HomeMy WebLinkAbout0119 SANTUIT-NEWTOWN ROAD - Health A=031v,003-007fTvp�R5-TC)(�33 LLS J
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Mr. Neal J. Fellman
119 Santuit-Newtown Road
Marstons Mills 02648
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IMPORTANT.Save this receipt and present it when making an inquiry.
PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047
COMPLETE THIS SECTION • 1 ON DELIVERY
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Mr. Neal-J. Fellman
119 Santuit-Newtown Road
Marstons Mills 02648 3. Service Type
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2. Article Number S + �7011 04701 000VI 4525 7369Q,I
(rmsfer from service labe/)
�„�Ps Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540
UNITED STATES POSTAL SERVICE " irSYFass Mail,.
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• Sender: Please print your name, add ess, a. ZLO; 'ins his " •
Town of Barnstable 1-0
1 Public Health Division X
200 Main Streety
Hyannis, MA 02601
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Town of Barnstable Bii.rnstabllp
i 1I�
Regulatory Services Department j Ie
. Bg MARS.LE,l: 1 public Health Division m
7 MASS.
�'prfa nen't°il 2007
200 Main Street, Hyannis MA 02601
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A. McKean,CHO
- CERTIFIED MAIL# 7011 0470 0001 4525 7369
July 13, 2012
Mr. Neal J. Fellman
119 Santuit-Newtown Road
Marstons Mills, MA 02648
The septic system located at 119 Santuit-Newtown Road, Marstons Mills, MA was
last inspected on 6/21/2012 by Ricky L. Wright, a certified septic inspector for the State
of Massachusetts. The Health Division has determined that the system "Fails".
• System 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 with in the deadline period will result in future
enforcement action.
PER ORDER OF HE BOARD OF HEALTH
Thomas McKean, R.S. CHO
Agent of the Board of Health
Q:\SEPTIC\Letters Septic Inspection Failures or Future Evahl 19 Santuit-Newtown Rd.,MM.doc
Health Master Detail http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=O31003007
Health Master . _...
Logged In As: TO'wN\flynnj Health Master Detail bYednesday,July 11 2012
Aoolication Center Parcel Lookup Selection Items Reoorts
I Parcel Septic ( Pe.rc I Well Fuel Tank
Parcel: 031-003-007 Location: 119 SANTUIT-NEWTOWN ROAD,MARSTONS MILLS Owner: FELLMAN,NEAL J
Septic 1,6/19/1996 New Septic...
Permit number: 1996276 Permit type: I Select type Complete system: F
Issue date : 6/19/1996 Complete date : 7/3/1996 12
Septic tank size: F- Type/Size of SAS:
Installer:I Select Installer Card on file: F
I/A service type: Select service Innovative/Alternative Technology type: Select IA type
Variance date :F Abandon complete date : F Abandon permit number:F-
Repair deadline date : 9/11/2012 I"' Repair notification date : 7/11/2012 Ila Keyword:
Comments: INSTALL PIT Delete Septic
Inspection 6/21/2012 New Inspection...
Number Inspection Date Inspector Result
IV — 6/21/2012 Wright,Ricky L. - F(Fail)
The following condition(s)are occurring:
F discharge or ponding of effluent to the surface of the ground
F pumping more than 4 times during the last year NOT due to clogged or obstructed pipe
i
F-71 backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool
F static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
r any portion of the SAS,cesspool,or privy below high groundwater elevation
F any portion of the cesspool within.a Zone 1 to a public well
F any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis
Received Date Comments
7/11/12 - 60 days - System in hydraulic failure - Delete Inspection
Report shows 5 Bedrooms; only 4 are allowed.jmf
7/11/2012
J
Save Septic Changes I Return to Lookup
http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=031003007 7/11/2012
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Commonwealth of Massachusetts
W Title 5 Official Inspection Form
a Sewage Disposal System Form -Not for Voluntary Assessments
119 Newtowne Road
M
Property Address
Neal Fellman
Owner Owner's Name
information is required for every Marstons Mills MA 02648 6/21/12
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. General Information
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Ricky Wright
use the return Name of Inspector
key.
B & B Excavation,lnc.
Company Name
14 Teaberry Lane
Company Address
Forestdale MA 02644
Citylrown State Zip Code
508-477-0653 S 14595
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 0�
Title 5 (310 CMR 15.000). The system:
❑ Passes `-
❑ Conditionally Passes ® Fails
❑ Needs Further Evaluation by the Local Approving Authority
6/25/12
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system 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.
t5ins-11/10 Title JOfficial ction Form:Subsurface Sewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°M 119 Newtowne Road
Property Address
Neal Fellman
Owner Owner's Name
information is required for every Marstons Mills MA 02648 6/21/12
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.
Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 '
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
119 Newtowne Road
Property Address
Neal Fellman
Owner Owner's Name
information is required for every Marstons Mills MA 02648 6/21/12
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
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 if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
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
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 119 Newtowne Road
Property Address
Neal Fellman
Owner Owner's Name
information is required for every Marstons Mills MA 02648 6/21/12
page. Cityrrown State Zip Code Date of Inspection
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 distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, 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
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than Y day flow
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
f
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,M 119 Newtowne Road
Property Address
Neal Fellman
Owner Owner's Name
information is required for every Marstons Mills MA 02648 6/21/12
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for 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.
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
°M 119 Newtowne Road
Property Address
Neal Fellman
Owner Owner's Name
information is required for every Marstons Mills MA 02648 6/21/12
page. Cityrrown 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 dwellinginspected for signs of sewage back u ?
9 9 P
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ 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)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 5
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
t5ins•11I10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
119 Newtowne Road
M
Property Address
Neal Fellman
Owner Owner's Name
information is required for every Marstons Mills MA 02648 6/21/12
page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 1
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 ears usage d n/a
9 ( Y 9 (gP ))�
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: current
Date
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:
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
119 Newtowne Road
Property Address
Neal Fellman
Owner Owner's Name
information is required for every Marstons Mills MA 02648 6/21/12
page. CityrTown State Zip Code Date of Inspection
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 ❑ 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) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
(Sins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
r Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 119 Newtowne Road
Property Address
Neal Fellman
Owner Owner's Name
information is required for every Marstons Mills MA 02648 6/21/12
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 2'
feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: >20feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
At time of inspection building sewer appeared to be in working order no sign of leakage or blockage
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: 1000 gal
Sludge depth: no sludge
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 119 Newtowne Road
Property Address
Neal Fellman
Owner Owner's Name
information is required for every Marstons Mills MA 02648 6/21/12
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle no sludge
Scum thickness no scum
Distance from top of scum to top of outlet tee or baffle no scum
Distance from bottom of scum to bottom of outlet tee or baffle no scum
How were dimensions determined? scour stick
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
At time of inspection septic tank appears to be structurally sound ,no sign of back-up
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
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 119 Newtowne Road
Property Address
Neal Fellman
Owner Owner's Name
information is required for every Marstons Mills MA 02648 6/21/12
page. Cityrrown 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.):
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:
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
l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
119 Newtowne Road
Property Address
Neal Fellman
Owner Owner's Name
information is required for every Marstons Mills MA 02648 6/21/12'
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert > 6„
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.):
At time of inspection there were signs of carryover and backup. Inspected with camera. 4' out from
outlet end of tank water was backed up due to leaching being in hydraulic failure
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 12 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°M 119 Newtowne Road
Property Address
Neal Fellman
Owner Owner's Name
information is required for every Marstons Mills MA 02648 6/21112
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 1
❑ 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.):
At time of inspection leaching was in hydraulic failure. Could not access leaching due to boats and
much debris in the yard. Septic camera was used but could only go 4' into pipe due to solids blockage
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
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 119 Newtowne Road
Property Address
Neal Fellman
Owner Owner's Name
information is required for every Marstons Mills MA 02648 6/21/12
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
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.):
t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
119 Newtowne Road
Property Address
Neal Fellman
Owner Owner's Name
inormation is every
Marstons Mills
requiredforeve MA 02648 6/21/12
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
o �
0
3
`+ 06 A ' - ail (olt
A2
A 3 -43' 8 .
ql
A 4 -W
Bq - q3'
t5ins-11/10
Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17
. Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,M 119 Newtowne Road
Property Address
Neal Fellman
Owner Owner's Name
information is required for every Marstons Mills MA 02648 6/21/12
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: >12'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:
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 119 Newtowne Road
Property Address
Neal Fellman
Owner Owner's Name
information is required for every Marstons Mills MA 02648 6/21/12
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
r.
