HomeMy WebLinkAbout0075 SANTUIT-NEWTOWN ROAD - Health 75 Santuit-Newtown Road
Marstons Mills
A=031-003-004
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THE COMMONWEALTH OF MASSACHUSETTS
Application is by made for a Permit to Construct (��or Repair an Individual Sewage Disposal
System at.,
`
-4p — 'E_6.�- -----6f —-------------------------
Owner .jj Address
Installer AddressU ��~�
Type ofBuilding Size « �� �
0-4 Z)w�ling--No. of 8edr000`u-��------------------Exoaouiun Att� ��d Gu� Grinder k9��
. P4 Other—Type of Building ............................ No. ofyezu000------------- Showers ( \ -- Cafeteria
°c - ------------'----'-----'--------'' —
Design ..gallons per person per day. Total daily flovr
6rybc Iuob Liquid Length................ Width................ Diamcter--_—_. Depth................ |
Disposal Ircucb--No .................... VVu1th.................... Total Length—............... Total area....................sq. ft.
Seepage Pit No—_—.---- .................... Depth h6o~ Total leaching area..................sq. f t.
(Jt6crD�tr�nzboobox ( ) Dosing~~ Percolation Test ��su�o b�- .----.-- Date—'— ���--_' |
Test P� No y�r��6` D:o�bof Tea Depth to ' �
Test Pit No inch Depth of Test Depth to ground wutec--_--___
..
1
0 , «
--'-------'--'------'---'-----------'---'—'--'--'--'—'-'---'---'-'------------'' J
'- Nature of Repairs or Alterations--/\oaw�r ���o ---.—.--_--'---_--'--__.--._-_'_____�
' "
Agccnozcur:
The undersigned agrees m install theufore6scribed Individual Sewage Disposal System inaccordance with
the provisions of TL I TL L14: 5 of the State SanitaryCode— The undersigned
in
operation no ���� � � u�� ��untilCertificatec� �uo ` _
igned ----------' — '- ----
Application — By � ......................................... --'- ---7—'���-- ----
Application Disapproved for the following reasons:..............................................................................................................
_
| note
-----------'----------'
No...7'"_.1o3 s- Fxs.. .. ?......
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD_ OF EALTH
- . ..................0 F....�r ' .-------------.------------------.--------_---
Applira inn for 14spnsttl o* niarnrtiun amit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at:
............. ._ ... ... .. .. .n't .4.1 ... ................ .......... = --
(/,,�.� Locatio d.�rpesus por I.9t No.
't-V'd-..- . x......... ..... `---------------------------
a.... Owner Address
W
---•-------�J ,c i .- 8 . ...................................
........; a.e...---....... •-----..........----........---......--
Installer Address -
�` �7
Type of Building .� Size Lot:. �q•
U
a Dwelling—No. of Bedrooms.. ......................................Expansion Attic Garbage Grinder
:
aOther—Type of Building ..........................:c No. of persons.......................... Showers ( ) — Cafeteria ( )
dOther fixtures ---...................................................................................................................................................
W Design Flow__,__�ti,__�..........................gall�on�s"lper person per day. Total daily flow----- .. .C......................gallons.
WSeptic Tank—Liquid'capacity __;;LI➢ns Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length..........:......... Total leaching area....................sq. ft.
Seepage Pit No....................;x02meter.._................. Depth below inlet—................. Total leaching area...................sq. ft.
Z Other Distribution box ( 9�)rl" Dosing tank ( ) ff
a Percolation Test es "lts� Performed by.._ _ _.:: s� +._r?c'7�4 � ... _....... Date.... y ��I_ ............
Test Pit i�To .....r_c_!� rlinutes per inch Depth of Test it Depth to ground water___,!�l +x.. '
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O Description of Soil..... .. Q.r { . --- -----•-------------------------------------------------•-------------
t i
----•-...... "� ----An.e'd.;",eu,..--f%)...fi.# -
U _ .._.. ,
W
------------------------------------------•------------------------------------•------••--------------------------------------------.-------------•----......------------•••..._..-••-••-----•--......
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 has been issued by the board of health.,, r
Signed ------------_-------- -���-�D --•--
e
Application Approved Y. -• �
.. ----- _ --------• .
Ii ate
Application Disapproved or the
PP PProved f following reasons:------•-----------------•--•----•-•--------------------•--------------------•--•----------------------•---...._
-••---••-------------------•---------•-------------•-----•-•--------------••--------------•----------•---•------•----•--------••------------ ---------------------------------------------•----•---
t"^-- Date..
Permit No..------ .-•--•........---1-0 �C� Issued. ==.......................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HE LTH
..................OF.. /, + ... 4.44..f
.Trrtifiratr of TomphFnta
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( )
g P �' (
stall ----
by 9 d n
has been installed in.accordance with the provisions of TITLE 5 of The State Sanitary Code. as described in the
application for Disposal Works Construction Permit No. l _..0 1. ......... dated__..�iA
. .&:�----------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C NSTRUED AS A GQt2NTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY q
'DATE.......... ... -•----... Inspector__. ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-t,��. /., c, .................OF... �.
