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HomeMy WebLinkAbout0796 ROUTE 149 - Health M Route-149f Marstons Mills F A = -101 020 ti r TOWN OF BARNSTABLE LOCATION Z16 AT /Y01 SEWAGE # —64 VILLAGE MIAZM66 MIUS ASSESSOR'S MAP & LOT n 1 — 02 U INSTALLER'S NAME&PHONE NO. QfQI�,A�oz SEPTIC TANK CAPACITY low LEACHING FACILITY: (type) �2—,5?V C4 ` � (size) ll k ,k2 t, NO.OF BEDROOMS 3& S Bde?C'l ' / BUILDER OR OWNER0. PERMITDATE: 1 2 tl COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility Of 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 w J f 77' /cam 6 r4l* TOWN OF BARNSTABLE LOCATION 01(0 '` '- 9 SEWAGE # VILI�AGE � MCI -S ASSESSOR'S MAP & LOT i )1 (oZO INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY / ow LEACHING FACILITY: (type) 3' �/l� R.QTp/J (size) NO.OF BEDROOMS 3 B�91,DER OR OWNER ✓✓)G AUl f �te, P_ERMITDATE: COMPLIANCE DATE.- Separation Distance Between the: Maximum Adjusted Groundwater Table and 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) L Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) J Feet Furnished by SiISIO&V Di1 �0�Cr 15o S S - a 3 a. �y A. - .... COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS John Graci DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAU1.CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 1 f 9 PART A `� f • r CERTIFICATION Property Address: - 796 RT. 149 MARSTONS MILLS MAP 101-020 Name of Owner TONY TAPPER Address of Owner: SAME Date of Inspection: 814/99 Name of Inspector:(Please Print)JOHN GRACI 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: n/a Mailing Address: n/a ti Telephone Number: n/a CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes The inpection Is based on criteria defined in Title V _ Conditionally Passes code 310 CMR 15.303.My findings are of how the system is Needs Further Evalugpon By the Local Approving Authority performing at the time of the Inspection.My Inspection does Fails not Imply any warranty or guarantee of the longgevity of the septic system and any of its components useful life. Inspector's Signature: Date:816/99 The System Inspector sha submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOM MEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 796 RT.149 MARSTONS MILLS MAP 101-020 Owner: TONY TAPPER Date of Inspection:8/4/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: nta 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. nLa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. nta Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced _ obstruction is removed _ distribution box is levelled or replaced nta The system required pumping more than four limes 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 revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 796 RT.149 MARSTONS MILLS MAP 101-020 Owner: TONY TAPPER Date of Inspection:814/99 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS HOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from polluticn from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nla.(approximation not valid). 3) OTHER Wa revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 796 RT.149 MARSTONS MILLS MAP 101-020 Owner: TONY TAPPER Date of Inspection:8/4199 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an 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 112 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 n/a. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412),Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 796 RT.149 MARSTONS MILLS MAP 101-020 Owner: TONY TAPPER Date of Inspection:8/4199 Check if the following have been done:You must indicate either"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 None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up., X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholles were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at BAH, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [1 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 796 RT.149 MARSTONS MILLS MAP 101-020 Owner: TONY TAPPER Date of Inspection:8/4/99 FLOW CONDITIONS RESIDENTIAL: Design flow:-M g.p.d./bedroom Number of bedrooms(design): 2 Number of bedrooms(actual):2 Total DESIGN flow: 221Z Number of current residents:2 Garbage grinder(yes or no):NQ Laundry(separate system)(yes or no): MO If yes,separate inspection required Laundry system inspected(yes or no):JLQ Seasonal use(yes or no):M Water meter readings,if available(last two