HomeMy WebLinkAbout0181 ROUTE 149 - Health 81 Igo rite '1 49 �.,
Marstons Mills ",_r "-;
A = 078 —018 -003
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TOw.Rd'OF BA-FVJT.P.BLE
LE�CA'1'ON SEWAGE #
VILLAGE—,..— ASSESSORS MAP & LOT
INSTALLER'S NAM%&PHONE NO. C�,c� _ f._C-0-Vo5SA
SEPTIC TANK CAPACI7y /5dd 6G..I
LEACHING FACILITY: (type) 12.57 �e ?4:S <X (siae)
I10.OF BEDROOMS -
BUILDER OR OWNER li-
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
`3 '
i
No. .�F�LQ� 12.W / 77�P(�v t;c� Fee_16aZ777
�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
Yication for ]Dig o.5ar * 6tem Congtructiou Vermtt
Application for a Permit to Construct( )Repair( )U rade( )Abandon( ) M-Complete System ❑Individual Components
0 o���resp�ocLQSNo. Owner's Name,Address and Tel.No.
"tbess lP /(�70 tic� 91 i n
A T d F `]9
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
. (itf r'�'�i c�.n') �.r'c�cr�'nai? �ct►7Kc�cSv�t��
Type of Building:
Dwelling No.of Bedrooms .Z Lot Size /5,OO d sq. ft. Garbage Grinder( )
Other Type of Building No. of Persons .Z Showers(z) Cafeteria( )
Other Fixtures
Design Flow x/&5 gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Z Revision Date
Title
Size of Septic Tank /SQQ la Jluris Type of S.A.S. 314 -Z Q -.00 6ro-Ilan
Description of Soil tj[diUM IV Cour3t. ZVAJ &A��/ d7.4CrS
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 Certifi-
cate of Compliance has been.ss e this of H alth.
Signed C�% Date
Application Approved by Date o
Application Disapproved for the following reasons
Permit No. 7 Date Issued /0
_ 4.. ` > ti ..s....
No. 2' LG.� 2e Yr ApPra v c� Fee
THE10MMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC.HEAU DIVIION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes
k-4[ppricatioin for Migaal *p.5tem Construction Permit rm
': ��
Application fora Permioto'Construct( )Repair( )Upgrade( )Abandon( ) M'Complete System El Individual Components j
1
oca on Addres or L No. / Ovner'sIarne Address and Tel.No.
Assessor's Map/Parcel PART d Far73 �,• ' / l�t/�Q t nr GGtG� J I`� , V
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
�it� l'iar►'l t c berm ark yanKcc sur✓C
Type of Building:
Dwelling No.of Bedrooi ,Z Lot Size /Si 00 6 sq. ft. Garbage Grinder( )
Other . `l Type of-Building No.of Persons Z Showers(z) Cafeteria( )
Other Fixtures .-
e ,
Design Flow y 6,5 gallons per day. Calculated daily flow &9'q gallons.
Plan Date l- S - 99 f Number of sheets Z Revision Date
Title .f f
Size of Septic Tank /.SOU ice./larLS I Type of S.A.S. 3 N Z Q 600 &CxJ1ar7
Description of Soil Iltd/-um �v cour3'c 'yar)d L act! Cha4e,1:.5
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
y Agreement:
The undersigned agrees to ensure the construction.and maintenance of the afore described on-site sewage disposal system
` in accordance with the provisions o�Title,(5 of the Environmental Code an¬ to place the system in operation until a Certifi-
cate of Compliance has been 'ss edi by this lloaSd of H alth. "
Signed !_ Date I `
Application Approved by Date
Application Disapproved for_the following-reasons L f
Permit No. _ Date Issued I v
~- ---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that ft On-site age Disposal System Constructed( )Repaired( )Upgraded( )
Abandoned( )b
at t (c has been_constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated 2 l J o/,►T,
Installer -Designer """""
The issuance of this /`.al tqonstrued as a guarantee that the sy t m will function as desig a//d. t
Date / Inspector ? v/� �J
i / — (/ / v v= ' V
---------------------------------------
No. 9 C) 1
' Fee / nc(10--
THE COMMONWEALTH OF MASSACHUSETTS .
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Migooal *potem Construction Permit
Permission is hereby granted to Construct(t:7 repair( )Upgrade( )Abandon . )
System located at L-/`'� _t Ve r
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 mus a coin eted 'thin three years of the date of Vs permit.