N ..............Q FEE...y
Disposal Vorks Tonstrurtion rumit
Permission is reby granted------... a te•$- c. -----------------------•----•-------------.-.---------.--..----------.------.-----
to Cons uct or a air an Ipdivid a1 v�'a `o s�eeS stem
at No ___. . a
P ) P Y
as shown on the application for Disposal Works Cons t on Permit Now .`f V . Dat d_._.._fl,/.1.
0 11137-11 = ------------------------------------
Board of Health
DATE.........................................,/ Z 0.........
FORM 1255 A. M. SULKIN, INC., BOSTON
Log 'IVumbet: 4167 Bottle. # D009
Date: I n/1 1%R4 '
04 BAR~ .
s� BARNSTABLE COUNTY HEALTH DEPARTMENT
a SUPERIOR COURT HOUSE
vBARNSTABLE, MASSACHUSETTS 02630
o •
tense DRINKING WATER LABORATORY ANALYSIS PHONE: 362-2511
Exr. 331
Client: ' Greenbriar Development Collector: Fred Clifford
Mailing Address: -Box 510 -Affiliation: well driller
Centerville,-MA 02632 Time•& Date of
• ' , Collection: 10/.9/84, 2:00 P.M.
Telephone: j ' Type of Supply: well water
Sample Location: Lot 4 Newtown Road, Well Depth: 73 ft.
Marstons Mills, MA Date of Analysis: 1.0/10/84
PARAMETER SAMPLE RESULT RECOMMENDED LIMITS
Total Coliform Bacteria/100�ml 0 0
H
Conductivity (micromhos/cm) 500.0
Iron ( m) 0.3
Nitrate-Nitrogen ( m) 10.0
Sodium ( m) 20.0
I . X Water sample meets the recommended limits for drinking of -all above tested'parameters.
II . Based only on results of the parameters tested for this sample, the water is
suitable for drinking but may present the problems checked below:
. A. Water sample has higher' than average levels of Nitrate. Future monitoring is
recommended (2=3 'times `per year) to establish any upward trends.
B. The low pH of the water may shorten the useful life of the house's plumbing:
C. Water may present aesthetic problems (taste, odor, staining) due to
D. Water sample has high levels of sodium. Persons on low 'sodium diets should
consult the'ir'doctor.,
III. 'Due to one or more of the reasons checked below, this water sample is unfit for
human consumption: A. High Bacteria B. High Nitrates
REMARKS:
CC: Barnstable Board of Health
CC: Clifford Well Drilling !�
Laboratory Director
7/17/A4 '
r
Explanation of Test. Results
F
Total°Coliform Bacteria j
w ter su I Water supplies ma become
u lit 1. a a
Coli form bacteria are an.indicator of the sanitary a Pp may
become
Y P PY
contaminated from.malfunctioning septic systems,cesspools and surface runoff. A total coliform count of zero
indicates that your water supply is safe and approved for human consumption..A.total coliform count of greater
than zero is most often the result of accidental contamination of the sample bottle.through improper sampling
methods. For thisyeason, it would be advisable to.retest any.well.water that is not approved.
pH
pH is the measure of acidity or alkalinity of the water.On the pH scale, the number 7 is neutral, less than 7 is acidic and more than 7 is alkaline. The.pH of water on Cape Cod tends to be acidic in the range of 5.0 to'6.5
Conductivity
Conductivity is a measure of the dissolved salts in solution. Amounts in excess of 500 micromhos'cm are
generally considered unacceptable and may have a laxative effect upon users.
Iron
The presence of iron in water in concentration of .3 ppm or greater may: give the water a bittersweet~
astringent taste, cause an unpleasant odor, often-gives the water a brownish color.and cause staining of laundry.
and porcelain..The'average concentration of iron in Cape Cod's water is ,2 - .6 ppm. Although the presence of
iron in water may cause the problems listed above, it is not considered deleterious to.health. Iron may be
removed by use of an iron removal system.
Nitrate-nitrogen
The Massachusetts Drinking Water Regulatio�is have set a maximum contaminant level for•nitrates at 10 : .
ppm. Excessive concentrations may cause.methemogl.obinemia (an infant disease),and have been suggested to.
form potentially carcinogenic nitrosamines.`Contamination sources include fertilizers, cesspools`and industrial.
wastes.
.0 per:
We to the acidic nature of the water on Cape Cod, copper tends to leach.from pipes. This.normally does
not present a health.hazard; however, concentrations in.excess of.1:0 ppm may causea metallic taste and/or a
bluish green stain on porcelain fixtures.
Sodium
A concentration of sodium over 20 ppm is only of concern to people who are on a low sodium diet. If the .
water supply has more than 20 ppm sodium, it is up to the people who are on such a diet to find another source
of drinking water or.contact their doctor to determine if consuming the water is advisable. Concentrations
exceeding 30 ppm indicate that there may.be ocean water or road salt runoff water Qetting into the well.
1k, .