To, of Byrn talE r# I ?3
De $>�nent, ,R l
P egula�tory Services
r a �}, � F Pub ���c HeaIth D><vison :note t
s639=� 2QO:Makn Street,Hyannis MA 02601
Date S0001ed Time. l! ,� Fee Pd: ce ce-)
Soil Suitability Assessment for Sewage Dspoal
Performed B : Z le V'�c- l yl}eC S ( 2 i
y Witnessed By: n i S
LOCATION$ GENERAL INFORM_TION: =
L,ocahonAddress "t�wner'sName 0.kt�(
4P3Z
ars tt)ns s 6-5 Address
Assessor's Map/Parcel: 1b I -tTa3-60 7. Engineer's Name ?,EKI
CONSTRUCTION REPAIR x Telephone# .�d ;737
NEW
Land Use Slopes('!'o) -Z Surface Stones N
D�stancesfrom Open Water Body ��'4 ft Possible Wet Area. ���ft Drinking Water Well 7lJ ft
Drahvige Way ft Property Line 'ZO —�d ft Other` ft
SKETCI t(Saeername;dimensions of lot,exact:locations of test�holes&perc tests,locate we fn Proximityto1bles) '
t
f
Parent material(geologic) `� h Depth to Bedrock N
:Depth to Groundwater. Standing Water in Hole: Af 1A Weeping from Pit Race Ail'
EstimatO Seasonal.High Groundwater
DETERyIINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: in, Depth to still mottle$: In,
Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft.
Index.Well# Reading Date: Index Well level,. Adj.fhetor ;e_ Ad;,tlroutTilwterl.eval,,m
PERCOLATION TEST bate� Time
Observation
Hole# Time at 9"
Depth of Perc �'� Z� of�� ✓1S Tlme at 6"
Start Pre-soak Time® I Time(9"-60') ..r..- ..._
End Pre-soak
Rate MinJinch LZ
Site Suitability Assessment: Site Passed �4_ Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Divisica Observation Hole Data To Be Completed on Back-----------
***If percolation testis to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one (1) week prior to beginning.
Q:\SEPTIW8RCP0RM.DOC
DEEP.OBSERVATON DOLE L'OG' HW
# l _
Depth from Soil Horizon Sotl Texture. Shcl Color. Soil Oti►er
Surface(in.) (USDA) (Munselq Mottling (Structure,Stones,Boulders:.
-13 C- P�l•-S 2 �l'
J .
DEEP OSERVATIONHOLE LOG Hole#?-
Depih from;: Soil Horizon Soil Texture Soil Color Soil Other.
Surface(m.) (USDA) (Munsell), ` Mottling (Structure,Stones Boulders
Cons
✓Lylz
s a
,�•2 13 ii GYv
•
DEEP OBSERVATION HOLE`LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munselq Mottling (Structure,Stones,Boulders.
DEEP OBSERVATION BOLE LOG' Hole#
Depth.from Soil Horizon Soil Texture Soi-I:Color Soil or.
Surface(in.) (USDA) (Munsell) - Mottling (Struotiire,Stones,Boulders.
Flood Insurance Rate Man:
Above SOO year flood:. oundary N' Yes
'Within Sooyearbo►mdary NoA. Yes
Within IOU year flood boundary No f\-, Yes
Death of Naturaily Occurrine Perviotis.Materlal
Does at least four feet of naturally occurring pervious material exist in a1i areas>obsarved throughout=the
area proposed for the soil absorption system? te.l
._.
If not,:what:is the depth of ilaturaiiy occurring pervious
Certtffcatiot!
I that on `,J.— (date):I,have passed the:soil evaluator examinarion approved by the
ce tify
=bf Environmental Protectiorrand thaC>the above analysis was performed by me consistent with training,expertise and ex/peri`estce;descn6ed`iti' 10 CMtt FS`.0'17a
Signature
-=--- Date / 2.
Q:CSEP'YICFPBRCPORM.DOC
TOWN OF BARNSTABLE
LOCATION �c,,.�vr^tY - Ne:,.da�,J SEWAGE# :Q/�Z -; !`'�_
V,LLAGE /1/l�,�s�i�. 11/1,I J� -ASSESSOR'S MAP&PARCEL 11
INSTALLER'S NAME&PHONE NO, A Ypao WFJ 1 nSr
SEPTIC TANK CAPACITY `CX r S+-k-J S
LEACHING FACILITY. (type) Arc '3 c, I4 G (size) 14Y, 2-
NO.OF BEDROOMS y/
OWNER
PERMIT DATE: 10 5 12.._ COMPLIANCE DATE: C7in I I
I
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED Y: :Efnc z 6,
5-
2
� aP
t
No. 1 ef� Fee
THE—COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Y
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01ppliCation for Disposal *pstem Construction permit
Application for a Permit to Construct( ) Repair(:./<pgrade( ) Abandon( ) ❑Complete System K
ndividual Components
Location Address oars of No.l��lr{ C,.w A-V Q t- O�n4 is Name,Address,and Tel.No.
,Mkrs ,'P 4
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
N S�nI ..�•e.
Type of Building:
Dwelling No.of Bedrooms 9 Lot Size sq.ft. Garbage Grinder( )
Other Type of Buildingp ,, No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) y rt 0 gpd Design flow provided Y yy gpd
Plan Dateg gj�c� Number of sheets Revision Date
Title T
Size of Septic Tank G�X�.��t Type of S.A.S. ke. 36 HC_
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 1 NS .�►1 AJ
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.
S' d Date /('� i 4"
Application Approved by Date tl
Application Disapproved by Date
for the following reasons
Permit No. Ids- ( � Date Issued t) Z
No. d 4 a Fee U v
TFE-<<-OMMONWEALTH OF MASSACHUSETTS Entered in cornputer:
91
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Y
01pplicatIon for ksposal *pstem Construction Permit
Application for a Permit to Construct( ) Repair( pgrade,( ) Abandon( ) ❑Complete System individual Components
Location Address or Lot No.' Owner's Name,Address,and Tel.No.
MarS�oac MiltS 2c�pP414
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
/lI V ,
I�pe of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building )4 ',=i No.of Persons Showers( ) Cafeteria( )
Other Fixtures _-
Design Flow(min.required) y n gpd Design flow provided "X./v gpd
Plan Date ;/*,I/� Number of sheets I— Revision Date
T
Title
` Size of Septic Tank 25iltik,—tc Type of S.A.S. Ze 36HI
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Ike��. 1� Ad p`10 G A
Date last inspected:
Agreement:
a
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.
S' ea Date /0' A--
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. O /�- r 3 f Date Issued U / Z
i -- - ---- --------- ---- --
THE COMMONWEALTH OF MASSACHUSETTS
'! BARNSTABLE,MASSACHUSETTS
(Certificate of Compliance
,+ THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( graded( )
Abandoned( )by
at i has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. --?/Adated
Installer I Designer
i
1 ro g I<t�s �a-�
#bedrooms y Approved design flow yam() gpd
The issuance of this permit shall not b construed as a guarantee that the systp ,,will- fu of ort ass d sighed. ^�
Date /l(),Ztn Inspect
a ? // ---------------
No. f J Cb Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
r3isposal *pstem Construction Permit
I Permission is hereby granted to Construct( ) Repair( Upgrade( / ) Abandon( )
System located at f,�% a,if yi`t N,o�.✓�� ,.� jzt/
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.
I� Provided:Constructi7,,mu7,,
be completed within three years of the date of this permi.
'i Date bZ Approved by ,
I
•
j
10/10/2012 15:53 5084775313 ENGINEERING WORKS PAGE 01
Town of Barnstable
Regulatery Services
1%omas F.Ceiler,Director
$ Public ReaA Div n
' Thomas'McKean,Director
200 Main Street, Hynni is,MA 02601
Offiioe: 508-862- 44 Fax: 508-7W6304
Sewage Permf 647 31� Assessor's MaptParce131 -CO 3-- oo-7
^� bstaller&Designer Certi5odda Form
Designer: En, War 4 s, Inc , Installer:
Address: a W. s �`� lel ► i. Address: F,6' %
on / D 9 /2—. 'LA �3 y-c...�^ was issued a pemit to install a
(date) (installer)
septic system at I 1 SGh i'v 4 I- (LY based on a design drawn by_
(address)
dated 1
(designer) -
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State& Local Regulations. Plan revision or
certified as-built by designer to follow. Stripout(if required) w ' and the soils
and satisfactory. tH OF
PETER T.
to 3 Si store WCEMTEE
) Ca CIVIL
tgner's Signature) (Affix Design
PLEASE RETURN, BARNSTABLE PUBUC ME TH DIVISIO TE
F' C LIANC WILL NOT BE ISSUED N BOTH THIS FFMXORM-
lBUEL RECEIVED Y T B L PUBLIC N.
MAM YOU,
gloMoe Pozm.dx
O N O BARNSTABLE
LOCATION 'it/.I 13 WA SEVbAGE#
VILLAGE 46, Mills ASSESSOR'S MAP&PARCEL CU _Oa3 d0-7
INSTALLERS NAME&PHONE NO.