year's usage(gpd): n1a. Sump Pump(yes or no): NO Last date of occupancy: n1a COMMERCIAL/INDUSTRIAL Type of establishment: n1a Design flow: n&gpd(Based on 15.203) Basis of design flow: n& Grease trap present:(yes or no):_NQ Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:n& Last date of occupancy: n& OTHER: (Describe) WA Last date of occupancy: Wa GENERAL INFORMATION PUMPING RECORDS and source of information: 6119/99 BY BORTOLOTTI System pumped as part of inspection:(yes or no):NO If yes,volume pumped W& gallons Reason for pumping: n& TYPE OF SYSTEM X Septic tank/distribution boxisoil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: n1a APPROXIMATE AGE of all components,date installed(if known)and source of information: THE SYSTEM WAS INSTALLED 6 YEARS AGO PERMTI 93-464 Sewage odors detected when arriving at the site:(yes or no) NQ revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 796 RT.149 MARSTONS MILLS MAP 101-020 Owner: TONY TAPPER Date of Inspection:8/4/99 BUILDING SEWER: (Locate on site plan) Depth below grade: 1.6„ Material of construction:_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: TOWN Diameter: nLa Comments: (condition of joints,venting,evidence of leakage,etc.) nLa SEPTIC TANK: X (locate on site plan) Depth below grade: V Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) IVA If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): No nLa Dimensions: L 8'6"H 5'7"W 4'10" Sludge depth: Q Distance from top of sludge to bottom of outlet tee or baffle: Q Scum thickness:-Q 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: Q How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING EVERY TWO YEARS GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) nta Dimensions: nLa Scum thickness: Wit Distance from top of scum to top of outlet tee or baffle:-nLa Distance from bottom of scum to bottom of outlet tee or baffle nla Date of last pumping: nLa Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) Wit revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 796 RT.149 MARSTONS MILLS MAP 101-020 Owner: TONY TAPPER Date of Inspection:8/4/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n(a Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) nLa Dimensions: nta Capacity: Wit gallons Design flow: nLa gallons/day Alarm present: NQ Alarm level: n/a Alarm in working order:Yes_No_ NQ Date of previous pumping: Wa Comments: (condition of inlet tee,condition of alarm anal float switches,etc.) nta DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert:LIQUID LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) DISTRIBUTION BOX IS STRUCTURALLY SOUND.SYSTEM IS FUNCTIONING PROPERLY PUMP CHAMBER: NQ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) Wa revised 9/2/98 Page 8 of 11 n SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 796 RT.149 MARSTONS MILLS MAP 101-020 Owner: TONY TAPPER Date of Inspection:8/4199 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located.explain. nta Type: leaching pits,number: Wa leaching chambers,number: 3-INFLUTRATORS leaching galleries,number: 1]La leaching trenches,number,length: Wa leaching fields,number,dimensions: nta overflow cesspool,number: nLa Alternative system: Wa Name of Technology: jVA Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE SAS APPEARS TO BE FUNCTIONING PROPERLY. CESSPOOLS: _ (locate on site plan) Number and configuration: WA Depth-top of liquid to inlet invert: Wa Depth of solids layer: Wa Depth of scum layer. nLa Dimensions of cesspool: Wa Materials of construction: Wa Indication of groundwater: nLa inflow(cesspool must be pumped as part of inspection)Wa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Wa PRIVY: _ (locate on site plan) Materials of construction:Wa Dimensions:nLa Depth of solids: Wa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Wa revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 796 RT.149 MARSTONS MILLS MAP 101-020 Owner: TONY TAPPER Date of Inspection:8/4/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a I cicl SO 5� � 6 A<<10RS revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 796 RT.149 MARSTONS MILLS MAP 101-020 Owner: TONY TAPPER Date of Inspection:8/4/99 NRCSReportname: nLa Soil Type: nta Typical depth to groundwater: n& USGS Date website visited: nla Observation Wells checked: NO Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHART revised 9/2/98 Page 11 of 11 � F AIED INSPECTION COMMONWEALTH OF MASSACHUSETTS, ,.c rj : far;_ ittLE EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS F:; 11: 42 DEPARTMENT OF ENVIRONMENTAL,PROTECTION 101 DARCEI 02 p TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 796 Route 149 Marston Mills. MA 02648 Owner's Name: Matthew McAuliffe Owner's Address: Date of Inspection: October 5, 2004 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ✓ Fails Inspector's Signature: Date: October 6, 2004 The system inspector shall sub 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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 796 Route 149 Marstons Mills, MA Owner: Matthew McAuliffe Date of Inspection: October 5, 2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 796 Route 149 Marston Mills. MA Owner: Matthew McAuliffe Date of Inspection: October 5, 2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of i l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 796 Route 149 Marstons Mills MA Owner: Matthew McAuliffe Date of Inspection: October 5, 2004 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than 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.] Yes (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered`yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 796 Route 149 Mars tons Mills, 1M Owner: Matthew McAuliffe Date of Inspection: October S, 2004 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS,located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]: 5 Page 6 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 796 Route 149 Marston Mills, AM Owner: Matthew McAuliffe Date of Inspection: October 5, 2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Number of current residents: 3 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped in 2003-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 9113193-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 796 Route 149 Marstons Mills.MA Owner: Matthew McAuliffe Date of Inspection: October S. 2004 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: 2' Material of construction: �/ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 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 Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Cement tees were present. The liquid level was even with the outlet invert. There did not appear to be an 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 sc.um to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 796 Route 149 Marstons Mills. MA Owner: Matthew McAuliffe Date of Inspection: October S. 2004 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: j Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was level. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 796 Route 149 Marston Mills. MA Owner: Matthew McAuliffe Date of Inspection: October 5, 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: 3-infiltrators 7'x 22.75'(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 infiltrators were under water and backing yp. The leach field was in failure. 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: 796 Route 149 Marston Mills. MA Owner: Matthew McAuliffe Date of Inspection: October S. 2004 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. 4 � a 1 5o S S a 3 �a �y 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 796 Route 149 Marston Mills, MA Owner: Matthew McAuliffe Date of Inspection: October 5, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25+/- feet Please indicate(check)all rr.ethods used to determine the high ground water elevation: Obtained from syst.-m design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic maps and water contours maps, the maps were showing approximately 25'+/-to zround water at this site. This report has beer,prepared and the system inspected and failed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied,relating to the system, the inspection and/or this report. I1 F. C„ TOWN OF BARNSTABLE LO(tATION /9( _ 1_49 SEWAGE # . VILLAGEm(2 *r& jig ASSESSOR'S MAP & LOTI61"�Nx INSTALLER'S NAME & PHONE NO��lp�` k' SEPTIC TANK CAPACITY D16O f 7te L EACHING FACILITY:(type)? /' (size) T X6,�r 'X, NO. OF BEDROOMS_j PRIVATE WELL O PUBLIC WATER BUILDER O �OWNE DATE PERMIT ISSUED:_ if �� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No i ss ram' '72 74 C No.. � _..`1. Fa$.... .J THE COMMONWEALTH OF MASSACHUSETTS APPROVED Barnstable Conservation Department BOARD OF HEALTH �L 4�3-43TOWN OF BARNSTABLE sigbed Applirati efur Uhipmial Morlai Tomitrnrtinn "amit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: / 796. ...:...../ .........................................................'Jc.c 71------------------------------------- Location - .................. ...... /y .