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0027 STARLIGHT DRIVE - Health (2)
24 STARLIGHT Dr) A= 100 040 k' z� i I') AF 10 TOWN OF BARNSTABLE LOCATION ?y .SrXeZ/;!,4r SEWAGE # 2609-IkS' VILLAGE AXI3I+St00S fZ�h iS ASSESSOR'S MAP & LOT /DO—O S'3 INSTALLER'S NAME&PHONE NO._SD$ SEPTIC TANK CAPACITY 140061 LEACHING FACILITY: (type) 2-SOO a' ,Wy415;1S (size) .;UX U NO. OF BEDROOMS 3 BUILDER OR OWNER &o%CJTod! LJayw-.CU PERMITDATE: .-- 7-63S -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 S��rL�yti s D�� �- y�� I � p� � V ' ' I _ � 1 �L�� �-1� BUG_1 • so` S3 _ c 7S. -,r c�, •,1, � �cs>p��t��N , port "' No. ) Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Z1ppYicatiou for �Digotal *pgtem Cow6truction Permit Application for a Permit to Construct(4t Repair(4*--Upgrade( ) Abandon( ) [:].Complete System 1XIndividual Components Location Address or Lot No. 05 2 � Owner's Name,Address;and Tel.No. 41, wai rah &.;;;;_ey Assessor's Map/Parcel /a-0 t'2 o'8— �952, Installer's Name Add ess,and Tel.No.s Designer's Name,Address and Tel.No. ✓os.,a* K Ns;:r, S �'rq,•��`rin y ee%®r!< Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of/Repairs or Alterations(Answer w en applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. r Signed Date Application Approved by Date d Application Disapproved by: Date for the following reasons Permit ' Date Issued �� 7 e . 'A ♦.. r- ...�,.* -. .. n's _ „-/'.w.�;1p�'+f•�•��.- tF.+.4"'.. ,.J n 'w�Y.•ti.+."y.i?r^.T�.l.ti',_..r.�.y .- ....-r., •._ ,. •' ! No. Fee THE C OMMONWEALTH OF MAS�l4CHUSETTS r. �V � `� Entered in compute PUBLIC HEALTH-DIVISION - TOWN OF BARNSIA►�BLE MASSACHUSETTS Yes y Application for Otopoal �&pztem Con5tructton Permit 'Application•for a Permit to Construct(i} Repair(4—Upgrade( ) Abandon( ) ❑.Complete System Individual Components q Location Address or Lot No. St�rl� ti r t V/� Owner's Name,Address,and Tel.No. / Assessor's Map/Parcel 08� g Installer's Name,Add less,and Tel.No.s Designer's Name,Address and Tel.No. Jos e ph 0, [.arroS �Ac�in«/Yn� cGar/< / G `P1 0 /h%/ 12 ul, Cro ri str�/,�' o 2 G sr Type of Building: Dwelling No.of Bedrooms ` Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) other Fixtures t Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date r Title t�J A � i ` 7 Size of Septfc Tank Type of S.A.S. Description of Soil Nature of/Repairs or Alterations(Answer w en applicable) 7p��kt�j �?_ S pGt �A� L/-sa,4 U// r 41 Date last inspected: Ir Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described ogVsite 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. Signed Date Application Approved by h/ . Date o Application Disapproved b�: Date s , for.the following reasons I Permit No. C1.0 f(� �r Date Issued 7 0 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed (L--) Repaired ( G.) Upgraded ( ) Abandoned( )by ne. f� /v .rtvy S at 2y srar/,��t rt i"t Ay'K4Srod.S Fy7. �lS has been constructed in accordance ` with the provisions of Title 5 and the for Disposal System Construction Permit No. :2 60L—/O YC"* dated Installer Joss_ Lgr!7Z S Designer„ #bedrooms 3 Approved design flow gpd The issuance of this permit all �Ot c nstr ed as a guarantee that the system wil unction as desi ned. e Date � �y'�(/� Inspector p' � q Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Mtgogal 6p9tem Qfowaructton Fermat Permission is hereby granted to Construct ( �e,) Repair ( f,..- Upgrade ( ) Abandon ( ) System located at 2!!� Star-b Z r r 1/4s -ply-4.,o Air of 1 V J and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Const cti o must be completed within three years of the date of thijwpert�t. Date Approved by ( � �� lvo �o_)t 0 06/05/2008 15:20 5084775313 ENGINEERING WORKS PAGE 01 < < i Town of Barnstable Rephitory Services # Thomas F.Geilear,Director ,.... Public Health Mvialon ' 'Thomas MCICean,Dire' .2A Main Street,Hyannis,MA 02601 Office: 50ti.86,2.4644 I= 508-790-6304 In &mull C F Date: �l �a Sewage Permit# 20/ -IM ..Aa or's Maplp'arcel =-m:Q � � ✓ 1''CC"-" a �. � " S � Svc lesser: _.._ Address: I�r w�� 5�-�-e 1 