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0221 ROUTE 149 - Health
�21�Route,149 . '�I Marstons Mills IF I A = 078, 023- I TOWN OF BARNSTABLE v �i , uv,.ATION as IC 1. y HW' 1�S, �Ay I� YVY r VIIsLAGE �V1 t L� ASSESSOR'S MAP &LA;0,?- oa3 `&STALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY CAS p�D LEACHING FACILITY: (type) (size) .NO.OF BEDROOMS BUILDER OR OWNER O V �- PERMUDATE: 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 S G 0.4 roll a i_ 59 119 a 63 50 LjOCATI SEWAGE PERMIT NO. J . / oT017 �� VILLAGE Aly I N S T A LLER'S NAME i ADDRESS 1-7—Hai /iPr)X , aal'ia"v ae'll f-/P ��i=Y i U 1 L D E III OR OWNER DATE PERMIT ISSUED Ip DATE COMPLIANCE ISSUED /,4 _ ® , ' I Z . TWO A73r� I o� - oa3- (poi Commonwealth of Massachusetts 19Pp Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 221 Rt 149 Property Address REDAN GROUP LLC Owner Owner's Name information is Marstons Mills Ma 02648 12/3/20 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 514r (s a-9,4 on the computer, Michael DiBuono use only the tab key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return Company Name key. Content Ln 16 Company Address Cotuit Ma 02635 City/Town State Zip Code 508-364-9587 S113522 Telephone Number License Number B. Certification I certify that: 1 am a DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CMR 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 12/5/20 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 221 Rt 149 Property Address REDAN GROUP LLC Owner Owner's Name information is required for every Marstons Mills Ma 02648 12/3/20 page. City/Town 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 an information which indicates that an of the failure criteria described Y Y in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System Contains a 1500 Gallon Septic tank as well as a Concrete distribution box and 2 500 Gallon chambers in stone. All components are H2O rated. 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): d i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 221 Rt 149 Property Address REDAN GROUP LLC Owner Owner's Name information is required for every Marstons Mills Ma 02648 12/3/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 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 ❑ 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): 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 c Commonwealth of Massachusetts � Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 221 Rt 149 Property Address REDAN GROUP LLC Owner Owner's Name information is required for every Marstons Mills Ma 02648 12/3/20 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 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 i Commonwealth of Massachusetts Title 5 official Inspection Form Im Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 P Y rY 221 Rt 149 Property Address REDAN GROUP LLC Owner Owner's Name information is required for every Marstons Mills Ma 02648 12/3/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria 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 cesspool is less than 6" below invert or available volume is less than %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 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 15,000 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 drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 c Commonwealth of Massachusetts U Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 221 Rt 149 Property Address REDAN GROUP LLB Owner Owner's Name information is required for every Marstons Mills Ma 02648 12/3/20 page. Citylrown 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 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 221 Rt 149 Property Address REDAN GROUP LLC Owner Owner's Name information is required for every Marstons Mills Ma 02648 12/3/20 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: Vacant 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 Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 189 GPD 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date i t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 221 Rt 149 Property Address REDAN GROUP LLC Owner Owner's Name information is required for every Marstons Mills Ma 02648 12/3/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No 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 occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Not provided Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 