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HomeMy WebLinkAbout0510 ROUTE 149 - Health 510. 149 Marstons Mills P A 079 032001 a I i 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 - (0 Property Address: 510 Cotuk Road(Rt.149) Marstons Mills MA 02648 Rke-1, C Owner's Name: Patricia Fog Owner's Address: Same oc T Date of Inspection: October 23,2002 TOt, 2 6 ZQQ Name of Inspector. PATRICK M.O'CONNELL yFo Hp�STq ` �° FAT etE Company Name: SEPTIC INSPECTION SERVICES CO. q Mailing Address: 189 CAMMETr ROAD MAP MARSTONS MILLS MA 02648 Telephone Number: (508)428-1779 PARCEL, ;o32pO L CERTIFICATION STATEMENT LOT 14q 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: _X_ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: b/7- oL r The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. 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. I Page 2 of 11 OFFICIAL INSPECTION S ECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(contimued) Property Address: 510 Cotuit Road,Marstons Mills Owner: Patricia Fog Date of Inspection: October 23,2002 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X_ 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. i 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: I Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 510 Cotuit Road,Marstons Mills Owner: Patricia Fox Date of Inspection: October 23,2002 C. Further Evaluation is Required by the Board of Health: Conditions exist which require fiu'ther 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 i 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 i 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 welt".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for conform 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. Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 510 Cotuit Road,Marstons Mils Owner: Patricia Fog Date of Inspection: October 23,2002 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool —X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than%2 day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. - X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface — water supply. X_ Any portion of a cesspool or privy is within a Zone I of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ 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 fads.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. 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. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 510 Cotuit Road,Marston Mills Owner: Patricia Fox Date of Inspection: October 23,2002 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X_ _ Has the system received normal flows in the previous two week period? X Have large volumes ofwater been introduced to the system recently or as part of this inspection? X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X _ Was the facility or dwelling inspected for signs of sewage back up? _X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site? _X_ _ 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? _X _ 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 X_ _ Existing information.For example,a plan at the Board of Health. _X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 C1v1R 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 510 Cotuit Road,Marston Mills Owner: Patricia Fog Date of Inspection: October 23,2002 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: 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):_ Seasonal use:(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): 123 Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIALIINDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gvd 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 Pumped Two years ago. Source of information: Homeowner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: ttallons--How was quantity pumped determined? Reason for pumping: Maintenance TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool —ivy _Shared system(yes or no)(if yes,attach previous inspection records,if any)No _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: System installed in l"I per town records. Were sewage odors detected when arriving at the site(yes or no): No f Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 510 Cotait Road,Marstons Mills Owner: Patricia Fox Date of Inspection: October 23,2002 BUILDING SEWER X (locate on site plan) Depth below grade: 6" Materials of construction:—X—cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: 10' Comments(on condition of joints,venting,evidence of leakage,etc.): Pipe in good condition. SEPTIC TANK: X (locate on site plan) Depth below grade: 10" Material of construction:—X—concrete X— — — concrete metal fiberglass_polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: 1000 Gal. 4.5X 8' Sludge depth: I" Distance from top of sludge to bottom of outlet tee or baffle:31" Scum thickness: I %" Distance from top of scum to top of outlet tee or baffle: 9" Distance from bottom of scum to bottom of outlet tee or baffle: 13" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tank not in need of pumping.No evidence of leaks. GREASE TRAP: No (locate on site plan) Depth below grade:— Material of constriction:— — — 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.