Date: Approved by
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
req u i red by law.
DATE: f �3l 16 Fill in lease:
P
APPLICANT'S YOUR NAME/S:
AlIffl, BUSINESS YOUR HOME ADDRESS: S &kenwood Lc.ne-
Fa3._. �� i�'t -
•.��=�. � .�:��#,: 'lo -ic+ 3� Se1n�A wi c N A e a U -Z e,-4-
r� TELEPHONE # Home Telephone Number. —10_3 - O"7 3-7
NAME OF CORPORATION:_ IPRA-r 7C5- t N rF P(Lt Sf S L L C—
NAME OF NEW BUSINESS TkAo PL-u�Y\ Pc,i2c14 (Puact-iasC- TYPE OF BUSINESS �_ -(FT S l-foP
IS THIS A HOME OCCUPATION? YES NO�_ 0 a6q&
ADDRESS OF BUSINESS \cd l 6o--00kT M kLLS,ry\A MAP/PARCEL NUMBER (Assessing)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth
Rd. & Main Street) two make
sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING J� h
LR'S OFF E
This ind ipfor eo any per it require ents that pertain to this type of business.
rized Signa,urCOMMENTS
2. BOARD OF HEALTH
This individual h een )nfor ed�f the er it requirements that pertain to this type of business.
n
uthorized Signature*
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS: �. T;, im b T.: TP
0:78-01B 00,3
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
'< 181 Rt. 149
M
Property Address
Plum LLC >
Owner information Owners Name
is required for Marstons Mills /
every page. V MA 02648 1/29/18
Cityrrown State Zip Code Date of Inspection P
&3
Inspection results must be submitted on this form. Inspection forms may not be altered in ny
way. Please see completeness checklist at the end of the form.
A. General Information
1. Inspector:
Frank Nunes III
Name of Inspector
saa
Company Name
Box 841
Company Address
East Falmouth MA 02536
Cityrrown State Zip Code
508.272.6433 13010
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
1/29/18
Inspect s Signatur Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original should be sent to the system owner and copies sent to the
buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
),°ecged VS
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
181 Rt. 149
Property Address
Plum LLC
Owner information Owner's Name
is required for every page. Marstons Mills MA 02648 1/29/18
City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® 1 have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
Commercial/Residential property
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System
will pass inspection if the existing tank is replaced with a complying septic tank as approved by the
Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins.doc•rev.6/16 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
5•`y` 181 Rt. 149
Property Address
Plum LLC
Owner information Owner's Name
is required for every page. Marstons Mills MA 02648 1/29/18
Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins.doc-rev,6/16 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
181 Rt. 149
Property Address
Plum LLC
Owner information Owner's Name
is required for every page. Marstons Mills MA 02648 1/29/18
Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1/day flow
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
181 Rt. 149
Property Address
Plum LLC
Owner information Owner's Name
is required for every page. Marstons Mills MA 02648 1/29/18
City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a mapped Zone 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.
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
181 Rt. 149
Property Address
Plum LLC
Owner information Owner's Name
is required for every page. Marstons Mills MA 02648 1/29/18
Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined?(If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): 4 Number of bedrooms(actual): 2
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 465 provided
t5ins.doc•rev.6/16 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
181 Rt. 149
Property Address
Plum LLC
Owner information Owner's Name
is required for every page. Marstons Mills MA 02648 1/29/18
Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
1,100 square feet of commercial space and 2 bedroom apartment above. Per owner the apartment
has not been used in some time
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: occupied
Date
Commercial/Industrial Flow Conditions:
Type of Establishment: Retail
Design flow(based on 310 CMR 15.203): 200 GPD minimumGallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.): 1,100 sq ft
Grease trap present? ❑ Yes ® No
Industrial waste holding tank present? ❑ Yes ® No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No
Water meter readings, if available:
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M SVy�` 181 Rt. 149
Property Address
Plum LLC
Owner information Owners Name
is required for every page. Marstons Mills MA 02648 1/29/18
Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: current
Date
Other(describe below):
General Information
Pumping Records:
Source of information: Pumped 2 years ago per owner
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
l5ins.doc•rev.6/16 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 s 181 Rt. 149
Property Address
Plum LLC
Owner information Owner's Name
is required for every page. Marstons Mills MA 02648 1/29/18
Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
1999 per BOH record
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 18"feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: >10'feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Septic Tank(locate on site plan):
Depth below grade: 12"feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
H-20 tank partially in the driveway
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1500g
Sludge depth:
2"
