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HomeMy WebLinkAbout0945 SANTUIT-NEWTOWN ROAD - Health 9 .5 Santuit-Newtown Road Marstons Mills F A = 027 041 7b �� 61 Ct pa/V� j Board of Health, G(M-h ,Gal A APPLICATION F®I, DISPOSAL SYSTEM C®NSTRUTI®N PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( andop( ) - ❑Complete System /11(lndividual Components Location ?d1 feLo" �,�� ' /, Owner's Name Map/Parcel# 0 2 '� • ��rl� Address 9 V r fA--1 Ai —4,0w&L,h fCP' 6/ Lot# Z Telephone# V Installer's Name Designer's Name Address Address Telephone# Telephone# Type of Building /L ,rf®.�/�i�i Lot Size �� /QA r sq.ft. `Dwelling-No.of Bedrooms Garbage grinder( ) Other-Type of Building No.of persons Showers( ),Cafeteria( ) Other Fixtures Design Flow(min.require ) 0 gpd Calculated design flow�_ Design flow provided _gpd Plan: Date 3/6 Number of sheets Revision Date Title Description of Soil(s) . Soil Evaluator Form No. Name of Soil Evaluator /Otj Date of Evaluation �4> DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to instaht<he above described Individual Sewage Disposal System in accordance ' further a ees to not t � y with the provisions of TITLE 5 and s.� gr Iilace the em in operation until a Certificate of Compliance has been issued by the Board of Health. Signed :.c Date InsP ectiorrs D:J..T:-...�.^::._.may..�� :.._:�........•1.i1.:.. ..-..-iY.il'...� + Q:• No. .. ..j i:TJ`l'ssf+.v"Fv. •K-w.. -.a.a.C: :.�J.a:..=i::�l .. -r.:a+c.+-hi-.1G.�.si —�j413-- 06 c) COMMONWEALTH ®t,M FEE�---_ SACHUSETTS o.2 7 —o q, Board of Health,_ G4► a+ )[ 4P�'� ,JVA. CERTIFICATE 09 COMPLIANCE Description of Work: brindividual Component(s) ❑Complete System The undersigned hereby certify.that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( ) by. pC . at 9' 1i/ T""` �S^r�T,✓J- �d� - /K, *t,,F, F� 1� �,r�►� has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. 06 U , dated 0 Approved Design Flow �? S (gpd) Installer Designer: Inspector: Date: 0 The issuance of this permit shall not be construed as a guarantee that the system will function as designed. .. No. 206 2 -0G0 FEE COMMONWEALTH Of MASSACHUSETTS 02 7 --o y/ Board of Health, M:f"}fAk/{ nay DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade( Abandon( ) an individual sewage disposal system at �' r AF ' /�/� n f� p'7i cT� as described in the application for Disposal System Construction Permit No. uJ-2`o0 , dated� 0 Z Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Board of Health n 4 C G�- ¢l ro � '�► �e.�("a c� Dom, ate- . r ���� f m �_ • ,TOWN OF BARNSTABLE L LOCATION j SEVi/AGE # O jt2o4 VILLAGE rGc/"Si/�f ASSESSOR'S MAP&LOT 02 7^D W INSTALLER'S NAME&PHONE NO. 4120-9*758 •lctt,c �IS�rr�roS SEPTIC TANK CAPACITY MV 401 LEACHING FACmrTY: (type) 1- 006ol P.i y Gr// I (size) /5 NO.OF BED�OOMS BUILDER OR OWNER ~5- ffd,*VZ PERMTTDATE: ^/S-O 2 COMPLIANCE DATE: 2 /9 ^02 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wetts:exist on site or within 200 feet of teaching facility) Feet Edge of Wetland-and Leaching Facility(If any wetlands exist within 300 feet of leaching f eili Feet Furnished by i � aUG. sd'lr— a r APPLICANT:NORMA UENTES ASSESSORS PLAN 27 PLOT' 41 0 R T G A G E INSPECTION PLAN O` L'.A, N LOCATED AT 945 SANTUIT NEWTON ROAD BARNSTABLE, MASSAC1 USETTS SCALE: V=50' June 27, 2003 LoT e3 Gj ' �QQ ls�T I LoT 1 ► SH I GO,C)d D EC.►C �945 g 1 sTo�Y N c. SANTU IT- N EWTOWN ROAD CERTIFY TO: DUNNING&KIRRANE,L.L.P.,USDA RURAL DEVELOPMENT, AND ITS TITLE INSURANC OMPANY,'THAT THERE ARE NO VISIBLE ENCROACHMENTS OR EASEMENTS EXCEPT AS SHOWN ANq Town of Barnstable Health Inspector - Office Hours FtHE Regulatory Services 8:30-9:30 ThomasF.Geiler,Director 1:00—2:00 t BAMSTABM 9�A , ; � Public Health Division rED MA'S A I110mas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT - SEPTIC QUESTIONNAIRE 1. General Information: - Size of Property: .~] / CLe Address: 9 ,c.)Ay Map o 2?.0yParcel Name: Phone#: yag-o g 7F 2a. How many bedrooms exist at your property now? 2b. Are you planning to add any bedrooms? y e S If yes, how many? l 2c. How many bedrooms total are proposed at this property(including the amnesty unit)? � 2d. Please include a copy of the floor plans for the entire property- showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or 00 If the dwelling is connected to public ssewer,sk-ip-questions#4 through#9,below. 