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0166 SANDY VALLEY ROAD - Health
166 Sandy Valley Road A= 101 —077 Marstons Mills TOWN OF BARN�STABLE LOCATION G & 111- IQUt. SEWAGE# '90 VILLAGE A SESSOR'S MAP&PARCEL /O/-O 71 INSTALLER'S NAME&PHONE NO. ,S'0$- �/!�O- �'3S JoSae y�4�roS SEPTIC TANK CAPACITY /QC 0 / LEACHING FACILITY:(type) ,54S00 ��I69H�l�r�s' (size) J0 X NO.OF BEDROOMS ,3 OWNER )— 4IlG 1 PERMIT DATE: q-2 3— /S COMPLIANCE DATE: /0 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) WFeet FURNISHED BY . �r�ah r 2 a, 7,, vh I lei ° I9 - 3 =. 17, ° C3- 4 12, 3 s (3 7,6 , 514001y i ` No. Fee (� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for Disposal *pstem Construttion 3pPrmit Application for a Permit to Construct(4;�—Repair(of<pgade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./GG S '1 f/114114E e/%704W Owner's Name,Address,and Tel.No. Assessor's Map/Pazcel/m/_0 7y �' ' �� r //,f In In tallec's Name,Address,and Tel.No.,SOg�'Y2D��f y� Designer's Name,Address and Tel.No. �o�Lj Oc�iliV�"�J /ff6�/!t/'�s°Od'��'A/C• . rYl,�r rmNS /J9��s' aaf /GG Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ,3 c3� gpd Design flow provided Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 2;1�/ r! U N Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued W3 ---------------------------------------------------------------------------------------------------------------------------------------- i ? j ¢ No Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOW,N_d?BARNSTABLE, MASSACHUSETTS Yes . ftplication for Misposar *pstem Construction J)Ermit Application for a Permit to Construct(4.- Repair(pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./66 5,490 !1 1/1/� y 2G4 Owner's Name,Address,and Tel.,No. Assessor's Map/Parcel/,rJ/_ ?7 Installer'ss/Name,Address,and Tel.No.S✓2-`7,2o y 7 3,S, Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 3 yo • y gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 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 Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si _ t,-. Date Application Approved by Date b-3 !S Application Disapproved by Date for the following reasons Permit No. C Date Issued 9 70 x.r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(L.) Upgraded( G}-- Abandoned( )by at b?41 If -1' /P/1*_/' T/ oy N�1 jas been constructed in accordance r with the provisions of Title 5 and the for Disposal System Construction Permit No-')�/S-' G, dated `a-i3 15 l Installer,�0)e,;�� yt /�, 'U> Designer`Wi= 33#bedrooms 'j Approved design flow gpd The issuance of this/permit shall not be construed as a guarantee that the sys in will fu c n a si 1 ed. Date Inspector - - -------------------------------------— No'gnt J5 3a&j I Fee 00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction J)Prmit Permission is hereby granted to Construct( ) Repair(L..-)- Upgrade(:--) Abandon( ) System located at /GG S�a 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. r i Provided:Construction must be compl ted within three years of the date of this permit. Date J '� _ J Approved ' 10/19/2015 03:22PM 17744139468 MEYER AND SONS PAGE 01/01 "e ti Town of Barnstable Regulatory Services Ri.ebard V.Scali,Interim Director = auasar�sc,s, • MASS. public Health Divislou Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office; 508-862-4644 Fax: $08-790-6304 Installer&Designer Cerbificatiou Form Date: w l a Sewage Permit# Assessor's MapTarcel Designer: G L Installer: T 0-°D, l�rrtLS Address: Po Address: LSZ.-5� On was issued a permit to install a (da ) bstaller)' �l lVAUN scptic systemat S r based an a design drawn by jj ( ddress) dated 9 Uat&, Me- W-/ (designe . I certify that the septic system Iftenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or amy vertical relocation of any component of the septic system) but in accordance with State&Local Regulations. Flan,revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was con stru fiance with the terms of the RA approval letters(if applicable) it°F D RR .tallcex Signature) N . 14fl (Designer's Signature) (Affix MW#JWWStanv Here) PLEASE ,RE`IMN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTWICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- SUxLT §ARR AHE RECEIVED BY THE BA NSTA.SLE PUS IC HEAL ION. TIIANK YOU. Q:\SepGCWesiVi1 r Cerufil%afivn Funn Rcv 3-14.13.acx Town of Ba' nsta.]ble P# Department of Regulatory Services b I� ` Public Health Division Date l tr 9. tee$ 200 Main Street,Hyannis MA 02601 3 Date Scheduled ' Time—1--'�'= Fee Pd. I , i ► oil' ,Szritability Assessmentf or Sew e Disposat' Performed �iy1 Witnessed i LOCATION & GENERAL INFORMCATION Location Address CAwny VkLLF- Owner's Name 1��e `'' y— '. I k t V t 5 ""1 "e •Cj � I Address Assessor's Map/P4rcel: 10 /0-7-7 I Engineer's Name M@verQ NEW CONSTRULnON REPAIR j Telephone# !M 3 6 0 —3 3 f Land Use -- ?�r��F 1e Nt'� �/ Slopes �)�I�' Surface Stones Nth�1 Distances from: Open Water Body ��� ft Possible Wee Area�� v ft Drinking Water Well �/.