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HomeMy WebLinkAbout0207 REGENCY DRIVE - Health ��. -1-89�9 REGENCY DRIVES �o'y / MA.RSTONS MILLS00 A. = 064 045 - - ,I I i I � I TOWN OF BARNSTABLE LOCATION SEWAGE# oer VILLAG SS SSOR'S MAP&PARCEL C9 INSTALLER S NAME&PH NE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) x V� J NO.OF BEDROOMS`�OWNER � P' U1 er PERMIT DATE: s 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 �y� site or within 200 feet of leaching facility) 4 �JV Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) 100 Feet FURNISHED BY 7aP"c`, 7Z �5 3 --� 5D Z } • No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4plitation for Mispo8al *pstem Construction Vermit Application for a Permit to Construct( ) Repair(grade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. 745- �/ 4 Owner's e,Address,and Tel.No. � /Assessor's Map/Parcel lq W-W-C "CL L Installer's Name,Addr e s,and Yel.No. �—. + Desi 1 r Nam ddresnd T1.�1n� Type of Building: f Dwelling No.of Bedrooms Lot Size l,l� ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.requir d) gpd Design ttflow provided �'J gpd Plan Date 7i Number of sheets 1 Revision Date Title I Size of Septic Tank Type of S.A.S. u Description of Soil Nature of epairs or Alterations(Answer wh n 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?Signed Date 64-6 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. `] Date Issued --------------------------------------------------------------------------------- -- �No.) /\)� �/ y, Fee 1 � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: L/" PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes v. 01ppfication for Misposal *pstem Construction 3permit Application for a Permit to Construct( ). Repair(V) Upgrade( ) nAbandon( ) ❑Complete System M nP dividual Components Location Address or Lot No.,> [.7 t�L 90i Owner's lame,Address,and Tel.No` Assessor's Map/Parcel A 5 J'-1 fi6r ► L Installer's Name,Address,and Tel.No. Designer's Name,Address,-and Te•„-l.�lo r s Type of Building: Dwelling No.of Bedrooms 13 Lot Size 111t3 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Y Showers( ) Cafeteria( ) Other Fixtures s Design Flow(min.required) 1 gpd Design flow provided gpd Plan Date ?' 12,1 b Number of sheets Revision Date Title e Size of Septic Tank (� � " V_XJ4,51 Type of S.A.S. F2,' i (�_�r L4 Description of Soil �"� Nature of Repairs or Alterations(Answer when applicable) t � --• '� �-� t L �,.. 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 J4 Compliance has been issued by this,Board-of-Health S';'igned " C a d�,"'. f1 Date ' Application Approved by R .__ Date Application Disapproved by Date for the following reasons i Permit No. ;f) %, ^"[` Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compiiante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded lV J Abandoned( )by 049�V,34(,,, at has been constructed in accordance J with the provisions of Title 5 and the for Disposal System Cons trruct'on Permit No—. 2gpg•''ft,r lateedd Installer _i�' � Designer � , �� `#�^, �t!,41} i' 1�4 ,►C"7 #bedrooms — Approved design flow _ "" _ ' ( gpd The issuance of this perm. shall not be construed as a guarantee that the system wil PC ot}as design6d. Date < �d InspectorU %V r1 r v No. ""'? Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS OispoBal *pstem Cons tructiopl)ernut Permission is hereby granted to Construct( ) Repair( ) Upgrade(� Abandon( ) System located at A .1.� �./!lV - e/R• .ITT � 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. i Provided:Construction must be completed within three years of the date of this peg Date Approved by--�� "�� Town of Barnstable °Ftrti Regulatory Services Richard V. Scali,Interim Director s�x[vsznetE. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 0 ffice: 508-8624644 1 Fax: 508-790-6304 Installer&Designer Certification Form Date: 12 �� Sewage Permit# 00 Assessor's MapTarcel 04145 Designer: Installer. Address: Address: =a4?1DNLqt1 MOn 16ft\wat. as issued a permit to install a (dat -4 (installer) se _4ptic -- - M based on a design drawn b sep c system at � �(� gn y A i (a�ddress - DWIP - ��`i�;( ` dated ?, M (designer) I i ZI 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 (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constru-c+y�� �liance,with the terms of the AA approval letters (if applicable) t1 QF�hgs� o� DAVID (MASON m (Installer's Signa ) No.toss a o-e11 � (Design s Signatures (Affix Des gn r s Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION.: CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Desiper Certification Form Rev 8-14-13.doc COMMONWEALTH.OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 207 Regency Drive Marstons Mills, MA 02648 Owner's Name: Augustus&Deborah Wagner Owner's Address: Date of Inspection:. December 8, 2005 Name of Inspector: (Please Print) James M Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400 a CERTIFICATION STATEMENT i c I certify that I have personally inspected the sewage disposal system at this address and that the irtf+nation W'orte below is true,accurate and complete as of the time of the inspection. The inspection was performed!based offmy training and experience in the proper function and maintenance of on site sewage disposal systems% I am a aP > approved system inspector pursuant to Section 15.340 of Titles(310 CAM 15.000). The sys -10 u ✓ rQ Passes Conditionally Passes t®o rn Ne Further Evaluation by the Local Approving Aut ority Fa' s Inspector's Signature: Date: December 11, 2005 The system inspector shaysubt of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of cinspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time-of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 207 Regency Drive Marston Mills. MA Owner: Auzustus&Deborah Wainer Date of Inspection: December 8. 2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or no:determined(Y,N,ND)in the for the following statements. If"not detennined",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. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or. obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 I Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 207 ReQencv Drive Marston Mills. MA ' Owner: Auzustus&Deborah Wagner Date of Inspection: December 8, 2005 C. Further Evaluation.is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the.environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The.system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria,are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 207 Regency Drive Marston Mills, MA Owner: Augustus&Deborah Wagner Date of Inspection: December 8. 2005 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 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. 4 Page 5 of 1.1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 207 Regency Drive Marstons Mills. MA Owner: Augustus&Deborah Wagner Date of Inspection: December 8, 2005 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: Yes No ✓ _ 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(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 207 Regency Drive Marston Mills. MA Owner: Augustus&Deborah Wagner Date of Inspection: December 8, 2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available.(last 2 years usage(gpd)): Private well Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): epd- Basis of design flow(seats/persons/sgft,etc.): 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/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped after the inspection for maintenance Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed in 1991 -per design plans Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 207 Regency Drive Marstons Mills. MA Owner: Aueustus&Deborah Wagner Date of Inspection: December 8, 2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 8" Material of construction: ✓ concrete _metal _fiberglass _polyethylene —other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 Qal. Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 10" Distance from top of s.-um to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert There did not appear to be any signs ofleakage The tank was pumped after the inspection for maintenance. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 207 Regency Drive Marston Mills. MA Owner: Augustus&Deborah Wa¢ner Date of Inspection: December 8, 2005 TIGHT or HOLDING TANK: None (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/day Alann present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.): The D-box was level. No solids were present. PUMP CHAMBER: None (locate on site plan) ) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 = Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 207 Regency Drive Marstons Mills. MA Owner: Autzustus&Deborah Wagner Date of Inspection: December 8, 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: I -6'x 6'w/2'stone(per design plans) leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): The leaching pit.had 3.5'ofliauid on the bottom. There did not appear to be any signs offailure A riser was installed and the cover is now ]'below grade. The bottom to grade was 14' CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 N a. N Page 10 of 11 OFFICIAL INSPE CTION FORM-NOT FOR.VOLUN TARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 207 Regency Drive Marston Mills. MA Owner: Augustus&Deborah Wagner Date of Inspection: December 8, 2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. A_ f3AUk Q 3 a � O O 13 a /s6 19 3 ai aq y as 31 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 207 Regency Drive Marstons Mills. MA Owner: Augustus&Deborah Wagner Date of Inspection: December 8. 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to grz)und water 20+/- feet Please indicate(check)all methods used to determine the high ground water elevation: ✓ Obtained from system design plans on record-If checked,date of design plan reviewed: 119/92 Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps the maps were showing approximately 20'+/-above Mystic Lake to the bottom of the leach Rit According to the design plans on file the well is 150'+ to the leach it This report Fas been prepared and the system inspected and passed as of the date of inspection. This report is not a warrarty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,written or implied,relating to the system, the inspection and/or this report. 11 Aug 30 2019 07:31 HP Fax page 20 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ; t � — 207 Regency Drive r r. Property Address Augustus& Deborah Wagner Owner Owner's Name information is c required for every Marstons Mills MA 02648 8-26-19 page. CitylTown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. OFAfd lnrp������ Important:When ``���� . ,. 61 filling out fowls A. Inspector Information �l ����� �pa•r' . 10 an the computer, S :' JAMES use only the tab James D.Sears = : key to move your Name of Inspector — ;y cursor-do not Ca ewide Enterprises use the return = �'•.c+ o:•Q- key. Company Name �F •..• ,, .• G� `���• 153 Commercial Street �Nrym!�rN mnut �� �`` BSI Company Address Mashpee MA 02649 Ci:yfTown State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that; I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CM R 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection;and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ .Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 8-27-19 c4ispector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 15in3p.doc rev.7/2612018 Tllle 5 OPodal fnspactlon Form:Subsurface Sewage Disposal System-Page 1 of 18 Aug 30 2019 07:32 HP Fax page 21 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments 207 Regency Drive Property Address Augustus& Deborah Wagner Owner Owner's Name information is required for every Marstons Mills MA 02648 8-26-19 page. CitylTown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6, 1) 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: The system is a 1000 Gal. Tank D Box and Pit, 2) 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): 5nsp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Aug 30 2019 07:32 HP Fax page 22 Commonwealth of Massachusetts Title 5 Official Inspection Form tSubsurface Sewage Disposal System Form - Not for Voluntary Assessments 207 Regency Drive Property Address Augustus & Deborah Wagner Owner Owner's Name information is required for every Marstons Mills MA 02648 8-26-19 page. Cityffown . State Zip Code Date of Inspection C. Inspection Summary (cunt.