�� ^� : \ddn-ss---�t�j_........- ----•....., -----�=-Or• �` .......... _..........._ !(� _ O"ncr r Addres Installer Address 10, U Type of Building Size Lot............................Sq. feet 1.3.. Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Pa Other fixtures----------------- -------------- W Design Flow..................... ,757...........gallons per person per day. Total daily flow.............:X.................gallons. WSeptic Tank—Liquid capacitN/—--gallons Length---------------- Width................ Diameter-..-..-.-..----- Depth................ x Disposal Trench—No. ......./........ Width-------7!..... Total Length. x STotal leaching area....................sq. ft. Seepage Pit No..................... Diameter...........--....... Depth below inlet--.................. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit...--............... Depth to ground water-----................... P+ ............................................................ ..... ....... 0 Description of Soil......................0 .�....4ei.4-'n �... G :� ... .0....... V .-------------------------------------------------------------------•---------------------•---------------------------------------------------------------------- W ---•------------------------------------------------------------------------------------------------------------------------------------- ------- -- UNature of Re i r Alterations—Answer when applicable....1N,�1. -Cf ._.�.-.-... .. .....Q%s...�..,�..- Q�?.�-..-.----.v�_.._._._� °�G�%- ' --•-----...jam ,c 7 ..... ...2M e................... 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 Compliancoh Wissuthe b and of health.Signed ------------- l.. ... / ... Application Approved By :... Dare Application Disapproved for the following reasons: ................................... .. .......................................................................................... ............. ..................................................... . . ...................... ............................. . . ............................. .. ........................................ s V � Dace PermitNo. ........ ..�............ . Issued .................................................................-.. Dare '..r-"✓-"".•'^y�".`r_•w....•-...--v^-p.4....-�1......•�-.1��-•,,;,,,-�....i^.,.rt."n-a....r.•�:...-.:•��,t"`a"..._,ti,:.,;._,-.,.,,�.�;.,:..,�i��..r-�....,..•.....r.�:�L�,r..'�r :�r�=-yv •-=s.v�r r Y '>1,a§ Fr;ic ���........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T 3 q 3 TOWN OF BARNSTABLE Apphratiaan for Diripnml lVarks Towitrnrtiaan aermit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: ................................................................. ........................... ----------•-................ Location-Address or Lot No. ............-- O�.ncr Address� i jnl,�.��l.................................................., 1l Installer Address Q Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No, of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------------------------------------•-----------•-----•------- ----•-----•-•-------•----•-•--.....-•---•--••--------•_.•---• WDesign Flow......................5. ..........gallons per person per day. Total daily flow..............—................gallons. 1:4 Septic Tank—Liquid capacity/Al lL a.galIons Length---------------- Width................ Diameter................ Depth................ Disposal Trench—No. ......./........ Width........ .-...... 'Total Length.,-_4 1�7-Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by........ -----------------------•--•------•-•------------•---••--•-----•-- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ --•-•-•-•--•-----•..............•-------•-•--•--------------------•••-----------.........._..------.......................................................... D Description of Soil----------------------r� '. ._..l..<.lrYl...... .__� .cJ / .......... ------• W x --•--•-----------------------------------------------•-•-•-- -----------------......•------•--••-----••-•••----------------------•--••-----•----...... .......................................... U Nature of Repairs or Alterations—Answer when applicable._--YeN .44,._._1��00 �-�-._:-..5--�_.'1_7 _22�Nk4'1. --- ............, ,_ o . .