SEPTIC TANK CAPACITY /M
LEACHING FACILITY:(typ ) (P,-r- Ci (� (size) otb
NO.OF BEDROOMS 3
OWNER S
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
FURNISHED BY 7—A T IC0/2 / 3 07
4p3c
3
eliq
y3 a sq
r
v•
i
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
.TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 119 Santuit-Newtown Road 003 _0 U'7
Marston Mills.MA 02648 w
Owner's Name: Estate of Frances Stearns
Owner's Address:
Date of Inspection: January 3, 2007
Name of Inspector: (Please Print) Janes M. Ford
Company Name: James M.Ford
Mailing.Address: P.O.Box 49
Osterville,MA 02655-0049
Telephone Number: (508) 862-9400
t
i
CERTIFICATION STATEMENT t
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my ;
C,.r
training and experience in the proper function and maintenance of on site sewage disposal systems: I am DEP `
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: -�
.r
Passes l -
Conditionally Passes
ja
s Further Evaluation by the Local Approving Au hority Ev r-
t
Inspector's Signature: Date: January 10, 2007
The system inspector shall sub it 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.
DER The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving '
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Tifle 5 Inspection Form, 6/15/2000 page I
Page 2 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 119 Santuit-Newtown Road
Marston Mills. MA
Owner: Estate of Frances Stearns
Date of Inspection: January 3. 2007
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass" section need to be replaced or
repaired. The system, upon completion of the replacement or repair,.as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the. for the following statements. If"not determined",please
explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken'pipe(s)are replaced
obstruction is removed
ND explain:
2
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 119 Santuit-Newtown Road
Marston Mills. MA
Owner: Estate of Frances Stearns
Date of Inspection: January 3, 2007
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to detennine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310.CAM 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has'a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory, for colifonn
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of anunonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 119 Santuit-Newtown Road
Marstons Mills. MA
Owner: Estate of Frances Stearns
Date of Inspection: January 3, 2007
D. System Failure Criteria applicable to all systems:
You must indicate either"yes"or"no"to each of the following for all inspections:
Yes No
✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow
✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped_.
✓ Any portion of the SAS,cesspool or privy is below high ground water elevation.
✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
✓ Any portion of a cesspool or privy is within a Zone 1 of a public well.
✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to.correct the failure:
E. Large System:
To be.considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped
Zone II of a public water supply well .
If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered
"yes" in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 119 Santuit-Newtown Road
Marston Mills. MA
Owner: Estate of Frances Stearns
Date of Inspection: January 3, 2007
Check if the following have been done: You must indicate"yes"or"no"as to each of the following:
Yes No
✓ Pumping information was provided by the owner,occupant, or Board of Health
✓ Were any of the system components pumped out in the.previous two weeks?
✓ _ Has the system received normal flows in the previous two week period?
✓ Have large volumes of water been introduced to the system recently or as part of this inspection?
✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
✓ Was the facility or dwelling inspected for signs of sewage back up?
✓ Was the site inspected for signs of break out?
✓ _ Were all system components,excluding the SAS,located on site?
✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has been determined based on:
Yes No
✓ _ Existing information. For example,a plan at the Board of Health.
✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CMR 15.302(3)(b)]�
i
i
i
5
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 119 Santuit-Newtown Road
Marston Mills, MA
Owner: Estate ofFrances Stearns
Date of Inspection: January 3, 2007
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 4 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
Number of current residents: 4
Does residence have a garbage grinder(yes or no): n/a
Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection_ required]
Laundry system inspected(yes or no): No
Seasonal use(yes or no): No
Water meter readings,if available(last 2 years usage(gpd)): Unavailable
Sump Pump(yes or no): No
Last date of occupancy: Currently occupied
COMMERCIALANDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sqft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no)
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Unavailable
Was system pumped as part of the inspection(yes or no): No
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
Septic tank,distribution box,soil absorption system
Single cesspool
Overflow cesspool
Privy.
Shared system(yes or no) (if yes,attach previous inspection records, if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight Tank Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
A new pit was installed in 1996-per as built card
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 119 Santuit-Newtown Road
Marstons Mills. MA
Owner: Estate of Frances Stearns
Date of Inspection: January 3, 2007
BUILDING SEWER(locate on site plan) .
Depth below grade:
Materials of construction: _cast iron _40 PVC other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: Mil
Material of construction: ✓ concrete _metal _fiberglass polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1000 gal:
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 5"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 10"
How were dimensions determined: Medsuring stick
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,.structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.). I
Cement tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage
GREASE TRAP: None (locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Conur ents(on pumping recoilunendations,.inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 119 Santuit-Newtown Road
Marston Mills, MA
Owner: Estate of Frances Stearns
Date of Inspection: January 3, 2007
TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain):
Dimensions:
Capacity: _ gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last purnping:
Cornrments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box, etc.):
The D-box was level. No solids were present. The cover was 16"below grade.
PUMP CHAMBER: None (locate on site plan)
Pumps in working order(yes or no):
,Alarms in working order(yes or no)
Continents(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
Page 9 of 11
OFFICIAL INSPECTION FORM_-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 119 Santuit-Newtown Road
Marstons Mills, MA
Owner: Estate of Frances Stearns
Date of Inspection: January 3, 2007
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
✓ leaching pits,number: 1 -6'x 6'(1000 gal.)
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.):
The newer pit had 2.5'ofliauid on the bottom. The scum line was at the same level. The cover was 15"below grade There did
not appear to be any signs offailure. The older pit was blocked off.
CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.):
PRIVY: None (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.):
9
j ,
I
Page 10 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 119 Santuit-Newtown Road
Marstons Mills. MA
Owner: Estate of Frances Stearns
Date.of Inspection: Ja.ivary 3, 2007
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including.ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
6Ack L
133
A3e aq 3 y3 a s9
'70 q3
10
f
Page 11 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 119 Santuit-Newtown Road
Marstons Mills. MA
Owner: Estate of Frances Stearns
Date of Inspection: January 3, 2007
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 35 +/- feet
Please indicate(check)all methods used to determine the high ground water elevation: .
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
✓ Checked with local Board of Health-explain: topographic and water contours maps
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Using Barnstable topographic and water contours snaps the maps were showing approximately 35'+,/-to ground water at this
site.
This report has been prepared only for the septic system and components described herein. This septic system has been
inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will
function properly in the future. There have been no warranties or guarantees, either expressed, written or implied,
relating to the septic system, the inspection, this report and/or any components of the septic system which have not
been located and inspected.
11
LOVATiON � j�-' SEWAGE PERMIT NO.
Le)f - o R.i 24 / ° '
1 (LLACE
410 RS� fi?,//s
IgSTA L R RIAME A ADDRESS
B U I L DE R 0R OWNER
Li �� i CU•
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED � �
E�
41,
W
5
THE C9AMONWEALTH OF MASSACHUSETTS
BOAR® F HEfALTH
Appliration for Diipusai Works Cnnnitrnrtinn ramit
Application is hgereb in de or a Permit to Construct (�r Repair ( ) an Individual Sewage Disposal
Syst ;a�
� -�� ® rl. -------------- --•- --...------........---...•.... ------. ......-• -- --....
--- ----------
I Location- ess or Lot L
• �s�_�!L.. d 'I."C.r ...d�.l CSd�.. �C ?.c...•........ ..-- �-.. .0...�..�.®...--.....� j] :co......�
{lwnez ` Address
.J ................................. ......................................................
Installer Address Type of Building Size Lot.A...Z tt��
�. �_._..Sq. feet
U Dwelling—No. of Bedrooms....... Attic ( / ' Garbage Grinder ( �®
'4 Other—T e of Building No. of persons............................ Showers — Cafeteria
aOther,4zg4Les .•................•--•-------•--••••. ••--•------------• .
W Design Flow..........; IS.......................gallons per person per day. Total dailyflow----- ..........................gallons.
R: Septic Tank—Liquid'capacity. Q44.gallons P Length____ ..___-.-_- Width................ Diameter---------------- Depth................
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing ) �
'-' Percolation Test Results Performed by..V1UrZ._4 :f_ 22C- 14._ ._ Date..... f-�•.� �7`
,aa Test Pit NO. inutes per inch Depth of est Pit. ../....... Dep to ground water. .
(i Test Pit N _ nutes per inch Depth of Test Pit.............•...... Depth to ground water..................
r ----------------•----....----•-•-------••------•--•--...
O Description of Soil......... : ��.1-_
x - �sa`�_...._ .r. t.>'#1 Q - t�Gt r'3. ... ., .................................................
txj 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 TITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee ssued by th and of heal
Signed.... - - --- ..............................