4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution t' public amply wells? _ c3 5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WAT R? - A, 6. Is a disposal works construction permit on file? v YES a or coNO 6a. If yes,how many bedrooms were approved according to this permit? edrooms. ry bNO7. Were any building permits obtained for construction of additional bedrooms? YES or CM M 8. Is there an engineered septic system plan on file at the Health Division? YES or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO -------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY The Public Health Division has no objection to 3 bedrooms at this property. " Special Conditions: Signed: Date: Q;/health/wpfiles/amnestyapp D v.� n1 fir' tl Ltjj `�� Ise rI Lo V) 79 1� 6pc, Cc 4011 . . DELIVERY COMPLETE ■ Complete items i,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date f Deliv ry ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑ es 1. Article Addressed to: If YES,enter delivery address below: ❑No p©rA►P► l �C444 c}�IIe O J� K.� 3. Service Type )I-Certified Mail ❑Express Mail ��p T°�N(-f+A j VIA,' p ab�k ❑Registered ]&Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number II (Transfer from service Iabso I, :> 7006 0 810 0000 3 5 2 5 0'14 4. , PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATEfitE�,. k "° ,, "•+'�« as 2.7. FINY fa OV* +:,:,:.ray"' •«.»»,..::r�. • Sender. Please print your name, address, and ZIP+4 in this box• Public Health Division Town of Barnstable i 200 Main St, i Hyannis, Massachusetts 02601 I iE .e a Ip Iru 1tv ; m Postage $ c j as n jvI r fcJ 0 Certified Fee J P� p Retutri Receipt Fee j Postmark p (Endorsement Required) r tH1011 �f t ,t „ I p Restricted Delivery Fee " f'. r9 (Endorsement Required) CO p Total Postage&Fees MSent To --- �- Street,Apt No.; /� �p' T n or PO Box No. �l'��'.�do /r -fVP ftJw 1 City,sate zIP+a Certified Mail Provides: a A mailing receipt (Gwamu)ZpZ eunr use-od sd V, A unique identifier for your mailpiece e A record of delivery kept by the Postal Service for two years Important Reminders: • Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. w Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with. Certified Mail. For valuables,please consider Insured or Registered Mail. is For an additional fee.,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSO postmark on your Certified Mail receipt is required. ■For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement'Restricted-Delivery. m If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. if a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. 'IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail ,addressed to AM and Ms. r Certified Mail#7006 0810 0000 3525 0144 afar Town of Barnstable Regulatory Services SARNSMLL Thomas F. Geiler, Director MAS& •bg9` Public Health Division rF0 MAy s Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 22, 2007 Norma Fuentes 945 Santuit-Newtown Road Marstons Mills, MA 02648 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.000 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE The property owned by you located at 945 Santuit-Newtown oad, Mar tons Mills was inspected on June 22, 2007 because of a complaint. j g s The following is a violation of the State Environmental Code: 310 CMR 15.214: Nitrogen Loading Limitations: 5 potential bedrooms were observed at said dwelling location which is located in a Nitrogen Sensitive Well Head Protection area. Septic permit 2002-060 was issued for a 3 bedroom dwelling in 2002. You may have no more than three bedrooms total at said location. You are directed to correct the violation listed above within Seven (7) days of your receipt of this notice by pulling a building permit to abate the violation. As discussed during the inspection you may remove the folding doors to the first room in the house which is being used as a TV room, which will give you the 5' Cased Opening without doors and exempt it from being considered a "bedroom." The two finished rooms in the basement can have a 5' Cased Opening installed without doors (in the cased opening) between the two rooms and used as just one large bedroom. The final bedroom count would then be two bedrooms on the main floor and one bedroom in the basement. The building permit is valid for 6 Months. You are reminded that you must get a building permit for the work, which includes installing an egress window in the basement bedroom. You are also reminded that a Carbon Monoxide detector must be installed in the basement. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. QAOrder letters\Sewage violations\945 Santuit Newtown road.doc Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF T E BOARD OF HEALTH T omas A. McKean, R.S. Director of Public Health Town of Barnstable Cc: Robin G. Zoning Enforcement Bob M. Building Dept. Q:\Order letters\Sewage violations\945 Santuit Newtown road.doc No. W a — U 6� j � FEE � COMMONWEALTH OF MASSAC14USETTS Board of Health,ff a.—k j 6"— /e , MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( Upgrade(01<bridonO ❑Complete System XIndividual Components Location 9 L�r 1�,� ro-7`s v, ;� Owner's Name ? Map/Parcel# Address Lot# J Z Telephone# Installer's Name �� � Designer's Name Address Address Telephone# Telephone# �� 'z�' Type of Building �/�d'J��� Lot Size 1� �QD r sq.ft. Dwelling-No.of.Bedrooms Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) ) 0 gpd Calculated design flow C) Design flow provided �s� gpd Plan: Date �/ �t Number of sheets Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation Z— DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the tem in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections i...Y* '1Mrini 4 '. h W a - 6 b r ,.-�. _ FEE _ C®MMONWTA]LTH OF MASSACHUSETTS- Board of Health, U a h )�P'1'AMA.�` i P APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( Repair( Upgrade( bandonO - ❑Complete SystemXIIndividual Components Location Sys Ja,,, ,� _�(/ ��r• Owner's Name bw Cr heeC..j., e Map/Parcel# 0-2 7 - Q y Address g y r A.,r{L°a�74- w 61,11 Lot# Telephone# Installer's Name G �� d s Designer's Name f /�,� Q, S' Address Address Telephone# r Telephone# a Type of Building �i } f Q�,�/L!/i� Lot Size �� %400 t sq.ft. Dwelling-No.of Bedrooms Garbage grinder ( ) Other--Type of Building No.of persons Showers ( ),Cafeteria ( ) f Other Fixtures Design Flow(min.required) gpd Calculated design flow�� Design flow provided gpd Plan: Date Z�40 Number of sheets Revision Date � r Title Description of Soil(s) �/ ! Soil Evaluator Form No. Name of Soil Evaluator (+- *Nr✓1,Kf Date of Evaluation / Z D Z_ DESCRIPTION OF REPAIRS OR ALTERATIONS V The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not t place the sv5tem in operation until a Certificate of Compliance has been issued by the Board of Health. f Signed -L Date Inspections No. �t Xl 1 U b U 1 FEE C®MMONWEALT14 OF,MASSACHUSETTS o Z 7 —G l / Board of Health, /\at n Ck �'� MA. CERTIFICATE OF, COMPLIANCE Description of Work: XIndividual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( ) by: 11 at �� ttn/J 77�/Cf - /'l� i fdL✓h lid i,�T has been installed in accordance with the pro}'sions of 310 CMR 15.00 (Title 5) and the a proved design plans/as-built plans relating to application No. a o 0 06 G , dated I0 X Approved Design Flow S (gpd) r Installer • B Designer: Inspector: 0,1 Date: _ I t 0 The issuance of this permit shall not be construed as a guarantee that the system will function as designed. r No. u2 06 Z -O6b FEE J V COMMONWEALTH Of MASSAC14US ETTS C7 7 7 -O`/ Board of Health, JfQ-r h) /f , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade( Abandon( ) an individual sewage disposal system at 1:�V 3 -A" ,V - /(/ rt leg A,1 Cf as described in the application for ' Disposal System Construction Permit No. W,2`O6 tj , dated Provided: Construction shall be completed within three years of the date of is permit. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Board of Health i TOWN OF BARNSTABLE L LOCATION S� �� I!G� SEWAGE # 9;26�, 0 VII.LAGE` .;�/ / I ! ASSESSOR'S MAP & LOT 01 T 0V INSTALLER'S NAME&PHONE NO. AV00 SEPTIC TANK CAPACITY LEACHING FACIL17N: (type) ?"