221 Rt 149 Property Address REDAN GROUP LLC Owner Owner's Name information is required for every Marstons Mills Ma 02648 12/3/20 page. CitylTown State Zip Code Date 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 I/A 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: New system installed 2008 Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: 2.5 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.): System is vented through the roof t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts F Title 5 Official Inspection Form T) Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 221 Rt 149 Property Address REDAN GROUP LLC Owner Owners Name information is required for every Marstons Mills Ma 02648 12/3/20 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1500 H2O If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 30" How were dimensions determined? Tape Measure/Data On File Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tee's in place at time of inspection t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts P Title 5 Official Inspection Form Subsurface Sewage Disposal System Foam-Not for Voluntary Assessments 221 Rt 149 Property Address REDAN GROUP LLC Owner Owner's Name information is required for every Marstons Mills Ma 02648 12/3/20 page. CitylTown 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): I 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 Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts ro Title 5 Official Inspection Form $, Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 221 Rt 149 Property Address REDAN GROUP LLC Owner Owner's Name information is required for every Marstons Mills Ma 02648 12/3/20 page. Cityrrown 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 Level with no sign of carry over 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 it Commonwealth of Massachusetts Title 5 Official Inspection Form `i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 221 Rt 149 Property Address REDAN GROUP ILLC Owner Owner's Name information is required for every Marstons Mills Ma 02648 12/3/20 page. CitylTown 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: ® leaching chambers number: 2 500 Gallon H2O ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts F Title 5 Official Inspection Form �i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 221 Rt149 Property Address REDAN GROUP LLC Owner Owner's Name information is required for every Marstons Mills Ma 02648 12/3/20 page. Cityrrown 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, et,-,.): No break out to ponding 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 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 221 Rt 149 Property Address REDAN GROUP LLC Owner Owner's Name information is required for every Marstons Mills Ma 02648 12/3/20 page. City/Town 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, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 221 Rt 149 Property Address REDAN GROUP LLC Owner Owner's Name information is required for every Marstons Mills Ma 02648 12/3/20 page. Cityrrown 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 UO �- 2 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 i Commonwealth of Massachusetts _ - Title 5 official Inspection Form M Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 221 Rt 149 Property Address REDAN GROUP LLC Owner Owner's Name information is required for every Marstons Mills Ma 02648 12/3/20 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 to high ground water: 10+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Jan 92008 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 des-.ribe how you established the high ground water elevation: Test Hole Data on plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form ^ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .� 221 Rt 149 Property Address REDAN GROUP LLC Owner Owner's Name information is required for every Marstons Mills Ma 02648 12/3/20 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 r_ Commonwealth of Massachusetts Title 5 Official Inspection or ' — `li Subsurface Sewage Disposal System Form -Not for Volunta ments 221 Rt 149 - Property Address ` REDAN GROUP LLC Owner Owner's Name information is required for every Marstons Mills Ma 02648 12/3/20 _ page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information filling out forms on the computer, Michael DiBuono use only the tab ___—_.___.__._.___.._..._.___._..-__._..