Application Approved B ---•- ••• ... ........ ..........•-_. - 1
ate
_. - Date-------------
Application Disapproved for the following reasons----------------------------•-•---...---------••----•.....-•-•-••----•-•----•-••••--•...........................
---•-------------•--•-•---•--•-----•--.....-•••-....•--------............••••••---•...........••••--•-------••-••••-•••••••••-•••-••---••-•-•--•••••----•••-----•------•••-••-••-----•-••••--•-••.......
Date
Permit No. `�� l 0.�.�.. ................ Issued....
Date
-- -—--- -- ----- ---------- - -- ------- -- - --------.....�.._-- - — --_----- -�.�.�.���.
No FEis
THE CQN_?AON. WEALTH OF MASSACHUSETTS
BOARD HEALTH
71aw.. ................OF...19� ...............................
Appliration for Biqosal Works Tonstrurtion Frrutit
Application is hereby made for a Permit to Construct (to<or Repair an Ina'ividual Sewage Disposal
Sys.° _.. .... . .
............. ............................... ........................................ ----------
Locatio firr Lot jpNo.
Address
.................................. .......sk^% ........................................................
Installer Address
U
ItIl Type of Building Size Lot.-SNjI61.....Sq. feet
Expansion Attic Garbage. Grinder
Dwelling No. of Bedrooms---- _----------------_------_-- (/W
aOther—Type of Building ............................ No. of persons............-------------- Showers Cafeteria CltherAxtALes ......................................................................................................................................................
Design Flow..........W4...IS........................gallons per person per day. Total daily flow----1,4.0..........................gallons.
9 Septic Tank—Liquid capacity)
p 'J0.00.gallons Length................ Width___............_ Diameter.........__...__ Depth.............__.
Disposal Trench—No. .................... Width......_............. Total Length..............._.... Total leaching area........---.........sq. ft.
Seepage Pit No..................... Diameter.............__..._. Depth below inlet................_._. Total leaching area..................sq. f t.
Z Other Distribution box ( ) Dosing it
Percolation Test Results Performed by. ....... --- Date..... A/ .......
01
Test Pit No. ginutes per inch Depth ; Test Pi ....... Dep`f� to ground water-.
Pit ...._....__
Test Pit Ni;i!d .... inutes per inch Depth of Test .................... Depth to ground water..... .................
............ ... ..... . .............
- --------------- ........................... .........................................................
0 Description of Soil......... ................. ...............*------------
U ....................... .....
i...... ....wa.r�T.:e...3��4 .. ................................................
............... .........................................................................................................................................................................711----------
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 T I TAIZj 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has beer, ,issued by th�6pard of heabb.
S' ned..��161WZ4",40,W.W- 4K�......................... a e--- -------
---------------
y-----
Application Approved B df ----------
' Date��
Application Disapproved for the following reasons:......................................................................... ................................
................7.......................................................................................................................................................................................
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEAILTH
.0
.....................A� .. . AN
.... ..............OF....4... .......... .6K. ............
TES IS TIFY,TO 11at the Individual Sewage Disposal System constructed (A-<or Repaired
by ---
, ,,
... .........................
---------
----------- -----
..............................................
-----------*------------ --- -----*e" ....... ---------------------------*-------
at------_----------_
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......................................... dated_--..:____-_-_.____-.--_........._._............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRIDE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
.. ..... .... .............
DATE.............. 05......................................... Inspector--.----.- .. ...... ........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HE T
A, ....4140.... ................. ................................
FEE.A.0...........
Dispos IVM5. Tonstr ion " mit 1,
sF
Permission is hereby granted_�'?)A!!??;�5... //................................................................................
to Construct (k� pair/( )&,divid Sewa Disposal
7 y?1%
0
...................... ........................7 op I _ ----- wo.....at No....
Street
as shown on the application for Disposal Works Construction Perm it-
......No _..........>_ Dated.. .........................
.......................................
Board of Health
...
DATE. ...............
.................................. V
FORM 1255 A. M. SULKIN, INC.. BOSTON
< - '_TOWN OF BARNSTABLE -
LO( A1ION SEWAGE # _I 6
VILLAGE ASSESSOR'S MAP & LOT O/ 06 ,&&7
INSTALLER'S NAME&PHONE NO. c -���t5 tJ ���C► AZT �"I�17°'a�°��
SEPTIC TANK CAPACITY r'® 60 g lnn�m wrr
LEACHING FACILITY: (type) 1000 (size) (a
NO.OF BEDROOMS 4 1
BUILDER OR OWNER
PERMITDAT•E: Jar 3 I`I °� COMPLIANCE DATE: cal 32 - 19
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
�3 qq
P� •
q 13 , .
}
No. T Fee .V
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,L MASSACHUSETTS
2 pphratiou for ;ie;pool 6petem Cougtruction Permit
Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. i-t!T 7 Owner's Name,Address and Tel.No.
It-0 0
H.
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms l' Garbage Grinder
YPBuilding.-4—
( )
Other Type of Building � No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 11rS14 4— //y /�h=S•C�Y�� >9�2A��
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 Certifi-
cate of Compliance has been iss d by this oof Health. 1k
Signed Date 3 "
Application Approved by e
` Application Disapproved for th follo ' g reasons
I
Permit No. 26 Date Issued
M ———————--—--%.-
--- -----------------
4
No. n _ /rS Fee [
_ - THE COMMONWEALTH-OF MASSACHUSETTS"
`k -PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
0[ppYicatiou for Mopaoai *pgtem Co h!5truction Permit
Application is hereby made for a Permit to Construct( )or Repair( )an-On-site Sewage Disposal System at:
Location Address or Lot No. L-v T At 7 Owner's Name,Address and Tel.No.
Pi-/'W g e,_?2 re'09-/Cksf�. STt •✓�
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
t 021.E tA a t ,— 4 5.
Type of Building:
Dwelling No.of Bedrooms Garbage Grinder( )
Other Type of Building.---V— No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
I Title
Description of Soil
t � ,
.Nature of Repairs or Alterations(Answer when applicable) 1N5%,�,�!� /T v� j� i /�Y /T S t /I Yr .4A?,e ' r
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 Certifi-
cate of Compliance has been iss d b t ' oard of Health. _
p Signed I b�( J.S ' Date
- r
Application Approved by
Application Disapproved for th follo ' g reasons
Permit No.9 4 Date Issued
THE COMMONWEALTH OF
.MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced( )on
by (�' .(� I1 We.. . for
I!; as 1 t 4 t has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. _ dated
Use of this system is conditioned on compliance with the pro ' 'on set forth below: ?
v
No.�� Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Digogal *pgtem Cou5tructtou Permit
Permission is hereby granted to
to construct( )repair( an On-site Sewage Seepwrage System located at
Ma 41
and as described in the above Application for Disposal'System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
All construction must be completed within two years of the date below. I
Date,: _ Approved by
Edwarl F. B]arnStable,
Health Inspector
y
. � Town of B suss A
f63q. `0!
CFO[
Health Department
Office Hours: 367 Main Street,Hy 8:30-9:30 a.m. (508)790-6265
12:45-2:00 p.m. FAX(508)775-3344
I No.RV:7M 7
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HE JLTH
OF.. .. . 1�?�Y .... ..............................
✓...�Ic�J•-�.............. .. . �.S
' Appfiration for Disposal Vorko Tonotrur#'tun Permit
Application is hereby made for a Permit to Construct (L11"or Repair ( ) an Individual Sewage Disposal
Sy ....// _L.17 .....C'V .......... . .--.... ----.....--.---- ....... .............. •.•-•-•-
Location- ess or
Iot
�i
..........
.�� Qwner ` Address
................................. .... ----•--- -•--
Installer Address ��••��
Type of Building Size Lot. ..Z�.TO/:....Sq. feet
U
.. Dwelling—No. of Bedrooms....... ................................Expansion Attic Garbage Grinder
Other—Type of Building No. of ersons............................ Showers — Cafeteria
a+ Other , s ---•.............•--••..._.._..------•..__...._._. _.. • ---------..._•-•-••----_. ........... ..------.............
Design Flow........... .... .......................gallons per person per day. Total daily flow.....
.�.Q .............
Septic Tank—Liquid capaclty_yQQQgallons Length________________ Width................ Diameter................ Depth................
W
F x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No..................... Diameter......_.._.....__... Depth below inlet.................... Total leaching area_...... sq. ft.
Z Other Distribution box ( ) Dosing � )i t �/ 149,
Percolation Test Results Performed by... 1. lq .�_ r ,flr> e,�-'1.,�. Date_..___ _ ._f..
,-1 v
i.a Test Pit No. _ inutes per inch Depth of est Prt__. /_..... Dep to ground water_..
(s, Test Pit N ..._____C-nutes per inch Depth of Test Pit____________________ Depth to ground water........................