� aft Drainage Way > l zaz) ft. Property Line / ft Other ft ,SIMTCH:(Street name,dimensioos'of lot,exact locations of test holes&perc tests,locate wetlands in proxitnity to holes) ddeA I i i i . - i Parent material(gedlogic ' �� v 5 I Depth t0 Bedrock Depth to GroundwaterStanding Water in Hole Weeping from Pit Fpee �r`1 Estimated Seasonal tiigh Groundwater D-tTERMINATION FOR SEASONAL HIGH WATER TOLE Method Used: I In, Depth 10 SOII MOtths: In. Depth obperved standing in obs.hole: in. 0Y0undwntef Adjustment tk Depth tolweeping from side of obs.hole: M Adj.faetOr,,,,_ Adj.(3oundwater Level Index Well# Reading Date: Index Well level -- - I PERCOLATION TEST . D$te- Observation I Time at 9" J A Hole# 6�—'?p Time at 6" - Depth of Pere ' f 0 p I Time(9"-6' Start Pre-soak Time.@ t End Pre-soak Rate Min finch ' Site Failed; Additional Testing Needed(Y/N) Site Suitability Assessment: Site Passed . Original:.Public k;e$lth Division Observation Hole Data To B e Completed on Back— 1 ***If percolalion test is to be conducted within 100' of wetland,you must first notify the Barnstable C41iservation Division at least one (1)wedk prior to beginning. S DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other .Surface(in.) (USDA), (Munsell) Mottling (Structure, tone Gravel Boulders. pt0 t Loo 544 l 3 ll DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel) otlLOAM-4 I DEEP OBSERVATION HOLE LOG Hole# MIA Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell): Mottling (Structure,Stones,Boulders. Consistent n'o Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ConsistenGravel) .r Flood Insurance Rate May: Above 500 year flood boundary No— Yes Within 500 year boundary No V Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the area proposed for the soil absorption system? e If not,what is the depth of naturally occurring per, ious material? Certification I certifythat on l ® date I have passed the soil evaluator examination approved b the (date) PP Y Department of Environ ental rotection and that the above analysis was performed by me consistent with the requirdTbainnig,expe Vnd e nce described in 3UO CMR 15.017. 4 . Signature Date l { Q:ISEPTIC\PERCFORM.DOC LL T I SEWAGE PERMIT NO. VI LAG � lNSTA L EER'S DAME ADDRESS e8 U i L D E R DR OWN ER 0- Z DATE PER'*MOT ISSUEa' DATE C0MPLIANCE ISSUED -2- -?S f I r I I i © 1 3 THE COMMONWEALTH OF MASSACHUSETTS b BOARD OF HEALTH Town Barnstable ...... ..................OF.......................................................................................... A1111 iration for Uhipaottl Voiks Tonotrnrtion Vamit Application is hereby_ made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: -1 of #15, Sander Valley Rd. , �iarstons Mills r+'� ................... --•--•--............._•--•........._........ .....-•-•-•-••••-..._...................-- ... La IT,-Ad ess or t No Capricorn Rea y rust 765 Falmouth Roa , hyannis ._ ......................-•-•.........•• •... ...........••--•.....•-•--...-•••--•-----...... ....--•-....... _..... ....... W Steve L e bel Owner Address Instal ler Address dType of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms.._.......................................Expansion Attic ( ) Garbage Grinder ( ) j p, Other—Type of Building rA]RPh.............. No. of persons............................ Showers (2 ) — Cafeteria ( ) a' Other fixtures -----------------•-------------.....--------.......-•-.•-•-----•--•----------•---------------•--...-----.....•----..............................•----- d W Design Flow........55...............................gallons per person per day. Total daily,flow.........330"..... -.-.......---........gallons. WSeptic Tank—Liquid'capacity 000 gallons Lengtl _..6_._._.... Widtl�l...1 Q...._. Diameter........:....... Deptl�j_.. ........ Disposal Trench—No. .................... Width.•..........._...... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.....6�..._._.... Depth below inlet �........._. Total leaching area._266.......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by..:�ldredge Engineering 11-2 -81..._ ... Date aTest Pit No. 1.2))..0... minutes per inch Depth of Test Pit..12........... Depth to ground wate�141?e....ano.ounter- f% Test Pit No. l.A._._.__._minutes per inch Depth of Test Pit(1/A............ Depth to ground water.IY� .............. e R: ........................................................... 0 Description of Soil......... �..2�_........1o3m..&..tOpSoll.. -. x 2' - 10' Tdledium yellow sand -----------------------------------•--.......---.......------------....._-• ............. t 10' - 12' med. white san drac . . es of ravel no water at 12' -------------------------------------------------------------------- -----------------------•---••----•---_... --------------------•---....-•- ------•-•----- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a-Certificate of Compliance as b en issued b the board f health. n r_ ......Pres . ��. 2 • ...... Application Approved BY = ....----•--•--•-•-•.....................