____._... key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return --- key. Company Name 35 Content Ln Company Address Ma _ 02635 Co_tuit —T — e Cit (Town �� y State Zip Code 5087364-9587 SI13522 Telephone Number License Number B. Certification 1 certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 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 1215/20 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original 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. t5insp.doc-rev.7126/2018 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 1 of 18 https://Mail.googic.com/maivu/ TOWN OF B STABLE LOCAn0 Mt MJIS ESSOWS MAP TNST 'S N E&PHONE NO. / t SEP4fC TANK C PACITY S; ! LEACH PAC rfY;(hype) of NO.Cr BEDRW S B OR OWN&it V PER,L ' DATE: CONIPLL kNCE A Sep 1040a DIVA406 atwcep M tnum Ad,{ustcd undwa r Table to the Bottom o Facility Pri fete Water Supply au L"Was Facility (if as lb mist c Wte or within foe f laaching faculty) Ed of Wetland and g Facility(if any wetiaods exist ltldn 300 fm of lane no facility Fat F ai.d by V OL 63 S'0 1 , IN Qv of 1 12/5/2020, 11:15 A l No. P �7 Ll - .~ Fee IG O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplication for Mtgo$af *pgtem Cotw- 6truction Permit Application for a Permit to Construct O Repair O Upgrade(-'I"Abandon-(-) 12 Complete System ❑Individual Components Location Address or Lot No. 22-\ P rj t'Q_ 14q Owner's Name,Address,and Tel.No. rYlatSa o ns n\��5, -The— ReAn (a'OJQ iAL P,u, Z too Assessor's Map/Parcel Installer's Name,Address,and Tel.No. ��$ y Designer's Name,Address and Tel.No. 5\1WWc,J\ Ce, �nxer moo. 1!, Sn� oam-r Sea- Z - 33`►• Type of Building: Dwelling No.of Bedrooms Lot Size /yps0 N sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3'�Z1 gpd Design flow provided 33 gpd Plan Date�une Ci ; ZMR Number of sheets ' Revision Date Title 5t\}C. V�S ?6, ns Sp ` �_ 0 c Size of Septic Tank — Type of S.A.S. 2'S06 (QS\ Description of Soil 2%C `F(LQ 41-3,S Ih LAyef-_ 5R,,-0ti LbAir Wif SO—74a" -J> t A,4iE-Z (oAy,\N 5 _Z) loy& S/ Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Date Issued (✓ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY t at the On-siy�, ewage isposal ys m.Construgted ( ) Repaired ( ) Upgraded Abandoned( )by y("� at 'LZ\ Aa�� �yw MVnax3 t— has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer w #bedrooms _ Approved est flow gp ,. The issuance of this pe t s 11 not be onst d as a guarantee that the syste ill f n designe Date Inspector Qj .n ,'. r'l :=.�'v. trt • ';`„•-c �� 7 :-4�t Fee 4- '� "a tY Entered in computer: THE COMMONWEALTH Of MASSACHUSE_TTS ,� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes li Z(PpYication for Migpogar *pgfens Congtruction Permit �` } Application for a Permit to Construct O Repair(_).Upgrade Abandon(. ) 'it Complete System ❑Individual Components Location Address or Lot No. 22,\ Roil 1 y9 Owner's Name,Address,and Tel.No. mktS�o n s �1115, i Assessor's Ma+/Parcel ` P.0, 10t) p O7$—OZ -OD `� Mar 1�s 6 Installer's Name,Address,and Tel.No. f 0�'y�����3� Designer's Name,Address and Tel.No. aa_ —3 ►` rt Type of Building: Dwelling No.of Bedrooms\ Lot Size k4 h sq.ft. Garbage Grinder Nb ) Other Type of Building No.of Persons - Showers(: ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3?ja gpd Design flow provided 33 1 gpd Plan Date t\e �( ; 7�p$ Number of sheets Revision Date '•r .�' Title t ` 1�Iy CA (`�2 i',L M C - Size of-Septic Tank 0 Type of S.A.S.Z'SOr, Cp4\ CI�u10�� Q •(� Description of Soil �C C le5j 17_,Z-4 F(t t 41-5'�l d� L Ak�r�2 ,M✓>ti t aA.C!ns \ONC, 413 S9-76 `) LA--&(Z S-1 Nature of Repairs or Alterations(Answer when applicable) \ Date last inspected: - Agreement: 1 The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in - accordance with-the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed ` r�fiLa?/ Date Application Approved by Date f Application Disapproved by: \` Date for the following reasons Permit No. `s Date Issued G THE COMMONWEALTH OF.MASSACHUSETTS f BARNSTABLE, MASSACHUSETTS.- 1 Certificate of Com4hance Y j THIS IS TO CERTIFYT that the On-si e,Sewage. isposal ys em Constructed„( ) Repaired ( ) Upgraded (/)' Abandoned( )by � ,(J ="• �:�•` ' at \ a� ,r-� �l5 has been constructed in accordance: with the provisions of Title 5 and the for Disposal System Construction Permit No. r_ —' y`i dated - Installer Designer " cJJGaT. #bedrooms _ Approved'design flow '� �jG'3 .1 gpd. The issuance of this pe s Aall not be onstrued as a guarantee that the syste ill function as designe,=. �? �7 Date � �s� � Inspector � / t4- �((� 45 No. t —11 y'�J� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS li5pogat Q�pgtem Congtruction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade (--) Abandon ( ) System located at ? f\w y 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 midst be completed within three years of the date of this ermit: Date ��� / Approved( y_ _ „�✓ Town of Barnstable P# . 