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO (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 ❑ NO (Explain below): 3) 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. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: 15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Pege 3 of 1B i Aug 30 2019 07:32 HP Fax page 23 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 207 Regency Drive Property Address Augustus& Deborah Wagner Owner Owners Name information is required for every Marstons Mills MA 02648 8-26-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (Cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet f o 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. c. Other: a System } ys em Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes Na ❑ No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Tltle 5 orflclal Inspecuon Form:Subsurface Sewage Disposal Syslem-Page 4 of 18 4 Aug 30 2019 07:33 HP Fax page 24 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L 207 Regency Drive Property Address Augustus&Deborah Wagner Owner Owner's Name Information is required for every Marstons Mills MA 02648 8-26-19 page. CityfTown State Zip Code Date of Inspection C. Inspection Summary (cost.) 4) System Failure Criterla Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth In is less than 6" below invert or available volume is less than 1/:day flow Piz" ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply 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 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,0.00 gpd. For large systems, you must indicate either"yes;'or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinkingwater supply PP Y ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well 16insp.doe•rev.712612018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Aug 30 2019 07:33 HP Fax page 25 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 207 Regency Drive Property Address Augustus & Deborah Wagner Owner Owners Name information is required for every Marstons Mills MA 02648 8-26-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: 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 maintenance of subsurface sewage disposal systems? proper 9 P Y 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)] 15insp.doc-rev.7Y160018 Title 5 Official Inspection Form:Subsurface Sewage Disposel System-Page 6 of 16 L Aug 30 2019 07:33 HP Fax page 26 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4_ 207 Regency Drive Property Address Augustus& Deborah Wagner Owner owner's Name information is required for every Marstons Mills MA 02648 8-26-19 page. CitylTown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Description: 1000 Gal. Tank D Box and Pit. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2017-24,000Gals g ( y g (gPd)) 2018-22,000 Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date t5insp.doc•rev.7/26/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Aug 30 2019 0733 HP Fax page 27 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v� 207 Regency Drive Property Address Augustus& Deborah Wagner Owner Owner's Name Information is required for every Marstons Mills MA 02648 8-26-19 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commerci all Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatslpersons/sci t., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancyluse: Date Other(describe below): 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5lnsp.doc•rev.7/26IM Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pop 8 of 18 it Aug 30 2019 07:33 HP Fax page 28 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 207 Regency Drive Property Address Augustus& Deborah Wagner Owner Owners Name information is required for every Marstons Mills MA 02648 8-26-19 page. CitylTown State Zip Code Dale of Inspection D. System Information (cont.) 4. 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 UA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other (describe): Approximate age of all components, date installed (if known)and source of information: 1991 Permit # 91 -578. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 20"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.): Pipeing is 4" PVC SCH -40. t5insp.doc•rev.7126/2018 Title 5 Official In edlon Form:Subsurface Sew sp age Disposal System•Page 9 of 18 Aug 30 2019 07:33 HP Fax page 29 Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Forth Not for Voluntary Assessments k 207 Regency Drive Property Address Augustus& Deborah Wagner Owner Owners Name information is required for every Marstons Mills MA 02648 8-26-19 page. City/Town State Zip Code Date of Impection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 10" 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: 1000 Gal. Precast H-10 Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle 28 Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 1211 i Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt-Plan -Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working Level.Tank and cover at 10". Inlet Tee w/outlet Baffle. No sign of leakage or overloading. t5lnsp.doc•rev.1/26/2018 Title 5 Official Inspection Form!Subsurface Sewage Disposal System-Page 10 of 16 Aug 30 2019 07:34 HP Fax page 30 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 207 Regency Drive v Property Address Augustus & Deborah Wagner Owner Owner's Name information is required for every Marstons Mills MA 02648 8-26-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7, 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:subsurface 5ewage Disposal System-Page 11 of 18 Aug 30 2019 07:34 HP Fax page 31 Commonwealth of Massachusetts Title 5 Official Inspection Form Ia Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 207 Regency Drive Property Address Augustus & Deborah Wagner Owner owners Name information Is required for every Marstons Mills MA 02648 8-26-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or'Holding Tank(cont.) 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 9. 