•-••-•---•-• l®.. _3._.�3 Date Application Di$approved for e f of ing reasons:...............•-----•---------......---------..........------•---------------........_.._:.. ............................•--•-•.._..................--•••••••••••-•-•-••--•-----•-•-••-...................................-----...------•--•-•••--------- ........................................... Date Permit No......... --. Issued--••--.1.0 'S - .... Date ---------------------------------------- .ra. c �No.4.-Y..1..5..?. FEf ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ........ _.................OF................................................... :...... _.. 'Appliratiun for Uhipviittl Workii Tonutrnr#ion rrmi# Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: Lot i 1 Sandy Valley Rd. ,Mars tons mills � 1';A ... ........... --------------•-•• -----•--._........................•••-------•-•-------•--...---------•----•-----.......e.......... Capricorn RLAAI ''fillist 765 Falmouth RdaIdt,Nohyannis ......................_........................O ...r......-----..................•-•---..----- •.........•••---••---••-•-••-•---•--••.....•.. ess........................................... W Steve Lebel Owner Address ,-a ----------•..........................................................................•-••--.._--•- ----••-•-•--••-•••-••-...-•---.............-------•••••-•--............-•-••••••-•................ Installer Address Q Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms..3.......................................Expansion Attic ( ) Garbage Grinder ( ) ar Other—Type of Building ang ................ No. of persons........................--.. Showers (2 ) — Cafeteria ( ) dOther fixtures -------------------------------•-•--------------------••-•••......-•-•-------•--••--••. ---••-•••-••-••.........-••-••.....-•-.........--...-•-••.... W Design Flow.......55---------------�] 000 gallons per persQ>: gel day. Total d ily��flow........33--...-..................______gallons. WSeptic Tank—Liquid capacitI............gallons Lengt ................ Width................ Diameter..--.--......... Depths...ti........ x Disposal Trench—No. .................... Widthr------------------ Total Length -... .I.......... Total leaching area.--. ... .. sq. ft. Seepage Pit No!------------------- Diameter....6_............ Depth below inle.. t...S.._.......... Total leaching area.. 6 .._....sq. ft. Z Other Distribution box ( ) Dosillaulce(dgfe r;ngneering 11-2 -$ Percolation Test Results Performed by-- . tea--�� ......................i -•-------.-....... Date.. .-•- 51 ................ ...-----------. �.7 Test Pit No. 1 2.0_......minutes per inch Depth of Test Pit..... .......... Depth to ground watennnle..encounte�- (i Test Pit No. P�A........_minutes per inch Depth of Test Pif�1.A........._.. Depth to ground water.Nl-ti.............. e -------------------------------------------------•--------------i---------........... --•-------•--------*......... -.---------------- O Description of Soil.........0 ry....- 2 r t o am & to s o l .--- - x - lie ium ye 1:ow sand------------------------------------------ --------------------------------- ru 12-,-------med-�---w�iite..saric�/races--o ...gravelfrio wader at•--12 -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--••------••• M. Nature of Repairs or Alterations—Answer when applicable................................................................................................ --------------------------------------------------•------ -----------------•--•-------------•--•-•----------------------------------------------------................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. ed - Pres. 9/22/ 3 . Application Approved By•••••••. •... -=-t. .... A. .:`.....-•----•----•-••----•.................•------- ...... ;... .?-. --------------- Date Application Disapproved for t ff oll ing reasons:------•-------------------------------------------------------•----- ......................... -------------•---------.....-------•--------------...----------------•-----------•---.-.-...---------•--------------....-.-•----------------------------•------------------------------•---------------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........Town..................oF......Barns table . ...... ..................................................... (9rdif iratr of Tomphatta THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed � ) or Repaired ( ) Steve Lebel at.. Lot 15, Sand Valle........ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code a es in the application for Disposal Works Construction Permit �'o..-. �-3�'.- .. ....... dated-- . . ......� .......................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM„WILL FUNCTION SATISFACTORY. DATE.... .`..................... Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSErrS BOARD OF HEALTH T o%t"n........................oF...Eai:rn-tabl e No.,D— .:7 J, FEE..... a.......... Disposal Worb Tonstrudion ami# S : • ..l l L. . . ?...e 1 Permission is hereby granted.....................