,
r. Massachusetts Water Resources Commission/Division of Water Resources
WATER WELL COMPLETION REPORT
IYELL 4OCATION��Address
City/Town MA4-S"5 �►'
G.S.Quadrangle Map {
Grid Location
Owne[C t'.2 a,n for IA•n �A_Jz1 q Owt 2vt� �J
Address-3 -kr, 31�
WELL USE CONSOLIDATED WELL
Domestic® Public ❑ Industrial❑ r
/� Type of Water-bearing Rock
Other Water-bearing Zones a
METHOD DRILLED 1) From To
Rotary(type)Cable ❑ 2) From To
Other 3) From To
4) From To
CASING a, Depth to Bedrock
Length O Diameter
Type •-Ar C'_ UNCONSOLIDATED WELL
STATIC WATER LEVEL Water-bearing Materials
Feet below land surface Sand: fine❑ medium❑ coarsex
Date measured Gravel: fine❑ medium❑ coarse❑
GRAVEL PACK WELL Screen:
Slot#,Q. length �J from�to7
Yes ❑ No '
Split Screen(or,2nd screen)
WATER QUALITY TESTS MADE Slot# length from to'
Chemical NA Biological ❑ Depth To Bedrock
PUMP TEST
Drawdown feet after pumping days hours at GPM.
How measured Recovery feet after hours.
LOG of FORMATIONS COMMENTS: (On well or water)
Materials From To
0
A-'rvl 0
CI&II : c
Firm CLIFFORD1iNRELL DRILLING
S i S Blue65 oc oa
Address
city South Yarmouth,Mass. 02664
Registration.No.
Aerators Signature
Please print irm y 1OM•8/81.164843
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EXISTING SPOT ELEVATION ®,�O -,-� -- CERTIFIED PLOT PLAN
EXISTING CONTOUR =--- p - -- ;Ao� . gss1cti
FINISHED _.SPOT ELEVATION V �� ROBERT- _ - ,LDT��-
F!N I SHE D :.Cp.N TO U R.>,:�.--�. 0�. „#, �¢ . �, i j tt ' �' Toy/S
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'DATE AGENT ,su p. SCALE] /''=4 0' DATE t l z0/8 5z
L DREDGE ENGINEERING C0: IN .
CLLE,NT> . I CERTIFY THAT THE PROPOSED
"REGISTER REGISTERED ._ J0811-NO. 9¢'077 BUILDING SHOWN ON THIS PLAN
7
CIVIL LAND- CONFORMS TO THE ZONING LAWS
{ 2 ENGINEER SURVEYOR DR 'BY= '�"� 1' OF BARNSTABLE MAS
712 MAIN STREET . CH. BY=
} HYANNIS . MAS.S.
' SHEET OF A E REG. LAND SURVEYOW
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/KOTE /F E17H&Ar TXE SEPT/C TAN/tC OR.. r
LEAC,"l oV6 P/r ARE MORE TNA/V /8"BELOJ�I
/Q FT•. /ti/N rRAOE,,A R4"O/AM ETER CONCR.FTE COi"ER
SMALL eLP ,&ROI/6rNT TO 41rAOIE.�A>✓ Fi�TRA
CONCRETE 4�PYC PIPE Nzr,4Yy CAST/ROW CO{/,—R SHALL BE !/SF-O
Af/N. P/TCN /F/N DR/VEyI/A Y
Et_.. /oz-a G'OYERS �'PEiP FT. ,.
CO/VCRZ 77--
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. • sD DEPTH J : WASNED STaNE
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/NYERT AT BU/LD1N6 Fr. C SRE wQWLATIO/V
//S/LET SEPr/C T-4IVK g8•B FT, FT O/AIN.- C
OUTLET SEPTIC TANK FT. .
/IVLET D1STR/BI?!ON BOX F7: SECT/O/V OF GROVNO J fTER Ti4d1.E
odTLETojsTRla1/rio/v BOX g 7.9 FT. S�wAGiE O/.Sf�4SA L.SYSTEM
INLET LEACN/A/Cr PIT 7,6 Fr. -rA4NVL.4TlDN,
LE.i4CN/N!� PIT _
JCALE : �4"
O/ME/V.S/ON A --3 FT,
DESISM CR/TE*TIA
FT. M r
NUMBER OF®EaROOAfS 3 D/MENS/ON C_
GA.48AGED/5.4005AL uNlr lyo/rE SOIL LOG SD/L TEST
TOTAL E3TlMA7-4=p FLO/N 33 o G.aL./DAV SOIL TEST JP/ SO/1- 7iCST#2
IIIUMBEA'QF t,E•ACN/NL PITS � � fg[EY. 99,6 EL�Y, OATS OF SOIL TEST
S/OE LEACHING PER P/T �SYg PT. RESI/�.TS IVITNESSED dY R C (TIl? a/e>.
a- ¢ �
BOTTOM A.ra AcN/NG PER P/T 7 9 ' S4. FT oo. L Da4 AWN COLATION RATE At/ Liss MIAl/1NCK
AREA, 7_ 6 so TOTAL LEAc`HlWCr h t FT su g 550 rL /�JOCOlATloN R•4T�> 2 MIN�1NCN
RESERVE LEACf!/N6 AREA SQ FT c Z-A y
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I SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1,2,and 3.Also complete A. Signature
I item 4 if Restricted Delivery is desired. Agent
■ Print your name and address on the reverse �604.sAddressee
so that we can return the card to you. B. Received by(Printed Name) C. Pat of ivery
■ Attach this card to the back of the mailpiece,,
or on the front if space permits.