�aUG�I!Ur y cr/�___�%!'l (size) •��/r l NO: OF BEDROOMS •3 BUILDER OR OWNER PERMITDATE: 4^/ '-02 COMPLIANCE DATE: 2^/q ^®•Z Separation Distance Between the: Feet Maximum Adjusted Groundwater Table.to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells:exist Feet on site of within 200 feet of leaching facility) I ii Edge of Wetland and Leaching Facility (If any wetlands exist , Feet within 300.feet of leaching f cility)e . Fwnished by ,,s1'�� Sr; • � t � Ids � I it 5/25/01 A/17'041 • Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, 64,,,. yqa wi ntw, oe f ,hereby certify that the engineered plan signed by me dated Zip o Z— , concerning the property located at fC1w�t �� r/jfQR, ►w�-i G[p�, >�' meets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation +adjustment for high G.W. =-6� g D DIFFERENCE BETWEEN A and B SIGNED : DATE: Z o Z_ NOTICE Based upon the above information, a repair permit will be issued for 3 bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:percexmp a T v COMMONWEALTH OF MASSACHUSETTS OFFICE OF ENVIRONMENTAL AFFAIRS EXECUTIVE OF .ate DEPARTMENT OF ENVIRONMENTAL PROTECTION y� � ���•{YYf vv,�./�,���....///���f�flVrr..i\/l'11{n//�ryJ�J S�li1 •SC K� t t 3. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS , SUBSURFACE SEWAGE DISPOSAL,SYSTEM FORM PART A CERTIFICATION "A 1T-NEWTOWN RD MARSTONS MILLS,MA 02648 Property Address: 945 SANTU , Owner's Name: ROBERTA KEANE Owner's Address: PO BOX 543 MARSTONS MILLS MA 02648 x x a , Date of Inspection: 1/8/02 ) 1 r Name of Inspector: (please print), j ; JOHN GRACI Company Name: SEPTIC INSPECTIONS JAN ] O ZOOZf Mailing Address: P.O.'BOX 2119 TEATICKET,MA.02536 { TOWN OF BARNSTABLE FAX 508-564-7270 HEALTH DEPT. 13 FA ' 1 Telephone Number: 508 564-68 j + a CERTIFICATION STATEMENT disposal system at this address and that the information reported below is I certify that I have personally inspected the sewage p Y true,accurate and complete as of the time of the inspection.The inspection was performed based on my roved s and {'` • experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved Y inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes _ Conditionally Passes _ Needs Fu Evaluation by the Local Approving Authority X Fails 'r, 'Date: 1/8/02 i Inspector's Signature: E rovin Authority(Board of Health or DEP)withmx u The system-inspector shall submit copy of this inspection report to the'App g com letin this inspection. If the system is a shared system or.has a design flow of 10,000 DThe original al should be° 30 days of p g ` inspector and the system owner shall submit the report to the appropriate regional office of the g w ies sent to the buyer, if applicable,and the approving authority. sent to the system owner and cop r i Notes and Comments ' SYSTEM FAILS TITLE V INSPECTION.LEACH PIT HAS NO EFFECTIVE LEACHING LEFT. K e t the time of inspection and under the conditions of use at that time.This k bi qfi { ""This report only describes conditions a ., inspection does not address how the system will perform in the future under the same or different conditions of use. ? 4 ^f 1 Titir, 5 1ncnrr6nn Fnrm 6/151innn Page 2 of 11 ,f OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS i 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM � . PART A CERTIFICATION(continued) Property Address: 945 SANTUIT-NEWTOWN RD MARSTONS MILLS,MA 02648 Owner: ROBERTA KEANEt Date of Inspection: 1/8/02 Inspection Summary: Check A,B,C,D.or E/ALWAYS complete all of Section D �3# 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 , ,y CMR 15.304 exist.Any failure criteria not evaluated are indicated below.s R^ � U : Comments: SYSTEM FAILS TITLE V INSPECTION.LEACH PIT HAS NO EFFECTIVE LEACHING LEFT. m B. System Conditionally Passes: _ nal Pass"section need to be replaced or repaired.The system..,' One or more system components as described in the"Conditio � upon completion of the replacement or repair,as approved by the Board of Health,will pass. ' t ai Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. r" - n/a 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 t„ { z with a complying septic tank as approved by the Board of Health. v ; *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating '. �k� " y 20 an ears old is available. `. that the tank is less than ND explain: n/a n/a 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'uneveddistribution 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: n/a x ! 4 times a year due to broken or obstructed pipe(s).The system will pass # n/a The system required pumping more than y , inspection if(with approval of the Board of Health): " i _broken pipe(s)are replaced _obstruction is removed _ NB UPWR 11/1 y f Page 3 of 11 3 'r OFFICIAL INSPECTION FORM.