--------------•--..--•.-----------------------------------..._...........-----•---•-••-• -..-•---...----- to Construct _ , ) or Repair (( ) an Individual1 Sewage Disposal System at No...._.°t.._-=...1.5� and .alley �'.d. , _.arsaons Mills , ;i+";A . . -••••••-•-•••-•-••--••---•--•----••-----••............•. --..... .............. Stree�0, as shown on the application for Disposal Works Construction Permit �'=...... ed......... .1. ..... ..:� ............ /V � Bo rd of Health DATE................................... = FORM 1255 A. M. SULKIN, INC., BOSTON - I � 203 b \ /l, 93 G ♦ // ti T / C 1\i a? C) OF P�(H 4 14sS /� CIz �a Be yG ' IV ,.p, 0�1i. o ORSE No.10951•p �i V -r7- 90 FG STEP >>��' �G/q NOTE FFS IN L�a� � 2 ', EX/5 Tin C-/ Tat O�{le ^A U � T��PRODvcco T-Try ,; 1>.v TE o DFc �9, 19 7� by LEGEND EXISTING SPOT ELEVATION Ox0 � ',�Gs� i CERTIFIED PLOT PLAN EXISTING CONTOUR ——— 0 --- FINISHED SPOT ELEVATION .�t' =�'j ` ' ' 5.�1(✓may L „.,t FINISHED CONTOUR 0 � RoaERT� �� ^' c��/s �� ` L, ERU E '~;o C APPROVED SOARD OF HEALT "�` IN a EICF E �''r DATE AGENT SCALEt 3 o DATE , /J:' ELDREDGE ENGINEERING CO. IN01 CLIENT�.__�_``= i CERTIFY THAT THE PROPOSED R POSEo EGISTERE REGISTERED ,JOB NO. F� - _� (_� BUILDING SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING LAYS ENGINEER SURVEY R DR CONFORMS OF BARNSTABLE , MASS. 712 MAIN STREET CH. BY$ HYANN I S, MASS. SHEET — _ � OF DATE REC. LAND SURVEYOR - 20 PT. M//Y r lOTE = /F E/7.-1 :NE Srr�T/C 7-A�1/,4C OR . �_E�GtI/NG P/T A.tE MORE T/•ri1:'/ /2"'BELOJ•v CONGtEI'L 9'PYG• P/Pt SNA L c 9p •,. CL, 6G.o. CCYEJ�S M/N. A/TCN trER y C V ^ ST /.PON C �l/L�.4 •p�� I� /F/N �R/VE A/A Y A ' - ? � .HiN. � COn�•c.2L�TE :: ..r_. Gft•�JE GO /E� •P/RIl '' • • 1 • • • • ,• • � • • • C.- /8 /d� S.EPT/C T�tivK DIS . �. .` s y �� - 1 ;�' QaX • • • • •@ • • • • �.• •; • WASh'FO 57,—NE 5 3/4 vz ' • All • too OL'PTN • • • •, & W.4SJyED STJNE , `e xJJI .�� i• • • • • • • • • • • D • PRl�CAS T SEf�A £ j IAIV /ZT.�'L EYAT%�!I! -''' /'_'�`" �. 14�1��t e.1 �"%/ r cJr7"f� `''''.r,P,.�/�'�_ / ••• • • • • • • • � �! JXYERT. A7 Sll/LD/JVik FT. A4,H.do c C�SFE TAdUL.ATJON} N�fre•c,e/����QJ�e•� •�*A. �..a.e�.S�.a" � .,. � �. iv 777 ,. TA Al M� l �I7 .r- .SdF�T`I C c GRvt/NO liG4TE.� OLE /JY1.GT.l.g CoAftA ' '' -�� •; f ,� ¢ � IC/YlN6• P/T `yK •JVI-AT/D/M t Iewi� O/JyE/VJI D ,V A w::: NlJNOER OF QE �O/YS D/McPIV S/ON -SO/ TOTAL EJT//rf4TE.D FLOIS/ 33 o OVAL-1 AV SOIL TEST A/�XUMBER CLF /' Ec r✓. �,D SO/LE CTXFYS SOIL 7Z5r - i -�CAcmi'va P/T3 gS/DE 4--ACH/NG PER 0/T R'r9- ,II TOF' SOIL, TT 90TTOM LN . Q, � ,?Ay-FG / GQ <r dY 7?L _G o`TOTAL LgACN/N AA G PE't CCLAT/Oiv .ISTE / �ESERYEGEAC/I/N6 ARE^ r' Sp FT. f '- ; AFhCO&A7iow RATE OF 7 NY.,�� .S',QCA �,. �� AL _\;-t7///0'n• 7 r 4-� /, r�s .�,-I�!!�i' %4:-'.L!`: TeZ>. v- ROBERT �G, m, % :!.�y in•_ f�/� t'' T' 6RU,CE MQRSE f_� c EL PIED- 40.10951 O LIL �' /-1E Di v!ter EL OREDGZ cNG/NEPRI.S�G CO /Y G- �, ' _;`; ;�� ZONAL NG 7/2 := `C7 G1TOVIVO yYi4T FM Jr1VC0U y rti�sy yirLq�°' Ll G/C O UNO Lv.4 TER �1 T �L EN, Fs,�p DATE =/o, ii d_ r-� a- m Ln M Postage $ 0"\ Certified Fee M Return Receipt Fee Q 00 Here Postma O (Endorsement Required) rL r Here O Restricted Delivery Fee C3 (Endorsement Required) Nb rU Total Postage&Fees �Z H NSusan Falletti �r 166 Sandy Valley Road Marstons Mills, MA 02648 Certified Mail Provides: { m A mailing receipt = �( m A unique identifier for your mailpiece 1 m A record of delivery kept by the Poltal Service for two years Important Reminders: m Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. m Certified Mail is not available for any class of international mail. m NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. m For an additional fee a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return4eceipt,a USPS®postmark on your Certified Mail receipt is required. j*, m For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". m If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and.present.it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 ' SECTIONSENDER: COMPLETE THIS COMPLETE THIS SECTIONON ■ Complete items 1,2,and 3.Also complete A. S 7ture item 4 if Restricted Delivery is desired. Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. , eceived by(Printed Name) C. Da of I eliv I■ Attach this card to the back of the mailpiece, a or on the front if space permits. D. Is delivery address different from item 1? El As I 1. Article Addressed to: If YES,enter delivery address below: ❑No J Susan Falletti 1`66 Sandy Valley Road I 3. Service Type Marstons Mills, MA 02648 j ❑Certified Mail® ❑Priority Mall Express' ❑Registered ❑Return Receipt for Merchandise �- ❑Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number . (Transfer from service iabeq i1 i t l.t a � t i i s 7014 1200 D0CI1 �03581 3919 rd. PS Form 3811,July 2013 Domestic Return Receipt I UNITED STATES POSTAL SERVICE First-Class Mail I - Postage&Fees_ Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4® in this box• I I I I Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 4 ;" : — Illill!