^i ............ ........................ ............ .........................................................
} _ -Soilescr Description of _.: ..__ _._ ..
r
:1 U .------•------ •_'•-�s � .c.lfLt�L._. .Q_._.COA r'-�--c ^ •--------------------------•------•----•-----•-
s a W
:.; x
'.,, . U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
r.; ..................•--•---------..........-----•--••-------...--------------••--••------....._.......---............
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
:say
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 bee ssued by th and of heal
ned___.
Application Approved B
a
Date
.: Application Disapproved for the following reasons:............................................................................:.:.............:............_....
...................................................................•--•-•-•---.....-----•--...---..................................---•-----.............---................__._....Date"....-•-•----
PermitNo..... v`� ......_. Issued_......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
/ BOARD OF HEA TH
..............OF.... .......1... . ..............................._...
Trr#ifiratr of Toinplinurr
< 2
T4jS IS TO TIFY, at the Individual Sewage Disposal System constructed ( or Repaired ( )
�.. ... -- _--•- •...........................................
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.................................______ dated......................... .
A ' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUED AS A GUARANTEE THAT THE
1i< SYSTEM WILL FUNCTION SATISFACTORY.
f
.....fo�
DATE............................................................................... Inspector......... ... ..
THE COMMONWEALTH OF MASSACHUSETTS
,.,,,,..•-- BOARD OF HE T
Novo.js fur Tunu ion Permit
Permission is hereby granted ] ... .. .5 _ ��,`J�to Constr�uc�t ( ......
airy( .>� •.._dav' . �f,ai Diosal;�OA<4
Street -•--------------------•- - -..................
{at No........ ......... .
a as shown on the application for Disposal Works Construction Perm' No` _._� >�Dated_�_I ..��...........................
1......_....... ......................
• Board of Health
DATE...................................
FORM 1255 A. M. SULKIN, INC., BOSTON
$
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s.t �s157 6� 1p,� 0 c/
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lot 1 ` `�of ais•S,{� ..
ROBERT
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/� ,� h� 7 ELURE
LEGEWD
EXISTING SPOT ELEVATION . 0x0 CERTIFIED PLOT PLAN
E fSTINO CONTOUR --- 0 --- ;' (_UT 7SAffTa 7--NE"+/7`0WA/ Xr-?
T' ",;�N SHED .SPOT ELEVATION Q ��
Hy .iFD CONTOUR 0 D,y
IN
FOVED-8 BOARD OF HEALTHO
Q, TE AGENT SCALE] / ' _ ` 0 ' DATE ZO Ig�f
:KEDGE ENGINEERING CO. INO
Gizc4tnil3 R /Z
CLIENT I CERTIFY THAT THE PROPOSED
REGISTERED JOB NO. B U 7 BUILDING SHOWN ON THIS PLAN
CIVIL LAND CONFORMS TO THE ZONING LAWS
G JURVEYOR DR.By, AA OF BARNSTABLE , MASS.
4
_,,,:.... 712 MAIN STREET CH. BY:
gZd 8y _
HYANN I S, MASS. Z
SHEET OF �A E REG. LAND SURVEYOR
�_.:�_...�r- .uJw�r:.bAaea[..vu�...�:Ya:.vt�:rr.w'rvm:..a..r•..r�_,,... .�....�.._. - _ .....__.._ _ __ _ .. �.�.��.c
/VOTE /F E/TNER 7WZrSEP7/G TANK OR
20 F7: MIN. ZzACAvlovG P/T AIgE MORE TNA/V /2"QELO
/O fT MIN SRAOE,A P4'O/AMETEK CONCXFT� COl�
SNALL SE B/ROtIIff Y7' TO GI;AGE.�AN.EX`TRA
CONCRCTL '¢�O+'� P1PZ h'E.4VY CAST IRON CCl/--_/r Sh+ALL BE l/S�'
A IN. P/TCN
r
v Z o COYE1 S o� /F/N GR/✓EJ�/.4 Y
2% M/N. CONCRL�TE
cy n� oe—
e0✓ER CLEAN SA/VI
A r . . . BACXF/LL.
_q LQU/O LEYEL
. -VIA. 201-AYER
4.; SCMEDULS40 � e• QW I V_j
t P/PE • •
••' /49
�IC1/V.P/TGII I f O /C O TANK . .�. I • • • • •• • : s+ WASHED S7i�NE
r�s"Pe�R 1'T. SEPT 6 X i i • • • • • •
l ri q rI✓tom 8E ., • I • •EEI_PECTI✓L ' ' : •; 31.#
• •.•• DEPTH • •• ' ,• WASHED 57,dN&
lop
i s. • • • • • • . •• • r pop PRECI�I•ST SEEA4G '.
lNIiG� CLE✓ATIONS n/T C 4 PA /.
STY 4.9 D GAL�D/a y / i• • • • •. • . • • • • s P/7 OR EQU/V.
. • �c 9 4
INVERT AT OU/LD/NG 9 8 D Fr. 3 /Z �. 0/AM C(SFE7AMVL�ITJOA
1NLET JA-PlTK• TANK FT.
OUTLET SEPTIC TANK g1-.B FT. GRpuNo NGgTEP� TAQ1.E a
INLET D/STR/d!?ION BOX g�� SECT/ON O F
Ot1TLETDI STR/BUT/ON BOX s¢/� SP1l�AGE OlSP+OSA t SYSTEM
INLET LEACNIJVG o/T Fr. -rA4WLATI0H
LEACH/NG P!T pjofFNS/ON A. 11
DES/6/Y CR/TER/A OlAwNs/o/V -�-�'•
NUMQER OF QEDROO�IS 3
D/MENS/ON C_�FT. /'I I^/-
GAReAG,Eo/SPO5AL UN SOIL LOG SOIL TEST
TOTAL Arffrh WrED FLOW 3 3.y G.4L.1DAY SO/L TEST#/ SOIL TFST*P
NUMBER OF 4rACIllNT PITS L r`fLt=✓, q•¢ Awl-AV A4 TE OF SO/L TEST
S/OE LEACH1NG PER P/T Z S/ 319 l:T. I� 0 _ Q RESULTS A0r'V&5SE9> BY
6oTTOM L6�CN/NG PER P/T I/3 S4. FT Loft ti( s soil PERCOLAwoov vArF O/ LEss M1 ViNG
TOTAL LEACH/NG ALROA 2_6 I SQ FT '• s-bM t-`-44 Y• P&A-COLA77ON RATE 2 Lo
a RESfrRVE Lg.RCN/N6 AREA 4 A
' ' soIc �-�sT P- 3-r-
pF M L a LOT 7 _5ANTvi r- NEB7v �t/ 1
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LEGEND
EXITING. SPOT ELEVATION OxO CERTIFIED PLOT' PLAN
�`4EXaSTIN0 .CONTOUR ——— 0 - -- L o 11 S�r�TviT-,Ve�r`51WAI 7�A
NI MED �Q.O,;SPOT ELEVATION �"
fRf.Nf.SMED CONTOUR 0 �7�rS7-O�l/S M/� 6s-
o
-PMROVEDj BOARD OF HEALTH Q IN
D E AGENT SCALE; / "- o DATE=
KpRfDOE ENGINEERING CO. IN CLIENT
kY _ I CERTIFY THAT THE PROPOSED.
EGISTERE REGISTERED JOB NO. B U 7 BUILDING SHOWN ON THIS ` PL AN
aCIV;IL LAND _
CONFORMS TO THE ZONING LAWS
EN:GLNEER SURVEYOR DR•BY' �' OF BARNSTABLE
h< ?.12 MAIN STREET CH. BY: 42019
F,
HYANNISt MASS. L ---
SHEET OF 7- A E REG. LAND SU.RVEYOW."
�, Ysc•taurt3u':� �..�' •rIr'G8 - .Z api.s�'.,5.^'� i'�Ia.eai'8S — '.M.N.'NorulY•.rvs.s.+--++t'� ., .._w.__...._...�.. t�_b u_..w -v - -.+L.a.,.. _ � .Y ... -.a+�iYe$;Wa.u6�:u
2O FT: MAW. /1lO.TE /F E/TNER THESEP7/C TANI< OR
L':EACNtivG_ Pi.T .41fe /YORE TNAN /2"BELOW 4'
/O FT• /r1/N. 6:RAGEj A 24"O/^METER CONG'RET,S COMER .
SNALL 8E BRO�/6yT TO GI;AOE.�AN•EXTRA -
�- CONCRL'TE PVC P/PZ JYE.4VY CAST /ROM COVER S1444LL DE l/SE.D
MIN- P/7c*q
CL. / l7Zo COVERS .4'Crr. IF/N OR/VEyt/AY
2�M/N. CO/VCRL�TE
A sa �y DE Cd✓ER CL EAA1 SAND
&ACX L
rqLQtJ/O LEVEL __ • '
"DIA. _
4`.: $«/fOtlL.640 '•• 2 LAYER
or vs,
G.f1t.