1' SING Department of Regulatory Services BAPMASM Public Health Division Date t p.&d� 200 Main Street,.Hyannis MA 02601 Date Scheduled '/ Time �Q Fee Pd. `� r Soil Suitability Assessment for Sewage Disposal Performed By:o%Lc/1%✓k/L. Ehb //LQ Q ,LAG Witnessed By: LOCATIONGIM ENF} AT,tN 'QRmtN � : : ... Location Address .� / / ;LQ Owner's Name” (C_06V\ t7.0_ -o\c lbv /7'/Cl/'S f7lh7j_S 1,21/ A , Address MkZA , V-A'o vn4- 02 Assessor's Map/Parcel: / D 003 001 Engineer's Name S'i t//%Yd/L NEW CONSTRUCTION REPAIR �/ { Telephone Land Use k63 Jk,TT." l Omows,•h ,Slopes(%)J e� Surface Stones /�OVI� Distances from: Open Water Body /an ft Possible Wet Area ft Drinking Water Well Shp ` ft Drainage Way SCA' ft Property Line ft Other /)P-Y ft J SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) i J2 Q RoUTE 148 f: f Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Nan Weeping from k'lt Face /�- — ter ` Estimated Seasonal High Groundwater �yi (CL.275 1�2r'1,©a. (oroj•%���f' W`4 I ET NATION FOP.SEASONAL GH WAT R TABU Method Used: A)'L 2 fnr� Depth Observed standing in obs. ole: in. Depth to Soil mottles: _, in. Depth to weeping from side of obs.hole: in. Groundwater.Adjustment ft• Index Well# Reading Date: Index Well level Adj.factor. Adj.Groundwater Level CI Ll�7' :' E T 1Dnt® Observation Z Hole# Time at 9" ..� 1' 'A Depth of Perc `1 Time at 6" Start Pre-soak Time @ c"id Time(9"-6") . r End Pre-soak /L Rate Min./Inch. Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# l Depth from Soi Surface in.) l Horizon Soil Texture Soil Color Soil Other ( (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistent %Gravel) © LL UAW, j a e, y t� DEEP OBSERVATION HOLE'.LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. 71Consistency,%Gravel) 18-Z7 Lo 0EE�" USE HOLE.LOG Hole:;# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface ace(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistent % ravel C BEEP OBSERVATION HOLE:LOG Hole# Depth from Soil Horizon .Soil Texture Soil Color SoilOther fl Surface(in.) (USDA) (Munsell) Mottling (Structure, (Stru to e,Stones,Boulders. ConsisteGravel) t :.a Flood Insurance Rate May: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? "C5 If not,what is the depth of naturally occurring pervious material? Certification I certify that on by (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,experti experience described in 310 CMR 15.017. Signature Date b( o Q:\SEPTIC\PERCFORM.DOC I ' COMMONWEALTH OF MASSACHUSETTS 1-I EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ED ED FAZED INSPECTION � JAN i a 2004 TITLE 5 70v%�EAt_TH DEt'TABLE OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 221 Route 149 MAP (,)77,6 Marstons Mills, MA 02648 --� Owner's Name: Oram Dubey PARCEL. 0 2.3 Owner's Address: LOT Date of Inspection: December 29, 2003 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 CERTIFICATION STATEMENT 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 Needs Further Evaluation by the Local Approving Authority ✓ Fails Inspector's Signature: Date: December 30, 2003 The system inspector shall submi copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. 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 Page 2 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 221 Route 149 Marston Mills, AM Owner: Oram Dubev Date of Inspection: December 29, 2003 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 not determined(Y,N,ND) in the 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. 