-diili1llsfilitl.!if4lilhd)}i°Ii'��i'filiFitlpfltalilif r • y 7. �f Z ,� Town of Barnstable . Barn t� Regulatory Services Department U�ftedcaC"j • ■ARNSPABLE. I I ,` ,0� Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED AIL#7014 1200 0001 0358 3919 May 19, 2015 Susan Falletti 166 Sandy Valley Road Marstons Mills, MA 02648 4 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 166 Sandy Valley Road, Marstons Mills, MA was inspected on April 25, 2015,by Mark Polselli, a certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system FAILED under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level,<12" below pit (per Town Code. You are ordered to repair or replace the septic system within two (2) years from the date of this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO • Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\166 Sandy Valley Rd MM May 2015.doc Town of Barnstable • awxrsrwsi�, ,�� Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scah,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/28/15 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ondin of effluent to the surface of the ground g p g ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS.or cesspool ONE 1 YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) eaching pit or cesspool with high liquid level, <1.2" below pit (per Town Code 360-9.1) OTHER f Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ftperty Address owner � �l ASuS� � owner's tUarre a rrS v ns // /' V 0,)6 V f d rh3 information is reqtdred for every page. Citylrown State Zip Code Date of hsoection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checidist at the end of the form. A. General Informaiaon on the c ooputer, use only thetab 1. Inspector key to nave your minor-do not ✓� o mil/ use the netum Nane of Inspector _ Co"aW Name ,O-Q. Cornparny Address �_/f ��lJ- UP l SFoL mate L O C_7L ZipCode fe phc ne Wrnber j/% License N MW B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information repoded 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 1&340 of Title 5(310 CM R I&000) The system: ❑ Passes ❑ Conditionally Passes Fails ❑ Needs Further Evaluation by the Local Approving Authority qV)m,,q / 9" ' �(,/dif//-r> Inspector' signature Date The sy ten 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,G00.god or greater,the inspector and the system miner shall submit the report to the appropriate regional office ofthe'DEP. The original should be sent to the system minter and copies sent to the Myer, if applicable,and the approving authority. '"'This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. SM-3M3 Ti8e8Qf6dal hspectim FafM Page 10 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Dio sal System Form-Not for Voluntary Assessments A 6 ;4�ti vc� Ile �ed Property Address ON rwr le required for everyifformabon is GWSNKf /l o�s.�� page, 55yrrown State Zip Code Date of hi0fpeoW B. Certification (writ.) Inspection Summary: Check A,B,C,D or E/al*Wscomplete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CHAR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 6) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass'section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box far yes .`no°or not determined'(Y,.N, ND) for the following statements. 9"riot determined,'please exain. 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 exfiitration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): i- ORM-Wt3 TNe50ff=d UspaetimFomt SuhsufW8 Sft%8DWpcW Sim-Dge 2of 1T Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Roperty Address avner OwnersN� 6ifomation's �.f /S /�J.L recpxedforevery drown Spate Zip Code a asp n Pap- B. Certification (cons) ❑ Pump Chamber pumps/farms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection N(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditi'ons exist which require further evaluation by the Board of Health in order to determine if the system is Tailing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR M303(1)(b)that the system is not functioning in a mannerwhich 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 Tift5ageidimpec6mFofmSUWXtamSev,W Ste•Page 3of17 t •3M3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .166 sa N ck, v r Roperty Address FG Ile, 4 Owner ON rter's Name information is �,� DJ regWred for every A6V5-44f is per, Ctyrrown State zip Code Date of ldspecWd B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well'. Method used to determine stance: This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indcates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Othw D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes ❑ Backup of sewage into facility or system component due to overloaded or cogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters 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 t9ts,3H3 Tive50ffidg