----------•` i��-�� / ✓ G�j . �, .sue, - 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 bee issu d li the board of health. Signed - -- ...... /`:._ f. � ...... ........ t7.... A 1?P PP lication A roved BY a�. � ....`.� ... .................................. � '° .._.... Dace Application Disapproved for the following reasons: ............ ............... . . . .....................................................................:............ . ............................ ..... .................... ........... . .............. . ... ... . . . . .................. .--...--........... . .. ........................................ e� / �t Dace Permit No. ........ "'✓-........... b-�------- Issued ----7 . Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (11,Prttftrat.e of Tompltttnre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired b / �`�:%.-<-moor `7------..._L&,vs- /Lucr�a�v .. y .....- Installer at ............................................................���..p .. - ` - ........./��f....•........./LL,_5 ..........:..... ....................................... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. 14 p���.m.._ .e ./, -.-.- dated ..i .---..' ...- .. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.....__........ .. �.. .'._ ................... - Inspector ............... .............. ............... _........... �.a THE COMMONWEALTH OF MASSACHUSETTS /6,1— G,;). G BOARD OF HEALTH TOWN OF BARNSTABLE No ..................... Khap anal Works Taanotrurtiaan a mit Permission is hereby granted ,. 7C'C.�-T----_r�J L�G?-/ !�U............................... to Construct ( ) or Repair O an Individual Sewage Disposal System atNo..................................................... _5.v-lot � ------- --------- 1 i-e/yI/L. ._S�_.! 4�-----•---•--........... Strc2t. F as shown on the application for Disposal Works Construction Perm?�1.. ..���_ Dated___..�'�_:�__`..s'__ V/J DATE-------- -----------=-----......... ................................ Board of Health FORM 36508 HOBBS do WARREN.INC..PUBLISHERS No. d Y — _T / Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for 30iopozal Opotem Construction Permit Application for a Permit to Construct( . )Repair(�)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address o1Lpt No. 796 � , ]j �� Owner's Name,Address and Tel.No. Assessor's Map/Parcel cei MTva-, /or ova 7 Ardl Installer's Name,Address,and Tel.No. Q� / Designer's Name,Address and Tel.No. O1 • &/aks 7 fo�r5 �t�. 'f�v- i Type of Building: Dwelling` No.of Bedrooms 02 Lot Size sq.ft. Garbage Grinder( ) iOther Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow AA gallons per day. Calculated daily flow gallons. Plan Date 0-Qgl6 t Number of sheets Revision Date Title Size of Septic Tank^,ZIQ Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with.the provisions of Title 5 of the on ent ode and not to place the system in operation until a Certifi- cate of Compliance has been issue y is Bo o e It Si ned Date Application Approved b Date Application Disapproved for the following reasons Permit No. °��© ` — ��_ Date Issued I'�) 3 G�/ Y No. 41 _ IL f Fee�t�0 / '° _� Entered in computer: v .,.r -THE COMMONWEALTH OF MAASSAFHUSETTS p Yes PUBLIC HEALTH DIVISION -TOWN OF BA6TABLEs MASSACHUSETTS ZIppYication for nig;pooar bpMem Conttruction Permit . r Application for a Permit to Construct( )Repair(/)Upgrade( )Abandon(- ) ❑Complete System ❑Individual Components Location Address or Lot NoN X�M ln*514W 51"A S Owner's Name,Address and Tel.No. Col`r OV 7 A-/ r{- Assessor's Map/Parcel 'O` Op'�Q 7W RT/ Installer's Name,Address,and Tel.No��' /Mr'A7`J� Designer's Name,Address and Tel.Noq,7,7- / .��l►�5��i�!i'll-Lt:� �f ,-�5� �. tt�CS�"C�..SS(rt'G�? �d, ��G�� Type of Building: '`�• Dwelling No.of Bedrooms Lot Size isq&(, y Garbage Grinder( ) Other Type of Building No.of.Persons 1 Sh�o�✓ers( ,) Cafeteria( ) Other Fixtures U ' Design,Flow .53 gallons per day. Calculated daily flow gallons. Plan Date /0 4C/ t Number of sheets Revision Date Title Size of Septic Tank /f!l Type of S.A.S. S60 61 Description,of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: ' Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with.the provisions of Title 5 of the-En'ironmental,�Code and not to place the system in operation until a Certifi- cate of Compliance has been issue, by/this Boar of Heal Sign r f Dated . Application Approved by Date Application Disapproved for the following reasons 4 Permit No. 0- Date Issued --------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance TTJIS IS To rVI?77PV that the On-site Sewage Disposal Systern Constructed( )Repaired(�)rJpgraded( ) Abandoned( )by UK1�/&01 t- at __ �w .4 7-/M h1 1�`t5 i1`►/L�S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.