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.): D Box is 12"x16"-26" below grade w/one line out. Box is clean and solid wlno sign of over loading or solid carry over. t51nspd"•rev.7/26/2018 Title 5 official Inspection Form:Subsurtace Sewage Disposal System-Page Q of 18 I Aug 30 2019 07:34 HP Fax page 32 Commonwealth of Massachusetts Title 5 Official Inspection Form ,)I� Subsurface Sewage Disposal System Form • Not for Voluntary Assessments k",'a9 207 Regency Drive Property Address Augustus& Deborah Wagner Owner Owner's Name requir required is Marstons Mills MA 02648 8-26-19 required for every page, City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located,explain why, Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ inn ovativelaltern at ive system I Type/name of technology: 16insp.doc•rev.1/16/2011 Title 5 Official Inspection Form:Subsurface sewage Disposal System•Page 13 of 18 Aug 30 2019 07:34 HP Fax page 33 Commonwealth of Massachusetts Title 5 Official Inspection Form 1i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 207 Regency Drive viW." - Property Address Augustus & Deborah Wagner Owner Owner's Name information is Marstons Mills MA 02648 8-26-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is a 1000 Gal. Precast Pit wl2'stone. Pit at 6' below grade w/cover at 1'. Pit is piped into riser. 18"water in pit wino sign of over loading or solid carry over. 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal Syslum•Page U of 18 Aug 30 2019 07:34 HP Fax page 34 Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 207 Regency Drive Property Address Augustus&Deborah Wagner Owner Owners Name information is required for every Marstons Mills MA 02648 8-26-19 page. CltylTovm State Zip Code Date of Inspection D. System Information (cont.) 13. 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, I5insp.doc•rev.7126/2018 Title 5 Offidel Inepedon Form:Subsurface Sewage Disposal System•Page 15 of la Aug 30 2019 07:34 HP Fax page 35 Commonwealth of Massachusetts # Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Poi207 Regency Drive PrapertyAddress _Augustus & Deborah Wagner Owner Owner's Name information is Marstons Mills MA 02648 8-26-19 required for every Page. City(rown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 15insp.doc-rev.7/21312018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Aug 30 .2019 07:35 HP Fax page 36 Aug 22 19, 11:63e Cepewide Enterprises 508-477-4977 p.11 V '1•Y{ YI YY•�� W�ar LOCH oN . �l Mt^r-� Dr►v SEIVAuE0 .kSSESSONS SUP a LOT 06 S LNSTALLER'S N5&?HONE N0, y SEPTIC TANK CA_7ACi'IY I dIA r-EACHN0 FJ.CACIY:(type) NO.OF BEDROUNS_S__ BJILDER dR OWND ?£RMRD,IIr: COMPLIANCE DATE Separation Disunce Bemeen the: WtimumAdj swd Cimndw=Table to t:nSFaciliii . Feu Private Water Sepply Well and Lauhing FaciGry(11 say wells east OR si i of wi;din Mo fe:t of leacldng facility) Fee, edge of Wadaad asdtcaching Facility(If my wclmds esist within 300 furor kachs jl faci&rv) Fee; -"shed by. — A ' a 1 � 0 Y 3 at aq yt� 3N.6� r 31 it b�s Aug 30 2019 07:35 HP Fax page 37 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 207 Regency Drive Property Address Augustus& Deborah Wagner Owner Owner's Name information is required for every Marstons Mills MA 02648 8-26-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth t ig 20'+h ground water: 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 propertylobservation 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: Rear of lot drop's off 20'+. Bottom of pit at 12'below grade. Before filing this Inspection Report, please see Report Completeness Checklist on next page, 151nsp aoc•rev.72&2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Aug 30 2019 0735 HP Fax page 38 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 .� 207 Regency Drive Property Address Augustus& Deborah Wagner Cromer Owner's Name information is Marstons Mills MA 02648 8-26-19 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section, ® B.Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C, Inspection Summary: 1, 2, 3,or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included ,a ?0, ,Pir 8 l5brsp.doc•rev.712512018 Tits 5Offldal Inspedon Form:Subsurfaoe Sawage Disposal System•Paga 18 of 16 No. Fee--------------------- BOARD OF HEALTH TOWN OF BARNSTABLE TippYicat ion for Vell Con0ructionvermit Application is hereby ade for a permit to Construct ( , lter ( ), or Repair ( )an individual el at: F = � - Locati�— Address AssessorsMap and Parcel Owner Address———— ---- ------ ol / `------�?! � Installer — Driller Address Type of Building � Dwelling -- Other - Type of Building------------------------ No. of - Persons-------J TYPe of Well— PV(_' ----- Capacity------------------------------------------------------_-------- _---_-_---_-_-_--_-_- _ Purpose of Well ------ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation unti Certificat of Compli n e has bee sued by the Board of Health. 4 ' 1!-x'AVWL g k--- V date Application Approved By --- date Application Disapproved for the following reasons: V------------------------------------____________________--______________________—______ -----__,___ --_---_--------------______-__—_______----___-_ ------ ------- -- date PermitNo.- - - - - ------------ Issued------------------ � —-------------------- date BOARD OF HEALTH TOWN OF . BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Co tructed (►/Altered ( ), or Repaired ------------------------ ------------------------------------------------------------------------ Installer wl/ --------------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Vnpz Regulation as described in the application for Well Construction Permit No. "l 'J�Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE --- --— - —---------------------------------------------- Inspector—----------------------------------------—---------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Vern Con5truct ion Permit Fee-- `C�- ---------- Permission is h eby granted-------/- �hJ/l�2-S - _l-1- --------- ----- to Construct ( , Alter ( )r Qr Repair ( ) an Individual Well at: Street as shown on the application for a Well Construction Permit / Cj No. ---------- Dated - ---1-'-r—`- -7 Y C ------- Board of Health DATE------------------------------— -- -- - --_---— - t No.