b1spw1cnFcrm SubwfawSexageOi9md 3lsbm'PV840W Commonwealth of Massachusetts Titie 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 6O le Roperly Address / F,, / 'Pi l ON fm as ner'S Name /V 0 ) C (,-If hifonr>a$on is ��4,VA4f � reftrred for every State ZpCode Date hspecbon per, ( yliown B. Certification (cunt.) Yes No ❑ uired pumping.more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ portion of the SAS, cesspool or privy is below high ground water elevation. [031 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. ❑ on 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 N the wen water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis a chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system ails I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either yes"or°no°to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 fleet 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.arty 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. TMeSOfiddtmpwfimFamtSubudawSONVO iP09dSp1em•Pd9eSelf17 tr7n 9M8 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 166 �yjdc 4/2:�7`le cq ,"Q c) Properly Address FF. ll Ow ner ON nees Nwr einf II regtdred �forevery �►�S tins �! �c�� 02,� mil' Pap- Clyfrown State rip Cade orate o lnspeatlo C. Checklist Check ifthe following have been done. You must indicate'yes"or no*as to each ofthe following: Yes No ❑ umping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the.previous two weeks? ❑ 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 NIA) 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 tarn manholes uncovered, opened, and the interior of the tarn inspected tr the condition of the bafBes or tees, material of cOnstnmtion, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CM 15.302(" D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): am-W13 Tift50tM 1mpwbcnFomt SuhWaee S9vMeDmpa9d System-Pbge WV Commonwealth of Massachusetts .WTitle 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments Ply Address ON ner , oN►ners n> hfollnaftis m aedfore:very peg CFylrown mate Zip code Cme of mpec on D. System Information / Description: / D 0) Number of current residents: Does residence have a garbage grinder? ❑ Yes 0 No is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes information in this report.) Laundry system inspected? ❑ Yes Seasonal use? ❑ Yes No Water meter readings, if available past 2 years usage(gpd)): Detail: Sump pump? ❑ Yes No Last date of occupancy: pate CommerciaUindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM R 15.203): Gaaons per day(9A Basis of design flow(seatstpersons/sq.1t., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5m•3M3 rineMfidd ImpecbmFam Subarfam Sevi ge Sysbm•Page 7017 commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Roperty Address F---jfonTMon is ra °'""ers"ame �/l �� r requQed for every �ylTown State Zip Code Date of peCOM per- D. System Information (cont) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: ' Source of information: Was system pumped as part of the inspection? ❑ Yes I� if yes, volume pumped: gallons How was quantity Pum ped determined? Reason for pumping: Type of Syste Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records,if arty) ❑ Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the VA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): TW960MCWNspeefwnFartsSAWlace Savage D Sysem•paesofV 1Srts•9n3 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not fix Voluntary Assessments � sC4 ti �-4//e kc-/ Ropetty Address Fes` v ON ner ON oar's Name iryformatan D�is ��? mpirwf�every Citylrown State Zip Code Date Inspe " n PW- D. System Informat on (cost) Approximate age of all components, date i7ed(�"known)an sof information: g �fl . Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): , / V Depth below grade. feet Material of constructi;'40 ❑ cast iron PVC ❑ other(explain): G Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade. feet Materi construction: catcrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: yeais Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No v Dimensions: x� Sludge depth: 15B•W3 ritle5pf5W bspeetw Fam bbbsufam SswapDmpasd S)Sbm•Page 90t17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments � V� Ili R'operty Address / L 7 t ar4 Fc, ` e, Ow nor infoanation i5 ONneJ'S NEW mquiredforevery A/4v-S461-f f 5 page. Cky/row n State Zip Code Date df hspe6f= D. System Information (cons) Septic Tank(cant.) 2LI Distance from top of sludge to bottom of outlet tee or baffle / Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): A(414 v11,0t rlr-7 4,) r2e'd"'-.1 �"VCX 7 OV7 lilo Gec,— Grease Trap(locate on site plan): Depth below grade. fee Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5m•3M3 TNe 5Q%Pd i hspectim Form S ibsufaee Sewage Disposal SyA m•Pop tO d V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage%Disposal System Form /-Not for Voluntary Assessments b 10 G N v� c `le Rvperty Address F,, l /2 a Ow tsar