1. Article Addressed to: D. Is delivery address different from item 1? 123 Yes
If YES,enter delivery address below: ❑No
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1 ► •' J 3. Service Type
❑Certified Mail ❑Express Mali
❑Registered ❑Return Receipt for Merchandi
j� ❑Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Ye<
2. Article Number -: _—'�""�-----_ :;��
(rransfer from service label) `7006 2150 0 0 0 2);10 41 =9 8 7 7 i i
PS Form 3811,February 2004 Domestic Return Receipt 10259E
UNITED STATES POSTAL SERVICE _
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I:::I I:::P",I I:::." I';.:I: 1-:1:;::'i:: r-�,:P647 �"Sb Fees Paid
• Sender: Please print your name, address, a`rid l'P+4!JK� this boz
I _
Town of Barnstable
Public Health Division W
200 Main Street
Hyannis,MA 02601
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Certified Fee
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(Endorsement Required)
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Total Postage&Fees
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or PO Box No.
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PS Form 3800,August 2006(Reverse)PSN 7530-02-000.9047
pf UHF Tp�
Town of Barnstable Barnstable
Regulatory Services Department ;e;eaC 1
BARNS-rABLF- I
MAC. Public Health Division
Cb i639, `0 m
Prfb""p�A 200 Main Street, Hyannis MA 02601 2007
Office: 508-8624644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
June 18, 2008
Heather Smith U rZJI — �`U C-) �--rjcfLf
75 Santuit-Newtown Road
Marstons Mills, MA 02648
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 75 Santuit-Newtown Road, Marstons Mills, MA was last
inspected on June 9, 2008, by Patrick M. O'Connell, a certified septic inspector for the
State of Massachusetts.
The inspection of the septic system showed that the system "Failed"under the guidelines
of 1995 TITLE 5 (310 CMR 15.00) due to the following:
Back up of sewage into facility or system.component due to overloaded or clogged SAS
or cesspool (liquid level was found over top of pit,pit is in hydraulic failure).
You are ordered to repair or replace the septic system within sixty (60) days from the
date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF T BOARD OF HEALTH
CoPa McKean,
Agent of the Board of Health
CERTIFIED MAIL#7006 2150 0002 1041 9877
Q:\SEPTIC\Letters Septic Inspection Failures\75 Santuit-Newtown Road.doc
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments
75 Santuit-Newtown Road M 3
Property Address
Heather Smith
wner Owner's Name
information is required for Marstons Mills MA 02648 . June 9, 2008
_ .. _ _
every page. City/Town State r Zip.Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.
Important: A. General Information _
When filling out
forms on the
computer,use
only the tab key 1. Inspector.
to move your Patrick M. O'Connell L- -
cursor-do not Name of Inspector
use the return
key. Septic Inspection Services Co.
Company Name
r� 189 Cammett Road
Company Address y' f
Marstons Mills MA 2648
Cityrrown State ip Code C11
508-428-1779 S112855
Telephone Number License Number - -
&'Certification
' I certify that 1,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 ® Fails
❑ Needs Further Evaluation by the Local Approving Authority
June 9, 2008
In ector's Signature Date
The system inspectorshall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****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.
08-146 Smith.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
75 Santuit-Newtown Road
Property Address
Heather Smith
Owner Owner's Name
information is Marstons Mills MA 02648 June 9, 2008
required for
every page. City/town State Zip Code Date of Inspection
B. Certification (cont.)
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
08-146 Smith.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
m
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
75 Santuit-Newtown Road
Property Address
Heather Smith
Owner Owner's Name
information is required for Marstons Mills MA 02648 June 9, 2008
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ 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:
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.
08-146 Smith.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 or 15
Commonwealth of Massachusetts
r
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
75 Santuit-Newtown Road
Property Address
Heather Smith
Owner Owner's Name.
information is required for Marstons Mills MA 02648 June 9 2008
every page. Citylrown State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ 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 indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "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
El ® 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.
08-146 Smith.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15
f
Commonwealth of Massachusetts
,p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
75 Santuit-Newtown Road
Property Address
Heather Smith
Owner Owner's Name
information is required for Marstons Mills MA 02648 June 9, 2008
every page. City/town State Zip Code Date of Inspection
B. Certification cont.
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No
❑ ® 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 fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered..A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
® ❑ 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 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 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.
08-146 Smith.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15
Commonwealth of Massachusetts
7
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
75 Santuit-Newtown Road
Property Address
Heather Smith
Owner Owner's Name
information is required for Marstons Mills MA 02648 June 9, 2008
every page. Citylrown State Zip Code Date of Inspection
C. Checklist
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?
I
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
08-145 Smith.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
75 Santuit-Newtown Road
Property Address
Heather Smith
Owner Owner's Name
information is required for Marstons Mills MA 02648 June 9, 2008
every page. Cityrrown State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents:
2
Does residence have a garbage grinder? ® Yes ❑ No
Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available(last 2 years usage (gpd)):
Sump pump? ❑ Yes ® No
Last date of occupancy:. Currently
Occupied
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe):
08-146 Smithdoc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
75 Santuit-Newtown Road
Property Address
Heather Smith
Owner Owner's Name
information is required for Marstons Mills MA 02648 June 9, 2008
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information: Tank has never been pumped.