-NOT.FOR'..VOLUNTARY ASSESSMENTS f SUBSURFACE SEWAGE DISPOSAL SYSTEMINSPECTION FORM PART A CERTIFICATION(continued) Property Address: 945 SANTUIT-NEWT.OWN RD MARSTONS MILLS,MA 02648 Owner: ROBERTA KEANE Date of Inspection: 1/8/02Ai '} 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 took F 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 systemr � 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 11 � P p _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh , 9 + dye 2. System will fail unless the Board of Health(and Public WaterSupplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: :, 4+ a _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water 'h supply or tributary to a surface°watee;supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. 3 stem has a septic tank and SAS`and.the feet.of aprivate water supply well. _ The s Y Y P SAS is within 50.f� _ 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 n/a r x "This system passes if the well water analysis,performed at a DER certified laboratory,for coliform bacteria and 4�� volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia h nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered A copy ; z ; 4 of the analysis must be attached to this form. t 3. Other: } n/a t„ T iV 7 rr 51 d .� y t•� Y.n 5 '�Y. 4 Page 4 of I I OFFICIAL INSPECTION FORM—NOT FOXVOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM'INSPECTION FORM �:� PART A t �,, . CERTIFICATION(continued) , ] Property Address: 945 SANTUIT-NEWTOWN RD MARSTONS MILLS,MA 02648 , Owner: ROBERTA KEANE Date of Inspection: 1/8/02 D. System Failure Criteria applicable to all systems: You must indicate"yes"or no to each of the following for all-inspections: i s Yes No X _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Ai k _ X Discharge or ponding of effluent.to the surface of the ground or surface waters due to an overloaded or clogged w � 1 SAS or cesspool ` H �" X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/:day flow ' f.��` _ X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times,t; ' pumped Wa. _ X Any portion of the SAS,cesspool or privy is below high ground water elevation. ion. ry supply. X Any portion of cesspool or privy is within 100 feet of a surface,water supplyor tributary to a surface water su 1 . � ^�� :, X Any portion of a cesspool or privy is within a Zone 1 of a public well: I X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with3� s no acceptable water quality analysis. [This system.passes ifithe well water analysis,performed at a DEP r a � �' certified laboratory,for coliform bacteria and volatile organic' indicates that the well is free w.,b axv�, •r from that facility and the presence of ammonia`:nitrogen and nitrate nitrogen is equal to o�r;w from pollution y less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be r, attached to this form.) . system fails.I have determined that one or more,of the above failure criteria exist as described in310 X _ (Yes/No)The y ° CMR 15.303,therefore the system fail" The system owner should contact the Board of Health to determine what will be i necessary to correct the failure. E. Large Systems: t: 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: a *h (The following criteria apply to large systems in addition to the criteria.above) {t ;� - yes no X the system is within 400 feet of a surface drinking water supply , � L 's a : _ X the system is within 200 feet of a tributary to a surface.drinking water supply �p � X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well : Fj ;i If you have answered"yes"to any question in Section E the`system is considered a significant threat,or answered �� '} "yes"m Section D above the large system has failed.The owner or operator,'of any large system considered a significant tlrreaf 4 i � "+ under Section E or failed under Section D shall upgrade the system in.accordance with 310 CMR 15.304.The system 6wtler. rt should contact the appropriate regional office of the Department. , .•e a� t' ' 46� Page 5 of I I b *"y 6* w 7s . 1'J1�� . OFFICIAL INSPECTION FORM—NOT FORVOLUNTARY ASSESSMENTS '. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART Btl CHECKLIST ' MA 02648 �`14 Property Address: 945 SANTUIT-NEWTOWN RD MARSTONS MILLS, , � Owner: ROBERTA KEANE x �� „ ,. ,.. Date of Inspection: 1/8/02i Check if the following have been done.You must indicate"yes"or"no as to each of the following. ZK Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? '' �= X _ Has the system received normal flows in the previous two week period? _ X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) _ X _ Was the facility or dwelling inspected for signs of sewage back up? cOf � X Was the site inspected for signs of break out'? X _ Were all system components,excluding the SAS, located on site? Were the tic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the se X _ P baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? , X _ Was the facility owner(and occupants if different from owner),provided with information on the proper maintenance f of subsurface sewage disposal systems? F C fi tif the Soil Absorption System(SAS)on the site has been determined based on: t �41. The size and location o j Y Yes no X _ Existing information. For example,a plan at the Board of Health. 'VI aP a`' 4 X _ Determined in the field(if any of the failure criteria related to Part,C is at issue approximation of distance is 71 t I unacceptable)[310 CMR 15.302(3)(b)] t to a x F � khr 3 } .. A S d f �'I Page 6 of I I sg Ri OFFICIAL INSPECTION FORM—NOT FOR'YOLUNTARY ASSESSMENTS � r� SUBSURFACE SEWAGE DISPOSAL SYSTEMIINSPECTION FORM ' ;; ; PART C SYSTEM INFORMATION '# SANTUIT-NEWTOWN RD MARSTONS M Property ILLS,MA 02648 Address: 945 . Owner: ROBERTA KEANE Date of Inspection: 1/8/02lt 1� FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 'utf 3 3C .: Number of current residents: 1 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no):NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO " ; . Water meter readings,if available(last 2 years usage(gpd)): n/a tt j Sump pump(yes or no): NO ' Last date of occupancy: n/a a 2r {�4 COMMERCIAL/INDUSTRIAL i ;, Type of establishment: n/a +' (' Design flow(based on 310 CMR 15".203):..n/agpd f�4 Basis of design flow(seats/persons/sqft,etc.): n/a Grease trap present(yes or no): NO , 1 Industrial waste holding tank present(yes or no): NO F j Non-sanitary waste discharged to the Title 5 system(yes or no):"NO ? ' Water meter readings, if available: n/a k Last date of occupancy/use: n/a OTHER(describe): n/a � GENERAL INFORMATION 1 Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO L If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a y ; Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system ` ' n� 3 *" Single cesspool _Overflow cesspool t 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 t system owner) Tight tank Attach a copy of the DEP approval Other(describe): n/a ' Approximate age of all components,date installed(if known)and source of information: j j 1974 ' s Were sewage odors detected when arriving at the site(yes or no): NO r t Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' a' PART C IP SYSTEM INFORMATION(continued) TNz . Property Address: 945 SANTUIT-NEWTOWN RD MARSTONS MILLS,MA 02648 Owner: ROBERTA KEANE Date of Inspection: 1/8/02 �� BUILDING SEWER(locate on site plan) Depth below grade: 22" Materials of construction:_cast iron _40 PVC Xother(explain):20 PVC Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): BOTH TOWN AND WELL WATER` r� SEPTIC TANK: X(locate on site plan) Depth below grade: 16" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a }�k If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6" H 5' 7" W 4'10" Sludge depth: 2" f Distance from top of sludge to bottom of outlet tee or baffle:32" F Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle:6" .3 . Distance from bottom of scum to bottom of outlet tee or baffle: 16" � }. How were dimensions determined: MEASURED ' Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related:' to outlet invert,evidence of leakage;etc.): SEPTIC SYSTEM FAILED.LEACH PIT HAS NO EFFECTIVE LEACHING LEFT. �Y %' • ] GREASE TRAP:_(locate on site plan) Depth below grade: n/a *; I Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a i •• Dimensions: n/a " Scum thickness: n/a ' Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a - ' Date of last pumping: n/a levels as related li qid Comments(on pumping recommendations,inlet and outlet tee or baffle,condition,structural integrity, u to outlet invert,evidence of leakage,etc.): " 4 c ; ` 7 Page 8 of 11 d' OFFICIAL INSPECTION FORM—NOT FORJqVOLUNTARY ASSESSMENTS ; SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM � # PART C d SYSTEM INFORMATION'(continued) Property Address: 945 SANTUIT-NEWTOWN RD MARSTONS MILLS,MA 02648 Owner: ROBERTA KEANE Date of Inspection: 1/8/02 y TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a ► 5> ;. a �r j• Dimensions: n/a Capacity: n/a gallons w : Design Flow: n/a gallons/day ' Alarm present(yes or no): N/A Alarm level:N/A Alarm in working order(yes or no): NO Date of last pumping: n/a ► Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:_(if present.must,be opened)(locate on site plan)e Depth of liquid level above outlet invert: n/a . Comments(note if box is lev el and distribution to outlets equal,any evidence_of solids carryover,any evidence of leakage into } or out of box,etc.): n/a eqiI n PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO s x 1 Alarms in working order(yes or no):NO r� i Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): k A R 5 Q i a k Pv 1 1 ► ! ys � , r }5 r Page 9 of 11 'g � 4'., OFFICIAL INSPECTION FORM—NOT FOWYOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART : , 41 M SYSTEM INFORMATION(continued) Property Address: 945 SANTUIT-NEWTOWN RD MARSTONS MILLS,MA 02648 Owner: ROBERTA KEANE Date of Inspection: 1/8/02 _ $ L� SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) 4 If SAS not located explain why: �r i n/a Type P „ } 1000 GAL 6' X 6' leaching pits, number: F '' n/a leaching chambers, number: n/a leaching galleries, number: n/a M ' jn/a leaching trenches, number,`length: n/a T n/a leaching fields, number: n/a4 f n/a overflow cesspool, number. n/a I innovative/alternative system f i n/a 1 Type/name of technology: ' n/a l 1 Comments note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) LEACH PIT FAILS.HAS NO EFFECTIVE LEACHING LEFT IMIT. 4 j CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a } Depth of solids layer: n/a µ' 1 4� Depth of scum layer: n/a Dimensions of cesspool: n/a " t Maerials of construction: n/a " , Y.St n Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): . n z. *F n/a ^:. PRIVY: (locate on site plan) x r t - S Materials of construction: n/a `' .l Dimensions: n/a I Depth of solids: n/a �" 1 Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): . ��,.. . ; n/a : . i jL,k'w�Y yl. X. x s+ta t,,3 -Page 10 of 11 " f OFFICIAL INSPECTION FORM—NOT FORNOLUNTARY ASSESSMENTS }�: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM A PART C ' SYSTEM INFORMATION(continued) � . Property Address: 945 SANTUIT-NEWTOWN RD MARSTONS MILLS,MA 02648 s Owner: ROBERTA KEANE s '. Date of Inspection: 1/8/02 `� �- 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. ,, . it �, t1 r tJ!y" Yv i a y ! t {rt � B 4 " A4 13 2Mz t je 4�� k d ` t Y iy i e '..� t ,F Plage 11 of 11 , OFFICIAL INSPECTION FORM—NOT FORNOLUNTARY ASSESSMENTS S'� 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) f. Property Address: 945 SANTUIT-NEWTOWN RD MARSTONS MILLS,MA 02648 Owner: ROBERTA KEANE . P Date of Inspection: 1/8/02 SITE EXAM � w Slopea _Surface water Check cellar ash t Shallow wells Estimated depth to ground water 1feet E f ; Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-1f checked,date of design plan reviewed: n/ah : YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators,installers-(attach documentation) NO Accessed USGS database-explain: n/a A You must describe how you established the high ground water elevation:; DETERMINED BY HAND AUGER- 12VT. r� ; q,w f k � x m T - I 4 y f n" X{NT [y ail r r�F i 11 �� �• - -0YQf+TOWN OF BARNSTABLE LOCATION -Z Z/S"/IK "14)UIV 11?J SEWAGE # _ 20n2000 VILLAGE (=ldk 10AS ASSESSOR'S MAP & LOT 0.2 7-0 eY/ INSTALLER'S-NAME&PHONE NO. S-08- 49240-97-rg J fx,N�'U�/�sp vros SEPTIC TANK CAPACITY _1000 0/0 LEACHING FACILITY: (type) 2-J'00601�p y WI/ 1l (size) NO. OF BEDROOMS .� BUILDER OR OWNER owes /ri_°p o69 PERMITDATE: 2-1 -O2 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 f cIli - Feet Furnished by .. , 4t e 04 r 1 �;r I 9 LOT Design Calculations29 SAn/ TOE T , Number of Bedrooms: 3 WAKEBY RD. '�/� Garbage Grinder: No W/ v Leaching Capacity Required: 330 Gal./Day 0 TO Q � 60 0 y RO/�D Leaching Area Required: 330 Gal./(0.74 Gal./Sq.Ft.)=446 Sq.Ft. �J 0 Proposed Leaching Structure: 1-25'L X 13'W X 2'D Leaching Trench �y z z Leaching Area Provided: 477 Sq.Ft, Z°o z Proposed Leaching Capacity-. 