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HomeMy WebLinkAbout0223 ROUTE 149 UNIT #A - Health 223 Route 149 d-Main Street Marstons Mills A = 078 —023 — 002 , TOWN OF BILRNSTABLE LOCA ON 223 I SEWAGE # j VILLAGE AW,5- ASSESSOR'S MAvP& LOT/ '7g E N &PHONE NO. GA3 NS/j�E U�22�t S /OL J yd SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS U�II.DEI�QRDWNER © D U,Q 88 a COMPLIANCE DATE: Separation Distance Between the: 4 Maximum Adjusted Groundwater Table and Bottom of Leaching Facility S 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 �ovS� ow �L k ,cps 4 IfN OF BARNSTAgBLE ec- LQ ATIOIN A? /y �} I SEWAGE # A049— j' VIL-LAGE &5 ASSESSOR'S MAP & LOT —bU2 INSTALLER'S NAME&PHONE NO. i��� SEPTIC TANK CAPACITY /S-00 LEACHING FACILITY: (type) �> l (size) O?f/ NO.OF BEDROOMS` BUILDER OR OWNER PERMITDATE: O G COMPLIANCE DATE: lU=XV7 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 L RPq R h o v S e o u 1 ;�• TOWN OF BARNSTABLE L'_aC/TIUN ! rW 9 SEWAGE# VILLAGE M� M+��s ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY /r0D LEACHING FACILITY:(type) c9' 5GO �(�1 (size) NO.OF BEDROOMS OWNER _{"CALUI,tt f- C�aJ�ti PERMIT DATE: 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 0n site or within 200 feet of leaching h') Feet et 'e Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY -nl C r6lZ 37 a �k 30 1 all- ly C- 3 �6 of COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION GD� Property Address: 223 Route 149 Marston Mills. MA.02648 Owner's Name: Scott Peacock&Scott Crosbya�3 Owner's Address: Date of.Inspection: March 19. 2007 'Name of Inspector: (Please Print) Jaynes M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 i ' ' - Telephone Number: (508) 862-9400 y CERTIFICATION STATEMENT 1 '+ I certify that I have personally inspected the sewage disposal system at this address and that the'informati(�n3zeporied below is true,accurate and.complete as of the time of the inspection. The inspection was performed based on 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: C3 r ✓ Passes Conditionally Passes ds Further Evaluation by the Local Approving'Authority ai s Inspector's Signature: Date: March 21. 2007 , The system inspector shall sutta y 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 1 i Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 223 Route 149 Marston Mills, MA Owner: Scott Peacock&Scott Crosby Date of Inspection: March 19, 2007 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: I B. System Conditionally Passes: Y Y 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 detennined(Y,N,ND)in the for the following statements. If"not detennined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the .existing tank is replaced with a complying septic tank as approved by the,Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed_ pipe(s): The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 223 Route 149 Marston Mills..MA Owner: Scott Peacock&Scott Crosby Date of Inspection: March 19, 2007 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 CAM 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 coliforin 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 L Page 4 of 11 s OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 223 Route 149 Marston Mills, MA Owner: Scott Peacock&Scott Crosby Date of Inspection: March-19, 2007 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the round or surface waters due to an g 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 %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 SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to.this form.] No (Yes/No)The system fails. I have detennined 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 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 223 Route 149 Marston Mills.AM Owner: Scott Peacock&Scott Crosby Date of Inspection: March 19, 2007 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 e' Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 223 Route 149 Marston Mills. MA Owner: Scott Peacock&Scott Crosby Date of Inspection: March 19, 2007 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents: 0 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL 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 na): . 