Was system pumped as part of the inspection? ❑ Yes ® 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:
1980's
Were sewage odors detected when arriving at the site? ❑ Yes ® No
08-146 Smith.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
75 Santuit-Newtown Road
Property Address
Heather Smith
Owner Owner's Name
information is required for Marstons Mills MA 02648 June 9 2008
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
1'
Depth below grade: feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Septic Tank(locate on site plan):
1'
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 8.5' long x 5.2'wide- 1000 gal.
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined?
08-146 Smith.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
75 Santuit-Newtown Road
Property Address
Heather Smith
Owner Owner's Name
information is Marstons Mills MA 02648 June 9, 2008
required for
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Liquid level at top of structure.
Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee.or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping recommendations, inlet and outlet tee or.baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
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):
08-146 Smith.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
r` 75 Santuit-Newtown Road
Property Address
Heather Smith
Owner Owner's Name
information is required for Marstons Mills MA 02648 June 9 2008
every page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank(cont.)
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
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
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: ❑ Yes ❑ No
08-146 Smith.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
75 Santuit-Newtown Road
Property Address
Heather Smith
Owner Owner's Name
information is required for Marstons Mills MA 02648 June 9, 2008
every page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
® leaching pits number:
One 6x6 pit.
❑ leaching chambers number:
❑ 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.):
Liquid level was found over top of pit pit is in hydraulic failure.
08-146 Smith.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
75 Santuit-Newtown Road
Property Address
Heather Smith
Owner Owner's Name
information is required for Marstons Mills MA 02648 June 9, 2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert -
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions —
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
08-146 Smith.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
75 Santuit-Newtown Road
Property Address
Heather Smith
Owner Owner's Name
information is Marstons Mills MA 02648 June 9, 2008
required for
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
dis disposal system including ties
e Disposal System: Provide a sketch of the sewagep y 9
Sketch Of Sewage p y
to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.
Locate where public water supply enters the building.
Santuit-Newtown Road
\ , \ \ , , , , , \ \ ,
%I
Pit cover at grade
a . Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
75 Santuit-Newtown Road
Property Address
Heather Smith
Owner Owner's Name
information is required for Marstons Mills MA 02648 June 9, 2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to ground water: N/A
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
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
08-146 Smith.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15
Town of Barnstable
0 Regulatory Services
INSTABLE, : Thomas F. Geiler, Director
pTFo639. Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS
DISCLAIMER
This septic system inspection report was completed by a private inspector who is certified by
the State of Massachusetts De
partment of Environmental Protection.
Although the Town of Barnstable Health Division received the original or copy of the report;
this Division does not warranty the functionality of the septic system in the future nor does
this Division agree with any technical observations and interpretations contained within this
report.
In addition, by receiving this report the Town of Barnstable Health Division does not
automatically approve the number of bedrooms listed within this report. The actual number of
bedrooms approved at a particular property would be listed on the "Disposal Works
Construction Permit'..
If you should have any questions regarding this report, please contact the certified Septic
System Inspector who conducted the inspection.
Q:ISEPTIC\Disclaimer Private Septic Inspections.DOC
i
6�
/ TOWN OF BARNSTABLE
LOCATION 7f jrylr, �✓ ri✓ SEWAGE#,;V
VILLAGE AJ ASSESSOR'S MAP&PARCEL A_y
INSTALLERS NAME&PHONE NO.,44!!Y � f
SEPTIC TANK CAPACITY /,Gryo
LEACHING FACILITY:(type)_,,,/4" 301V (size)30•VX/o.Vt'-47'
NO.OF BEDROOMS
OWNER S11,14
PERMIT DATE: -7-3/ey COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility t Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) /0V14' Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
FURNISHED BY 7��' 61-f C/�S�r/�sn•J
��r ����
,b
��� ��
O
.,
��
S°{ � � -
..
yr�
V
+, ,
No. 9 Fee v
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Application for Di" o Y *pgtem Con0tructiou der 't
Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑.Complete System Individual Components
Location Address or Lot No. ✓3— Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel r
Installer's Name,Address,and Tel.No. i�a� / 1a� Designer's Name,Address and Tel.No.