'¢ M/1V.P/TCI✓ i 1 a.00 DIS•T. r • • • • •• �' �„ WASHED S70 E
"PERfT.� SFPT/C TANK ' , s rr . . . . • . �, e . �
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• 1
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t`.•:: • . �.•• DEPTH • • r • WASHED STD�YE
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J�/T e,u-AA <7 LI • • • •. • • • • • e O P/7 DR EQU/V.
!AtV,CA ' ELE✓ATIONS
INVERT AT QU/LD/NG 9 B FT: 3
/NLE7 SEPTfC TANK . 97.0 FT, C CSEE 7�M1/LAT10N�
OUTLET SER77/C7-i1NK AFT.
IN D/S LET TRZO&VDN BOX `I G,o FT. GROuNo WATER TABLE
tITL OETD/STR`marlON 6QX �-s8 FT. SECT/ON OF
INLET tEACN/N4 /�/T �S¢ FT, s��'�/AGE OISPO�SA Z SY.STE/►? -TA&MAT/DN
LZACH!/YG P/T,
scAtE : .� /=o� DIMENSION A —FT
oxstax CRITERIR D/f1EIVS/oN SO `/ FT•
• NUMBER OF 6lE�ROOlyS 3. D/HENS/ON C_ 4 _FT. /,l r N.
Gr/+�eeAG,EO/soo �s�u^rIr n�oH;E r SOIL LOG
7-0TA4 ESTIAIA7-ED FLorV 3 3.0 6At./DAy DSO/L TEST�/_ SO/1- 7EST�2 S®/L TEST /
NUMBER Olr IOACMIMa Firs f^ECEr �Q.¢ �c�y .DATE OP SOIL TEST
S/OE LG*ACN/NG PER P/T S� S1Qt PT. r RESULTS IV/TNESSED BY R B &
007-M/M AA4CNiNG PER.PIr L/3 so. A7 1-0,4 s,soiL PERCOLAT/ON RATE jo/ LEss M/A/I'NCH
TOTAL LEACH/NG AREA Z-� g S 1 fT. sbM en-c-44% PONCOLA7.YOM RATE I�2 T i o M/N�INCH
RESERfiE1_EACN/N6 ARE/ 2-162 4 S.P. FT. ` �
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rt
Department of Environmental Management/Division of Water Resources
WATER WELL COMPLETION REPORT
/ f WELL L09A_TI`ON ��
Address T / - JL fad tjnZ A.) 1'C C1
City/Townes C Val,,
O
G.S.Quadrangle Map X
Grid Location 3
Owner Ell.f A3 1'3fII (L -1)9-V`4e 1QVt� orfJ
Address L- nY S�C)6 C2Vl rVi 11-t "h O�lo31
WELL USE CONSOLIDATED WELL
Domestic� Public ❑ Industrial ❑
Type of Water-bearing Rock
Other
,,��11
Water-bearing Zones
Method Drilled loroq q I— 1) From .To
f 2) From To
Date Drilled 3) From To
4) From To
CASING a
/— Depth to Bedrock
Length/� Diameter
Type ✓c UNCONSOLIDATED WELL
STATIC WATER LEVEL Water-bearing Materials
Feet below land surface �:�1 Sand: fine❑ medium❑ coarse[
Date measured 9-may � Gravel: fine❑ medium❑ coarse[:]
Screen:
GRAVEL PACK WELL
Slot#_length from 710 to1�l
Yes ❑ No Xk
Split Screen (or 2nd screen)
WATER QUALITY TESTS MADE Slot# length from to
Chemical 04 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 FromAwl
To
i
Ct
0
M
CtIFFOi ff'4'0R . ": : ro
PIING
,5 !.� SS Firm 65 °viva Reek Renate— �
d S'— 7 3 Addre Muss. 02664
r
city
Registration No. R
p tors Signature
Please pant tirmly CUS_TOMER COPY 15M-2 84-176471
---- Fee------=-------------
BOARD OF HEALT"-
TOWN OF BARNSTABLE
Application Ar Veil Congtruction permit
Application is her by de for Tpit to Co struct ( ) Alter ( ), or Repair ( )an individual Well at:
Location — Address Assessors Map and Parcel
ner f Address
�Jf'L I � -------------—-------------
-- — ------__ ---- -
Installer — Driller — — — Address
Type of Building
Dwelling --- -- ---- --
Other -jType of Building------------- No. of Persons----------------------
✓Type of Well—1� � • Capacity---- — --------
Purpose of Well----- ------ --
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to
place the well in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed
date
Application Approved By — --- ------— -
date
Application Disapproved for the following reasons:--------------------- ------------------
_ --- date------
t u
Permit No. ---11" Ud — — Issued--- -� ------ ---- - - -
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(t ertif irate Of (Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( )
by------- ----------------- - --- - --- - - --
Installer
at- --- — ---- --— -- -- --- - --- ___-has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. ------------Dated-----------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE----- --- —- -- Inspector------ - - - -----------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Ivell con5trurt ion]permit
No. Fee
Permission is hereby granted pwA"
to Construct ),,AlteL( I or Repair an Individual Well at:
� k M.
------------------------------
Street ef --—
as shown on the application for a Well Construction Permit
No. L"JaU Date —--------------------
2 10 --------------------------
DATE Board of Health
No. w Gu Ll_-0 ..�, � Fee-----------a------
BOARD OF HEALT,14�
TOWN OF .BARN-STABLE
f Zpp[ication: Veil c w5tructionVermit ,
" Application is hereby mi de for a p rmit'to Co struct ), ter' ( ); or Repair ( )an'individual Well at:,'p g
�� �[.( _I►I(,(1
— Location — Address ——� — t Assessors Map Parcel `
r Address ---- --- —
Y_Y1ei��1_I )a!_rns
rs11�_ -----
Installer — Driller k Address
Type of Building
Dwelling ----- — --—---- r !
Other - Type of Building- ------------- No. of Persons--------------
Capacity----------- --------�---
A ype of Well Q�Q �( tfM
--- -- -
- --- Purpose of Well
Agreement: n
The undersigned agrees to install the aforedescribed individual well in accordance with the'provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation The undersigned further agrees not to
place the well in operation until a Certificate of Compliance has been issued by.the Board of Health.
Signed
date
Application Approved By \ '_ __ --___— 6 f U �J
CT
T
a date.:
Application Disapproved for the following reasons.— ----' - -- -----'--- -
date
7x '..iff r���` �
a,q a V�/,u�. U —, l,. �! _
Permit No 1- Issued t - - F�
u — :date
BOARD OF HEALTH
i
TOWN OF BARNSTABLE
Certificate Of Comoiiance
THIS IS TO CERTIFY, That the Individual Well Constructed-( ), Altered ( ), or Repaired ( ) T
Installer
at- ---- --------— - ---------------- --- ---- -
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. -------------Dated----- -------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE _
t _, '' .Inspector `' ----:------------------- ---' ----
BOARD OF HEALTH _ -�'� f ..
` TOWN OF .bBARNSTABLE `
Veil Congtructionl3ermit "
No. - a o0q-0_ l o Fee-- - _—_---
Permission is hereby granted
to Construct ), Altet' ?
) or Repair. ( ) an Individual Well at:
,I (�ra �t"7 �r� A�� �)Vv-n ------------
No. -- ------ -- -- - - - f
Street
as shown on the application for a Well Construction Permit`#
-W4 U r1��r9 f� -- Date —�^r /e�/
�I � Board of Health:-
DATE r ___ " , p , '
i
r
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RUBERT
BRUCE a
ELDREL!
•
z LEGE D
4,11NG SPOT ELEVATION OXO CERTIFIED PLOT' PLAN
IT1=N4 CONTOUR
ED SPOT ELEVATION 10.0 c 7
lD 'CONTOUR
VQ'= BOARD OF HEALTHO Q° IN
AGENT SCALE= / "= o/ DATE= o
r ?GE ENGINEERING CO. IN Gr� w/3reirz
CLIENT I CERTIFY THAT THE PROPOSED
�STErRE: REGISTERED JOB NO. B U 7 BUILDING SHOWN ON TH•!S P 'AN `.
�VtL LAND :
�., � C.ONI±ORMS TO THE ZONlNQ LA�II�
x IN ER URVEYOR DR.BY ARN:STABLE, MASS. rx r
.,
7.I2 .MAIN STREET CH: BY=
,any♦ ti,pis � g f/`" 6! -'
r,
w`YANNIS, MARS. Z
SHEETS OF A'L E REG. LA14 4iiR ' 1 10.