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 in 2006-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: Installed on 10128102-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 L Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 223 Route 149 Marston Mills. MA Owner: Scott Peacock&Scott Crosby Date of Inspection: March 19. 2007 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 9" Material of construction: ✓ concrete _metal _fiberglass polyethylene _other(explain) If tank is metal list age: Is age confinned by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Continents(on pumping reconnnendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.). The Tees were present. The liquid level was even with the outlet invert There did not appear to be any signs of leakage 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 recorn nendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 223 Route 149 Marston Mills. MA Owner: Scott Peacock&Scott Crosby Date of Inspection: March 19, 2007 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: Alann in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Coirunents(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was level. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION(continued) Property Address: 223 Route 149 Marston Mills. MA Owner: Scott Peacock&Scott Crosby Date of Inspection: March 19, 2007 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 gal. Dry wells 12'8"x 25'(per as built card) leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil, condition of vegetation,etc.): The dry wells were dry and clean. There did not appear to be any signs of failure The bottoin to grade was 56" The cover Was 26"below grade. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,.etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 223 Route 149 ' Marston Mills, MA Owner: Scott Peacock&Scott Crosby Date of Inspection: March 19, 2007 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 Lk 0 3 t7 O O A 6 � 1 as ly a. Y/ 19 CC 3 LD J . 10 Page 11 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 223 Route 149 Marston Mills, MA Owner: Scott Peacock&Scott Crosby Date of Inspection: March 19, 2007 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 45'+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: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps, the maps were showing approximately 45'+/-to groundwater at this site. This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed 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 septic system,the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 No. 002 • 6 qj FEE ( U Board of Health, ��✓SST I MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair(L'Upgrade( ) Abandon( ) - U-C<omplete System ❑Individual Components Location Aa3 jZ7- 1,441Owner's Name k— Sb Map/Parcel# `703 A'3 © Address "-o..0 rft- Lot# Telephone# qzk• (c?o •�� Installer's Name (kk e �d��-�-® Designer's Name YA Ake-e-�(J,-VeA C"UV60c la KA Address �� � Address e� 1 -s- V 44&Qt*V S P1 Telephone# Telephone# Sd yag OOS Type of Building Lot Size rJ , A�,I/ sq.ft. Dwelling-No.of Bedrooms Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow (min.required) gpd Calculated design flow 3-3 Design flow provided 3 Z/-7 gpd Plan: Date Sr 0 AS,a o� Number of sheets __ Oti Revision Date Title e It 6, X) Description of Soil(s) f✓ Soil Evaluator Form No. Name of Soil Evaluat VV'C'0-./11 4L, Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the Zstem in operation until a Certificate of Co plia ce has been issued by the Board of Health. Signed �Q Date Q Inspections No., .1n -•. � FEE_/ V— Board of Health, _: $l 2 MA. APPLICATION FOR DIS�,OSA . SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair(41<pgrade( ) Abandon( ) - 3<00mplete System ❑Individual Components •y � FMa cation RT f 1 Owner's Namep/Parcel# ��} p�3 oo}- Address �t# Telephone# �2FC • ��i t� •�� Installer's Name A r, (�4-* e p-4)�`� Designer's Name yV �e 5,j/Ve CC1UlSOc.