-------------------- �- Fee-------------------- 1 BOARD OF HEALTH TOWN OF BARNSTABLE Applitation-*rIftl Con5truttionPermit Application is hereby made for a permit to Construct Iter ( ), or Repair ( )an individual Well at: Location,— Address Assessors Map and Parcel _—/40)g4—/'--------Hzlw ----------------- -- J. Q/ s� ii1,E - '-�l F -- Owner Address --------------------------------------------------------------- %` Installer — Driller / // Address Type of Building < �j�}yyi rG�t/ Dwelling - � ------- ------------ Other - Type of Building ---- No. of� Persons--------- ------------------------------------- � � ---- ----------------- Capacity Type of Well-------------/------------------------------ P Y----------------------------------------------------------------------------------- I Purpose of Well Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation it a Certificate of Compli a has been issued by the Board of Health. Signed—�— --------�---------=-r�---�/! � --------�-------��--date Application Application Approved By- t� date Application Disapproved for the following reasons:---------------------------------------------------------------------------------------------- --__—-- --- -- - —------ —— —------------------------------------------------------------------ date Permit No.---r - - - ----------------------- Issued --------------- - ---�r?1 - = - date BOARD OF HEALNI-H f TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Co structed (V"), Altered ( ), or Repaired ( ) by----- 11J/S _ �_'�I}�/�/ �—-Installer ---------------------------—----------------------------------------- �,r) r has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. 41'' r-" Datedn -7 � THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------------------------------ ---------------------- Inspector--------_—_------------------------------------------------------------ BOARD OF HEALTH TOWN OF BARNSTABLE Veil Con5tructionPermit �6V ,� � No.---------------------- _ Fee------------------- Permission is hereby granted----- '-'�-� j ---- �'`��'� ---- ----------------------------------------------------------------- to Construct (VrAlter ( ), or Repair ( ) an Individual Well at: /n-4- l'� !l 4 _ I_ 277�Z l Street as shown on the application for a Well Construction Permit 4 No. l��_^ /.�_ — - ---- --- Dated ----- Board of Health DATE------------------------------------------------------------------------- 1?1???1???1!??nttaT?i?(??i??(?1!!!t?rt(ittmm�Tnr?tmtf tnnmtrrm rr?tn(nry,fttmni?itrtntrrn?rnriprtrrrrnrttrnnrtnrrn„±trttrT,rf+trrgtnmrsir?int?t?titt Jill!in????T????????(?????TT??????(?(R????TtfT??T'ii?^►J.�7 ENVIROTECH LABORATORIES =a Mass. Cert. #:MA063 449 Route 130 Sandwich,MA 02563 (508) 888-6460 CLIENT: Jack Delaney LOCATION: Lot 19 Regency Drive 404 Main Street hlarstons Mills, MA OZb48 - ADDRESS: Mashpee, MA 02649 COLLECTED BY: D.A. Scannell SAMPLE DATE: 12-28-91 TiME: 11:30 - DATE RECEIVED: 12-28-91 SAMPLE 1D: M84 3 - New �%Iell JOB WELL DEPTH: 83 : — - z� - = RESULTS OF ANALYSIS: - Parameter Units Recommended limit Result _x Coliform bacteria;100 ml (MF Method) 0 0 pH pH units 6.0-8 5 5.62 Conductance umnos.'cm 500 121 Sodium mg/L 20.0 12.6 10.0 Nitrate-N mgi L <0.03 Iron mg/L 0.3 0.39 - Manganese mg/L 0.05 = Hardness mg iL as CaCO 3 500 - c Sulfate mgi L 250 Potassium mg/L 20.0 Alkalinity mg/L 200 =x Chloride mgi L 250 Ei Turbidity NTU 5.0 E c: EE Color APC units 15.0 Background bacteria I~ COMMENT: Iron level is not a health hazard. s: EPA Method 601/602 ug/L Chloroform= 3* See Attached Sheet YES No WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. him DATET- �1f1111U111111111111111111111111►1111W11111t1111111U111111111!l111111l1111111111U11111111U11111i111U11111illiiiiiillliiluuliilililiGiiiilllllilllllllttii ll lllllllilllllll11111111111111111U11111i111111U111111U1111UU111111U\�� 'G. SROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: 84 Lab ID: 2461-01 Project: Delancy . QC Batch: VGA-909 Client: Envirotech Laboratories Sampled: 12-28-91 Cont/Prsv: 4Oml VOA Vial/NaHSO4 Cool Received: 12-31-91 Matrix: Aqueous Analyzed: 01-03-92 PARAMETER CONCENTRATION REPORTING LIMIT (ug/L) (ug/L) Dichlorodifluoromethane BRL 5 Chloromethane BRL 1 Vinyl Chloride BRL 1 Bromomethane BRL 5 Chloroethane BRL 1 Trichlorofluoromethane BRL 1 l , l-Dichloroethene BRL 1 Methylene Chloride BRL 1 trans-1,2-Dichloroethene BRL 1 1, 1-Dichloroethane BRL 1 cis-1 ,2-Dichloroethene * BRL 1 Chloroform 3 1 1 , 1 , 1-Trichloroethane BRL 1 Carbon Tetrachloride BRL 1 Benzene BRL 1 1 ,2-Dichloroethane BRL 1 Trichloroethene BRL 1 1 ,2-Dichloropropane BRL 1 Bromodichloromethane BRL 1 2-Chloroethylvinyl Ether BRL 1 trans-1 ,3-Dichloropropene BRL 1 Toluene BRL 1 cis-1,3-Dichloropropene BRL 1 1 , 1 ,2-Trichloroethane BRL 1 Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL 1 Ethylbenzene BRL 1 m+Mylene * BRL 1 o-Xylene * BRL 1 Bromoform BRL 1 1 , 1,2,2-Tetrachloroethane BRL 1 1 ,3-Dichlorobenzene BRL 1 1 ,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene BRL 1 QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS Bromochloromethane 30 29 97 % 83 - 117 % Fluorobenzene 30 30 100 % 87 - 113 % BRL = Below Reporting Limit. ' Non-target compound. "Trace" indicates probable presence below listed Reporting Limit. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). i r TOWN OF BARNSTABLE 9/—�� LOCAnON old-7 SEWAGE # 5V, ILLAGE ,.//e ESSOR'S MAP & LOT -O INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ( II NO.OF BEDROOMS BUILDER OR OWNER 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 Ap NW../... THE CLWEALTH OF MASSACHUSETTS APPROVED BOARD OF HEALTH �;(1 Barnatebb Canc--motim :.a mient 1VV 4. ...................oF..... �a�a a. : .c- ..................................... /Apt Y �. Y .. ------ i=l Appliat n for MiltooFal luorks Tonotrnrtlun ramit Application is hereby made for a Permit to Construct (/) or Repair ( ) an Individual Sewage Disposal System at: �. )d L c ti Address or Lot No. - ...... �caner 1 Address .--- Installer Address ' p - Type of Building Size Lot-.. ..... Slr,. U Dwelling—No. of Bedrooms...............Z........................Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ............................ No. of persons---.----.----..__-..------- Showers ( ) — Cafeteria ( ) 0.1 Other fixtures . W Design Flow.....................5.5...............gallons per person per day. Total daily flow........................3 3_0........gallons. WSeptic Tank—Liquid capacityA .gallons Length--------_----- Width................ Diameter.-.----.-.-----. Depth................ x Disposal Trench—No...:................ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.............I-------- Diameter.-------.jQ..-- Depth below inlet..........69..... Total leaching area.....�s16..sq. ft. Z Other Distribution box ( V-f Dosing tank ( ) 0-4 Percolation Test Results Performed by.--...BA)tr *.4Z.................................. Date............ tea_: <?......... Test Pit No. 1..... ...minutes per inch Depth of Test Pit-------13�m.... Depth to ground water.----- Test Pit'No. 2................minutes per inch Depth of Test Pit.------------------. Depth to ground water...----............----. a' ---•------------------------------------••---------•----....---.....----------------••......•--••---......................................................... 0 Description of Soil............................. • ...... ----..........•----- -- ------------- 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 has en issued by the board of he lth. Signed.. ..` ,(.1.ssvV1..��1......... .. ...... .�. t:Z"�•.�'CL.� d/ s � -------- ---Application Approved By ... --------- -- -- ------------------- `7 Date Application Disapproved for the following reasons: .... ...................................... ..................................................................................... ................................... ............................--.............-. ....--------- --------............. -- ..... ..................................... g Date Permit No. ....'"?...:�.1.a----_--------------- Issued --.._........�—7-'Z ,--��.... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEALTH ............ OF -------------- -------------------------------------- .............. Gertifirate IIf Grapttia ce THIS IS TO RTIFY, That the Individual ewage Disposal System constructed ( �orpaired ( ) by ................................ tL..el�'j/-�/-�.......601"y�CL Lt..... a.kV..._....---------------..--.-.......,.....--------------.....---..__..........-.-.-------------------------------- + 1 Installer at �� _ ��,.....1 I ........R - - � - 1'11-Q-? J, ---------------------------- --------.............-- ------------ has been installed in accordance with the e provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ------- dated _ °'..• '�.dl THE ISSUANCE OF TH CE TIFICATE SHALL NOT BE CONSTRU S 4GUARANTEE THAT T SYSTEM WILL FUNCTION TIS ACTO Y.DATE ... Inspector Xy .... . �t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ......................OF..... °?.' .. - ..................................... Appliration for Disposal• Works Tonstrnrtian Vrrmit Application is hereby made for a Permit to Construct (t/) or Repair ( ) an Individual Sewage Disposal System at: .r �. - �#Mee••.... _ � �................. --. __ ...pp-pp.....-.. ..._ Y1 . ' j q r) 1 �� • L t^r.� �v��K� �V� �� Lot No.1 1 I iG,.. ....-- uk1S - --;;a�-., .�A-.--••------------- --- i � ...................................................... W n e. 1 U. �� Address t ............... .............. ......... ;._................ e of BuildingSize Lot..........: Installer dress `b ltc Type U DwellingNo. of Bedrooms...........................................Ex ansion Attic— p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) f-4 Other fixturtl� es ------------------------------•--------••--'---••. -- - •-----•------------------- W Design Flow.....................�5................gallons per person per day. Total daily flow............... Q.._._....gallons. 1:4 Septic Tank—Liquid capacity_10.00.gallons Length................ Width................ Diameter................ Depth................ W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No._..----_.-I--------- Diameter---------- _._. Depth below inlet..........(41..... Total leaching area..... t�...sq. ft. Z Other Distribution box ( Dosing tank ( ) Percolation Test Results Performed by......-3A)(1 t4a.................................. Date........................................ as Test Pit No. 1------7-i!!:...minutes per inch Depth of Test Pit.......! ..... Depth to ground water........................ Test Pit'No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' ----------------------------------------•-----------•....................................................................................................... Descriptionof Soil ....... •----------------•------- --------•--------------- W ----------------------------------------------------------•----------------•--i------------•------------------•-----------------------••---------------------------------------•--------..........-'---- 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 Compli nce has ben ' ued by t board)f,health. Signed ............................................................... 3...-�............................. mace_ Application Approved BY tf =��� ' 1-�-J-----Y.._ � ......� � Dace Application Disapproved for the following reasons: .-........ ------------------------------ -------------- -------------------------------------------- ------- - - - ------------------------------------------------------------------ - --------- ---- ---- -- -- -- -- ------------------------------ -- ------------------------ ---------------------------------------- Date Permit No. .. r/.."-. '"''�.. .0 Issued /��,;,,,7'... �..... - --------- ----- ------- ---........ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH t-------------I--U-- ---y>------------ OF - - -------------- t .7. ------------------------ --- Trdifirate of C�umplianre THIS IS T01r( � ,lTh f&hp k 1- 4�a isposal System constructed ( ) or Repaired ( ) 1 f( by.. --....--- . 6 (_I W'9ee` ���...,.�� �.................... at --------------------------------------------------------------------------------------------------------------------.............