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 510 Cotuit Road,Marstons Mitts Owner. Patricia Fox Date of Inspection: October 23,2002 TIGHT or HOLDING TANK: No (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: allons 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.): s i DISTRIBUTION BOX: No (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: No (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.): Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 510 Cotuit Road,Marstons Mills i I Owner: Patricia Fox Date of Inspection: October 23,2002 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: One leaching chambers,number j leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/akernative system Type/name oftechnology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): H-201.eaching pit in good condition.Has 1%1 of eMuent never more than 2'. CESSPOOLS: No (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: No (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.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) I Property Address: 510 Cotuit Road,Marstons Miffs Owner. Patricia Fox Date of Inspection: October 23,2002 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 too feet.Locate where public water supply enters the building. �,3 55 f Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFO RMATION continued Property Address: 510 Cotuit Road,Marston Mills Owner: Patricia Pox Date of Inspection: October 23,2002 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 25 feet. Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-Hchecked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet.of SAS) Checked with local Board ofHealth-explain: Checked with local excavators,installers-(attach documentation) X Accessed USGS database-explain: Checked USGS topo maps and town groundwater contour map. You must describe how you established the high ground water elevation: Property approximately EL.70 groundwater at EL.35. t No. 1:210IV ' Fee ih THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ue PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftPYitation for Misposal 6pstem Construttion i3ermit Application for a Permit to Construct( ) Repair(✓Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 5 10 RTll Lq Alcvsjf,s M,Iis Owner's Name,Address,and Tel.No. Assessor's Map/Parcel `] -gol er J e h,;j j ki i e J Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 1r� i3rawn9 ��� s00 00--71 ^�� °�a► chefs Type of Building: Dwelling No.of Bedrooms 3 Lot Size /,k &t('S sq.ft. Garbage Grinder( ) Other Type of Building &4 e No.of Persons 2 Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 3 ,95 gpd Plan Date ►12011© Number of sheets Revision Date Title Size of Septic Tank 1Q C'jC 15F6Nc Type of S.A.S. SCx7 C�C�1IC��J (krc5 Description of Soil f' Nature of Repairs or Alterations(Answer when applicable) I L3S+&,Jr Akw 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 ]th. Signed Date Application Approved by 9 �' Date —1 Application Disapproved by Date for the following reasons Permit No. op C71(., " �,j Date Issued V7 " - - -•.-...+..,..r...v+r.`..a,..,..,t".-.�-•t N-Au'-.:'y...Oy.;..r...Yi.,y�j,+r y,...�...w........i---'..=,..n,..+w_-.en:. w"tiT.-^'fir°-.`i:..-,-rnt"_`t-"rY 'r 'w' r .,w -. ,�-•-. •....;y;.�+�n..-.;1......r_.....__.- _. No. Fee THE COMMONWEALTH OF,MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes t._, ftplitation for bisposal *'stern Construction Permit a "'Application for a Permit to Construct( ) Repair(,")/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 'b RT'q l /S �,�� . Owner's Name,Address,and Tel.No. Assessor's Map/Parcel (a -(-)I _ I Installer's Name,Address,and Tel.No. V Designer's Name,Address,and Tel.No. CGS R 13(c of ZrJc 5( NDC�-7/ •vStNt"p�t^I W0/fS Type of Building: Dwelling No.of Bedrooms Lot Size t( &PS sq.ft. Garbage Grinder( ) Other Type of Building hai?,p No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided '3?1 . gpd Plan Date 1)?(A i n Number of sheets Revision Date Title Size of Septic Tank 1 Q n c'y 154 inl c Type of S.A.S. s(r) oo rJ (�nran+It1�Y Description of Soil Nature of Repairs or Alterations(Answer when applicable) ►4 y,}<��� /�>Pt 41 , Date last inspected: Agreement: The undersigned ag'rees to ensii Ahe 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 d by this Board off Heaalth. Y Signed /}F - Date Application Approved by " ' V, Date 2 Application Disapproved by Date for the following reasons Permit No. a d I D ~ 631 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(( Upgraded( ) Abandoned( A T2,In, ,),) �-tK at S'1 n 'Q I t y cr kL 1 SVj r-A S AA A c, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 0010 —031 dated a t U Installer 1)-, ,/{ Illclwtj -. NC Designer F ,x,Nrr-/,NC lD&I/ lic #bedrooms Approved design flow gP d �* The issuance o hi s per/mitshall not be construed as a guarantee that the system�far�ctioln as design) ' S Date { J ' Inspector ,.� F� ---- -- -- ------- - ---- 22 ------------'-------._. -'------------ No. dLO to �J� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS MiSposal 6pstent Construction J)ermit Permission is hereby granted to Construct( ) Repair( L-K Upgrade( ) Abandon( ) System located at �-10 �'( j N j 1m r,/S f r•" "s 1U J I S and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit.- Date '— r I V Approved by r� v TRANS;_,NO.::. CITY/TOWN (�s s Fa(v APPLICANT: V. A ADDRESS:. s I h�ia-e 14°I DESIGN FLOW.: 336 gpa REVIEWED BY: DATE: N/A Legal boundaries denoted 310 CNM 15.220(4)(a)] ✓ Street, Lot, tax parcel number and lot number noted on plan [310 ✓ CMR 15.220 4 'u Locus Provided 310 CMR 15.2204(t)] Plan proper scale? (1"=40'for plot plans, 1"=20' or fewer for components) 310 CMR 15.220 4 Easements shown 13.10 CMR 15.220 4 b System located totally on lot served [310 CMR 15.405(1)(a) for ✓ upgrades]- if not, a variance is required 310 CMR 15.412 4 Location of impervious surfaces (driveways, parking areas etc.) 310 CMR 15.2204 d Location all buildings existing and proposed 310 CMR t 15.220(4)(c)] f Location and dirpensions of system components and reserve areas. ✓, 310 CMR 15.220(4)(e)] System Calculations 310 CMR 15.220(4)(f)] ✓ daily flow septic tank capacity (required andprovided) soil absorption s stern(required andprovided) whether system desi ed for&arbage grinder North arrow 310 CMR 15.220 4 Ddsting and ro osed contours 310 CMR 15.220(4)(g)) ✓ Location and 10$ of deep observation holes (e)isting grade el. on each test 310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220 4 h and i Location and dale of percolation tests (performed at proper elevation?) [310 CMR 15.220 4 i Percolation test results match loading rate? 310 CMR 15.242 Certification statement by Soil Evaluator 310 CMR 15.220 4 Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.22 4 n Address Sheet 1.of 9 N/A o hFQ' Loaatiori of every water supply, public and private, [310 CMR` 15.220 4- k within 400 feet of the proposed system location in the c4se; .w ..,.✓ of surface water.supplies and gravel eked: tic.water.su 'a' within 250 feet of the proposed,,system location in the case within 1507feet of the.proposed system location in the caae of pwiyate water .,'.. wells Location of all sface waters and wetlands located up to 100 ft. beyondLsetbaeks fisted in-3.10 CMR l_5 211-.and.any catch.basins locatedvitlun SO;ft 310 CMR 1522,0 4 V�ater lines and other subsurface utilities.located [310 C1V1R 15.220 4 m (' water-line cross see 310'Ci& 15.211 l'' 1 profle of.system-showing invert elevations of:allsystem. ,f co and*bottoin_of the SAS 3.1U CA15 22, 4 0` gi*p of deli 'er, 310 CMR 15.220 1 and 310 CMR 15.220`2 Stamp of Registered Land Surveyor (required if construction activities wthin.5 ft of tof line) 31-_O.CMR;15 22Q 3 Test Holes adequate (two in each of the primary and reserve unless trenches,as permitted in 31.0 CMR 15.102 ;as a .roved for an u _ade under LUA at 3'10-CNM 15 4'05 1 .k Test holeadequate to demonstrate four feet of suitable.material? 3,10 CMR 15.123..(4)] Test�Iioles adequate-A confirm adequate groundwater separation? 31 O CNIR 15 103 3 Benchmark,within:-.-50 75' of.s stem_. 3:1.0.CNW,15.220.4 , Materials.specifications noted? [various sections.of 310 CMR 15 000: System components not > 36" deep (unless Local Upgrade Approval.or..LUA re nested) 310 CMR T5..405 1 s Address Sheet 2 of 0 f z N/A QK N-0 Size OK? 310 CNM 15.223 1 Inlet tee located ten inches below flow line 310 CMR7r2777, 7' Outlet tee 14" or 14" + 5" per foot for increase ft dept CMR 15.227 6 , - Outlet tee with gas baffle bra roved filter 310 CMR 15.227(4)] Note regarding ir*aation on stable compacted-base[310 CMR 15.228(l)] Separation between inlet and outlet tees(no less than liquid depth) 310 CAR 15.227 2 Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA 310 CMR 15.405 1 k Minimum cover . (Tanks.buried.more.than 9" must have risers on all openings and on the d-box) [310 CAR 15.2228(1) and 310 ✓ CMR 15.232 3 Three access covers (inlet and outlet must be 20" or greater) - ✓ �,. middle access at least 8" 7/07 310 CMR 15.228(2)] Access to within'6 " of grade -one port for systems<i 000gpd, two.for;, stems>1000. d 310 CMR 15.228 2 . All at-grade covers secured to unauthorized access? `[310 CNIlt 15.228 2 > 10 ft from foundation 310 CMR 15.211 1 Buoyancy calculation Re uired/Done 310 CMR 15.22E 8 H720 Where a ro riate? 310 CMR 15.226 3 Setbacks from resources 13l0 CMR 15.211 Required when qther than single-family dwelling or flow>1000 d 310 CMR 15.223 1 First compartment 200% daily flow; Second compartment 100% �IA daily flow 310 CMR 15.22 2 and 3 "U" pipe througld or over baffle, outlet of each compartment with as baffle or approved filter 310 CMR 15.224(4)] Address- .: Sheet 3,of 9 N/A OK NO Located at least ten feet.froit any water line? [310 CNM 15.222(2)] Disposal piping�t least.,18" below water line(when water and sewer cross see 310 CR 15.21 1 1 1 , Clean titrts -'aired/ rovided ? 310 CMR 15.222 Thrusi,s,s_q6ed in forte mains? 310 CNN 15.221(6)(c)] / slope..of sewer brie not less than 0.01 (1/8"/ft) 0.02 preferable 340 CMR 15.2 6 Proper pitch. all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251 9 and 310 CMR 15.252(2)(c)] Siphon problem/ eacield below purnp chamber. Endca s or'vW manifold ed? Size and onentl of discharge holes specified?.(not smaller than 3/8 not larger than.5/8 ) [310 CMR 15.251(8) and 310 CMR 15.252 2 Mmrials,,specified (310 CMR 15.251(5) specifies various pipe es allowed Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232 2 a' 77,7f - Splash or baffie tee required on inlet/provided?