353 gpd > 330 gpd. req'd. AO�OCST = L X 99,00, � S � TC LL 4, 5, 4, }-- O f Ln shed PEAOSTONEB(WASH TO D)" ~ S 11 u� O SPUR SANE Z ___J z 99,50 98,85, MT -1-= © © RHM�24" MIN. < LOCUS 98,64' a 100,85' NO SCALE 3/4" TO 1 1/2" WASHED CRUSHEDSTONEtiers U X 98 94' _� 0) TRENCH CROSS—SECTION v do B o O J 0 g VVV III NO SCALE pen T,H #1 L-Li GENERAL DOTES 100,83' C� O 1. ADDRESS: 945 SANTUIT—NEWTOWN ROAD 2. ASSESSORS NUMBER: MAP 027 PARCEL 041 3. DEVELOPER'S LOT: LOT 12 101,44' In/ 4. TOPOGRAPHIC INFORMATION WAS COMPLIED FORM AN 101 , V q C� ON THE GROUND INSTRUMENT SURVEY. O O� kV O 5. MUNICIPAL WATER IS SURROUNDING PROPERTIES.PROVIDED TO SITE AND Z erg........ concrete e��-,., 6- REFERENCE PLAN: LAND COURT PLAN 34846E — �'�'/ 7. NO WETLANDS ARE LOCATED WITHIN 100 FEET OF SAS. X 101. 4 O pad stag c/ 8. NO POTABLE WELLS ARE LOCATED WITHIN 150 FEET 0'F SAS. vent O �/ 99,7 g Ove/ ariV(e 0 CONSTRUCTION NOTES 9 9,5 2 ay i C)_ � 11. Contractor is responsible for Digsafe notification ---- and protection of all underground utilities and pipes. ...., 2. The septic tank and distribution box shall be set 1 _ 2 5 'L X 13 ', A , \ , 0' D O level on h of be clean 1 sand stone. �/�/ x ; ' ''•, � � 3 Backfil should be clean sand or grovel with no ( stones) over 3" in size. I e a c h I n g trench u s i n g \\ 4. This system is subject to inspection during installation �'`• 99,79' X by Glen E. Harrington, R.S. 2 H - 10 500 gal . chambers with��`•,, , 5. The contractor shall install this system in accordance °f' �` 4 of stone on sides C C ends. with Title V of the Massachusetts Environmental Code ) O and the Regulations of the Town of Fal 6- Provide a Acme Precast 5—Ho!e H-10 D—Box with 101.09, X 2 H-10 500 gal, chambers or equal. 7. No vehicle or heavy machinery sha!1 drive over the septic system unless noted as H-20 septic components. 8. Instalf gas baffle or equal on septic tank outlet tee end. 9. All existing inverts and site conditions Shall be verified by contractor. !/ �J 101. Existing leach pit to be pumped and backfilled. ��ca� O Q 11 . Contractor to notify Board of Health & Designer to verify 5' of pervious soils. r O / /� 12. Leaching trench to be vented with 4" did SCH 40 PVC. LOT I ) / 1-20"DIAM.ACCESS MANHOLE i 100,90' x 9� AREA -- 31 900± SO.ET. -- ---- .. 5' A SOIL EV LUATION Date of Soil Evol.: January 12, 2002 O�j C.B. f nd Test Performed By: GLEN E. HARRINGTON, R.S., CSE �� 34„ Excavator: Abco Excavating 4 I o o � o Test Hole /� No. 1 STEEL REINFORCED PRECAST CONCRETE � H-10 500 gal. Chambers DEPTH SOILS ELEV. !\�/� PLAN VIEW END—SECTION 0 00.83 / H-10 1500 GALLON CHAMBER A f, sandy im NOT TO SCALE aw 5 100 43' X/ USE ACME PRECAST OR EQUAL loamy .sand SITE PLAN \I V 24" 10 50 .04 YRfs 6 98,83' SCALE: 1 "=20' `,.R% BENCH MARKON CORNER of OF '�pC PROPOSED SEPTIC SYSTEM UPGRADE C 1, fine— CONCRETE STEP ELEV.=100.00' (ASSUMED) GLE PREPARED FOR Parse sanER d 2.5Y7/4 LEGEND o H RRI� ON ROBERTA C. KEANE 132' 89.83' ' . 1070 AT NO GROUNDWATER ENCOUNTERED D i EXISTING LEACH PIT TO BE 9F �4ia 945 SANTUIT—NEWTOWN ROAD PUMPED & BACKFILLED S CIS CE *NOTE: ALL PIPES ARE TO BE 4" DIA. SCHEDULE 40 P.V.C. EXISTING 1000 GAL. -91VITA�k\P BARNSTABLE (COTUIT), MA 10' min. from 'NOTE: INSTALL GAS BAFFLE OR EQUAL ON SEPTIC TANK OUTLET TEE. o O H-10 SEPTIC TANK house to septic tank Septic t nk covers must be Finished grade over system=2% slope away I a Existingwithin 6" of finished erode 5 HOLE X 104.46 DENOTES EXISTING PREPARED House SPOT GRADE D-Box cover must be DIST. BOX one chamber cover must be within 6" of finished o nse grade EXIST( ADE g within 6" of finished grade E fisting Grade Elev.=101'± 0 N s ----95 — --- EXISTING CONTOUR GLEN full MIn. 2"-1/8"-1/2 2 - 9 LEDA ROSE LANE 5 = °2 washed stone 36 max. r M A R S T O N S MILLS, M A 02648 5=.D1 Level for 2' Top Elev.=96.5' t- � DEEP TEST HOLE cellar EXISTING 5 ° taoo GAL. 22 Approx. location> P SEPTO 7ANK m 0 7' Invert Elev.=95.23' 10 o m ® o o o z4"MIN. Bottom of Leah - / --�/- - TEL: 508-428-3862 GAS BAFFLE rn GR EouAL I, „ „ N 25' Trench Elev.= 93.23' existing water service FAX: 508-428-3862 w v v w m m ; m ° LEACH TRENCH 3.4' (Verify 5' of pervious soil at ` 6" OF 3/4"-11/2" STONE 5 - II time of installation) 5. .Bottom of T.H. #1 Elev.=89.83' SCALE: 1 "=20' DRAWN BY: GEH FEB. 6, 2002 SYSTEM PROFILE 6" OF 3/4"-11/2" STONE FILE: KEANE.DWG SHEET 1 OF 1 Not to Scale DATUM: ASSUMED I I I I j