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
181 Rt. 149
Property Address
Plum LLC
Owner information Owner's Name
is required for every page. Marstons Mills MA 02648 1/29/18
City/Town State Zip Code Date of Inspection
D. System Information cont.
Y (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle '12
Scum thickness trace
Distance from top of scum to top of outlet tee or baffle
>2"
Distance from bottom of scum to bottom of outlet tee or baffle
>2"
How were dimensions determined? measured
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Pumping suggested evry 3 years to prolong the life of the system
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 181 Rt. 149
Property Address
Plum LLC
Owner information Owner's Name
is required for every page. Marstons Mills MA 02648 1/29/18
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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
181 Rt. 149
Property Address
Plum LLC
Owner information Owner's Name
is required for every page. Marstons Mills MA 02648 1/29/18
Cityrrown 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.):
H-20 box, 2'6"below grade, very good condition, in the driveway
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
" If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
lugTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
181 Rt. 149
Property Address
Plum LLC
Owner information Owner's Name
is required for every page. Marstons Mills MA 02648 1/29/18
Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 3
❑ 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.):
Chambers were video inspected and are damp at this time, bottom of chambers is approximately 5'
below grade, no indication of past backup
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 181 Rt. 149
Property Address
Plum LLC
Owner information Owner's Name
is required for every page. Marstons Mills MA 02648 1/29/18
Cityrrown 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.):
Soils are compact and dry
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
181 Rt. 149
Property Address
Plum LLC
Owner information Owner's Name
is required for every page. Marstons Mills MA 02648 1/29/18
Cityrrown 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
� � a
� u �
� O [
C__ 31
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
181 Rt. 149
Property Address
Plum LLC
Owner information Owner's Name
is required for every page. Marstons Mills MA 02648 1/29/18
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 round water: >132"
p g g 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: 1999 NGW 132"
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:
See above
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
'< 181 Rt. 149
Property Address
Plum LLC
Owner information Owner's Name
is required for every page. Marstons Mills MA 02648 1/29/18
Cityrrown 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
D TOWN OF BPk TABLE
LOCATIO ie. Jyq l5/
C
—i---�� .�.__. SEWAGE #
VILLAGE C
yC /U�) ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. Gc��otiiA
SEPTIC TANK CAPACITY �S'Ods I l
LEACHING FACIL=: (type) (size) i�&,c k- C AS
NO. OF BEDROOMS 3 __
BUILDER OR OWNER.��J�G- �—�J�rQV '
PERMIT DATE: 77
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__
A3- ql 63-3'
0
—� /'ter-
I MARSTONS
PLAN `��RE MADE - LEGEND.' f Lore MILLS
I CERTIFY 771A T THIS SURVEY Y AND
IN ACCORDANCE WITH ThE PROCEDURAL AND TECHNICAL
STANDARDS FOR THE PRACTICE OF LAND SURVEYING Ili' FIRE HYDRANT
c
TH COMMONW sALTH OF MASSACHUSETTS'
CA TCH BASIN LOCUS
UTILITY POLEwv
WA TER VAL VF,
PA UL A. MERITHET, P:L S DA TF I v
oH6Y — — 0 VERHEAD WIRES
OAK TREE'
�'
1r,F" , "') OAK CL U.S'TER Po
MILL
D.N.H. ;S 0 DRAINAGE MANHOLES Ro UTE 28
LOT 4 — -- 108 CONTOURS
y' EDWARD BARRY ETUX
i PROPOSED LIGHT
po RIVER ROAD
( !ArsTorrs 111LLS POST OFFICE) 100.5 PROPOSED SPOT ELEV.
I UPOLF
Locus MAP
• ,. - , 1�s EXISTING SPOT ELEV
PLAN REF,
541118
--- r /
1 I� IL f 40946 EDWARD BARRY PETITIONER
DEED REF.' 46821,40
ZONING �,VB—A
0 VERLA Y DISTRICT.• "A p„
I
20 WIDE ACCESS EAS,�'11dL'�'VT �`'' ., f � . � � ASSESSORS. MAP 78 PARCEL 18
' i >' FLOOD ZONE: "C"
a PA vF2vFNT EDGE L-- 1�� -` f f MAX LOT COVERAGE BY BUILDINGS=259
01
MIN. LOT REQUIREMENTS.•
`��' f DESIGNED BUILDING AREA R WIDTH wv _
-- — — — — -- — — -- — -- W --- — -- - - �`'� f .. RETA1' BUSINESS 1ST FL) 10,000 �� F. ,20' 100'
APPRO�Y LOC. OF WATERLINE ~� , i °'a / �'-REP APT. (2ND FL)
LOT B .�
AREA=15,918E ' S.F. SETBACKS.