Log Number: 4149 Bottle # C098 Date: 9/27/84
BARNSTABLE COUNTY HEALTH DEPARTMENT
--}. —$UPERIOR COURT HOUSE
VBARNSTABLE, MASSACHUSETTS 02630
o •
wSo DRINKING WATER LABORATORY ANALYSIS PHONE: 362-2511
EXT. 331
Client: Green Briar Development Corp.Collector: , . Fred Clifford
Mailing Address: .Box 5 0 Affiliation: - Clifford e , Drilling
Centerville, MA - 02632 Time & Date,of
Collection: 9/24/84, 5:00 p.m.
Telephone: Type of Supply: well water
Sample Location: Lot 7 Newtown Rd. Well Depth: 73'
Marstons Mills Date of Analysis: 9/2.5/84
PARAMETER SAMPLE RESULT RECOMMENDED LIMITS
Total Coliform Bacteria/100 ml 0 . 0
H 5.6
Conductivity (micromhos/cm) 45. 500.0
Iron ( m) t, 0.08 0.3 r
Nitrate-Nitrogen ( m) <0.04 10.0
Sodium m) -- 20.0 j
t c
I , xx 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' their 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: Clifford Well Drilling
CC: Barnstable Board of Health
Laborat Director
7/17/84
Explanation of Test Result
• 3. . 1. '• f n
Total Coliform Bacteria
Coliform bacteria are an.indicator of the sanitary quality of a water supply. Water supplies may become..
contaminated from malfunctioning septic systems;cesspools and surface runoff. A total conform count of zero
indicates that your water supply is safe and approved for human consumption..A total coliform count of greater' .
than zero is M'ost.often the result of accidental contamination of the sample bottle through improper sampling
methods. For this reason, it would be advisable to retest any_well,water that is.not approved.
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,th'e,range of 5.0to 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,.if is norco.nsidered.deleterious to health. Iron may be., f
removed by use of an iron removal system
Nitrate-nitro en -
The Massachusetts Drinking Water Regulations have seta maximum contaminant level for-nitrates at 10
ppm. Excessive concentrations may cause.methemoglobinemia (ar ,jnfant:disease)and have becn,suggested to
form potentially carcinogenic nitrosamines. Contamination sources include fertilizers,'cesspools and industrial. '
. ;
wastes.
Copper ,
i
Due to the acidicnature 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 1.6 ppm may cause a 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 50 ppm indicate that there may be ocean water or road salt runoff water Vetting into the well.
TOWN OF . BARNSTABLE I BAR-W F3
Ordinance or Regulation
WARNING NOTICE
Name of Offender/Manager N\1 *xk— r- �L- W.-No dob 7 4!
Address of Offender MV/MB Reg #
Village/State/Zip 'iAN.
SO
Business Name 'r,jaam/p&", on -720 .:)M
Business Address
Signature6f Eriforcifng- Officer
Village/State/Zip fN K) Lt C,
Location of Offense
Enforcing Dept/Division
Offense t\\z
Facts 1;V4."9 k-j 7 x
4".
This will serve only as a warning. At this time no legal action has been taken.
It is the goal of Town agencies to achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in.
appropriate legal action by the Town.
WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT.
°A NEAL FELLMAN
y
119 Santuir-Newtown Road
DOIk
' Mclstons M lls
977-423-1259
5,", -783.0454
�I
December 200
Town of Barnstable
Regulatory 0 Services
E¢� Public Health Division
200 Main Street
Hyanriis,Ma. 02601
Afteation. Jaime A. Cabot
RE: Assessors (03 i/003/007)
Iri yesterday's mail I received a certified letter from you regarding a new rental
' ordinance. I was a bit surprised in these tight economic tunes and budget shortages
that anything more costly than first class trail would be considered a bit of an excess.
In any eve-nt,any house at 119 Santuit=Newtown Road is a single family house. It is
my primary residence and there are no rental units as part of the property. As such,
I am just a bit p--Tl6xed as to why I am being asked to a fees relating to rental units.
Y b pay �
} If an inspection of my home is required...I ' do all I can to arrange my work schedule
to allow fox a onvenient time for us to meet at the property. Comments regardLng failure
� 1� 17 Y•a to comply and fines that would seem to add.up to substantial amounts in a short p= iod of
time axe a great concern to me. If you have access to e-mail...it really is the quickest and
}
most efficient means.of maintaining a dialog reoa.�dingtl is matter. My�--rnail add-rass is:
r shutters(a',coracastmet. My phone numbers are listed above_Please contact nae as soon as
passiole to resolve an questions y regarding garding this matter.
r r.
Wishing,you and yours a Joyous Holiday Season.
}� Thank you.
j.. .Regards_
ilieal llvnali
,t
9 1
CERTIFICATE OF ANALYSIS Page: 1
A:�
t Barnstable County Health Laboratory
Report Prepared For: Report Dated: 2/13/2007
Tom Greene
Today Real Estate Order NO.: G0739534
1533 Falmouth Road
Centerville, MA 02632
Laboratory ID#: 0739534-01 Description: Water-Drinking Water
Sample#: Sampling Location: 119 Santuit Newtown Rd.Marstons Mills,MA Collected: 2/12/2007 I
i
Collected by: C.S. Received: 2/12/2007
I
Test Parameters
ITEM RESULT UNITS RL MCL Method# Tested
Total Coliform Absent P/A 0 0 P/A 2/12/2007
I
Water saatple meets the recommended limits for drinking water of all the above tested parameters. B
Approved By: �p '
?(Lairector) ! "d
ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level
Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605
f
02/13/2007 TUE 16: 03 FAX 5083627103 Barnstable CTY HealthLab -'-'- BARNSTABLE HEALTH 12001/001
I
°F CERTIFICATE OF ANALYSIS Page:
! Barnstable County Health Laboratory
l `yss,�CHtr,W,, Report Prepared For: Report Dated: 2/13/2007
Tom Greene
Today Real Estate Order No.: G0739534
1533 Falmouth Road
Centerville, MA 02632
Laboratory ID#: 0739534-01 Description: Water-Drinking Water
[ Sample ff: Sampling Location: 119 Santuit Newtown Rd.Marstons Mills,MA Collected: 2/12/2007 I
Collected by: C.S. Received: 2/12/2007
Test Parameters
ITEM RESULT UNITS RL MCL Method# Tested
Total Coliform Absent P/A 0 0 PIA 2/12/2007
Water sample meets the recornnrended limits for drinking water of all the above tested parameters.
Approved By:
j (La�irector)
.2. 7
i
i
i
i
i
i
I
ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
i
CERTIFICATE OF ANALYSIS
Page: 1
• � Barnstable County Health Laboratory
Report Prepared For: Report Dated: 2/9/2007
Tom Greene
Today Real Estate Order No.: G0739514
1533 Falmouth Road
Centerville, MA 02632
Laboratory ID#: 0739514-01 Description: Water-Drinking Water
Sample#: Sampling Location 119 Santuit Newtown Rd.Marstons Mills,MA Collected: 2/7/2007
Collected by: T.Greene Received: 2/7/2007
Routine
ITEM RESULT UNITS RL MCL Method# Tested
Nitrate as Nitrogen 4.6 mg/L 0.10 10 EPA 300.0 2/8/2007
Copper 0.58 mg/L 0.10 1.3 SM 3111B 2/8/2007
Iron. BRL mg,:. 0.10 0.3 SM 3111B 2/8/2007
Sodium 11 mg/L 1.0 20 SM 311113 2/8/2007
Total Colifonri Present P/A 0 0 SM9223 2/7/2007
Conductance 130 umohs/cm 2.0 EPA 120.1 2/7/2007
pH 6.0 pH-units 0 EPA 150.1 2/7/2007
Recommended maximum contamination level exceeded due to Coliform Bacteria. Retesting is recommended
Approved By:
( irector)
2l9/2�
i
MCL=Maximum Contaminant Level
RL = Reporting Limit Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
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i
LEGEND LOCUS
N
EXISTING CONTOUR a
t. 1o7so X 100.98 EXISTING SPOT GRADE ® o
fi c.
� WELL A DRINKING WATER WELL ; d
PB -G EXISTING GAS SERVICE
386 --9H. - OVERHEAD WIRES 9� E
/A 63��pT) ' TEST PIT -4 Asa Meigs Rd oA Sanaa% Street
J O ��• BENCHMARK
CP,
---------------
00
EX/STING LEACH PIT LOCUS A P
CONTRACTOR SHALL PUMP, �� NOT TO SCALE
FILL WITH SAND AND ABANDON. 14. (LOT 7)
EXISTING SEPTIC TANK N ��26� .�t� APN 31 -003-007 +108.70
(TO REMAIN) N` j �e�4 54,801 S.F.t
TOP OF TANK, EL.=107.67 0 �+,1 �� F GS .2 GENERAL NOTES.