------------------------------------------------------------------------------------------------------------------ has been installed in accordance with the provisions of TITLE 5,of The State�Fnvironmental Code as described ' the application for Disposal Works Construction Permit No. ...� :'.- ..�� ' -- ---------------- dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED• S A G ARANTEE THAT THE SYSTEM WILL FUNCTI N ATISFACTORY. DATE.............. .......... .. -�✓ ----------------....---.......-- Inspector ....-.... .......... ...... THE COMMONWEALTH OF MASSACHUSETTS BOARI OF HI�A ..O F.. ,rt 7 /�- .................................... ........................................................---- •--.................. No _....... ..:....�.. ................�J Permission 's reb ranted.............. ._.............---••----.--------........-----•-----..... ' Y g to Construct ( ) p�Yep 0 q) )N I_i0iV6t1a1)Sey''ai g Z4sposal Syss7elr► I at No............................................ 1--------.........................---------...------------------•----------------------•------------------------------'•--'••..'.'.t._ Street 4 7'� � ✓'i j ; as shown on the applicat' n fo Disposal Works Construction Per tt o.��=- _Y'..�Dated?. �__` C..:_!. ! ....... 37 � 1 ---- DATE....................• -! r`� FORM 1255 HOBBS JARREI, INC.. PUBLISHERS � SiF:1I Fatitlt_Y 3 BEL'.PDOM I �p �-AZBAIE 6W14VE- .-DAILY( FLOW -- sr'Fl c rANV- 3�ax I507a-zqs 6?-D U/7G Ions D I SFCM L PIT t,�E Lrr q 2 w G-/ brz►yt ' � 51DEWAl.L A>�A =.lO�SF F I ?OTToM Aaf�A = .-T& SF E 7g 4f 4 ►;o -79, , ToV\L tz-516W - 54-8 TOTAL VAILY FL-0N! 2�o�ATtoN ¢A'(E. = In IN ZttW DRLe; 17 N. SILI_,bIN r: I 4�o5t -r.52 3 rl= -7 TF = SS + P v-e• � ,�. �5 5U�.SOIL L;-0 I m0 I�JJ. I °1ST V:: GAt-Ioor� twv. ��g 74L T pN t i GAL �3 �r L� _... .__. . _..M u/►I om' - i WMF 8-,) C 37.5 =&3' I sTotJE I � �►�. c�r►�►o nor F/-AN Ho.varU? DATE-; ► 7- �-R Pao ; PLAN SSE �RF�JC,� 1 CEIETF`/ 714AT TI s FcoNt?AmarJ � °lc��.;�� �I��'%EcN �oM�pLYS ��viT�4 T�kE 51•DE��Ic �.o�' I�1 � i 'r'Ax3LL 1-� �' � G, I �4-2�� �--� •r� ol•� � NOT-LocwTe�D W1, Moon M,&It L IIS ill IS NOI" i�A/© Del /at1 I�ST¢OdtElyl" c�U I t_ DJ611J EELS AIJT-') TNT. oF[::sETs -1,40ULD u Ur TE MA/i! , �:C-1� T'D ESTQ�-ISI� FTZo�E�.T`/ la tJLS . APPLICANT; GI—T `f_ Co�:,�.,3,�1JC' {„ \�Ptol•¢ �p/r� L- �c.-Q L� � ' Sir Ton of G3 1001 101.7 .-.._ y>r�S_ .,_._ 9�• \ Wes-. . �to \ Z07- /8 1 TH / 2 _ _o , - 90 O 7110 SEPTA `• _,...:�.. , \ � 2 ,� N.•..>,3a 8 •3 90 1S 7J �1 14 � Ot4-70 O LOr�l 63 9 + �A 6t 4 i r AG, m 61 4 ` 14 SHVI 733 IN y LLL o � 'TT it 7 t mmmm97m n m n� t mmm !t mmm tt m t m mTM. p m & -EF ENVIROTECH LABORATOWES \_ Mass.Ccrt.#MAO 3 449 Route 13 Sandwich,MA053 . (0)aa86460 $ CLIENT: Jack Delaney LOCATION: . tot 19 Regency )rive q E ADDRESS- 40 Main Street Marstons Mills, MA 0264 _ k Mashpe, MA 02649 k COLLECTED BY: D.A. Scannell SAMPLE DATE 12 28 91 TIME: 11:30 k DATE RECEIVED: 12 22 91 SAMPLE ID: M84 E 4 JOB f New Well WELL DEPTH: 83` & _ � RESULTS OF ANALYSIS: 2 � q . Parameter Units Recommended limit Result § � 4 . E Co Wr b de a/10 m| (MF Method) O 0 \ F © PH pH units «*\/ 5.62 & Conductance umhopcm 500 121 k EE: Sodium mg/L 20.0 12.6 4 k N#keN mgZL I¢O <O.OJ ] ; ¢ Iron mg/E . 0.3 = 0.39 � 2 ; E Manganese mg/L 0.05 = k � g Hardness mg/L as CaCO 3 5O q k � F Sulfate mg/E 250 ] % 7 Potassium mgZL 20.0 k R q 2 Alkalinity mg/L 20 d 6 = @ K Chloride mg/E 250 / F � Turbidity NTU &O j F C&2 APC units 15.0 § Background bacteria COMMENT: Iron level is not a health hazard. % £P Method 601/602 aR/L Chloroform= S# \ # See Attached Sheet q � \ s NO WATER G SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS ESTER. § K « Lem— DATE g E � GROL NDIA..IATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: 84 Lab ID: 2461-01 Project: Delancy QC Batch: VGA-909 Client: Envirotech Laboratories Sampled: 12-28-91 Cont/Prsv: 4Oml VOA Vial/NaHSO4 Cool Received: 12-31-91 Matrix: Aqueous Analyzed: 01-03-92 PARAMETER CONCENTRATION REPORTING LIMIT (ug/L) (ug/L) Dichlorodifluoromethane BRL 5 Chloromethane BRL 1 Vinyl Chloride BRL 1 Bromomethane BRL 5 Chloroethane BRL 1 Trichlorofluoromethane BRL 1 1, 1-Dichloroethene BRL 1 Methylene Chloride BRL 1 trans-1,2-Dichloroethene BRL 1 1 , 1-Dichloroethane BRL 1 cis-1,2-Dichloroethene * BRL 1 Chloroform 3 1 1 , 1 , 1-Trichloroethane BRL 1 Carbon Tetrachloride BRL 1 Benzene BRL 1 1 , 2-Dichloroethane BRL 1 Trichloroethene BRL 1 1 ,2-Dichloropropane BRL 1 Bromodichloromethane BRL 1 2-Chloroethylvinyl Ether BRL 1 trans-1 ,3-Dichloropropene BRL 1 Toluene BRL 1 cis-1,3-Dichloropropene BRL 1 1 , 1,2-Trichloroethane BRL 1 Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL 1 Ethylbenzene BRL 1 m+p-Xylene * BRL 1 o-Xylene * BRL 1 Bromoform BRL 1 1 , 1 ,2,2-Tetrachloroethane BRL 1 1 ,3-Dichlorobenzene BRL 1 1,4-Dichlorobenzene BRL 1 1 ,2-Dichlorobenzene BRL 1 QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS Bromochloromethane 30 29 97 % 83 - 117 % Fluorobenzene 30 30 100 % 87 - 113 % BRL = Below Reporting Limit. * Non-target compound. "Trace" indicates probable presence below listed Reporting Limit. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). I LOCATION / - -- _ ,� - NO. 2 VILLAGE ( — DATE _ L APPLICANT 0 jQ-S FEE ADDRESS (Non-refundabl( �(� n'1 - TELEPHONE N0. .ENGINEE , Z .c- 0. TELEPHONE NO. c5V_ �.` DATE SCHEDULED (Applicant' s signature ASSESSOR'S MAP & LOT NO. - SOIL .LOG SUB-DIVISION NAME DATE P ' L/5 TIME EXPANSION AREA: YES_,X__NO U1ye4aR� j, _� _ ENGINEER ;.N' TQWN WATER - PRIVATE WELL —kc BOARD OF HEALS EXCAVATOR SKETCH: .(Street name, etc. ,dimensions of lot, exact location of test holes and �'"percolation tests, locate wetlands in proximity to test holes) NOTES : 7S 90"_'-' V7 C_c>T Is 1,0 PERCOLATION RATE: 47ZPWQ kkoc{� TEST HOLE NO: `-CIF— 1 ELEVATION: TEST HOLE N0: 'I- ELEVATION: 2 c_ 1 Lox—, 2 2 3 4 5 CA. 5 L e5�()4 6 6 ' 8 A 8 9 9 10 10 ti ll 11 i l 12 12 13 . t2 13 14 @.�c7 VJAI 14 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD. LEACHING PITS • LEACHING TRENCHES UNSUITABLE FOR SUBSURFACE SEWAGE. REASONS:• JF.A_ NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTTRETY BY P .