Type of Building: s,
Dwelling No.of Bedrooms Lot Size S�116-7 sq. ft. Garbage Grinder ( 6
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures Design Flow(min.required) �30 gpd Design flow provided 3 s'a• 7 gpd
Plan Date Jd 0$� Number of sheets Revision Date
Title t S� S� �4 O � -7r Y-04;�"/f�/� X)
Size of Septic Tank /.OGOy6OCtsD�i v� Type of S.A.S. y " 7�w,C'l �`- tJ e
Description of Soil c zlt. ,�14,1y
Nature of Repairs or Alterations(Answer when applicable) �� L�c'�,n -ram 10/
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 eal l
Signed ,Date / 0 ox
Application Approved byte? Date
Application Disapproved b Date
for the following reasons
Permit No. �� 32 f Date Issued 31 o
No. �U .:. .:.�--+.� a "\ Fee
w y THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2pYicatiou for �Dioogar *- p5tem Con.5truction Pert�u't
Application for a Permit to Construct( ) Repair(Xupgrade( ) Abandon( ) ❑.Complete System T Individual Components
Location Address or Lot No. r � �f. 19 Owner's Name,Address,and Tel.No. J/W /—T
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
J
fPS-34;-%ry/
Type of Building:
Dwelling No.of Bedrooms Lot Size i�G sq. ft. Garbage Grinder
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 330 gpd Design flow provided 3 gpd
Plan Date ,Tr./1 /S e Jo O Y Number of sheets Revision Date
Title T,//-e 3' S'• /-r //,747 o 14' -73- 5Q1111/1,� /�'/+w, .✓✓ !� /t`J ��1
Size of.Septic Tank . l/OGo C4 e CXIS A'11 Type of S.A.S. � ' Z "«�•
Description of Soil S-/—C /�►�
Nature of Repairs or Alterations(Answer when applicable) /C��/` L�'�lj,n( „'� Gky
Date last inspected_:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
/ �decordance 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 this Boar of)S
fq/
g Date,,// // / y
Application Approved by L�)V1N•, 2� Date
Application Disapproved bV Date /
for the following reasons
y /
Permit No. G4/a 32 f Date Issued 13 110 t
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the/On-site Sewage Disposal System Constructed ( ) Repaired (11/) Upgraded ( )
Abandoned( )by / Z;7.1
at /f �9yTdi /{� Cr�YI �1 has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 02.009--32/ dated d
Installer /�i rb !`^�r �Gh)�7.Irf'u.i Designer
#bedrooms Approved de5ign�flow �Jy�(� /1 gpd
elf
The issuance of this per s all not a co trued as a guarantee that the s stem wl( 11 function as desi ed.
Date p g Inspector ' S
No. 204- ' 2 Fee 1616 THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION— BARNSTABLE, MASSACHUSETTS
Migogal 4§pgtem Construction Permit
Permission is hereby granted to Construct ( ) Repairk
Upgrade ( ) Abandon ( )
System located at -7 S Si,41 T 4t / /4-01/f
and as described in the above Application f'or Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title 5 and the following local provisions or special conditions.
Provided: Construct
ion
must be completed within three years of the date of this pe it
Date f/ d/1 Approved by ` G�
�r
No. .r} 0(J _. 1 y,. .«„ Fee
= v computer:
Entered in t_./�
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
._ pplicatiou for �Mpogar *p5tem Construction Permit
Application for Permit to Construct( ) Repair(41)' Upgrade( ) Abandon( ) El Complete System 0 Individual Components
`7 , �»
Location Address or Lot No. .� � Owner's Name,Address,and Tel.No. /
/71, ftdr//j .7)- r .J -e f13
Assessor'sM.ap/Parcel t r � ' < )
�z's•F � � �� - � �ZJ�',�,J�'�r '�,� /'/ ,ell"j/5
Installer's Name,Address,and Tel.No. 7 Designer's Name,Address and Tel.No.
//i :(fa %r"%J r •n '+. rr/
Type of Building: r t
Dwelling No.of Bedrooms 1 Lot Size S��,16 7 sq. ft. Garbage Grinder (�)J
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures q
IV
Design Flow(min.required) 31 O gpd Design flow provided 3 / gpd
Plan Date l'_ JS �� `� Number of sheets f Revision Date
Title i /. ,'jlx.. c. 7t. Jr, <
Size of.Septic Tank s !6-0 41,< X 0 !,F7 tr Type of S.A.S. Z1 r� �x., iy- +S27 w/1 ,v
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 EnvironmentaICode and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signedf. 1 i / .�1 t � Date,
,+'f..A t�
Application Approved by i cy;u a!f Date �� f/d J-
N F
Application Disapproved by: V � Date
` for the following reasons
u` /'- Date Issued I l i 11 G h
Per'm'itNo-_.� �
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE;MASSACHUSETTS
Certificate of Compliance----_�Y-
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (Upgraded`(
Abandoned( )by /,aI J+��
at % tJ'Jl/vi V-T,0lz,, 17 has been constructed in accordance /
with the provisions of Title 5 and the for Disposal System Construction Permit No,
}.7(.�)�/ - 3�/ dated 7741 lof
Installer In , �D ���� L a -r 1�•x/.�. Designer �.Jr .✓ � c.'Ii•rr. Y�t., a r -/
#bedrooms 3 Approved design flow gpd
The issuance of this permit shall not be construed as a guarantee that the system vc�ilf function as designed.
} ector71 Ins
Date_ l 1 1 P 1101
{
No. )UU.�- X 1 _ Fee / d
THE COMMONWEALTH-OF_MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE;MASSACHUSETTS
&.gPo9;a1 �&pgtem Con5truction permit
Permission is hereby granted to Construct ( ,J) Repair ( � Upgrade ( ) Abandon ( )
System located at Jf � /fir 1r�i
f
and as described in the above Application for Disposal System Construction Petritit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions. _
Provided: Construction must be completed within three years of the date of thi!gpermit. )