��V`� Address 7' �� �tA�A Address 410 Q �iiL�v 7`✓ /�� /���,S S/�l�� Telephone# 71 - Lt \2 Telephone# SOS- �/, g OG75 rs a y Type of Building 9 LotS�i*ae� 1 sq.ft. 3 Dwelling-No.of Bedrooms 1 Garbage grinder ( ) Other`-Type of Building No.of persons ,l f Showers ( ),Cafeteria ( ) Other Fixtures F Design Flow (min.required) gpd Calculated design flow -gyp g p gpd 33 J a �l Desi n flow provided 3 y7 Plan: Date Sr/�� d S1 a yo`�' Number of sheets ��, T C.T IRevision Date Title SP Ttc V Pottle C.R111 4ly Description of Soils) >!� C.4� r w ` . Soil Evaluator Form No. Name of Soil Evaluat JLC Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS r The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agr to not to place the 'system .operation until a Certificate of Co pli ce has been issued by the Board of Health. Signed 10 Ok 'Qr..►+� Date Z 1 Inspections , °. ;Ooa-y�`l No. FEE COMMONWEALTH Of MASSAC14USETTS gk_ Board of Health CERTIFICATE OF COMPLIANCE a Description of Work: ❑Individual Component(s) complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired t-�,Upgraded ( ),Abandoned ( ) n by: at has been installej in cc d ce with the r visi ns of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. 00 � dated a Approved Design Flow 3 Y-7 (gpd) r ll. Installer E Designer:)v lq A e�S`,.,U!!i ecrA50C'rb Inspector: M' V.0k, Date: The issuance of this permit shall not be construed as a guaranteeIL the system will function as designed. t No. FEE1"' COMMONWEALTH Of MASSAC14USETTS Board of Health, 'aa-✓V' S C&-�/e I DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is herebyranted to; Construct air Upgrade Abandon an individual sewage disposal s g uq ( ) Repair() pg stem ( ) ( ) g P Y at / ! ) as described in the application for Disposal System Construction Permit Noma dated A .2ld; Provided: Construction'shall be completed within three years of the date of this per{/Jqmii�t.. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Q v Board of Health s�.ry y"• /{,, -�� I - - TOWN OF BARNSTABLE e& *` LOCATION o� � �0� / SEWAGE # VILLAGE RPS 7dltsi � ASSESSOR'S MAP &LOT —6U3 INSTALLER'S NAME&PHONE N0. ����SEPTIC TANK CAPACITY If LEACHING FACILITY: (type) "sO LQP l (size) Aix X 0�S NO.OF BEDROOMS' BUILDER OR OWNER JOA&4 PERMUDATE: azm G 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 Feet on site or within 200 feet of leaching facility) • Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by ReAR 0. tiotoS iu y� TOWN OF BARNSTABLE - U„ FN)ERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION OWNER AND INSTALLER INFORMATION In 10) ADDRESS: [__riff)I r 120A (I -n !9`7 MAP NO. ( I PARCEL NO, a OWNER NAME: () J i c ..r7 C" fIY A VILLAGE: INSTALLATION DATE: 9/`s BY: / . - — ADDRESS: � CERT. NO. TANK INFORMATION ,�"} / ^^�� ��rr ea d o LOCATION OF TANK: A �tl ' C � � S/ '' 1 IL ` CAPACITY, TYPE Gam- AGE l� f 1" FUEL/CHEMICAL TESTING CERTIFICATION C I PASS C I FAIL DATE r LEAK DETECTION C)] CHECK IF N/A TYPE/BRAND � ZONE OF CONTRIBUTION C I YES /3 NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED C YES C ] NO DATE CUNSERVATION C CHECK IF N/A DATE r, BOARD OF HEALTH TAG NO. 673 IC IC IC I DATE /`7. �'> Al - - 11 PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD ► r ooq Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 227 Route 149 r u Property Address Karen&Duncan Moodie Owner Owner's Name information is required for every Marstons Mills Ma 02648 3-30-2021 t 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 on the computer, Brett Hickey use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code rare (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 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 Brett Hickey 7 Digitally signed by Brea Hickey Dale:2021.03.3107:58:00-04'00, 3-30-2021 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.7262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 c Commonwealth of Massachusetts w� 60 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 227 Route 149 Property Address Karen&Duncan Moodie Owner Owner's Name information is Marstons Mills Ma 02648 3-30-2021 required for every 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 any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The system was in working order at the time of inspection. 