p l4w�3y g -3/'F" AD wze> Nature of Repairs or Alterations(Answer when applicable) 4 5 1� ffi' I1l U «Gd T l7—cy,f7f Date last inspected: P 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 Certifi- cate of Compliance has been issued by this Board of Health. ,�,,11 Signed Date / <00 Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued No. Fee THE COMMONWEALTH OF.MASSACHUSETTS Entered in computer: i es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for Migool 4�.pgtem Construction Permit Application for a Permit to Construct( )Repair( grade( )Abandon( ) ❑Complete System g>d6lidual Components Location Address or Lot No. `// u Owner's Name,Address and Tel.No. t ay /irj(� 5J aQC� C I , Assessortnipffi t d s� (� 9�E 7 r� F Installer's Name,Address,and Te1.No.!/ Designer's Name,Address and Tel.No. Type of Building:: Dwelling No.of Bedrooms Lot Size sq.*it. Garbage Grinder( ) Other, Type of Building U 'No. of Peisons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow_Z=5-- gallons. Plan Date Number of sheets i Revision Date G � Title e ' Size of Septic Tan - Type of S.A.S. Description of Soil s ip 5 �_ ,��� //._�C ����_ _37 t Nature of Repairs or Alterations(Answer when applicable) (7574ef7442 G �rc^ f 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 Certifi- cate of Compliance has been issued by this Board of Health. Signed A Date 1 Application Approved by Date�,..T Application Disapproved or the of o ing reasons Permit No. fi'', Date Issued ———————� �———————------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( ").Fl g aded( ) Abandoned( )by at y r �14 has been constructed in accordance with(theprovisions of Title 5 and the for Disposal System n ction PerrnV2 , dated ef� Installer ,1 Designer The issuance o s permit shall no a construed as a guarantee that the syste ill function as designed. Date a— ` Inspector.d �/� --------------------------------------- No. Feel Gj i - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 13i5po5a[ *pgtem Con5truction Permit Permission is hereby granted to Construct( )Repair( ,,)Upgrade( )Abandon( ) System located at � / s ` f r.-�- 1 6 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this t. Date: Z;_�, '0 _Approved i i 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I'Y) Z(�/✓�Y►;Ihereby certify that the application for disposal works construction permit signed by me dated Tu , �i i �2 concerning the property located at b S iA C 16- 4,4 41t fill 4,6ets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) l P B) G.W. Elevation +the MAX.High G.W.Adjustment. _ ,yam DIFFERENCE BETWEEN A and B V SIGNED :. 1 C. DATE: (d U [Please Sketch proposed plan of system on back]. NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without encr septic system plans. q:health folder:cert Qkk I� / � 1 w ro �� b MEW o ` -k--r tucrc,�5' j TOWN OF BARNSTABLE LOCATION/ �� S 1'466 L I-K)& SEWAGE #2 000 VILLAGE M'11l.)-SG&z4 PV11 IIS ASSESSOR'S MAP & LOTS a '0 INSTALLER'S NAME&PHONE NO. ,VNI 2- '^- � J'—t_ t�''A t./ 7 SEPTIC TANK CAPACITY LEACHING.FACILITY: .(type) (size) _2,y q )uz) NO. OF BEDROOMS 3— -� BUILDER O(�WNE PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of.Leaching Facility, + Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) _ — Feet Edge of Wetland and Leaching Facility(If any wetlands exist / within 300 feet of leaching facility) Feet Furnished by _1�Y1, ��%►r�1t4'�'Y` - II t� �Il Town of Barnstable Health Inspector optHe rp� Office Hours ti Regulator Services NP o b y 8:30-9:30 Thomas F. Geiler,Director 1:00—2:00 • &utNsrABLE, 9 ,�� Public Health Division prFD MA3 A Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-63f AMNESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: Address: �(pQs � /� �A��Ta PUS Map _Parcel Z4 Name: \�(h(�1'� �- �/ Phone #: q2t3-729 Q 2a. How many bedrooms exist at your property now? V 2b. Are you planning to add any bedrooms? If yes, how many? _ 2c. How many bedrooms total are proposed at this property (including the amnesty unit). 