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 Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 221 Route 149 Marston Mills, AM Owner: Oram Dubey Date of Inspection: December 29, 2003 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 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 221 Route 149 Marston Mills, MA Owner: Oram Dubey Date of Inspection: December 29, 2003 D. System Failure Criteria applicable to all systems: Y PP Y 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 pp y w 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.] Yes (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 II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 221 Route 149 Marston Mills, MA Owner: Oram Dubey Date of Inspection: December 29, 2003 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 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 221 Route 149 Marstons Mills, MA Owner: Oram Dubey Date of Inspection: December 29, 2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a 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: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system (yes or no): No [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)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCLUJINDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd 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 4 years ago-per owner 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: Approximately 1961 -per owner 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: 221 Route 149 Marston Mills, MA Owner: Oram Dubey Date of Inspection: December 29, 2003 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: None (locate on site plan) Depth below grade: 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: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): 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 l l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 221 Route 149 Marston Mills, MA Owner: Oram Dubey Date of Inspection: December 29, 2003 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 Alarm 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: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): PUMP CHAMBER: 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 r Page 9 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 221 Route 149 Marston Mills, MA Owner: Oram Dubey Date of Inspection: December 29, 2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits, number: leaching chambers, number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: ✓ overflow cesspool,number: 1 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 overflow cesspool was 5'Wx 6'Tx 8'6"bottom to grade. Liquid was above the inlet pipe. The system was in failure. The cover was 10"below grade. CESSPOOLS: ✓ (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: I with overflow Depth -top of liquid to inlet invert: above Depth of solids layer: 6" Depth of scum layer: 1" Dimensions of cesspool: 5'Wx 5'Tx T bottom to grade Materials of construction: Cesspool block Indication of groundwater inflow(yes or no): None Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Liquid was above the inlet pipe, backing up from the overflow cesspool. The system was in failure The cover was to grade 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 i Page 10 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 221 Route 149 Marstons Mills, AM Owner: Oram Dubey Date of Inspection: December 29, 2003 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� a 8 i S� y9 10 Page I I of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 221 Route 149 Marston Mills, MA Owner: Oram Dubey Date of Inspection: December 29, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 20 +1- 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: 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 the Barnstable topographic map and the Cape Cod Commission water contours map, the maps were showing approximately 20'+/-to ground water at this site. This report has been prepared and the system inspected and failed as of the date of inspection. This report is not a warranty 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 . 6 7 Commonwealth of Massachusetts B Executive Office of Environmental Affairs 4* 4A Ito Department of 9 s Environmental Protection 19 William F.Weld �F `9, Governor Trudy Coxe �►� Sacrstary.EOEA David B.Struhs Commissioner Y v SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 0 b? PART A � U �3 CERTIFICATION ONO iA-„ Vv� y j )11 q P)A R s7o to-q I�ills Property Address: �a Address of Owner: o2aZ� S Date of Inspection: /+RG a�, 11TI (If different) Name of Inspector: Goftdt3i� '�7ur11/�- � Company Name, Addre s and TBlephone Number. �GE,Aro Gc►�.eri, Coy .3oX G6q , 0S_".2v1�f>;� rlHss oa ss yag-s6��d CERTIFICATION STATEMENT 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails 1 Inspector's Signature: � Date: 3 D� The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. li the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the wstem owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: Ai SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure aiteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes; no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank!is metal, cracked, structurally'unsound, shows substantial infiltration or exfiltration, or tank failure is 'imminent. The system.will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) 1 One Winter Street a Boston,Massachusetts 02108 • FAX(617)556-1049 a Telephone(617)292-WW C?Printed on Recycled Paper (PK'operty SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Address: =0wner:10k Dvl3 / Date of Inspection: p�\a 97� BJ SYS�TEMjCONDITIONAL•L' PASSES (continued) '=. 5SV�a�geva?ckup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): Ir %• broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed Cl 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soli absorption system and is within 100 feet to a surface water supply or tributary io a surface water supply. _ The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 PPm. D) SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: oZ 3 n, Pyq /Wf,5-oW M;//s Owner: ORf>rl�'I-Du v Date of Inspecfiok SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' � aa3 HoasC (S 1 � aa' y O DEPTH TO GROUNDWATER Depth to groundwater:}feet method of determination or approximation: }�(=r S o2 r4 2 CGTu1T uNCr!£ t lop � s C (revised 8/15/95) 9 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: aa3 "K�. �N� V,49S00AJS I 116 Owner: O RA�4 ()U Q£.y Date of Inspection: ViVq? TIGHT OR HOLDING TANK:-AIDONFj (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP _other(explain) Dimensions: Capacity: Qallons Design flow: eallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:, jV0"£ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and d:stribu!:r,- ev�de^.ce or sn!id� c?ynver, evidence of leakage into or out of box etc) PUMP.CHAMBER: NONE (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Ada• �T I ( IYIA sTo1JS Owner: N'1A I)(l&y Date of Inspection: - I-�9rf SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but maybe approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) CESSPOOLS: , (locate on site plan) I�► s to N C Number and configuration: ` 5 '(,X -RL oc� aNd rwa c�Ry w�l� s'45 wi Depth-top of liquid to inlet invert:_ 1 Depth of solids layer: 6 1� - Depth of scum layer: iy Dimensions of cesspool: G-X ' 1 ' Materials of construction: Indication of groundwater. 1U0A1J' - ' inflow (cess ool ust be pumped as part of inspection) HovS� f:/71 7r r. .An /h)Sl�tG ld w M54300 Comments: (note condition of soi, signs of hydraulic failure, level of oncling, condition of vegetation, etc.) So r is ►z v a �.L 4 pi/u c?IZ dN n1 ' V PRIVY: 0 Y`J (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) 8 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Rs Property Address: V%3 Owner: R'qM V 0 Q E y, Date of nspedion- 3/a��97 " SEPTIC TANK:_LUON (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP_other(explain) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) GREASE TRAP:__WON£ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Scum thickness. Distance from top of scum to top of outlet tee or baffle: Distance from bottom M srum in bottom of ouNet tee or baffle, Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.i (revised 8/!5/95) 6 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: aa3 'Ar tq9 '/BARS dos 071 Owner: 0?W, 0 V Q�y Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:—11(i gallons Number of bedrooms:3 Number of current residents: 4 Garbage grinder (yes or no):r Laundry connected to system (yes or no)JT)o Seasonal use (yes or no):T Water meter readings, if available: ig If Last date'of occupancy: 9� COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ water meter readings, if available: Last date of occupancy:_ S mTR Q6 OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION - PUMPING RECORDS and source of information: C An T - 6u ?V 4' System pumped as.part of inspection: (yes 6r no)_p If yes, volume pumped: hi O gallons 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) Other(explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: Aj Sewage odors detected when arriving at the site: (yes or no) O (revised 8/15/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: aa3 -Ry � Owner: ORMIDU,8E1y Date of Inspection: 3/a Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. large volumes of water have not