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): t5insp.doc•rev.7/26/2018 Title.5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts M - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 227 Route 149 Property Address Karen&Duncan Moodie Owner Owner's Name information is Marstons Mills Ma 02648 3-30-2021 required for every page. City/Town 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.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 i 1 i c Commonwealth of Massachusetts n - =P Title 5 Official Inspection Form l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments g 227 Route 149 Property Address Karen&Duncan Moodie Owner Owner's Name information is Marstons Mills Ma 02648 3-30-2021 required for every 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 aseptic 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, prodded 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 clogged of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ a 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.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts r - - ; Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 227 Route 149 Property Address Karen&Duncan Moodie Owner Owner's Name information is Marstons Mills Ma 02648 3-30-2021 required for every page. City/Town 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 ❑ 0 Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow ❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0 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. ❑ El 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 i Commonwealth of Massachusetts �.j Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 227 Route 149 Property Address E Karen&Duncan Moodie Owner Owner's Name I information is Marstons Mills Ma 02648 3-30-2021 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes";to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No t ❑ El Pumping information was provided by the owner, occupant, or Board of Health ❑ F Were any of the system components pumped out in the previous two weeks? ❑ 0 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) [-I 0 Was the facility or dwelling inspected for signs of sewage back up? El ❑ Was tthe site inspected for signs of break out? 0 ❑ 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? ❑ 0 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: 0 ❑ Existing information. For example, a plan at the Board of Health. ❑ O 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)] I t I t5insp.doc-rev.7/26/2018 I 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 227 Route 149 Property Address Karen&Duncan Moodie Owner Owner's Name information is Marstons Mills Ma 02648 3-30-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 3 3 Number of bedrooms(design): Number of bedrooms(actual): 348/GPD DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes [j] No Does residence have a water treatment unit? ❑ Yes No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ® Yes No information in this report.) Laundry system inspected? ❑ Yes No Seasonaluse? ❑ Yes No See below Water meter readings, if available(last 2 years usage(gpd)): Detail: 2019- 84,000gallons 2020- 100,000gallons Sump pump? ❑ Yes ❑■ No Last date of occupancy: 1 week agoDate t5insp.doc•rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 t I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 227 Route 149 Property Address e Karen&Duncan Moodie I Owner Owner's Name information is required for every Marstons Mills Ma 02648 3-30-2021 page. City/Town f State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA Type of Establishment.- Design flow(based on 310 CMR 15.203): Gallons per day(gpd) r Basis of design flow(seats{/persons/sq.ft., etc.): Grease trap present? f ❑ 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): I k I a 3. Pumping Records: Source of information: Owner- date of last pump is unknown M Was system pumped as part of the inspection? ❑ Yes ❑■ No If yes, volume pumped: gallons How was quantity pumped determined? r Reason for pumping: I t t t5insp.doc-rev.7/26/2018 Title 5 Of dal Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 i r Commonwea'Ith of-Massachusetts M -r Title 5 Official Inspection Form J. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 227 Route 149 Property Address Karen&Duncan Moodie Owner Owner's Name information is Marstons Mills Ma 02648 3-30-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: 0 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: 2014 per COC Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 1'10" Depth below g-ade: feet Material of construction: ❑ cast iron ❑■ 40 PVC ❑ other(explain): Town water Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 ' S c Commonwealth of Massachusetts Title 5 Official Inspection Form - to Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1 227 Route 149 Property Address Karen&Duncan Moodie Owner Owner's Name information is Marstons Mills Ma 02648 3-30-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 10" Depth below grade: feet Material of construction: ■❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 1 Dimensions: 000gallons 10" Sludge depth: 26" Distance from top of sludge to bottom of outlet tee or baffle 411 Scum thickness 511 Distance from top of scum to top of outlet tee or baffle 1419 Distance from bottom of scum to bottom of outlet tee or baffle measured 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.): The tank was in working order at the time of inspection. The tank is in need of pumping at this time and should be pumped every two years for maintenance. t5insp.doc•rev.7126r2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts i,F .__. _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments c : 227 Route 149 Property Address Karen&Duncan Moodie Owner Owner's Name information is Marstons Mills Ma 02648 3-30-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): NA Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day l5insp.doc•rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts =_r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f/ 227 Route 149 Property Address Karen&Duncan Moodie Owner Owner's Name information is Marstons Mills Ma 02648 3-30-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): 0" 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.): The d-box was in working order at the time of inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 f Commonwealth of Massachusetts -- !� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 227 Route 149 Property Address Karen&Duncan Moodie Owner Owner's Name information is Marstons Mills Ma 02648 3-30-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * 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: (2)500 gallon chambers El leaching chambers number: ❑ leaching galleries number: ❑ Teaching 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 ------ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 227 Route 149 Property Address Karen&Duncan Moodie Owner Owner's Name information is Marstons Mills Ma 02648 3-30-2021 required for every page. City/Town Satet Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS was in working order at the time of inspection. Leaching chambers were dry when viewed with no evidence of past backup. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): NA 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 conditioni 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 � 227 Route 149 Property Address Karen&Duncan Moodie Owner Owner's Name information is Marstons Mills Ma 02648 3-30-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: NA 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 i c Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 227 Route 149 Property Address , Karen&Duncan Moodie Owner Owner's Name information is Marstons Mills Ma 02648 3-30-2021 required for every St page. City/Town ate Zip Code Date of Inspection D. System Information (cont.) r 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 I Fee, t,;✓J�_ THE COMMONWEALTH OF MASSACHUSETT.S PVBLIFC°HEALTH DIVISION-"BARNSTABLE,MASSAC`,HU;SETTS � his nsaT �pstetn Con, stru.ctinln A@srmit :Permission is hereby granted to Con."..( ) Repair( "I)� Upgrade,( ) Abandon( ) :system located at 2_1aI�t i, and as described to the above Application fix Disposal System Constntction PZirrnir. The applicant recognized his/her thhry to comply with - Title 5:and,the following local provisions or special conditions. Previdsd:C nstructimr moat be completed within three yoare of the.date of this Date. ........ .. ... Approved l ,_ .— "..