(when pressure sewer to d-box or-steep pitch of gravity sewer) [310 ,✓ CMR 15,323(3)(a)] Riser if dee er than 9 310 CMR l5.232 3 Inside minimum dimension 12" 3.10 CMR 15.232 2 Minimum 310 CMR 15.232 3 e Watertight coverdf<2000gpd)- waterproof manhole if>2000gpd J 310 CMR 15.23 3 d Capacity(eirrerg�ricy storage above workuig-design flow)?'[310 pro per setbacks .310 CMR 15.211 same.as s .tic tanks Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE 310 CMR 15.231 5 Service components accessible(not too deep with piping, disconnects accessible Alarm floats alarm on circuit separktiefrom pyMgsspecified? Exceeds two units must have two pumps operating in lead-lag mode.: 310 CMS 15,211(6) and 8 Stable Coin ed Base .310 CMR.15.221(2)] . Address Sheet 4`of 9 Buo fa cc terns needed'?Provided? 31.0 CMR 15.221(8)11 " 7 ' i. . S3'"Y"�+i Yn t. f ' 3 1 et :of 9 . N/A OK NO Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.24 1 Required separation togroundwater? 310 CMR 15.212 Aggregate specified as double washed 310 CMR 15.247 2 System Venting required/provided?-(system under driveway or >36" d 310 CMR 15.241 Inspection ports specified and within 3"final,grade? [310 CMR 15.240 13 Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.21 1(1)[4] and Guidance Document] Chambers and Gal. in trench configuration supplied with inlet every 20 ft. 310 CMR 15.253 6 Each structure v�rith one inspection manhole(if>2000 gpd must be tograde) 310 CMR 15.253 2 Aggregate I minimum- 4' maximum: 310 CMR 15.253 1 2' sidewall credit maximum 310 CMR 15.253 1 a In bed confi ration, inlet e U1 40 ft. 310 CMR 15.253 6 Width 2'minimum 3' maximum 310 CMR 15.251 1 100 feet-maximum len h 310 CMR 15.251 1 a Minimum separation 2x effective depth or width whichever greater 3x if reserve between trenches)1310 CMR 251 1 d Situated along epntours 310 CMR 15.251 2 Breakout OK? �10 CMR 15.211 JIJW and Guidance Document mini n 2.d stribution lines. 310 CMR 1.5.252 2 a Maxirrium se aration between Tines 6' f310 CM R15.152(2)(d)] Maximum se n between lines and outside of bed 4' [310 �MR:15 252�2 e Aggregate depth below discharge pipes 6" minimum, 12" maximum. 310 CMR 15.252 2 S aration between beds 10' mtnum. 310 CMR 15.252 2 Bottom area'used in calculations only 310 CMR.15.252(2)(1)] Shed 6,of 9 Address,.. Pressure Dosed Sy-stem ? Provided pump and piping calculations as required 310 CMR 15.220(4)(r)] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A f Remedial Use ovals If used in gravellpss system -make sure jet is directed as not to scour soil interface Guidance Document Inspections once per year(systems<2000 gpd)or quarterly >2000 dgoo to note on plan 310 CMR 15.254(2)(d)] Construction in fdl -Did the plan specify that the fill shall meet the specification d 310 CMR 15.255 3 ? Impervious barrieer and/or retainin wall ? Guidance Document Impervious harTier installation must be supervised by designer 310 CMR 15.25 5 2 Retaining wall Faust be designed by Registered Professional En ' eer 310 CNM 15.25 5 2 a Side slope not exceed 3:1 ? 310 CMR 15.25 5 2 Breakout retluirements met? [310 CMR 15.252(2) and Guidance Document At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended 10 CMR 15.255 2 e Check DEP Approval letters for credits and design conditions t If used with pressure dosing do not allow pressure discharge to scour soil interface Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a rote on the plan regarding the requirement for N PerPetual maintenanceagreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has t submitted a copy of a maintenance eement? Are the variances listed on the an 1 . 310 CMR 15.220 4 p [ � RLS Stamp:-necessary on plan if a component is within five feet of ro a 310 CMR 15.412 4 :.:-Address :St 7 of 9 . e , r��������n or increased flow proposed - [1�efet'to 3 I0 r ` s s r t r' R' f; > 5 4� Address N/A OK NO. Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and ✓, 310 CMR 15.21¢ -also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? 310 CMR 15:21-4 2 Are the nitrogen loads proposed in compliance? [310 CMR ✓ 1 Pumping to septic tank ? 310 CMR 15.229 Shared System 310 CMR 15.290 i Address Sheet 9.of 9 Town aalrn Department of Regulatory-Ser ices ,4�wterastc F 10-L1 Da 1 i63y. 200 Maip Street,IiyanntsMA 02601 Date Scheduled v Time / Fee Soil Suitability Assessment for Sewagesp�sal 4 Perfrnmed:By, e �' KC Witnessed By ✓ IN LOCATIOv& .INFORMATION. Location Address " Owner's Name Address 01,0 '(Zrr� 14w _ ✓�i�l s Assessor's Map/Parcei: b GI C) Engineer's Name ? NEW CONSTRUCTION REPAIR Telephone# 0$ `ii _1 Land Use 5` Slopes(%) Suifece Stones Distances.from: Open Water Body ft Possible Wet Area 1 ft Drinking Water Well j ft Drainage Way ft Property Line ft Other ft SKETCH::(Street name,dimensions of lot,exact locations of test:holes&peretests,locate wetlands in proximity Wholes) 0 W a r� s i32 ParentDepth in 'c to tied►ock Depth to OroundwAm. Standing Water in Hole: �CIA— Weeping from pit Face �,� Estimated'Seasonal High Groundwater DETERMINATION FOR:.SEASONAL.HIGH wATEIt TABLE Method Used: Depth Observed standing in obs.hole: In. Depth to soil mottles. Depth to weeping.from side of obs.hole: in, ©roundwater Adjustment ft Index.Well:#.,.: Reading Date: Index Well level AdJ,faotoi;�,m,. At({.'drvufldvvdter leVol PERCOLATION TEST bete Observation Hole# Time at 9" Depth of Pei+c:: I/ Tlme at 6" .Start Pre-soak Time® q j'i�� �� Time(9"=6") End Pre-soak Z y 5`c 1 Uri 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' Qf wetland,you must first notify1he. Barnstable Conservation Division at least one (1)weak prior to beginning. Q:ISEPTICIPERCFORM.DOC Hole# ( , DEEP.OBSERVATION"DOLE LOG Depth from Soil Horizon Soil Texture:'• Soil:Color Soil Other, s Surface(in.). (USDA) (Munsell) Mottling (Structure Stones,BV alders. :a �-:i1Z 1a �L�%1 777777--­ DEEP OBSERVATIONHOLELQG Hole# 2- ; Depth frop� Soil Horizon Soil Texture Soil Color. Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cons Z ` �' J'e 2 Liz :. , DEEP'OBSERVATION HOLE LOG Hole# pepth from: Soil Horizon Soil Texture Soil Color. Soil Other Surface(in.) (USDA)" (Mansell) Mottling _ (Structure;Stones,Boulders. , • 7,• I DEEP`OBSERVATION'HO'49 LOG ``: .. Hole# De th from Soil Hprizon SoifTexture i 1, Soil Cola4w _ soli Other Surface(in) -. _ _• _.. (USDA) ' r(Munsell) k Mottling (Structure,Stones Boulders. ' 1 well . ; Flood It>burance=Rate Mau A"W 500-year flood boundary' No Yes -- VWithin`SAU'year°boundary: Yes,.. .�. Within 100 year'flood boundary No Yes Deutb of Naturally Occurrin>Y Pervious Material Y Does at least four feet of naturally occurring pervious materlal:exist in all areas observed tt►ritlghout,the h area proposed for the soil absorption system? If`no what is the'depth.of naturally occurring Perkions matefial? t,. Cecs nit I certify that:on (date1.)I have:passed the soil.e'yaluator examination approved by the Department of Environmental protection and that the above analysis was performed by me consistentwith ,. the required tra ing, x zrtise and experience described.in I0 CiVIR 15.01�. Signature Date.AL Q\SEP'PICePBRCFORM,DOC IO2/04/2010 19:33 5084775313 ENGINEERING WORKS PAGE 01 r Towln ofBarnstable Regulatory Services Thomas F.Geller,Director Public Health Division t0f4 Thomas McKean,Director 200 Main street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 10 Sewage Assessor's Map/Parcel 'ID3 Z 1 Installer&Desgger CerdHcatiog Form Designer: 1`•�,w� r*+tiS c�.>`erY(•�, It'c . Installer: Address: n- W. Cre l s;.1c 1 a( 0A Address: ZS Z 1`4 C*- " 1. F-� ) C-1k M R QZGyy Ceix-+er•,I ju M A, OZIa 30Z r On P.A .3 ra CN A I r k was issued a permit to install a (date) (installer) septic system at r7 1 G 1 A�1 t fA based on a design drawn by (address) 'FC*4,r i, M c_£►,r-ems f dated 1 Z o (designer) i I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required)was inspected and the soils were found satisfactory. H OF 4f4s PETER T. . nsta ler's Signature) McENTEE CIVIL u' `N0.35109 (Designer's Signature) (Affix D P BARNST PUBLIC TIi D N. C E A OF WILL NO D FO B BY In BARNSTABLE PUB ON q:�office rom,a'Jesipmcernfioadon fhmdoc TOWN OF BARNSTABLE LOCATION J 10 ` `i� SEWAGE#',20 k Q O13 1 VILLAGE ASSESSOR'S MAP&PARCEL 0-7 `� - 6�2-00 INSTALLER'S NAME&PHONE NO. S 1�foyi ni 3:Nc SEPTIC TANK.CAPACITY ®® F ►j( S�"i�� LEACHING FACILITY:(type) 50DG1C, (size) j�k,,1ST X NO.OF BEDROOMS OWNER JC f ��Cc.fee� Bj0e r i PERMIT DATE: )L-'i t k 0 _ COMPLIANCE DATE: :2-'Li " 10 Separation Distance Between the:: Maximum Adjusted Groundwater Tahle to the Bottom of Leaching Facility to� 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 �' e A Ex�sri�5 Cq'3Y y v TOWN OF BARNSTABLE LOCATION �(� � oAct SEWAGE # ' VILLAGE {NI, I S ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 1 Q-bZ S' c -T LEACHING FACILITY:(type) (?NT (size) NO. OF BEDROOMS :3 PRIVATE WELL PUBLIC WA�-� L,- BUILDER OR OWNER 1914`) co 1' DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: Zz VARIANCE GRANTED: Yes No U P r� No.. �....J...--.. Fmc............._.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diopooai Marks Tontrttrtion lirrutit Application is hereby made for a Permit to Construct ( ) or Repair ((tea ' Individual Sewage Disposal System at: .............5a. lQ Imo:..... `` e� �J .---------•-------------------------------•--------............--••---•._.......--- __.. - L ion- dress .-.or Lot No. +! . CV ��E ---------------------- •----••---------- -•----- •--- ---- ---------------- owner ress A,� ( - �� /�<� Installer Address Type of Building Size Lot.................... Sq. feet aDwelling—No. of Bedrooms----5..................................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------•---- ---•-•-------•---•-•••••-•-•----•---••---•••-----••-•--••---•--•----------••--•-•••---•..............•---•----------•............... d W Design Flow._Ste.........................gallons per person der day. Total � flow_33...........................gallons. WSeptic Tank/—Liquid capacit)/.000.gallons Length... ----...... Width................ Diameter................ Depth----_-_-__--__-. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....../-.________- Diameter....1Q_`_-_--- Depth below inlet.._k........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_-___-_______-__-____--. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -•••-------•-•---------------••--•---------------•-••...------------..............--•-•.......••••••......................................................... 