-=0.37f AC. �' 1��' FRONT SIDES I REAR
TtI�' MINIMUM Tt':TAL SIDE i'ARDS .SE"TBACIC S'HALL EF' TIIL' 7:` s30) t�'F^T PieC� Drt7 THAT
t >_ r�CI A� !)C,4?'ION C) ° T OT44L,R.�'..SUI TS IlY A � ET At7ff__. _. _ _AN Tom_ 0 ) FEET.a
EXCEPT °EUT77NG A RESIDI:NTAIL DISTRICT, 971iVWE A MINIMUM 01' TWENTY (20) FTET
Csi 11�� IS REQ`UIRRD.
- 10•G f
vo
PRW
1® , �Q. \ SITU ' ' ; T
�� -- _- q o r PLAN O L1VI�106 �
PROPOSED o5 a R 11 1 �\` C� "
1 _ .� AS. YAP 7 '/2E'
LOT A ``, -STORY , =. ,. , l GILHTRAfINA A. COUTO LOCATED I11'
LOT sur,°,OL✓G p '' c`� �� i DE D 2239123
(VACANT ) 1lARSTO.NS MILLS, MA.
102 ,_� .�
T.C1.f �101• �' M;1 � _._ �` OWNED BY AND PREPARED FOR
DETNA & PAUL RO,S,SI
+ 100 .-._ _.__ pOG'H I ,� 1
o Io 713 OLD BARNSTABLE ROAD
PROPOSED � � p G �, " � ' C�
\ PARKING �IOO.1 �2 `-
�✓ � � MASHPEE; 1��A. 02649 �
(TxI', PI-1 (508) 4 77—9668
_ Q
' 99.8 JAIVUARY 5, 1999
RE599.4
L'
�II1CF c.� UPOLF — GRA?HIC SCALE
�.
�CA rARE Mfjrr 9s.7„ 99. , la f3
�'n � I
` 123
53 ',S UPD a . • — IN IaEET`";
j7. ALA' -' "' ICt.E G 1 inch = 20 . ft.
OHW
lao" _ '� U T N U � _ YA.NK.E'E SURVEY CONSULTANTS
UPOLE 7' II7'`- f 'ST0 .. 3,0.1 _ — p ��a. i �' 1
�,/A co TUB PUBLIC
9®® ,� — .�_ f _ . � '�A Uf�T. .r 1; 4 0 INDUSTRY Y ROAD
BENCHMARK f �` 0 �' _ — --'"-. ° - - 1 .
sln � — 4 # P. 0. BJX ,'65
W Itl1AM
719F�OF�ELF, aAr sHsu — . �- ___ ,N MAN M.A ' 'TONS MILLS, MASS 02648
T 'L. 4 8— 0055 �'A.1� 42C--5553
v
qq
J/;,/ 51762 GGM
�---
:
EL
TOP OF FOCINDAT70/Y '
a
10 MIN. r�R,rnnmr rn, nFt�s �r
' SSIXDl&LE 40pl.. V C. II
l ArA'V PER FT �" ,.�i YF F
100. 8 ,.' o�vC�Eyzll .Co•VE�I� I „ ,R o
�) EL. =100. 5'
1/6 _1/2
7 MAx / WASHED STONE
4" CAST IRON PIPE ��l -�, ! i 7-
(OR EQUAL MINIMUM
PITCH 1/4 PER FT y CLEAN SAND 9"
FLOW LINE'
MIN.
INVERT 1 10" EL=97° 5
14A ;
98. 3' MrN :
------ G� INVERT L °°°° r_ a o o ci o a ° 0 °° °
BAFFLE' 9 7 85' '„ SUM o INVERT EL. - INERT � " RT ° c� o ra o 0 0 °
95. 0
EL
:. ...