•""' TOWN OF BA.RNSI'ABLE LOCATION -2e`)'7 .624 c -IU4, SI'WA(;'rE�# �o rSY-19'0 . VILLAGE -!'h'l. (*Z_l:!> �. ASS.ESSOR'4 MAP&PARCEL INS-TALLER'S NAME&PI-IONF_NO SEPTIC TANK CAPACITY aot:.'f '> LEAC7HING FACILITY:(type) $00 9a fsG'h.a,•nS Cz)(size)NO.OF BEDROOMS 3 - OWNER PERMIT DATE;_. 6-Z—:/.Y COMPLIANCE DATE G.'.:S Separation Distanoe Between the: Maximum Adjusted Uroundwnter Table:to the Bottom of Leaching.Facility Feet Frmne Water Supply W611 and.Lcaching,Facility(lf erny wells exist,on ,.,. site or tvithin 200 feet of leaching ftuitity) - Feet._.. �_.. ._..... Edge of Wethtrid and Leaching Facility(Tf atry wetlands cmisi within :300 feet,of leaching facility) - _.. 5..,.,..._Feet FURNNISTILD-I3Y., .. _ 1 i . A1— '�mti l' t5insp.doc-rev.7/26/2018 I Title 5 Of dal Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts iT Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 227 Route 149 Property Address Karen&Duncan Moodie Owner Owner's Name information is Marstons Mills Ma 02648 3-30-2021 required for every St page. City/Town ate Zip Code Date-of Inspection D. System Information (cont.) 15. Site Exam: ❑■ Check Slope ❑■ Surface water 0 Check cellar ❑O Shallow wells Estimated depth to high ground water: No GW @ 132" feet Please indicate all methods used to determine the high ground water elevation: El Obtained from system design plans on record If checked, date of design plan reviewed: 5-2-2014Date ❑ 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: A plan on file at the local Board of Health was used to determine high groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 - l c Commonwealth of Massachusetts -__0 Title 5 Official Inspection Form -- la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,may, 227 Route 149 Property Address Karen&Duncan Moodie Owner Owner's Name information is Marstons Mills Ma 02648 3-30-2021 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ❑■ A. Inspector Information: Complete all fields in this section. ❑� B. Certification: Signed &Dated and 1, 2, 3, or 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 R t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18. TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date _t I Time: In Out Owner L C— Tenant Address �b ` `' Address a �� ��� Complian a Remarks or Regulation# Yes 46 O Recommendations 2. Kitchen Facilities 3. Bathroom Facilities -.� 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents par- 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal N ( ( 5-0 17.Temporary Housing 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms ;2— Number of Vehicles Allowed (max) Number of Persons Allowed (max). Person(s) Interviewed Inspector. If Public Building such as Store or Hotel/Motel specify here L- BARNSTABLE ti ASS MAP 78/24-9 \ \ ! LOCUS 0IN, � 6 � / O S�q FQ 20.1 ft \ op`� 20:2ft ROUTE 28. °'h' �DIA �\ LOCUS MAP 1� 3i f \ i 6 I Vic. POLES PLAN REF 529-2 10.ofjE iR _ I DEED REF 15416-178 ��— —— �p ASSESSOR'S MAR- 078—023 •cj ° ° — — ZONING. MAR- "IBA'$ / �\ \�J moo. r� EXISTING \� \ FLOOD ZONE.• "C" All ca p \ l� PANEL NUMBER.- 250001 0015 C DATED.- 08-19-1985 o / ONcS� 10, ryACl qd 0.5 // 1' ) �cSI ��sz U.POLE81 FIRST I FLOOR 65' `�' PLOT PLAN OF LAND C 3 WA7zR / l \ \" �p // O LOCATED A7ti NO UNDAZION / 223 ROUTE 149 A SS. MA P 78/18 010.3 0 / `\ `� y MARSTONS MILLS, MA. 14.1 63 AREA=15,247 S.F. HOUSE / W #221 PREPARED FOR. w_ ASS. /��,� SCOTT PEACOCK / �' OCTOBER 28, 2009 LOT 1 // ► ; / REV NO VEMBER 13, 2009 i ®®©*AA _4 / Y �Y REV ass � O REV o STEPH.- -A A / A YANKEE LAND SURVEY J. GRAPHIC SCALE 4 4 rOYLE CO. INC. 30 0 15 30 60 B �,. = DoR ® �$ly o a 40 INDUSTRY ROAD ©®b9`�0 ��� MARSTONS MILLS, MA 02648 1 inch = 30 ft. vl l J i O TEL• 508-428-0055 FAX 508-420-5553 i SHEET 1 OF .1 JOB #.• 54581 t i .y �F�''�'•�' Saa..............3.tK'F+.�W.��iPsv;r VW- t { B ,�r2•-au� ,: �s I Z v: I i .� j ..-:._ ' __.�srxe-_.,�, �� :a _^......----* .: �:�,.�nwvaf-�•cct�.eu s� —.__..__ _.... . areL��m �i.u� �. S sue••_-�SAa;e �. � <_; ,,, i � %u.'lz...s:a.�!Aititv-t'x...•�•.� I arP"�-.t_...,�i:,3tr:Q�it�.:v._...... ( I I ' � n�; i %•-ti'rc:f,'ttnr�.:.__.. Pa.Z:,F''� --. >q� .....:':�a-Yc+arti:n,t .�tf�� iI � ` i I d I .l.46'? C g : —._........ .. I _¢ t j 1 ........