Date A f/u;�" Approved by /
t �
�, _-
FROM :down cape engineering inc FAX NO. :15083629880 Aug. 13 2008 08:30AM Pi
Town of Barnstable
Regulatory Services
t ,� t Thomas F. Geiler,Director
+ SARNWABiL,
r'ublic Health Division
' Thomas McKean,Director
200 Main Street,iiyannis,MA 02601.
Office: 509-862-4644 Fnx.: 508-790-6304
Installer& Dexigner Certification F4)rm
Date: Sewage Permit# 00 Assessor's MaplYarcel
1<lc8igncr: p�J� , Er1� / J_o Installer: ®r' 1010 a"O*-4A�
Address-. in Address: � �• (�k ��
a r ►.o ..- y°` �� -send M 4�ff tY4
On 7 3/O ?iXl� i , J __• was issued a permit to install a
(date) j6z
septic:system at 7S v1�Gv� W�G+J� based on a design drawn by
(address:)
o..- �. dated 7
(des L'M:r _.....__._..___—
_ T certify that the septic system reterenced above was installed substantially according; to
the design, w.h.ich may include minor approved changes such as lateral relocation ol'the
distribution box andior septic tank.
T certify that the septic system referenced above was installed with major ch.allgelr (Le,
greater than 10' lateral rel.ocati.on of the SAS or Uiy 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.
ARNE H yc,
0,J
Onstedle;x Signature) CIVIL N
No. 30792
(T)eN finer ti Signature) (Allix Designer's Stamp Her(-,)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTINI('ATE OF
COMPLIANCE WILL NOT BE ISSUED UN'I'IL HOTII 11I1.8 FORM. ,AND AS-BUILT CARD ARE
RECEIVED BY THE BARNS'TABLE PUBLIC.HEALTH DIVISION. THANK YOU.
Q:Hcatth/Septic/llcsig.licr CcrtiFc*ion.T rai 3-26-04.4vc
ALL SYSTEM COMPONENT SHALL BE S
SYSTEM PROFILE NOTES
LEGEND MARKED WITH MAGNETIC TAPE OR
SYSTEM DESIGN. (NOT TO SCALE)
COMPARABLE MEANS FOR'FUTUR E LOCATION.
PROVIDE IF NECESSARY 1. DATUM IS _APPROX. NGVD (CIS SPOT EL)
99 EXISTING CONTOUR ACCESS COVERS TO WITHIN 6 OF FIN. GRADE OBS. PORTS TO WITHIN 3" GRADE
Locus
X 99.1 EXIST. SPOT ELEV. GARBAGE DISPOSER IS NOT ALLOWED TOP FOUND. EL. 112.9'
2. MUNICIPAL WATER IS
EXISTING (LOCUS)
3. MINIMUM PIPE PITCH TO BE 1 8" PER FOOT.
9 CONTOUR MINIMUM .75' OF COVED OVER 2% SLOPE REQUIRED V ' /PROPOSED CO DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD PRECAST EQ ED OVER SYSTEM 111
_ s �a
» 4. DESIGN LOADING
FOR AL
L PROPOSED PRECAST UNITS
s
o
W 2 DOUBLE WASHED PEASTONE A I
I 98 0
f .4 r L. GPD DESIGN FLOW
0
SPOT E A 330 G PROPOSED USE
TO BE AASHO H- 5
• �• OR GEOTEXTILE FABRIC
LQ
rH 1 4'SCH4O PVC 1 10.5 4 ,CH40 PVC ,
TEST HOLE SEPTIC TANK: 330 GPD (2) = 660 PIPES LEVEL 1ST 2'
1'06 5. PIPE JOINTS TO BE MADE WATERTIGHT.
3
6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH °
2> TEE
SLOPE of GROUND RE-USE EXIST. 1000 GAL. SEPTIC TANK ** E EXISTING o0o GAL. 'y
14*
105. ' 0 310 CMR 15.000 (TITLE V.) z
109.1 f
* 5
0 0 0 0 0 0
0 0 0 0 0 0
� 2'
SEPTIC TANK o 0 0 0 0 0 0 0
UTILITY POLE LEACHING: 8
103.5 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO
0 0 0 0 0 0 �
RE-US .� GAS BAFFLE ..' 000000000000 0 0
(, � o0
B o E USED FOR LOT LINE STAKING
E S AKI G OR ANY OTHER
SIDE$:(30.4 + 10.25) 2 (.74) = 120.3 GPD 102
5.67' 105.5 _ PURPOSE.
T - H 20 3050 INFILTRATORS FIRE HYDRANT 0 S
MAY APPEAR IN Dw,wwc BOTTOM 30.4 x 10.25 .74 = 230.6 GPD _ Lon
NOT ALL SYMBOLS 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40 4" PVC. �o Pond
NOTE: ( ) » » C.
3 4 T 1, 0 1 2 DO
UBLE LE WASHED ST N o
TOTAL: 474 S.F. 350.9 GPD DEPTH OF FLOW = 4 PROVIDE INLET TEE ON D BOX O E o
9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED o oa
TEE SIZES: 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 30.4' X 10.25' WITHOUT INSPECTION BY BOARD OF HEALTH AND
H-20 INFILTRATOR UNITS INLET DEPTH = 10„ COMPACTION. (15.221 [2]) 4' PERMISSION OBTAINED FROM BOARD OF HEALTH.