��"�I' 3 dated i a 13 I�y Installer �5 2MA/1 11%iff Designer n The issuance of this permit shall not Ube construed as a guarantee that the s6`istem w l0functioX as designje\d. Date_.. 1� /�t)L� Inspector o No. ) 6'.0_3 Fee IeO THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS ;Di!6pool *pgtem` �Con�truction permit Permission is hereby granted to Construct( )Repair )Upgrade( )Abandon( ) System located at W E/A fig/0/4A<5 M/LG!" _ and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions., Provided: Construction mustbe completed within three years of the date of this,:permit� r Date: t >! ' ~ . Approved by � �} TOWN OF BARNSTABLE LOCATION IZ°� 1 � SEWAGE # —6"4 " VILLAG ASSESSOR'S MAP & LOT d nl , 2 D INSTALLER'S NAM&PHONE NO! I, d9Ya� r SEPTIC TANK CAPACITY 10a LEACHING FACILITY: 2(type) (size) NO.OF BEDROOMS 13UILDER OR OWNER P1 4.J Ap > PERMITDATE: lJ�10 COMPLIANCE DATE: 3 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 Feet within 300 feet of leaching facility) Furnished by 77 G',4U.&r L i i 9/1&03 Notice-, This Form Is To Be Used For the Repair Of Famed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXE1MPTION FORM I, a `v `c &v4u a hereby certify that the engineered plan signed by are dated \(1, Z d concerning the property located at -2c F KgCS�Wl3 meets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no c011111 e"ralwhyr--- business uses associated with the dwelling. • The.soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above then _ maximum adjusted groundwater table elevation. [Adjust the groundwater table using the =' Frimptor method when applicable] Please complete the following: W � � � Z -1 A) Top of Ground Surface Elevation(using GIS information) > u sir B) G.W.Elevation +adjustment for high G.W. DIFFERENCE BETWEEN A and B SIGN : DATE: NOTICE Based upon the above information;a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. y 4AseptiCV=exeM.dM Town ®f Barnstable Regulatory Services • Thomas F.Geiler,Director a w�rn�s, t 'y Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 InstaHer&Designer Certification Form Date: Z(( 4 Sewage Permit# 04j�-6 Assessor's Map1Parcel_ ( © \ 7,C) Designer: ^v� �_L0 installer: a ' Address: 2 W Al C_Y�_ s cam': i\r� Address: n ` (JV- ram) mac,le Y`Al4- iCi��� �y v M Ids (,A On 1�3-04 1 ®TRIS _was issued a permit to install a (date) (installer) septic system at 701 (y_ 0 k I/A C� _ based on a design drawn by (address) �y1 ►� &'\V((A� dated (design ) 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. 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. 'jy H OF{��s � s7 PETER T. tiG o WENT N*' (Installer's Sign CiVi� y -o' NO.35109 /STEP�� aA ss/ONAL ENG�I'► (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUEDsAe1TIL BOTH THIS NRORM AND AS-BUILT CARD ARE RECLEUD BY THE BARNSTABLE PUBLIC HEALTH DIVISION THANK YOU Q:Ficalth/Scptic/Dcsigecr Ccr icativa norm 3-26-64.doc N � LEGEND LOCUS rt , a Shuboel \6O Q o 0 0 0 Pond Q� 99 PROPOSED CONTOUR I Lakeside D, `�!- Calvin Hambli Flint St \ 99 PROPOSED SPOT GRADE Road -- EXISTING CONTOUR 52 1°38'0 "W +99.7 EXISTING SPOT GRADE o 183. 19' ��, `9\ �Y TEST PIT N 23' � GG W — EXISTING WATER SERVICE °�`� �° w c:, 0 0 :I EXISTING TREE ' BENCHMARK Old Falmouth Rd EX15TING 5.A.5. TO BE ABANDONED L---- - ST WOTETI I O5EE 7D U F EX15TING 5EPTIC TANK ON TOP OF TANK EL: 91 .97t w INV. EL. = 90.64± ' (LOT 6) �o� ,.� LOCUS MAP N.T.S. v APN 10 1 -020 GENERAL NOTES: y 37,200± SF 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BENCHMARK: ` �- \ TOP OUTSIDE CORNER OF (REt✓0�) BOARD OF HEALTH AND THE DESIGN ENGINEER. ! 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS BULKHEAD EL.= 1 OO.00 5EWERNO.2 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE A55UMED DATUM) --, 5EE NOTE 12 LOCAL RULES AND REGULATIONS. 5EWER NO.I 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR SEE NOTE 12 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE No. 796 DESIGN ENGINEER. N " 1 1/2. STY. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING t N /WD. FI FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. T.O.F. = 100.84 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. W 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF rn ` N THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. CM ,AAAA"A U � _ 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. oj _ P��� �F MgsS9c 8. THERE ARE NO PRIVATE WELLS LOCATED WITHIN 150' OF THE S.A.S. V Z o� PETER T. �G✓ 9• ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED . F— g McENTE TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR, I o CIVIL N AND/OR, AS DIRECTED BY APPROVING AUTHORITIES. No. 35109 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE t THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING ISfE�i �FC �� `�� CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS �. IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. I,lQ AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3). 12 CONTRACTOR SHALL INSURE THAT SEWER NO. 1 & 2 IS DIRECTED TO THE EXISTING SEPTIC K N2 I°3600"E 25053'S5"E + PROPOSED SEPTIC SYSTEM UPGRADE ROUTE 149 796 ROUTE 149, MARSTONS MILLS, MA Prepared for: Matthew McAuliffe, 796 Route 149, Morstons Mills, MA 9 Engineering by: Surveying by: SCALE DRAWN JOB. NO. Engineering Works HOOD SURVEY CROUP 1 "=30' P.T.M. 94-04 12 West Crossfield Road 18 Route 6A Forestdale, MA 02644 Sandwich, MA 02563 DATE CHECKED SHEET N0. (508) 477-5313 (508) 888-1090 10/24/04 P.T.M. 1 of 2 I Y , �{ NOTE: TO PREVENT BREAKOUT, THE PROPOSED PROVIDE RISER OVER D-BOX FINISH GRADE SHALL NOT BE < EL:88.5 r TOP.OF FOUNDATION TO WITHIN 6" OF FINISH GRADE F.G. EL: 93 - 92t VENT FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. ~ EXISTING F.G. EL: 94.0t MAINTAIN 2% MIN SLOPE OVER S.A (EXISTING) S. EXISTING F.G. EL: 93.3t INSTALL RISERS W/COVERS OVER INLET INSTALL RISER OVER ONE CHAMBER & OUTLET TO WITHIN 6" OF FINISH GRADE (MIN.) WITH FRAME & COVER SET TO •`: * L =27' L =13'(MAX) FINISH GRADE. 6,. 4" SCH 40 PVC 4" SCH 40 PVC 7 SEE NOTE 12 6 io" as ®® DOUBLE WASHE2" LAYER OF D STONE/2 SHEET 1 14 ® S= 1% (MIN.) 6' 0 S= 1% (MIN.) a®®�aaa . 2' EFF. DEPTH '�- �: EXISTING EXISTING :TANK AL. INV. ELEV.=89.00 INV. ELEV.=88.83 a a® 3/4"-1 1/2" SEPTIC 4' 5.2' 4' D-BOX DOUBLE WASHED INV.EL: 90.64t EFFECTIVE WIDTH = 13.2' STONE INSTALL INLET & OUTLET TEES (EXISTING) INV. ELEV.=88.00 2-500 GALLON LEACHING CHAMBERS GAS BAFFLE TO BE INSTALLED ON IN SFRIES WITH STONE ALL SIDES OUTLET TEE AS MANUFACTURED BY TUF-TITE, ZABEL, OR EQUAL O-BOX SHALL BE SET LEVEL AND TRUE TO GRADE TOP CONC. ELEV.=89.00 —BREAKOUT ELEV.=88.5 ON A MECHANICALLY COMPACTED SIX INCH CRUSHED INV. ELEV.=88.00 STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). mm"mwom BOTTOM ELEV.=86.00 3' 1. 2 x 8.5' = 1 7.0' j 3' SEPTIC SYSTEM .PROFILE 5' MIN. ABOVE MAX. SEASONAL EFFECTIVE LENGTH = 23' HIGH GROUNDWATER ELEVATION LEACHING SYSTEM SECTION R�q NO G.W. ENCOUNTERED �P�1� s,gCr N.T.S. BOTTOM OF TP, EL: 81.0 �� G (3) 5" DIA.OUTLETS o PETER McENTEE 2" 1_ 23' —.I CIVIL U No. 35109 + " SOIL LOG 1 DESIGN CRITERIA I PROP. 9.A.5.I q Of NAM 141 l I SS 15.5" :' 8" ----- 6.. " DATE: OCTOBER 22, 2004 - - NUMBER OF BEDROOMS: 2 BEDROOMS C.S.E. d EVALUATOR: P E. `` �� SOIL EVAL R: PETER McENTEE SOIL TYPE: CLASS I 2" INSPECTOR: NOT RE D-FAILED S.A.S. DESIGN PERCOLATION RATE: 2 MIN I N Q D-BOX CLASS 1 SOILS DAILY FLOW: 220 G.P.D. N.ts Elev. TP Depth DESIGN FLOW: 330 G.P.D. 93.0 0" GARBAGE GRINDER: NO FILL M a LEACHING AREA REQUIRED: (330) = 445.9 S.F. INVERT ®®®® ® ®®®® 92.0 A SANDY LOAM 12 �^ � CO .74 ®®®®®®®®®®® 39 10YR 3/3 EXISTING SEPTIC TANK: 1000 GALLON ®®®®®®®®®®® 24' ®33®®®®®®®®® 91.7 B 16" I SANDY LOAM 102" 10YR 5/8 USE 2-500 GALLON LEACHING CHAMBERS IN SERIES SECTION 89.5 C1 42 SIDEWALL AREA: 2(13.2' + 23.0') X 2 = 144.8 S.F. SILT LOAM 10YR 7/6 BOTTOM AREA: 13.2' x 23.0' = 303.6 S.F. 4" KNOCKOUT TOTAL AREA: 448.4 S.F. 20" Ow. COVER 87.0 C2 72" NO. 796 1 2 5TY. DESIGN FLOW PROVIDED: 0.74 448.4 / ,. I / ( ) = 331.8 G.P.D. 4" KNOCKOUT { I 4 NO 62 M C SAND \\�/ 10YR 6/4 WD• M. 4" KNOCKOUT T.O.F. = 100.84 PROPOSED SEPTIC SYSTEM UPGRADE 81.0 144" 796 ROUTE 149, MARSTONS MILLS, MA PLAN PERC RATE: 2 MIN/IN. ("C2" HORIZON) NO GROUNDWATER ENCOUNTERED Prepared for: Matthew McAuliffe, 796 Route 149, Morstons Mills, MA Engineering by: Surveying by: SCALE DRAWN JOB. NO. 500 GALLON CAPACITY, H-20 LOADING S.A.S. LAYOUT e P.T.M. 94-04 Engineering Works HOOD SURVEY GROUP N.T.S. CHAMBERS N.T.S. 12 West Crossfield Road 18 Route 6A Forestdole, MA 02644 Sandwich, MA 02563 DATE CHECKED SHEET NO. N.T.S (508) 477-5313 (508) 888-1090 10 24/04 P.T.M. 2 Of 2