_. — — —_ — — — ---- — t ao 1 R ' q. ...�iTc,�V' t {,.--....�- .... :A`D.F fsh L.•t.YCM.•. _ _. - �, • 'I i 33 . 1(j ff ' I F� ly ! � I : u Lill B j _........._:Z=rr� 14 -- ,. .• � �:c;x.�.t__.'»'T_.+�`Y--����� '1-�;ib?ii?iff�:it:�l.Sa.JE�CT..'S.-j�7SCS... � � a i I� r� � `;1 � �! , s! i i � � {{ � � � �I � z-•. � rr'arzaLJ Pm�: u'i z-; -i jay, I 3 �=— -.�;r. -�- .ram—• LIwl.L4).._. pT w.. ,� ..., �....,.. :_rg.;.....>..�...... i,-om----`_--— • �fJ✓—'�.y:SF-�+`--.�...____.��!—t.A�'.��.....GY.\Za`6�a�ae,r....}!,h:o..��!�i�a'2].-Pc�.S.. . _ fo....;•w�eii BARNSTABLE CONTOURS BASED TOPO BY YANKEE SURVEY 'INN ADJUSTED TO C.!.S. DATUM. BOG 4O ASS. MAP 78/24-9 a LOCUS ; \ \ C Q ' � 28 �i ROUTE �y. 0 TP ' POLE\ .' LOCUS MAP 1 R i o`\ o o_ 8 / f?e• �� �� � f ASSESSORS MAP 78 PARCEL 23 - 6U a- 10 1¢- 2� / _ �O ' \ ' PLAN REF 52912 I4.1 4��( 1 `� �, to, ZONI VB-A INV.=62.1 � �1r 0/ F. PUMP & FILL �y`�/ � w COI \\ 0 VERLA (STRICT "AP" CESSPOOLS c'"a 14 O.5 � Q`Z' y / s' � U.POLE ,. " / / I 6' FLOOD ZONE. C INV.=62.5 / s' �' ` / L2 8 5 \ �' COMM.. PANEL f250001 0015 C i I 8 / /+ / WATER & CAS L/NES C� / U1 FIRST(FLOOR 6 / �' �/ I MARKED LINES ON GROUND r 0' / O 8119185 ` 1 6 EL=168.8' A%ETERR/ ' 4/� n� p �J NO I Ft9UNDAT/ONn1 14.1'�10.3 ASS. MAP 78/18 A 14.1 `\ ` \ �" /' SEPTIC UPGRADE PLAN �O ` ' OF LAND w AREA=15,247 S.F. � �21E � . ; W_ ASS. MAP LOCATED AT 78/23 �� LOT 1 �/ 223 ROUTE 149 / ti MARSTONS MILLS, MA. PREPARED FORgoo • OF PEACOCK AND CROSBY O SEPTEMBER 25, 2002 M0PHY y N& ?49 SCALE 1" = 30 FEET YANKEE SURVEY CONSULTANTS ,���� UNIT 1, 40B INDUSTRY ROAD P. 0. BOX 265 O MARSTONS MILLS, MASS. 02648 TEL• 428-0055 FAX 420-5553 PACE I OF 2 ✓f 532328 DB (EXISTING)FIRST FLOOR 20' MIN. 10' MIN. CONCRETE COVERS 4" SCHEDULE 40 P.V.C. EL=63 MIN. PI%CH 118 PER FT. 2LAYER OF 1/B"-112" 4 6 VAX CONCRETE COVER WASHED SrOXE "MAX • � • " . . . � . � . . . . . EL=63.5 1 4" CAST IRON PIPE 6 MAX � / z / 6 MAX (OR EQUAL MINIMUM PI%L^H 114 PER FT. RISER CLEAN FLOW LINE SAND INVERT 10 1 10" EL=60.5 MIN. �� INVIs'RT LEVEL o o 0 0 0 o a o 0 0 0° k EL.=_62.5 2 E INVERT BAFFLE EL=61, 75 INVERT 6" SUMP INVERT o o 0 0 0 0 0 0 0 0 0 0 0, EL.=62 EL.= 61.25 =57. 75 EL.__61__ 4' 4' INVERT 1500 --GALLONS DISTRIBUTION EL.= 59. 75 PROPOSED SEPTIC TANK Box ---- TO BE WATER TESTED -25' X 12.8' TRENCH F1')RMATION n2 IF MORE THAN ONE OUTLET O PLACE ON 6" STONE SOIL ABSORPTION PROFILE OF DOUBLE WASHED STONE SYSTEM (SAS) SEWAGE DISPOSAL SYSTEM NOT TO SCALE NO OBSERVED WATER TABLE (12114101) ELEV.=_51_5' ROUTE 149 ELEV.__ 42 9' PERCOLATION RATE _ 2 MIN./ INCH AT _36"_ INCHES OBSERVATION HOLE I ELEV= 63 DEPTH I HORIZ TEXTURE COLOR MOTT. OTHER 0'"-3" O ORGANIC 3 -10" A SANDY IOYR 5-3 r LOAM 10"-3' B LOAMY 10 YR 6-6 SAND 3'-11.5' Cl MEDIUM SAND IOYR 7-6 PERK GENERAL NOTES ! NO WATER (OIL 5' 1) ALL TITLE 5KMANSHIP AND AND THE TOWN OFMATERIALS BARNS� _---CONFORM RULES AND P SOIL TEST REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO DATE OF SOIL TEST 911412002 SOIL TEST DONE BY BRUCE G. MURPHY , RS WITHIN 6' OF FINISHED GRADE, OTHERS WITHIN 12" 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN DESIGN CALCULA TIONS. 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. NUMBER OF BEDROOMS . . . . . . . . (3 DESIGN) 4) ANY MASONARY UNITS USED 70 BRING COVERS TO GRADE SHALL GARBAGE DISPOSAL . . . . . . . . . NO BE MORTERED IN PLACE. 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH INSTALL TWO (2) ACME TOTAL ESTIMATED FLOW 1 DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO 500 GALLON LEACHING CHAMBERS ( 110__GAL/BR./DAY x 3 BR) 330 CAL/DA Y i OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. WITH FOUR FEET OF DOUBLE PROPOSED SEPTIC TANK CAPACITY 1500 GAL ; 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR WASHED STONE SIDES AND .ENDS IS 719 .CALL 'DIG- SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS SOIL CLASSIFICATION . . . . . . . . I PRIOR 719 COMMENCING WORK ON SITE. 25' X 12.8' DESIGN PERCOLATION RATE . . . . . < 2 MIN./IN. 7) CONTRACTOR IS 719 VERIFY GRADES AND ELEVATIONS AS WELL AS EFFLUENT LOADING RATE . . . . . 74 _GAL/DAY/S.F. SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE.8) PARCEL IS IN FLOOD ZONE___C"_____, NOTE. 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