2d. Please include a copy of the floor plans for the entire property - showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or NO 'If the dwelling is,connected to pubhc"sewer,skip questions t'4 through#9 below 1 T 4. Location of dwellingo is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? 5. Is the d Hellm- �connected to an . ONSITE WELL or to PUBLIC WATER? 6. Is a disposal works construction permit on file? YES or NO 6a. If yes, how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or NO S. Is there an engineered septic system plan on file at the Health Division? YES or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years?. YES or NO ------------------------------------------------------------------------------ ----------------------------------- FOR OFFICE USE ONLY —1-0 •.� The Pub lic Health Divis ion has no objection to � bedrooms at this property. q � Special Conditions: Signed: s Date: 0;/health/wpfiles/amnestyapp f,40rQSe4 fJ46rw 66 P- Coc)e- IT Ld3(7 oPi;aiinq 3lab1SNUVEI r �2CDC:><s �tl17C ti�JG`l.F=�•, h�N F �y. � 9 F1����� F_� .,�'.j ( _. Y /-� ry 9 , 0N5�+ . .Rk4S 4� 1 aye _ �(,a�,� � N�� �,�� '�• D L o� .IA, 1/20 R lro A/ Ao I^O ^— —��_'._�,l'� ��� —._?ram— �� " (Tli:I —_ m lT _q �- co �p 3 • � D — ---• ` r � O _. . 0 m I r -moo — - - - ' z pi 1 nL-- �� O 9 V i ILI f N N wlyleis - r -fir I (( i �7477/ COG ell- Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1605 Race Ln Property Address Joseph Chretien Owner Owner's Name / cr). information is Marstons Mills V MA 02648 5.16-16 required for every page. City/Town State Zip Code Date of Inspection W Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the.end of the form. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.,)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 Furthe cal Approving Authority 5-16-16 s Sigi 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System /•Page 1 of 17 Commonwealth of Massachusetts Title 5 official- Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments H 1605 Race Ln ;,. Property Address Joseph Chretien Owner c7t Owner's Name information is required for every Marstons Mills MA 02648 5-16-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by, the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 's . i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1605 Race Ln Property Address Joseph Chretien Owner Owner's Name information is required for every Marstons Mills MA 02648 5-16-16 page. City/Town State Zip Code Date of Inspection B.. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational._System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. C 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 1605 Race Ln Property Address Joseph Chretien Owner Owner's Name information is required for every Marstons Mills MA 02648 5-16-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: j D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No",to each of the following for all inspections: Yes No El ® 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 '/Z day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official, Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . °M 1605 Race Ln Property Address Joseph Chretien Owner Owner's Name information is required for every Marstons Mills MA 02648 5-16-16 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 dogged 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 ❑ 11 the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—RNPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M 1605 Race Ln Property Address Joseph Chretien Owner Owner's Name information is required for every Marstons Mills MA 02648 5-16-16 page. Cityfrown 