Qa nets Nam1q4r'Verk,,,r X111f /¢ �rfomration's required for every Cflylrown State Z"iP Mode Date f Nsp lion D. System Information (corc) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: g Design Flow. 9al=per dW Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): `Attach:copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No GM•3M3 ri9esOf6Ci�InSpeCtiatForrtc sabs+face SewFgeo&pasal Syslem•Page lid T/ F. F Commonwealth of Massachusetts I ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments --Z6 4 C4 Ile-5 ) Property Address ' e .A i �f rmMIM is ner owners name a rs��'`f /„, /� required for every /Town State zip Cow Date of I n Pam- D. system Inforrmtion (cont.) Distribution Box(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(locate on site plan): pumps in working order. ❑ Yes ❑ No' Alarms in working order [I Yes ❑ No' Comments (note condition of pump chamber, condbon of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Tite50f d kspectmFam[Submgtace SewageDMpWd Syftm•Page 12 d 17 En-3M3 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address lel i Ow nff Owner's Nine77 tequiredforevery infdiff�is page. Cky/Town state TO Code Date of pectf n D. System In lion (cons) Type. 0/ leaching pits number. ❑ leaching chambers number. ❑ leaching galleries number. ❑ leac Nng trenches number, length: ❑ teaching fief number, dimensions: ❑ overflow cesspool number. ❑ innovativelaltemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, edition of vegetation, etc.): 0 ✓!�i✓1 j 2 lOV✓ t 0 r v►e l►�liPfi lq-Z,f T, /, c- -7<,, 114 Cesspools(cesspool must be pumped as part of inspection)pocate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5m-3n3 riive50fbad impmomFarm Sufssufaca SwAW 04asd Sysfam-Page 13 d 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for)Voluntary Assessments 6 G 0 Cc,7 Property Address F7 ,:;i /4 # Owner ON nees informationsrequired for every Cily/rown sty zP Code Die Pap- D. System Information (coca.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of sal, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): y13 TAle50tkial tmpectm Fa m subwfaw smwem9mal SIMm•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Vq Ile larl Property Address r"O' 'e Ow ner Owner's Nameinfonrefionis reqWred / for every cdylrown State Zip Code Date of bspeeboff D. System Information (coat.) Sketch Of age Disposal System: Provide a view of the sewage disposal system, inclucing ties to at lest permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where ubtic water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately 40 illLl A3- 3 L.?d 0 ` 3 tWs.3M3 Tide 50f dal hspectim Forte subsurface smme oisp�symm•Page 15 Q T7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments Property Address Fo IL 41 ,74-- Ow nor Oar rers NameWonnsfim is / /, mque�edforevery A/a VIL �I A[ l �o� 'z J page- Cityfrown State Zip code Date of bfspeeftV D. System Information (cons) Site Exam ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 0` Estimated depth to high ground water feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ bserved site(abutting property/observation hole within 150 feet of SAS) Checked Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: vl.r A.Ile cJ �✓ �l ti �f' Before filing this Inspection Report, please see Report completeness Checidist on next page. ISM-W 3 TrU 50tkg trspecbm Form&ft0aoe Serape DWPWd SYMM-POP 16 OF 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal Systerm Form Not for volurrtary Assessments 1" � J Ve,- Ile I PmperlyAd*m ONner ON nff'S NOW FC, /1-e #1 Wannaft is mgpdredfareviry /e� LO S- PW Cdyfrown ate Zip Code lie E. Report Completeness Checklist 0/h�Specuori Sumnw ry:A, B, C, D,or E checked hs L...� p Summary D(System Failure Criteria Applicable to All Systems)completed 2/System lnfom melon—Estimated doh to high groomer O Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file Tdosof eel faspeotanFG=&AWt oO.%vM9 WM SYWM-POP 17 d 17 r rtKE r Town of Barnstable Office: 508-862-4644 ,. Fax: 508-790-6304 Regulatory Services Department saWtnz Public Health Division MASS, Thomas A.McKean,CHO 200 Main Street, Hyannis,MA 02601 Payment Receipt Septic Inspection Payment received: $25.00 (Check) on 5/13/2015 Permit number: 10866 .Check number: 2787 Check amount: $25.00 Name on check: Susan Falletti 'Owner: SUSAN J FALLE7TI Address: 166 SANDY VALLEY ROAD, Marstons Mills i MARSTONS MILLS EXIST. 1 ,000 PIT LEGEND (see Note I O) ROAD � PROPOSED CONTOUR SA r� D .Y VALLEY ® PROPOSED SPOT GRADE 0 _— 98 —— EXISTING CONTOUR EDGE OF VEMENT + 96.52 EXISTING SPOT GRADE k ' W— EXISTING WATER SERVICE } 3 WATER GATE Q �.69 93.79' __ o /131.28' 68 j I o v, TEST PIT 2 w cAs I I cYi 67 -----t � 70 f,� 9cArd I � z � r SITE U \ I O I I I OLD FALMOUTH RO 9 0------- EXIST. 