been introduced into the system recently or as part of this inspection. _As built plans have been obtained and examined. Note if they are not available with N/A. /The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow /The site was inspected for signs of breakout. I3 /.Aj system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. _ The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. /The facility o Nnc: ;and oaapants, if diffe.en: frc^r o„•ner! were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: a a,3 /'/9 / S)� ' Owner:®RAg Date of Inspe3opah/9� D) SYSTEM FAILS (continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or.cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greate( (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the-system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area(IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 .'cK,.:...lr �.F..:.. •-s..k-_ ._.,� -�1'�k x, -^vx. .:�;.,„ w.'d..r;.r-F,....w-r.n'°r+ey.a•..:ra.*+�w:..�3L.,r�?�,.•e,.+�r.,5 ,.-..:;;T.r�'�r 'TE "-'-�'.z ...=.na,..,n-r rrNr+. TOWN OF BARNSTABLE BAR-WO. 3784 Ordinance or Regulation WARNING NOTICE y Name of Offender/Manager ) Address of Off ender MV/MB Reg.# J Village/State/Zip � /'f1U✓t! M1I/ M4 � r Business Name 3o am/p 0n20n .. — . Business Address Signature of En orcing Officer Village/State/Zip , Location of Offense y 1 ti� ��,�C+ �� �y✓��,�b�V/ / A T014j, Enfo�cing/Vept/Division Offense Facts Pam,n4 kAhf nl- 41 U,%_o ,O ,;4`�_4,A.4.A/ [)v� '� 0 d✓Slv/►!� �t dJ / ✓n� h /fir !1/ 1r1 ! /,n 1100r 1 01 Gl��t. l/t Jla r 1' 0 r O Timis wi►11 serve only as a. warning. Al this,/tifnd no legal action has been "taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in •appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W Weep 3704 Ordinance or Regulation . WARNING NOTICE Name of Offender/Manager , r�fap l R.,J (-)ri do Address of Offender_ C/ MV/MB Reg.# Village/State/Zip mry a/ej J r ) 4 ! e 6�'F Business Name am/pm) on A 120t) Business Address' Signature of Enforcing Officer Village/State/Zip rr�� /� } , Location of Offense cf� R"'1W Or fr l� bl /Aq, Enforcing/0ept//}Division Offense f,�s�r nir/ t6+�YF' l� nf�!!b rlrir�� CJCJi 'V lrsk�tfacTi�'irx # !�'r4� f'� ,F,�� Facts #'tn:/t •/t/u/ �^f - 49 i dler;A rk. O fi9n,n h.. Aoll 0^ �kaa/�11fi1p� Lfa.1 ,(� ,,) ��ln7fef r ia,a f l� r.., �r Ir► ttftc/f f f'irr A*11-'+r !1a'#,;u- dAlp T9is will serve only as a warning. At this/time; no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in . appropriate legal action by the. Town. WHITE-OFFENDER CANARY-ORDJREG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W Ordinance or Regulation WARNING NOTICE Name of Offender/Manager f� , ( �mrj Pr.j (-;rjjli Address of Offender :),� l I'V9 MV/MB Reg.# Village/State/Zip V�l IJ /P,�,I M, (I,f /02 6 1VS m"Business Name :?0' am/p on /2 017 ,V Business Address llj t ) V 0'r Signature of Enforcing Officer Village/State/Zip Location of Offense s Iz-�r EnforcingiDlept/Division Offense of)rf,0_j Facts t^,[ 7-fl , 111)IJ,tA- :P 0.-. 11 4A r r 1 7 fA t 4144rd 00401.4 ' This will serve only as a warning. At this/timp' no legal action has been taken. It is the goal of Town agencies 4to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. ...:..- :; :. -- -- _-.-..-�...r�...-.� -,,. .�. .-f' ..-,-.e•...r .-R�.-„«...nre,....z•--•---«w e.,.^.. ,.�.-+�„,.t-.--r..rgy..,gM+,hrnr:rya=..... ,.. -- .. .. .,.� .- . :--.. r+r 61^^ •�,.--r^.-+. ram';'^ .'+.x^.`°^'" -r_„ TOWN OF BARNSTABLE BAR-W MCI 3701 Ordinance or Regulation WARNING NOTICE Name of Offender Mana e Address of Offender, , ox MV/MB Reg.# Village/State/Zip M f c t)A kv� A /.,),A 4 ta Business Name 7 `,36 yam/pZ. on 31 20/W Business Ad ress ./ rs�'/'` ' flx/ / 1• y Signature of'E'fipfp'°r"bing Officer Village/State/Zip (� V Location of Offense �� ur { AAktdc1nj Ml + "u tti v t7lr� �} --' / U" f E forc hg/Dbpt/Division Offense In.� l � [ C 1�, , � .rr�/ 11 aud � rr Facts !/ 1/ Pf4,14 n�.� �1 f ✓M r CY �n .�?? U�d # ,JJ'�a�/ f,v+l�y �t r,44- ,1e r U, Me ri r t,vrl t+ fit�b.l / lei A d+ ![/I:., f►J4R/��fl�Ml��n 1.)�! �Gl!� 7 !.t 4M,11 This will serve only as a warning.\,At this t�ilme no•Jlegaljaction has been` taken. It is the goal of Town agencies to achieve voluntary compliance of TownI�i # Ordinances, Rules and Regulations. Education efforts and warning notices are ud. attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. I/ ASSESSORS REF., Map 078, Parcel 023-001 x • �{R 5 OVERLAY DISTRICT: ! : . k 1 / AP — Aquifer Protection District00 w _ ZONE: FLOOD ZONE: / / / / / vB—A Zone C / Area (min.) 10,000 S.F. Community Panel No. f; X 65.8 / / /� 1 / / / -� / �Y Fronts a (min) 20' #250001 0015 C g August 19, 1985 p / 4, 8 e S.F,.