0 Description of Soil........................................................................................................................................................................ U ----------------------------------------- •-•--------------------------------------•---------------------------- W UNature of Repairs or Alterations—Answer when ap Iicable ,STi�l--------- I.ACC ........... • Q ......... -------------------------•----------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersi ned further agrees not to place the system in operation until a Certificate of liance has been issu he b rd of health. Signed ----- - -------- .......... - '. . to ApplicationApproved By ---- - ------ ------------------------------ ---------------------- ....... ..Date Application Disapproved for the following reasons- ----------------------- ------------------ ---------------- --- ----------------------------------------------------------------- ............................................... - ------...-----...------------------------------------------- Permit No. j .l-�,, ..Ll-------------------------- Issued ------- -- --- e.. ._j.......--.pace .. No. .._..._._..----- Fs$...... ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applirttfion for lliipoott1 Workii Tonfstrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( (,)-'an Individual Sewage Disposal System at: � 01 O Loc at`\CC ............ ._. . ---..................• ...............................................��� ..............._.._...._._................._. ion- r o • `gl��" r� .!�"P......................................................... .._......._._................... .....-----------•---------- -........._.......--- Owner � ddress ,�j / r w,-� .....................6..I L L t�(Ct � ,L la� iC�C?k ` ( (r�....../!�_c l 11_.15..._......... ----- -----------------`------------..........---- Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) U-t Other—Type of Building No. of persons............................ Showers — Cafeteria QI Other fixtures ---------------------------- - w Design Flow___ ______________________________gallons per person per day. Total da_1y flow---��-..�.........................gallons. WSeptic Tank L Liquid capacity.-U.gallons Length...r_-....... Width_-.)........ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length........__._........ Total leaching area--------------------sq. ft. Seepage Pit No....../........... Diameter.....«`_..._ Depth below inlet.._6............ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) • Percolation Test Results Performed by.................................................................'_.____ Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.......--............... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -------------------------------------------------------------------•--•------' ........................................_................ 0 Description of Soil.........................................................................................------------------•---------...--------•--......._......................__-•---- x --------------------------------------------------------------------------------------------------•----------------------------------------------------------•------------------------=Z-..........-- r U Nature of Repairs or Alterations—Answer when ap livable_.- '!*.C,T ........I. -..S P ) :-.---�<c i. '-----------------•--------------------------- -----.................... Agreement: The undersigned agrees to install the aforedescribed Individual;Sewage Disposal.System in accordance with the provisions of TITLE 5 of the State Environmental Code=The undersigned further agrees-not.to place the - system in operation until a:Certificate'of`Compliance has been issued-by the bo rd of health'.. , r Slgned l ---- --- -� - .; -- .i to -`�� Application Approved By.'-- / �lti[ ----------- --------- ----------------- -------------"- ...................... ------.J-/�J,1... / / Da[e Application Disapproved for the following reason:r: ......----------- ----........................... ------ ' .....--------"......--:...................................... Da ---------------------- / te Permit No. /. - Issued .....[e. ........ ........................ i t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Te>r#tftra e of Cfompliattx.e THIS IS TO .E TIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by................... .A..:. LK1tY S 7 '--------------- _ ---...-------------......----------------------------- --------------------- Installer at ---------------------------- .�. ...... �� `�`� A''' ..1 r has been installed in accordance with the provisions of TITLE 5 f The State Environmental Cod as des7�fibed in the application for Disposal Works Construction Permit No. -._-`?..�..'`. ... .>.. ..... dated .------ � ��1.. ---------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A.GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE .1f6. -.. Inspector A, THE COMMONWEALTH OF MASSACHUSETTS. BOARD OF HEALTH C 33 TOWN OF BARNSTABLE No....................... FEE........................ %Vowel Vorkg Tono#rudiou 'v"ami# Permission is hereby granted--------------r..!�1 l k= (-,4 N �_.S z� C== _._.. at No.............�' •or Repair ( (-)--an Individual Sewage Disposal System to Construct ( ) r.��---------••-------�.�`... t ` ------- .,. a.- 1 — ...t Street / ' // as shown on the application for Disposal Works Construction Perrnit ated�.._ /�l!