1 ,000 GAL SEPTIC TANK Locus MAP \ 69 o I LOCUS INFORMATION 10 f --- --- ---————————•---- I—�--- —68 TITLE—67 PARCEL ID: MAP 18 1015 8 PAR. 077 J E XI STING 66 L___J ,r 1 65---- DWELLING SEPTIC SYSTEM 65 TUP OF FND REPAIR PLAN `''J EL — 68.35-I- — LOCATED AT: 60__ 166 SANDY VALLEY ROAD ---------- -60 MARSTONS MILLS, MA. PREPARED FOR i I FALLETTI BENCH MARK LOT 15 SEPTEMBER 8, 2015 TOP OF FOUNDATION r w AREA = 22270 sf+- 68. 35 PLAN BOOT! 334 PAGE 5 OF 00 o s BARNSTABLE GIS DATUNI, ASSR MAP 1 01 PCL 77 �Q�, s 11 I N o. 1140 Psi NCI A0 l �� ) ) � MEYER & SONS INC. P. O. Box 981 E. SANDWICH , MA 02537 PH. (508)360-3311 t fax (774)413-9468 meyerandsonstitle5@gmail.com www.meyerandsons.com E SCALE 1"=20' I SHEET 1 OF 2 J#1491 ELEV. TOP FOUNDATION NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS (Existing) BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE FINISHED GRADE (68.0) 68.35 F.G.EL: 67.4 F.G.EL: 68.4 F.G. EL: 68.5 A MAINTAIN 2% MIN SLOPE OVER LEACHING AREA a• :Q F.G.EL: 66.24 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" .�. . STONE OR FILTER FABRIC DOUBLE WASHED STONE 4 6" 4" SCH 40 PVC 10"1 716 ®®®® O ®®®® A. 14" S= 1% (MIN.) ®®®®®®®®®®® :Q T4" SCHR40 PVCE TO INV.64.87 F 2 E F. DEPTH ®®®®®®®®®®® INV.64.95 GAS J INV.64.70 2.2 3 X 8.5' 2.25' EXISTING OUTLET BAFFLE PROPOSED DB-3 DISTRIBUTION BOX EFFECTIVE LENGTH = 30' (H20) INV. ELEV.= 64.50 INV. 65.20 EXISTING 1 ,000 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON ���� OF gss9 BREAKOUT OUTLET TEE AS MANUFACTURED BY �`` �y� ELEV.= 65.50 TUF-TITE, ZABEL, OR EQUAL o DA�R/ EN Mt. TOP CONC. ELEV.= 65.50 NOTES: 1 CONTRACTOR H VERIFY ALL EXISTING N.o. "1 40" " / INV. ELEV.= 64.50 jjjr CO S ALL E /PIPE INVERTS PRIOR TO CONSTRUCTION ®®®2) D-BOX SHALL BE SET LEVEL AND TRUE TO 6/S1E 3E3 GRADE ON A MECHANICALLY COMPACTED SIX SANITAR�A� BOTTOM EL.= 62.50 INCH CRUSHED STONE BASE, AS SPECIFIED IN b 2.S' 5 FT. - 2.5' 310 CMR 15.221(2) 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK SEPARATION 6.00 FT. EFFECTIVE WIDTH - 10' WITH 1500 GALLON SEPTIC TANK IF FAILED, SEPTIC SYSTEM PROFILE 0 F I L E DAMAGED, NOT H2O LOADING, OR UNDERSIZED. SOIL ABSORPTION SYSTEM (SECTION) 4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL: 56.50 GAS BAFFLE AS REQUIRED (500 GALLON LEACH CHAMBER) GENERAL NOTES: DESIGN CRITERIA SOIL LOGS 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL P 14796 NUMBER OF BEDROOMS: 3 BEDROOOM BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: AUGUST 25, 2015 SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE DESIGN PERCOLATION RATE: <2 MIN/IN LOCAL RULES AND REGULATIONS. SOIL EVALUATOR: DARREN MEYER, R.S., CSE #1614 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR WITNESS: DAVID STANTON, BARNSTABLE B.O.H. DAILY FLOW: 110 G.P.D. X 3 BR DESIGN FLOW: 330 G.P.D. = TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE GARBAGE GRINDER: NO (not designed for garbage grinder) DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING Depth Eger. T P-2 Depth SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXISTING 1,000 GAL SEPTIC TANK Elev. T P- 1 Oe FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN C! ENGINEER BEFORE CONSTRUCTION CONTINUES. 67.9 O 0" 67.50 0 0" LEACHING AREA REQUIRED: (330) = 445.94 S.F. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 74 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 67.48 5" 1 67.0 6" THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF A LOAMY SAND A LOAMY SAND HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. IOYR 3/1 1OYR 3/1 USE THREE (3) 500 GALLON PRECAST LEACH CHAMBERS W/ 2.25' 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 66.90 12" 66.58 11 STONE ON ENDS & 2.5' STONE ON SIDES: 30' L x 10' W x 2'D 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED BOTTOM AREA: 30 x 10= 300 SF TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. B LOAMY 6/8 SAND L10 6/8 SANG 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE 64.82 37" 64.75 33" SIDE AREA: (30 + 10) X 2 X 2 = 160 SF THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING PERC ® EL 63.3 C C CONSTRUCTION. TOTAL SQUARE FEET PROVIDED = 460 vs. 445.94 REQ'D 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5. DESIGN FLOW PROVIDED: 0.74 460 S.F. = 340.4 G.P.D. vs. 330 G.P.D. re 'd KLPLACL WITH CLEAN mEUIUM SAND PER TITLE 5. MEDIUM SAND MEDIUM_SAND ( ) 4 2.SY 6/4 2.5Y 6/4 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION PROPOSED SEPTIC SYSTEM UPGRADE PLAN 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 56.90 1 132" 56.50 132" 166 SANDY VALLEY ROAD, M. MILLS, MA 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. PERC RATE <2 MIN/IN. (-C2" HORIZON) Prepared for: Falletti 15. ALL PIPING TO BE 4" SCH 40 ® 1/8'/FT (UNLESS SPECIFIED) NO GROUNDWATER OBSERVED Engineering and Survey by: SCALE DRAWN • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 MEYER&SONS,INC. N.T.S. DMM to conduct soil evaluations and that the above analysis has been performed by me consistent with the PO BOX981 P requirements of 310 CMR 15.017. I further certify that I have passed the Soil Eval. Exam in October, 1999. EAST SANDWICH,MA 02537 DATE CHECKED SHEET NO. 506-3622922 09/08/15 DMM 2 of 2