7. 4
r
(TO BE PLACED ON FIRM BASE) i. TR E �'•rt ON LPL ro
4 '
. ;
3,�4 :To 1—.1/2
MECHANICALLY COMPACTED OR 6" OF STONE
�f'ASS ED STONE --.�
GALLONS TO . E RYA" M {
T T TTT ``TDova
��I- TIC T 12:5' .'�'""•35. 5 X ,2 TRENCH FORMA
ANKH TN.'.ON� ; TT
(H—.2D LOADING) '! +C' " t°1 8" ,S�T �` ~a ' C�+' L 1�LJ SV 1 L 1 Tl Ol V
J i
# a
1 a
SYSTEM (SA
s)
ski
PROFILE __���_
BOTTOM OF rE,ST HOLE PLEV 0 '
NO OBSERVED WATER (10/17/-97)
SEWAGE IIS �' 0S L SYSTEM"
t L ro
NOT TO SCALE w ,
,t s
HOLE,' 1 ELEt� 01 �i' O.�SL'.�rf4!A���+nT ,h�"OLE�' 2 F'LEV. =_ 103 0' `
= --
PERCOLA:i10N ??ATE ._ Mi'1'�I •�'" INCH AT I �' " ��`JNG" �5 . :�'�'h'COLA7IO�1� RA1rl _�_ MIl'd.; Il!'C'R AT ��_-�O' 111�Ct1E'S'
DEPTIf HORIZ TEXTURE O'C�LOR' �'+�TT.' . OTHER' DEPTH HORI2 TEXTURE COLOR MOTT. OTHER
0 12" O/A f LOAMY SAND r2.5YY512 1Vo �'"-�12" 01A LOAMY SAND 2 5 Y5/2 No
12"—36" P LOAMY SAND ..IOYR 616 12»—3,6 B , LOAMY' SAND 10 YR 6/8
36"-126 C NEED TO COARSE, 1{JYR 7,/80 ,� a„ Cl FINE, TO MED.SAND 10�'R 7/4
q,4ND & GRAVEL
i .6 132' C2 MED. TO COARSE 10 YR 716 u
SAND & GRAVEL
i1.
NO WA TER ENC UNTE'R�'D
NO WATER 'E'NCOUNTE'RREII —
GENERAL NO TES
f
1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D°E.'P.
TITLE 5 AND THE TO WN OF _.,8A.�N_,FL4B_LE—_—_ RULES AND
REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE' ��T� OF S��L 'S ST" 10,,-'�7,✓�7 S�II, TEST D®NE BY CRAIG R SHORT
2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO E` BY: '`' "' JERRY pUh1NING ti`" Of
FYITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12"
3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WILLIAM
WITHSTANDING H—,20 LOADING. �� L�EBERMnri N�
4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE' SHALL N DE'SIGN CALCULA TION� �
BE MORTERED IN PLACE. 1Fi�" 1 �3E'l�' OF" 'E1IROOMS" . 3 ' ""'
5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH INSTALL a 'RE' ' (3) rI 2l� AC ddE, G AGE` DISPOSAL . . . . . . No
DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO 500 VALLON LEACHING` a tOPAL ESTIMATED FLOW it
OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY CHA R`' tITTLI FOUR. EE`E?', `(�iO GAL IBh'IDA Y x 3 BR) +
6) UTILITIES SHOWN ARE APPROXIMATE ONLY, STONE" SI E.S AND FNDS , H 330 + 54 = 384 GAL/DA Y
EXCA VA TION CONTRACTOR � {
TAIL 501.�Odf1,§ x 1,080 S:F'
SPACED ONE 'FOOT APART ,
IS TO CALL "DIG— SAFE" AT 1—800—322—4844 AT LEAST 72 HOURS #WI UIRRE"D . " ?1 " TANK CAPACITY 150o GAL
35 5' X2�5' �,
PRIOR TO COMMENCING WORK ON SITTE' '
H SGIL."CLASSI�'IOA TION . . 1
7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS ` ` r° �S'IGN PE'RC , ArION RATS ' 2 1LIIN./IN.
tia 1 t 1
8 PARCEL SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE `' UE"11' ''` IIVG RATE .
. . 74 GAL/DA YES.F. 1
EL IS IN FLOOD ZONE LE'A 'HINC CAPACITY (ARE .X RATE') 465 G/D (384 G/D RQD <
9) LOT IS SHOWN ON ASSESSORS MAP _78_ AS PARCEL _18 RE ` 'h'VE Y.E'A " IING CAPACITY . 465 GAI/DAY
i.74)+(35.5+35.5+12. 5+12.5 X 74 X 2)
SHEET 2 OF 2 JOB N0. 51762 `.
is
I