INV.(OUT)=106.34f
....+ioe.7a.• TP_2 1 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
t roA'i3 .4 BOARD OF HEALTH AND THE DESIGN ENGINEER.
l 1
:+I08.84
2. ALL WORK AND MATERIALS- SHALL CONFORM TO THE REQUIREMENTS
fT0eo3 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
' LOCAL RULES AND REGULATIONS.
0 �9, 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
T +109.13�� 109.00 p St• TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
01 SP+ 8.94 0 DESIGN ENGINEER.
U IX +108.49 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
0 1oe.e7 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
o ' 0 ENGINEER BEFORE CONSTRUCTION CONTINUES.
+toe. x 10e.e3 \ 0 x� 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
x - \ sM F. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
xloe.s7 08.96x '09.92 q:` THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
a EC! 1F 108.99 ���•rl�'�o HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
/ EXISTING �, 0 ,1oe.s1 ° h / 7. WATER SUPPLY PROVIDED BY PRIVATE WELL.
108.71 10?po /HOUSE) 1b9.02 108.8e ,\ham �r1oe.37 �rO 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S.
T.O.F=1f0.50 �77 ° SJ¢'' 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS
0 BENCHMARK AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE
`0925 '09.U9 09.?6. a°y BULKHEAD CORNER DIRECTED BY THE APPROVING AUTHORITIES.
`n4 Co } EL.=109.92 Assumed 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
r '':; `' G�..:::. ;....'. THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
` '::....'. CONSTRUCTION.
<,;..0,,`.:, �108. 7"' . .. •�,�;._•. 08.62 i%•••.69 _c>S ' 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
IN THE AREA OF Mass REPLACE WITH BCLEAN HSAND A�R SPECIFIED L N SIDES310 CMR T255(3),HE S. AND 1oe.e8 9
q� 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE
PETER T• �, INSPECTED BY DESIGN ENGINEER. PRIOR TO BACKFILL.
I - - McENTEE 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
108.01 oe.90 CIVIL IS NOT CONSIDERED TO BE A PROPERTY LINE SURVEY.
, U
91B
. R .: 683..05!�' •., LE 118.92�PK's�4.,,. No. 35109 14. THE CONTRACTOR SHALL BE RESPONSIBLE FOR OBTAINING A TRENCH
F0 PERMIT FROM THE LOCAL MUNICIPALITY IN WHICH THE WORK IS BEING
- > �O ' E� `�
108.aV edge 108'30 1oe.6o 1oe.89
toe.47 of pavement AEG/Sj
O0 109.45 90r5 A ENG� PERFORMED.
107.71
SAN TUI T-NEW TO WN. ROAD PROPOSED SEPTIC SYSTEM UPGRADE PLAN
119 SANTUIT-NEWTOWN ROAD, MARSTONS MILLS, MA
OWNER OF RECORD Prepared for: John Zapalla, P.O. Box 921, Centerville, MA 02632
FELLMAN, NEAL J Engineering by: SCALE DRAWN JOB. NO.
P.O. BOX 921 Engineering Works, Inc. 1"=40' P.T.M. 240-12
CENTERVILLE, MA 02632 12 West Crossfield Road, Forestdole, MA 02644 DATE
%ZAPPALA, JOHN 9 23 12 CHECKED
T M. SHEET 2
(508) 477-5313
NOTE: TO PREVENT BREAKOUT, THE PROPOSED 14.2'
FINISH GRADE SHALL NOT BE < EL.105.3i'' -y
FORIA DISTANCE OF 15' AROUND THE
PERIMETER OF THE S.A.S. 1 LLJ ;
1
SEPTIC TANK PROPOSED D—BOX PROPOSED S.A.S, 1 to 1
INSTALL RISERS & COVERS OVER INLET & ' INSTALL INSPECTION PORT OVER END UNIT N 1 aQ i
INSTALL RISER & WATERTIGHT 1 O 1
OUTLET AND SET TO 6" OF FINISH GRADE 1 Of
1
T.O.F. COVER SET TO 6" OF GRADE
EXISTING F.G. EL.=109.1t F.G. EL.=108.4t F.G. EL.=108.3t
ff MAINTAIN 2% GRADE (MIN.) OVER S.A.S. C
• I INSPECTION / l�
L = 72' L = 10'(MAX) PORT
® S=1% (MIN.) @ S=1% (MIN.)
4"SCH40 PVC 4"SCH40 PVC 1 MINIMUM) O
tO"I e"
14" 10.75" TO 0j
EXISTING 48" LIQUID INVERT I I O
GAS
LEVEL ADD" INV.=105.17 PROPOSED INV.=105.00 r- 5 ROWS OF 5 UNITS AT 5.0'/UNIT = 25.0'
INV.=106.34t D—BOX INV.=104.90
EXISTING SOIL ABSORPTION SYSTEM (PROFILE) Cb'
1XISTING SEPTIC TANK ESTABLISH VEGETATIVE COVER Z
BACKFILL WITH CLEAN NATIVE OR
PERC SAND TO TOP OF CHAMBERS
NOTES: BREAKOUT=TOP
TOP ELEV.=105.33
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INV. ELEV.=104.90
INVERTS, PRIOR TO INSTALLATION.
=1 4. —
- T
BOTTOM ELEV. 0 00
2 BOX SHALL E SET LEVEL AND TRUE o ECK
D L B
_k�RA IX GRADE ON A MECHANICALLY Y ME COMPACTED C L C C ED S L:2.83' ,
INCH CRUSHED STONE BASE, AS SPECIFIED 5' MIN. ABOVE BOTTOM OF EFFECTIVE WIDTH=14.2'
IN 310 CMR 15.221(2). EXISTING
3) INSTALL INLET & OUTLET TEES AS REQUIRED. T.P. EXCAVATION OR G.W. EXISTING SUITABLE �/ , /
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE NO G.W., EL=97.2 z MATERIAL /T7 SE SAS LAYOUT
OV
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL.
USE 5 ROWS OF 5-ADS Arc 36HC UNITS WITH NO
SEPARATION BETWEEN EACH ROW & NO STONE 63.25"
SEPTIC SYSTEM PROFILE TYPICAL SECTION
N.T.S.
34.5"
SOIL LOG
DATE: SEPTEMBER 11, 2012 (REF 13 739) TOP VIEW
SOIL EVALUATOR: PETER MCENTEE A#1542)
DESIGN CRITERIA WITNESS: DONALD DESMARAIS IRS HEALTH AGENT 60"
NUMBER OF BEDROOMS: 4 BEDROOMS ELEV. TP- 1 DEPTH ELEy. TP-2 DEPTH FEND CAP END CAP
RONT VIEW SIDE --
SOIL TEXTURAL CLASS: CLASS 1 108.2 A 0" 108.3 A 0 END CAP
SANDY LOAM SANDY LOAM REAR/TOP VIEW
DESIGN PERCOLATION RATE: <2 MIN/IN 10YR 4 2 10YR 4/2
107.7 6" 107.8 6" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW
DAILY FLOW: 440 GPD B B TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
DESIGN FLOW: 440 GPD /
SANDY LOAM SANDY LOAM DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.105.2 10YR 5/4 104 8, 10YR 5/4 4640 TRUEMAN BLVD
GARBAGE GRINDER: NO A ' �p C 36" C 42" ® HILLIARD, OHIO 43026 Arc 36HC DETAIL a
= A) /' - PERC
LEACHING AREA REQUIRED: (440 GPD) 594.E SF
ADVANCED DRAINAGE SYSTEMS, INC.
42"/54"
74 GPD/SF- P-- IT—Y` , „7 /uou 95/��p PROPOSED SEPTIC SYSTEM UPGRADE PLAN
EXISTING SEPTIC TANK: 1500 GALLON�APACITY MED. SAND MED. SAND
PROPOSED D-BOX: 1 INLET, 5 OUTLET (MINIMUM)P'f N✓�, 2.5Y 6/4 2.5Y 6/4 119 SANTUIT—NEWTOWN ROAD, MARSTONS MILLS, MA
USE 5 ROWS OF 5—ADS Arc 36 UNITS WITH NO � 6- y Prepared for: John Zapalla, P.O. Box 921, Centerville, MA 02632
SEPARATION BETWEEN EACH ROW & NO STONE 97.2 132" 97.3 132" Engineering by: SCALE DRAWN JOB. NO.
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF UNIT) PERC RATE <2 MIN/IN. ("C" HORIZON) Engineering Works, Inc. NTS P.T.M. 240-12
(Arc36HC Units) 25 UNITS x 5.0 LF x 4.80 SF/LF = 600.0 SF NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
DESIGN FLOW PROVIDED: 0.74 GPD/SF(600.0 SF) = 444.0 GPD (508) 477-5313 9/23/12 P.T.M. 2 Of 2
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