�F_ AND RETURNED TO BOARD OF HEALTH COPY: RETAINED• BY APPLICANT =A ►` ; . TOWN OF BA.RNTSTABL.E 0"1 %ttn C i briv — SEWAGE # _YV% ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.., SY-R fIC TANK CA-PACITY l 0�110 L-ACHING F ACILLPI'Y: (type) R-r C;X(o I M (size) oZ •S*Ak NO.OF BEDROOMS- BUILDER OR OWNER GyAT/ P'ERMITDATE: COMPLLANCE 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 witMr,200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leacng facility) J Feet Furnished by TI-I S'Pe u Ion FD/ A_ GAuk a 3 a � O O Q a 19 3 a► aq - Y aS 31 f 207 Regency Drive, Marstons Mills, MA r / � 5'-11" �—5'-9�• 14'-5" d playroom his office entral vinyl flooring c carpet �f her office storage AVAC ��� carpet unfinished quip � `J UP Uyi keak-c� - �Lc+sc•� lal ill 18 EO ._5.. utility gym F� rubber flooring i LIVING AREA 23-74 50 FT rti I I o I I 1 14' I 1 I 1 1 I � I 1 I - 1 I N I 1 (V I I 1 N I III I I � I 1 LL UP I I UP --I IFT I 0 0 II O r I LAI ❑ I Laundry I I I iv 5' UP _. 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I� 1 I i i -�Sc+1T,RTIN.T,- I � �2r:K:.=sTOOS..w_1-4::f.`1:JALScx- a, �' � - l5`•"�•'_'" -anC: � � ' 17TS3z.-.. I I d �2T13Y -tSG4-`�.UC' -tcre. IQ SUS'�ss:-rp ti >� I _ - < I. � I I I I .C.. I t I 1' JJ , I 1 ! a I. , r < ' � l �I � � �� � ��' � �;S,scr+�z:•r �'c-3_�tr<-1Y>r�' _ ._-"rd �+cl' . .Y.SJOM."_%..:_. •;I': _...SAC. _C5hl I � 1 i , , { ,. ij - i !1 0 ji t'• :: I ,., ;. _,�.Y...rr. �?�-seas_ 2-o'+xa __ .._ r ._a... .._..__ 4 c�` a_e: I': 1 i J " - - i - Y �� 1,' � i ,�-��rra�-tea u.- �:�t � . • r : : - I tv ._.._-.r._�.L—_ .. �1 IL CA .20 N j nth act uu S f3v, ': .: •�� � ....-.� ._J2"`::CST_ _—__.__.__—:12 O.' __._.__.— � .fa:C...._._.._7-:.=:.�Ce',C5 ...... _ — .-:i'e:o—:— .-fe-fo: � � 4�ZS.._'.. _$�G.LL._— ___ ;8-LS_ __:G:.C] 4•. .. � � � � �..,,,.c',•v-..i�7SQCLlT"TE[.'C'ETP'L�l'•'6L Cl��-_..:'ai.�,..';. tP � r .•YY.'+YN4�:NI.4tr�i"`N �.: w.fiS�°�/}yY,{1Mf0! ll9fld►1J1► - �iX°<�lP..lr/K.10 ••••'• 'T.416d►aP•<lftlegRY'.'.•.,i�^J�'4'9�'.LfaTW'f411Gpf1Q141Rr'GLU'•AOgOC�'��a'1.r'uHCM20w+RMta4:4i-^`-':(T^N?R'i'P4'�^Rt.{Y[k,+iY6i/AhWiN<vyt�...rp. W. .. ��*+{{-�� {TSV':A,1!}Rr(Gi•.�:;t:•±2."SaY31:4 'YLR'i• Nf•.Y`vR+yAylrJ'I•ptt..•,a,.ayr.�C»<j,,�+'•••.• .. .:i•.•.S,•.nJ M+.41010R:4 V.:v.....+'AYe .,"9at n'a lv:.:�.:sa''My�'•1Y rn tu:. N1C4f,'...^'k'f'9^.!!Oi4.tMb4tl+'6,ds l7iR•'.aewT7 ':Y+!t+.:i•.l:ie�q' :..a.RM sV,. •.,Yw '�k r n L A.., C -_ ._ .._._ _._.._.__ .._._ .._ ,.._ 1 installation to Environmental Code ( '' t ' � �-'��� �'� 1) `"hK 'tali shall cnritply t�;ith the State ta! Titie'J and Town of � } Board of Health Regulations. FLOOD � �NE. �Q� ��1�� �- �. �a , ''/�1_c� � Z} The septic system aspr�'Posed can 4hrs plan shall not be installed until a licensed town installer REFERir l'��r : Z 0 CtJ 7 /�7 7 _ D y ' �� t1! receive approval an installation pc pWicable town. _ L,A . E t IV '�.p7l T n S l• d Permit frarrt the a - w. . ,,..,_ . _ r rt Trr�it :tail r ca ion os utilit f� r.r� lines P iar#o '�staitarian,t e shall vr+rify the la #' ies,se� e vats, sewer!' S �'" I - ��-•/� -��� �. .___ ____.+(�'_,�►'�y..►T./JJj `"�, 2!:ZU16.�eLt) • F sCC't and existing septic components prior to installation. 'r I a' r AH gravity 4/-_. W.`•�. .____-. '"` 'i t 1+i v. '' f` t , s' f�. r sewer c g �s tc be 4 ir►,r piping h schedule�10 PVC at 118"per foci, The first Z feet out of the distribution box shall be level. All piping connections to be glued. S; This septic design piar, is not to be utilizes!for property line clatermination or for any other purpose other thz n the proposed w.[ic system installation. x p i� r I' y Ar M CS y 9 e ; CD -i j� �'l All Title V comporents are to meet Title V specifications, cry • /� � ' Parking shall be prohibited over Title V components unless c_.impenents are H20loaded. 4_O A T 1 0�� �,�r IVIV £j Tl'�c� existing Teaching cr ceasl�aois small be p�.mnnped and filled with material per Title V abandonment procedures Leaching and e n co ntairtinated soils within the ,.: :----._._ ��� � p • � , p ucedirr �. c sspaol(s� and a proposed SAS shall be removed and replaced with clean sand per Title V specifications. Rft424,, • 174 y 9l Septic components are to be 10 from a water service line. Sewer lines crossing ,. ( i • ' t # 7 p P B a water line sl, �-7 be sleeved with an appropriately sized schedule dQ PVC with ends groLrted. The water service A101 t •ni *5Q s lls7A or the septic line can be sleevpcl rdth the sleeve being 2 distance of !C on boV-sirles r.` crossing the line. 4 1 )} designed�d gte acrr grinder ©cs to`ats in rhe irrt grinder, t0 be =em0«t�ci if the septic system i5 not / g o garbage g d� , { 11) The installer is responsible for-care of excavation around all utilities on the property and t \ / protecting the structural Integrity of all structures during the instaiMation process of the septic. �" • _ system. 1.2.; This plan only represents that a septic system can No installti,d on the property meeting Title V \ c _ 1// ) �l requirements. +../ t.t'mRrC?4,},= Ay} ! !�„/ Aiy4)AY `5w P.04rM ^�� v.r'�!+?Jrt:r��{ •• --•• ---- _ 1 31 The property owner Thal! review design,criteria to approve the total number of bedrooms and P f} '� design flow.Installation of tho, septic system as proposed and receipt of payment for the design r r f a. y .! . shall be deemed approval of the. design criteria by the property owner or agent of. n r. '..4) Tire validity of this plan stall expire with the expiration of the town installation permit issued fci f,At.z -14 :ry•�.sy = { 1"ANK � ��� is plan or the vallditti of this plan shall expire an the expiration of the Certificate of Compliance ij r issued forth of the pros.iva ed system on ll,is plan. ri,i it t� ��l•'.�' 't `;�j 1 ♦.rt,*a S�•.!"' .••f,•', VOT�!011,qc - 61 -4— _ f ISO 7___ IN, �� _ ► fir Z') _ . G� __ � c� 31 206 - _ AV � ._.._ _.... �rev ►� ; ,� � ,:. +�6' ® _ '$"f , 2AD .� Q--�-- l -' _ 'a : 4J p ✓ '�I .; y �7 1...-�._..� � �` �� � ...�.---"���,'�w'��`�y'�— r ;-L S4...i i I� _..'•! ^ `.?i S V"ro�Y''f�T V�./ yaf 4 � r 11 Yl/ a.._r_..,,�,.. .�. .'"»•..'sue' j,":.---•'=t. 'e 1 � � � :_..' .....�__ � ...._..�..._._.. �jy '""' �_' .' r �''-ia .✓': ,.4� .�°.`. - .«, •m-...... a�A V ?.� . J'�jr :•1't,� � S �'r�' ..G. 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