//r .�._........ 41,2 Board of Health DATE.. .......... ......------------------------------- FORM 36506 HOBBSA WARREN.INC.,PUBLISHERS TOWN OF BARNSTABLE h9 LG:A- lON 51 D SEWAGE # VILL&GE � �ASSESSOR'S MAP Q LOT INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY r LEACHING FACILITY:(type) /�, � (size) NO. OF BEDROOMS-PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER O� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 1 ARIANCE GRANTED: Yes No I Mrrol I�. Ah ?3 I w7z:2 LIAh`7 TOWN OF BARNSTABLE � ��� rA -I_0 IVUNDERGROUND FUEL AND CHEMICAL STORAG SYS S // ASSESS ORS MAP NO. PARCEL N0. C C*7 oM s. c� L A� WO ADDRESS; J� ! ©'��0.�7 VILLAGE' ILLAGE J rr NAME,. CONTACT PERSON PHONE NUMBER. I:OCATIOP:-ter-TANKS:. CAPACITY: TYPE OF' FTT AGE: TYPE: LEAK w �f OR CHEMICAL! ` DETECTION c; a '� �s 5`�.;��� � � 4- SYSTEM! o 4 0 S'z")-fk(, bif Race- -,wd) pa d--ucc��y (v) -01-f/ I Mo A Z s DATE OF PURCHASE OF EACH: 1. 2. 3. 4. 5. DATE OF.FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS PLEASE PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD. r j84 BANKOF BOSTON CAPE COD REGION April 22, 1988 Thomas A. McKean Town of Barnstable Office of Board of Health 367 Main Street Hyannis , MA 02601 ESTATE OF RACHEL BURGESS Dear Mr . McKean: I am returning to you the Registration Card for the Burgess property located at 559 Cotuit Road, Marston Mills , MA. I have completed the Registration Card to the best of my . ability. Please fill in the Assessors map number and the parcel-number- of the property_. - I have enclosed a _copy of_ the Real. Estate Tax Bi-11 ' for this property'which may provide you with this information. Please send the brass valve tag to my attention at the address listed below. If you need additional information concerning the Registration Card please contact me. Sincerely yours , Thomas J. Landi• Associate Account Administrator TJL: sb Enclosure 7-5880-0 THE FIRST NATIONAL BANK OF BOSTON, 125 Main Street,Yarmouth Port,Massachusetts 02675 Tel.617-362-6551 z z D D' COMMONWEALTH OF MASSACHUSETTS r TAX RATE TOWN OF BARNSTABLE c PER$1,000 SCHOOL GENERAL TOTAL oISTRICT OFFICE OF THE COLLECTOR OF TAXES NOTICE OF > RESIDENTIAL 1 C E N Ti Q S T r 14 Af FIRE DISTRICT SECOND PAYMENT OPEN SPACE 2 4 �' � s8 9.85 .28 REAL ESTATE TAX 4-27 5_5� 9.85 ��� PATRICIA A.PACKER COLLECTOR OF TAXES FISCAL YEAR ENDING t CO MERCIAL 3 6 l $ 5 f $ Based upon assessments as of January 1. 1987 your REAL ESTATE tax JUNE 30,1988 - IND STRIAE 4 q 7 � 9 8 9 5 1 $ for the fiscal year commencing July 1, 1987 and ending June 30, 1988 v bn the f011owmo desc!ibedparce!of REAL ESTATE is as follows: ACCOUNTFt PROPERTY DESCRIPTION ASSESSMENTS&LIENS PARCEL ID: fin• DE RIPTION q .' T/lIL'LIE DESCRIPTION AMOUNT LOC : 559 g C t ~0 $ .RD 41 : s35.1Qi) DEED REF: 892/576 0100 #3 DIG(4)—CAR-0-1 STATE CLASS" tfli?t: 1Q1 HER FEATURE _.... TOTAL FULL VALUE RESIDENTNL - EXEMPTION TOTAL TAXABLE VALUE TOTAL TOWN TAX EFYA ST.TAX TOTAL ASSESSMENTS.. . .. TOTAL TAX& SEE REVERE.SIDE 738.700 fl 738:700 7�276.20 45.54 ^iTs . ��1.7� FOR cnraslE tlr Noy.15Y,199> . FURTHER iNFORFAATION LN TOWN TAXDISTRICT TAX BY MAY 75TF •1988 x FASSESSMENTS TOTAL TAX TOWN TAX DISTRICT TAX TOT f�.11Q�87 .a38.10 172_77 a• a7 OWNER I/1/87 SURSESSi RACHEL L SCHOLARSHIP FUND 18275 ` .1 PAYABLE 11/1/87. -�fl4YABLE 5/1/88 evRGESS, RACHEL L 1.TOTAL PAYMENT DUE COTUtT RD 40110.87 st.w $sm ��110.8,7 ; :< 2.AMT.OF CONTRIBUTION $ (PAYMENTS) 40, • . PARSTON HILLS NA 02468 T ss.o0 sto.00 MHER (ADYS) ❑ ❑ ❑ ❑ ❑ (CHGS.&FEES) y Tip ECK AMOUNT TE YOu MnSN INTEREST - . - _ - _ All J _must payments be made �T t0.Town of Barnstable Mal to Collector s Office.P.O.Box 1360TC,Hyannis.MA OZ601 3.ADD ITEMS 7 8 2 AND Office Hours:Monday—Friday 8:30 AM—4:30 PAY TOTAL AMOUNT $ r PM u �ed Reo menu not . _payments made tJwember 1 Or by May 1 are subsea to interest at 1456 annum fromfirs', _ • ' _ �d per ro t the i he da prece ding month. n9Y COLLECTOR'S COPY -4 RETURN WITH PAYMENT vs/v2ie8 41 FORM,r P mmED BY THE OO tSSIOHEq 8.4'61. _ CIFR�VENUE d �, !E N Old Falmouth Rd LOCUS b Rp\QG I N 40'50'23" E e+ 115.32 o � r IN GROUND O ` Ott I cn SWIMM/NG POOL � � �" � I LOCUS MAP LOT 14B NOT TO SCALE A o� N GENERAL NOTES: O Pan SHED O � ���,, I 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL PAVED O O I BOARD OF HEALTH AND THE DESIGN ENGINEER. DRIVEWAY I 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE �+ W I 1EX1S77NG pJE� i LOCAL RULES AND REGULATIONS. S 41'41 37 HOUSE (#510) GR I 3, THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 1� 60.00 Pa no T.O.F.=100.54.* - ( TODESIGN INSPECTION ER D APPROVAL BY THE BOARD OF HEALTH AND THE I I 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING : FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6, THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF �' THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. IN o L _ _ _ _ _ _ _ _ _ _ - SEE SHEET 2 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 00 0 20 SCALE 8. THERE ,PRE NO WELLS WITHIN 100' OF THE PROPOSED S.A.S. a0 r- 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS z LOT 14A AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE O'er DIRECTED BY THE APPROVING AUTHORITIES. 