- � �,,�.---5 i ( Width in) 100 9 , . f0 / / O \ Front 10' •a• ����' r / / / / / / / s>D / r — Side 30', Location Map: / / Rear 20 Scale: 1 — 2,000 f SEPTIC NOTES 1.Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours Prior to Any Excavation For This Project the Contractor Shall Make the Required Notification to Dig Safe(1-888-344-7233� / �'b 2.The Contractor is Required to Secure Appmpriate Permits From Town DESIGN DATA Agencies For Construction Defined by This Plan. Single Family-3 Bedroom 3.When Required,Water Line Shall be Constructed in Coordination With With NO Garbage Grinder COMM Water,and Shall be in Accordance With 248 CMR 1.00-7.00 Septic Tank:330 GPD 200% 660 GPD on &310 CMR 15.00.The Water Line Shall be Sleeved Where R / 4.Install Risers to Within 6"of Finished Grade 4 ( Use 1500 Gallon 2 Compartment Septic Tank ` ` /' / r0/ / / "9 • s \ / / f 5.All Structures Buried Three Feet or More or Subject �9 / to Vehicular Traffic to be H-20 Loading.It is the Engineer's LEACHING AREA O / Recommendation that Ii 20 Always be Used. / �c j "`� 330 GPD/0.74=446 SF Gj �0 / �c 6.Septic System to be Installed in Accordance With 310 CMR 15.00& Regalred (O / 248 CMR 1.00-7.00 Latest Revision and the Town of Barnstable Sidewall=2(12'+25')2'-148 SF �� Bottom Area=(12'x M=300 SF / l Board of Health Regulations. ►� Provided REPLA X 42.9 � 7.All Piping to be Sch.4o PVC. 448 SF Total STING / 8• The rrst Comp�eant Shalil HHaa•a vbiCompartments. ofN��� LEACHING CHAMBER DESIGN SE "R LINE /, , 660 Gallons and the Second of Not Less than 330 Gallons `V All Pipes to be Schedule 40. Use PRO. Q The Compartments Shall be Interconnected by a Minimum 4"0 2-500 Gal.Leaching Chambers in SEP TI C Vented Inverted U-Shaped Pipe with a On Baffle on the Outlet IT x 25'Washed Stone Fields as Shown. }TANK \\ / O / 9.Inlet Tees Shall Extend a Minimum of 10" ,wv / ry / Below the Flow Line. 4 -2 PR 0. �O pry — / 10.An Outlet Tee Shall Extend 19"Below the Flow Line, � D—BOX cb / and Shall be Egniped With a Gas Baffle. S.A.S. C'� --42 _ — a / f / / / / i• r ` / 'A,• l / rMm compmWPO Filter // / / / / •�6,, 70' O / / yekb r U PO sow f D yr 3 H-20 nauNe w.sboe LEACHING smm EX. PI TS / / _ CHAMBER TO BE REMOVED rz CROSS SECTION OF CHAMBER Le� / �" GAR�we n..wa NOT TO SCALE F.G.Fr..420 PERC TEST: 12,245 PERFORMED BY:JOHN O'DEA,Err-SULLIVAN ENGINEERING,INC. RNIACE EXffr NG 9teNam4(I,p.) WITNESSED BY:DONNA M Deciduous Tree iORANDI,RS.-TOWN OFBARNSTABLE a ERLM JUNE 9,2W8 TEST HOLE-1 TEST HOLE-! FL 42W EL 42.0 EL 43.0 LwlkrtoOmO® H 20 Coniferous Tree �r" :' :1 '.... 15000aEon Top EL4o 0 ::•F..........:.::t:{..'rt'r ti{i}1i4:. ......:..:::. 2 Compaommr H ZO 4" .... •::' 38.6 18" .rqt�r Septic T� D Burt •'rC11 Flow lizef H 20 ® Water Gate (round) �r }:Jfiit4wl� SEENOIES AaRega 3.7 L8 r g v,.tEaaaui Sb?0?X>4 Cn ben © Gas Gate (round) }: ::: ,. :':::.: ® Catch Basin ,s F`+Ti L r, B LAYER 10YR5/6 B LAYER IOYRS/6 £;,;. YELLOWISH BROWN YELLOWISH BROVA ro ��i&Beffels 0 Iron Pipe S , ,11 LOAMY SAND 57 LOAMY SAND (See Notts 9✓k 10) heG fthw Qd7kS„em z Fi.315 H 39.7 El CBlt) 3. 2 7 3 C LAYER I0YR618 40" PERC TEST taMre-art, No Grouedw.uerCaoama -0 Guy ' BROWNISH YELLOW COULD NOT MAINTAN rrra ,>r 126" Mom-sAND 31s " PERC RATE:Q MIN N. 139,8 DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM ns -0- Utility Pole "h d NOGROUNDW%A R;ENCOUNTERED CLAYERIOYR6/6 BROWNISH YELL(W NOT TO SCALE Pa T.oB.G`amd"aterMq OHW— Overhead Wires l �1t4 R MED.SAND 33.0 25 Elevation Contour '� °" i2 NOGROUNDWATERBNCOIP,TBRED 33x9 Spot Shot Elevation TITLE: Site Pla n PREPARED BY PREPARED FOR: NOTES i ) The property line information shown was • compiled from available record information. Proposed Septic Upgrade Sullivan Engineering, Inc. The Redan G roup Inc. 2.) The topographic information was obtained A/� t PO Box 659 from Town of Barnstable G.I.S. j w Osterville, MA 02655 P. 0. BOX 100 A !� J.) The datum used is NGVD '29, a fixed mean 221 Route 1 i1Q (508)428-3344 (508)428-3115 fox MarstonS Mills, MA 02648 sea level datum. 1 ! t� T�J 4.) The intent of this plan is for permitting a BARNS TABLE (Marstons Mills) MASS. Draft: JOD 20 0 10 20 4o 80 septic upgrade only. DATE: SCALE: „_�O, Review: PS 5.) This plan is only valid with an original June 09, 2008 1 Proj. # 28004 stamp and signiture.