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage•Disposal System Form -Not for Voluntary Assessments ,M 1605 Race Ln Property Address Joseph Chretien Owner Owner's Name information is required for every Marstons Mills MA 02648 5-16-16 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 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: - 5-2016 Date Commercialtindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons r day d Pe Y�9P ) Basis of design flow(seatslpersons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system?., ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts , W Title 5 Official Inspection form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 1605 Race Ln Property Address Joseph Chretien Owner Owner's Name information is required for every Marstons Mills MA 02648 5-16-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped 2015 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: , gallons How was quantity pumped determined? Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of_the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M SVe,a 1605 Race Ln Property Address Joseph Chretien Owner Owner's Name information is required for every Marstons Mills MA 02648 5-16-16 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: 2000 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 30"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.): Good condition. 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: F 1000 gal Sludge depth: 12" t5ins-3/13 Tide 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 M 1605 Race Ln Property Address Joseph Chretien Owner Owner's Name information is required for every Marstons Mills MA 02648 5-16-16 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 20" litScum thickness 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 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to,top of outlet tee or baffle„ Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13' Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 I , Commonwealth of Massachusetts w v. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , y 1605 Race Ln Property Address Joseph Chretien Owner Owner's Name information is required for every Marstons Mills MA 02648 5-16-16 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 ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G„M 1605 Race Ln Property Address Joseph Chretien Owner Owner's Name information is required for every Marstons Mills MA 02648 5-16-16 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.): Both d-boxes in good condition with water at working level and no sign of back-up from trenches. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 1605 Race Ln Property Address Joseph Chretien Owner Owner's Name information is required for every Marstons Mills MA 02648 5-16-16 page. City/Town . State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number, i ❑ leaching galleries number: ® leaching trenches number, length: 2-2x4x30 ❑ 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.): Leach trenches in good working order with no sign of back-up into d-box or surrounding stone. 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 1605 Race Ln Property Address Joseph Chretien Owner Owner's Name information is required for every Marstons Mills MA 02648 5-16-16 . page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil: signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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 1605 Race Ln Property Address Joseph Chretien Owner Owner's Name information is required for every Marstons MillS MA 02648 5-16-16 page. City/Town . State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately r � LJ D r. r 0 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1605 Race Ln Property Address Joseph Chretien Owner Owner's Name information is required for every Marstons Mills MA 02648 5-16-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® . Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Original design plans show.no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 1605 Race Ln Property Address Joseph Chretien Owner Owner's Name information is required for every Marston Mills MA 02648 5-16-16 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal SystEm•Page 17 of 17 EXISTING CONTOUR N d EXISTING LEACHING TRENCHES x 100.98 EXISTING SPOT GRADE ® R°° C 3C• o� TO BE PUMPED ABANDONED ��9 -Wy EXISTING WATER SVC. �� -G EXISTING GAS SVC. --- e.H.-W- OVERHEAD WIRES pc�� E � an Pn N 47'01'50'+ W �o TEST PIT �f20 O �) BENCHMARK ce � 121.41' x 69.25 d fnd. �j� qne 2 � x 71,61 a �\ PROPOSED SEPTIC TANK LEGEND � a �.11 \\ (1000 GAL-IN SERIES) 1CWV) .' IAJ o 69,92 \\ EXISTING SEPTIC TANK Coe/ 4TOP OF TANK, EL.=68. 14 Ob,�,� ssx 70.14 LO b � 1NV.(OUT)=66.8of / LOCUSGARAGE T __ _ _ \PETER T. � -� � LOCUS MAP MCENTEE - ?TP-1 _-_ 70 9� 70 0e i NOT TO SCALE CIVIL - STUMP x '� BENCHMARK No. 35109 �f 8+ \ (TYP. \ 71.sa ,' RfCIS1 �� �______�1-- " `^ VEN27 1 6 e x 69.69 92j X �� x v. TOP OF CONCRETE AT \J I Y CORNER OF STEPS L �cn o .•. EL.=70.72 c 71.39 71.331 "� ® ®BM \� cazEeo ° ; °Ji 15, 70.72 • \\ GENERAL NOTES: ° ° x 7Q.74 \ 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL / a \ \ BOARD OF HEALTH AND THE DESIGN ENGINEER. 9,e7 O \ \ x 72.21 O / � 69.73 AA \GS 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS O 71.39 / j-- OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE O M / \ ` LOCAL RULES AND REGULATIONS. O / 7o,a7 DECK \ �' -310 CMR 15.405(1)(b): N �~ 70.70 1 1) A 3' variance to the 3' maximum cover requirement, for up to 71.06 , PATIO j I 6' of max. cover. S.A.S. shall be H-20 and vented. i I 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR /EXISTING II 1 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 72.07 71.44 / HOUSE(#1605) DESIGN ENGINEER. / 70.79 T.O.F.=71.35f I 71,2a q / 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING S c / FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 70.50 x 70.76/ ENGINEER BEFORE CONSTRUCTION CONTINUES. GRAVEL J� x t 69 k� v ! 5. ALL ELEVATIONS BASED ON ASSUMED DATUM (BARNSTABLE G.I.S.t). / - 70.69 70.43";.: �� / 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF �\ DRIVEWAY 71,34 �.•. ���, vi' P� THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF \ i DRAIN / HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. / 69.51 x 70.74 71,92 / '' J 7. WATER SUPPLIED BY TOWN WATER SERVICE. 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. �IF'O 70.2D �.': 71.32 / 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 71.s2 P';: /:. N N-POTABLE WELL AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE LOTS 4�� _& 484 Q... '`•;.' 48,741 fS��- \ 70.27 ! - (APPROXIMATE) DIRECTED BY THE APPROVING AUTHORITIES. y' TOWN WATER SERVICE / 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY I?- ARCEL ID. 47-� 0,69~ THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING qv �'`. . --1-� 1---7 p PROVIDED FROM STREET CONSTRUCTION. \ N 48'29 45 W V. �1.35,,'r - ---- Bdh fnd. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS x 7 R=673.51 � � \ .,:'. ... ::•:. ) IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 0 / REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). ----7-4--------- ------72--�--- 12. R T UNSUITABLE SHALL BE / AREAS REQUIRING ST IPOU OF SU TABLE MATERIALS L INSPECTED BY A LICENSED SOIL EVALUATOR PRIOR TO BACKFILL. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND .�3--------�_ 73.09 IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. _ . ' �� PK SET -------��� ------- Of73,37 pavement 73,12 '72'99- , DATC BASIN 72.94 PROPOSED SEPTIC SYSTEM UPGRADE PLAN 74.38 72.76 75.61 74.96 1605 RACE LANE, MARSTONS MILLS, MA RACE LANE Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. CHRETIEN, JOSEPH J & MARTHA Engineering Works, Inc. 1+,=30 P.T.M. 257-17 1605 RACE LANE 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. MARSTONS MILLS, MA 02648 (508) 477-5313 12/30/17 P.T.M. 1 Of 2 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:66.5 SEPTIC TANK FOR A DISTANCE OF 15' AROUND THE INSTALL RISERS & COVERS OVER INLET PERIMETER OF THE S.A.S. AND SET TO 6" OF FINISH GRADE. PROPOSED D-BOX PROPOSED S.A.S. JNSTALL WATERTIGHT RISER & PROVIDE TWO ACCESS MANHOLES TO WITHIN 3" EX/STING COVER SET TO 6" OF GRADE OF FINISH GRADE IFOR INSPECTION PURPOSES CHARCOAL HOUSE(#1605) F.G. EL.=69.9t F.G. EL.=69.9f F.G. EL.=70.5f F.G. EL.=71.0f VENT MAINTAIN 2% GRADE (MIN.) OVER S.A.S. DECK L - 5 j - ® S=1% (MIN.) L = 10' L = 23' S.2' •' � 4'SCH40 PVC ® S=1% (MIN.) ® S=1% (MIN.) 4 s - 4"SCH40 PVC 4"SCH40 PVC 34.5' 1 1 14" 1o"I .. B aaa�aaa 14 �a���aa ;� IN GAZEB INV.=66.75 48" u4ulo G ADAS BAD�LE LEVEL ADD INV.=66.40 PROPOSED INV.=66.23 3.5' 4.8, 3.5' 1 y1 INV.=66.80f , GAS BAF�E EFFECTIVE WIDTH = 11.8' 1 (VERIFY) INV.=66.50t �� INV.=66.00 2 5'� EXISTING (VERIFY) 3-500 GALLON LEACHING CHAMBERS 1.8 �11.8 SEPTIC TANK PROPOSED SEPTIC TANK SURROUNDED WITH STONE AS SHOWN SHED H-20 RATED TOP CONC. ELEV. =67.1 f SEPTIC LAYOUT BREAKOUT ELEV.=66.5 INV. ELEV.=66.00 aaaa NOTES: aBaBaF 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE BOTTOM ELEV.=64.00aINVERTS, PRIOR TO INSTALLATION. 3.5' 2 X 817.0, 3.5' 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND TRUE 4' MIN. OF NATURALLY OCCURING EFFECTIVE LENGTH = 32.5' TO GRADE ON A MECHANICALLY COMPACTED 6" CRUSHED PERVIOUS MATERIAL STONE BASE, AS SPECIFIED L 3 O CAC 15.6" CRUSHED . 5 MIN. ABOVE GROUNDWATER LEACHING SYSTEM SECTION ®®®® 0 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTT. OF TP-2, EL.=59.2 - ®®®®®® ® ®®®® 37"• 4) CONTRACTOR SHALL INSTALL A GAS BAFFLE ON ESTIMATED DEPTH TO GROUNDWATER BELOW BOTTOM 3/4" TO 1-1/2" DOUBLE ui ®®®®®® ® ® ®® THE OUTLET TEE. OF S.A.S. = 14't (EL.=50, BARNSTABLE G.I.S.) WASHED STONE N Z ®( ®®®® ® ®®® 3" LAYER OF 1/8" TO 1/2" SEPTIC SYSTEM PROFILE DOUBLE WASHED STONE (OR APPROVED FILTER FABRIC) 102" DESIGN CRITERIA SOIL LOG 4" KNOCKOUT NUMBER OF BEDROOMS: 2 (HOUSE) + 1 (APARTMENT) = 3 DATE: OCTOBER 2, 2017 (REF#15 489) 20" DIA. COVER SOIL TEXTURAL CLASS: CLASS I SOIL EVALUATOR: PETER McENTEE PE(SE#1542) DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DONALD DESMARAIS R.S.HEALTH AGENT 4" KNOCKOUT / 4" KNOCKOUT 58" (0.74 GPD/SF LOADING RATE) ELEV. TP-1 DEPTH ELEV. TP-2 DEPTH DAILY FLOW: 330 GPD 70.6 A O" 70.2 A 0" DESIGN FLOW: 330 GPD SANDY LOAM SANDY LOAM 4" KNOCKOUT GARBAGE GRINDER: NO 69.9 10YR 4/2 8„ 69'7 10YR 4/2 6„ LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF B B SANDY LOAM SANDY LOAM 500 GALLON CAPACITY, H-20 LOADING .74 GPD/SF 10YR 5/4 10YR 5/4 EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 68.3 C1 27' 68.0 C1 26" CHAMBERS PROPOSED SEPTIC TANK: 1000 GALLON CAPACITY-IN SERIES COARSE SAND I N.T.S. PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLETS 10YR ` COARSE s4° >2GVEL � PROPOSED SEPTIC SYSTEM UPGRADE PLAN USE 3-500 GALLON LEACHING CHAMBERS IN SERIES >20% GRAVEL 66.6 48" 66.2 48" SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES C2 PERC C2 1605 RACE LANE, MARSTONS MILLS, MA SIDEWALL AREA: 2(11 .8' + 32.5') X 2 = 177.2 S.F. 2E5Y 6A8 40/58" MED. SAND Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 BOTTOM AREA: 11.8' x 32.5' = 383.5 S.F. <5% GRAVEL <5% GRAVEL Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:..............................................................560.7 S.F. 59.6 132" 59.2 132" Engineering Works, Inc. NTS P.T.M. 257-17 NO GROUNDWATER, PERC RATE: <2 MIN./IN. 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(560.7 SF) = 414.9 GPD (508) 477-5313 12/30/17 P.T.M. 2 of 2