1�/` APN 7.7QQ-032-001 ��` 00 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY V 1.688 Acres± /j �O. THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS l— 352.63' IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). N 44'06'28" E 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE sidewalk INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. edge of pavement 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. ROUTE 149 ��� °F Mgss ��P q�yG PROPOSED SEPTIC SYSTEM UPGRADE PLAN MARSTONS MILLS — WEST BARMSTABLE ROAD PETER T. s g Mc 510 ROUTE 149, MARSTONS MILLS, MA � CIVIL i No. 35109 Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 ADF STE��� �� Engineering by: SCALE DRAWN JOB. NO. F Engineering Works, Inc. 1 =40' P.T.M. 238-09 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. ! l (508) 477-5313 1/26/10 P.T.M. 1 Of 3 l , 97, LEGEND EXISTING SEPTIC TANK EXISTING LEACH PIT '� CIS —— 98 —— EXISTING CONTOUR TOP OF TANK, EL.=99.54± TO BE PUMPED, FILLED W/ f�� INV.(OUT)=98.20t SAND & ABANDONED ^q� �' x 100.98 EXISTING SPOT GRADE _ �P1 U UNDERGROUND WIRES �- G EXISTING GAS SERVICE N 40'50'23 E Lam° _ 115.32' x 99.3 1 G'b W EXISTING WATER SERVICE 1;� TEST PIT x 1a;.09 i/ C 97,07 S b BENCHMARK O C) IN GR ND = 100.53 '_ SWIMMING POOL fx(100,09 �1 100,33 Ti�-1 m 97,55 o OF MA 99, 96.81 PETER T. 'i�/ �` �� McENTEE N + 5• CD CD CIVIL No. 35109 99.81 X 99.59 1� _--� 97,36 W 97.58 STE�N� � 1 !J•� � � � SI \ O x O x 97,10 (b 100.15� I 100,16,E X ` TJ 1 100.18 6 100.19 PA VED ED ,a`.0 PA`Tl0 _-- _— —___---� DRIVEWAY If, ,0�9,99 99.32 x 84 97.58 ' 160. 5 � i \jEL \� 98.02 EX/STING �99 90 99,69 99,34 DR OENPY ��� LOT 14A HOUSE (#510) APN 79 032 001 = T.O.F.=100.54± ��� 1.688 Acres± \` PAT10 99.74 �� ���' 98.1 ilk Benchmark Set � _ --- Corner of Window Well x 97,90 99,90 EL.=100. 19 (Assumed) ��� ------ PROPOSED SEPTIC SYSTEM UPGRADE PLAN x 99.3 510 ROUTE 149, MARSTONS MILLS, MA \ 99.90 99.88 Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. G BUTLER, JOHN M & KAREN E Engineering Works, Inc. 1"=20' P.T.M. 238-09 510 ROUTE 149 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. MARSTONS MILLS, MA 02648 (508) 477-5313 1/26/10 P.T.M. 2 Of 3 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:96.2 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. (3) 5" DIA.OUTLETS SEPTIC TANK PROPOSED D—BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL RISER & COVER OVER ONE CHAMBER AND 15.5" LL 16" I 2" T.O.F. OUTLET AND SET TO 6' OF FINISH GRADE SET TO 6" OF GRADE SET TO 3' OF F.G. TO SERVE AS INSPECTION PORT r` �� EXISTING F.G. EL.=100.4f / F.G. EL: 98.5t F.G. EL: 99.5f(MAX.) v '�Q / ��ppJJ�,�1}���@ y •l �7�7�7Y • if 37117Ai7Y1•YJ " 15.5 2 6�� ® S=1% (MIN.) ® S-1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC 2" LAYER OF 1/8" TO 1/2" P 6 DOUBLE WASHED STONE 10"I 6 Maea�aaa (OR APPROVED FILTER FABRIC 2. •� 4" aaa6aaa EXISTING 48" LIQUID kINV.=98.2O± MaaaM -3/4" TO 1-1/2" DOUBLEH-10 LOADING LEVEL4' S 2' 4' WASHED STONE D_B O/� GAS BAFFLE INV.=96.37 INV.=96.20 X PROPOSED D—BOX EFFECTIVE WIDTH = 13.2' INV.=95.70 N.T.S. EXISTING SEPTIC TANK 2.500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H-10 RATED TOP CONC. ELEV.=96.5 BREAKOUT ELEV.=96.20 INV. ELEV.=95.70 ease ®®®® 0 E3 Ea E:d Ea NOTES: 1) D-BOX SHALL BE SET LEVEL AND TRUE TO a666a MBaaaBa GRADE ON A MECHANICALLY COMPACTED SIX Maas Baaaa H ®®®®®® ® ® ®® ® 33" INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.=92.70 _ 8.5=17.0 3' d w ®®®®®® ® ® ®® ® 310 CMR 15.221(2). N Z ®LMEI®Ea® ® ®Ell® ® 2) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' MIN. ABOVE BOTTOM OF EFFECTIVE LENGTH = 23.0' — 3) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE T.P. EXCAVATION OR G.W. AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. LEACHING SYSTEM SECTION 4) MAXIMUM COVER OVER SEPTIC TANK, D-BOX & S.A.S. NO GROUNDWATER, EL.=87.0 = 102" SHALL BE 36". SEPTIC SYSTEM PROFILE N.T.S. 4" KNOCKOUT 20" DIA. COVER �%2�'"'S; N SOIL LOG DESIGN CRITERIA Is OP P 8 4" KNOCKOUT / 4" KNOCKOUT 62" DATE: JANUARY 7, 2010 (REF#12, 11) SOIL EVALUATOR: PETER McENTEE (SE#1542) s s•NUMBER OF BEDROOMS: 3 BEDROOMS WITNESS: DAVID STANTON R.S.`�s "3�. HEALTH AGENT 4" KNOCKOUT SOIL TEXTURAL CLASS: CLASS I r ye°j 4`�9 ELEV. TP-1 DEPTH ELEV. TP-2 DEPTH DESIGN PERCOLATION RATE: <2 MIN/IN 98.2 A 0" 98.0 A 0" DAILY FLOW: 330 G.P.D. SHE/ SANDY LOAM SANDY LOAM DESIGN FLOW: 330 G.P.D. 97.5 10YR 4/2 10„ 97.3 10YR 4/2 101, GARBAGE GRINDER: NO B SANDY LOAM SANDY LOAM B 500 GALLON CAPACITY, H-10 LOADING EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 10YR 5/8 10YR 5/8 CHAMBERS EXISA C 95.7 42" 95.7 40" LEACHING AREA REQUIRED: (330) = 445.9 S.F. /HOUSE C PERC C .74 54" N.T.S. USE 2-500 GALLON LEACHING CHAMBERS IN SERIES M-C SAND M-C SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 2.5Y 6/4 2.5Y 6/4 510 ROUTE 149, MARSTONS MILLS, MA SIDEWALL AREA: 2(13.2' + 23.0') X 2 = 144.8 S.F. BOTTOM AREA: 13.2' x 23.0' = 303.6 S.F. Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 TOTAL AREA:..............................................................448.4 S.F. 87.2 132" 87.0 132" Engineering by: SCALE DRAWN JOB. NO. S.A.S. LAYOUT PERC RATE <2 MIN/IN. ("C" HORIZON) Engineering Works, Inc. NTS P.T.M. 238-09 DESIGN FLOW PROVIDED: 0.74(448.4) = 331.8 G.P.D. NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 1/26/10 P.T.M. 3 of 3