USE 4 3050 k
e
( ) 6
* » 47 f
THE INSTALLER SHALL VERIFY THE
WITH 1 STONE AT ENDS AND 3 AT SIDES = 14 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING
d
w
LOCATIONS OF ALL UTILITIES AND ALL
OUTLET DE
PTH
DIGSAFE (1-888-344-7233) AND VERIFYING THE
BUILDING SEWER OUTLETS AND
LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES
ELEVATIONS PRIOR TO INSTALLING ANY
PRIOR TO COMMENCEMENT OF WORK.
9.3% SLOPE 1
( ) � SLOPE - ,
TT( ) BOTTOM TH 1 & TH-2
PORTION OF SEPTIC SYSTEM 99,5 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE
N 0 GROUNDWATER FOUND
0 ER FO LOCUS MAP
MA ,
' D� , LEACHING REMOVED 5 BENEATH AND AROUND THE PROPOSED
APPROVED DATE BOARD OF HEALTH FOUNDATION EXIST. SEPTIC TANK 37 BOX 2 G-W ESTIMATED AT 56'f LEACHING FACILITY. » ,
EL
FACILITY AS PER TOWN MAP SCALE 1 =2000 f
12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND
REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. ASSESSORS MAP 31 PARCEL -
3 4
GP DISTRICT
**INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT
1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE
WITH 1500 GALLON H-10 SEPTIC TANK IF T NO SUITABLE.
44g ,
8
9 TEST HOLE LOGS
ENGINEER:
DAVID FLAHERTY, R.S., SE2755
O
E
O
DONNA MI RA
ph X WITNESS. 0 NDI, RS
k DATE:
JULY 16, 2008
< 2 MIN INCH
111.32 X PERC. RATE _ /
11.20 \,X
I- 11.35
-� 1 �7
�i- u. I 1 2282
111
coN o.97 -� _ `� .07� � CLASS SOILS P#
i k
)12.04
A 0
111 �
U 5
W
SHED
},� SWELL
2 I STONE 'I�>\4\ `0 IPIT 112.39 ELEV. ELEV.
DRIVE / �
111.22 11.53 /1'I 1.89 1 2
4 , 4
• 0 111 .0 0 111 .0
89 Z 11 L74 /
TH 11 �� j1 / A A
.r - - �- - iA UNSUIT. /LS UNSUIT.
`�-.' 7" 10YR 6/3 /I 8" /10YR
- - 6/3
,f,,, - B
/. TH2 �t 11.72 112.34 n"..." O 8
,c i SEl'IOHMARK GARAGE
`•
CONC. O'// ,r� f 11.62 /
Cv�.. 5
�LS / UNSUIT. IL UNSUIT.
• �3 EstJ��K1•IEAD Q// 2.25 PAVED
t11.65 n� h
EL.'-- 112.2 �=�O DRIVE -�t.74 J i� / ® 1.89 10YR 5 8 '° /8
19 / 19 10YR 5
1.71 WELL
PROP. VENT WITH CHARCOAL FILTER k k
1 .11 �\+'�1.4 v// 'I 1L84 / PIT
S.TAN C s C 1
AND BUGSCREEN FINAL PLACEMENT BY �u LPIT 1t� 2z-�' OH WIRES .11
C1
CONTRACTOR WITH HOMEOWNER / 2. 12.86 112'.48 SL UNSUIT. SL
CONSULTATION) , �` +11 49 / 2 ` \ 1�- 1 - / UNSUIT.
k / 7.5Y 5 4
1 2.06 / 7.5Y 5 4
36 7
3
/ +111/5 k 1 �c�08 EXISTNG GAS LINE 1 9` � \ / Q 108..0 107.9
+t 11. DWELLING
/ TOP FNDN METER 1 t 2.4 / Q C2 C2
1
O
' DECK ELEV. 112.9
11 51
( l i LS
)) UNS IT. UNS IT.
111.78 C/ / U AS U
J
J jl�2.02
w
/ 11.26 't�L 1.96 112.37
k 1.86 W 2.5Y 6/4 2.5Y 6 4
TO » ,
W
W /
Q 65 105.6 65 105.6
q
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3 k � l
8 P RC
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88 / 11.53 \4V Spp112_.29 MS MS
/ ♦ �111.76 /
» 2.5Y 6 4
/ 2.5Y 6/4
o ,
138
k 99.5 138
99.k 0 5
�J
/ 1.66 O
A
NO GROUNDWATER ENCOUNTERED
J
LOT 4 /
52,167 SFf 112.12
o
TITLE
5 SITE PLAN
/ OF
(NOT USED PER
OWNER) 2.25 75 SANTUIT NE® WTOWN RD.
WELL
T MARSTONS MILLS
'I
2.1 �111.74 PREPARED FOR
WELL
PIT
BORTOLOTTI CONST./SMITH
JULY 15, 2008
Scale: 1 = 20
0 10 20 30 40 5 FE
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HOF off 508-362-4541
OF
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a 508 362-9
s 880
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o p � m downcape.com O
ANIELA.
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own cape e
IL d n inee hn Inc
No. P
40980•o �
No.46 q
civil engineers
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ass NG. N S R '� land suave ors
5a
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/f 1 939 Main Street ( Rte 6A)
DATE YARMOUTHPORT MA 02575
DANIEL A. OJA A P.E. P.L.S.L ,
08- >53