D� l�1 Address: $l 6A01 rh�#� 61 Z& was issued a permit to install a ( ) (installer) c sya=at L7'ri basedon a design drawn by . (address) ` foe}-er MC 1'' dated 1 d 7 (dcs ) I edtify that the septic sysu=referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the dimIxition box and/or wptic tank. I certify that the septic system refs mc;ed above was installed with major changes (ie. gar them 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State A Local Regulations• Plan revision or certified as-built by designer to follow. OF PETER T. u g McENTEE (I 's sigbawt) CIVH. 9 No'15101�q �4, ' � ;��fi FG1 S I.�P / �SS�oNa� (Designer's Signatkirc) (Affix Designer's Stamp Here) Y■w Asm s1 u'r."1 10 DAMMAM PUBLIC HEALTH DM AM, CEEUF'1tcATE MIPi & M" NOT BE VMD UINTIL BOTH M FORM An ATdBUILT CARD ARE am BY TiuE BAENSTABLE PUBLIC HEAL3M 009 I�XM Q C a iScadw Fom 3-2&44Am -79 r TOWN OF BARNSTABLE LO ' -' r (';v0�'�'I J �j ITT- SEWAGE # VILLAGE MdtyL.STEI S .GAO & ASSESSOR'S MAP& LOT 10U a INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ( O C')c!> c 16-- 1 LEACHING FACILrrY: (type) C { (size) (600!21 h- NO.OF BEDROOMS S n BUILDER OR OWNER PERlvfl'T'DATE:_ ,(r� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and *ty k Z Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) A, I Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) N Feet Furnished by 1 _— AI AZ- a%� CO CAT ION Ova 'Z SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NAME m ADDRESS BUILDER OR . OWNER DATE PERMIT ISSUED 7 A, Z X5- DAT E COMPLIANCE ISSUED 2�h� 4f 42 33' �� Fizz..................sons- THE COMMONWEALTH OF MASSACHUSETTS BOA W)-.,OE HEALTH .............. .........O F..._�r�'� ,-f..%............................ Appliration for Disposal Workii Tonstrnrtiun 11trutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys em at: Loca Address c or Lot No. Owner Address Installer Address UType of Building Size Lot..a?Qf_t----------- feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOth fixtures -----•----------------------------------•-------------.-•----------•-•--...._.. ------------•----•-•--------•--•---•-•......•---....-••---............ W Design Flow....__.....`�.................:.........gallons per person qr day. Total i flow....—..33.0..A.P.-ID......gallons. WSeptic Tank—Liquid capacity._ )0.19;'gallons Length...___..... Width ......... Diameter________________ Depth.t 1,'/l.... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----------1------- Diameter-----1�o----------- Depth below inlet....4i a•......_... Total leaching area...'' sq. ft. Z Other Distribution box ( ) Dosin nk `~ Percolation Test Results Performed by. ............... ................................. Date_. ..................................� 04 Test Pit No. 1................minutes per inch Depth of Test P' .__........__......_ Depth to ground water_____-_--._._.__-_-__-_. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •--• Q. ------ ---------.............................................................................................................. O Description of Soil.....•.•..............1J .._� -------------------------x V ------------------••---•---•-•------•-•••-•------•-••-••••-•-•--•-----•••....---•--.........-----••-••---•--••-------••-••----•--•--•---•--•------------•---------------•--------- ----------- W -------------------------------------------------------------------------------------•---•-------------------------------------------------•----................................................... U Nature of Repairs or Alterations—Answer when applicable._.............................................................................................. -----------•---------------------•-----••-------------•------•-•-----•--•-•--•-•-----•-•-•-•-•----------•-••-••-•--••••-•--•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bewi issued by thq board,of health. te Application Approved By...... . •--- •.... . -• --••--... ........... — Date Application Disapproved for h following reasons---------------•---•-----•---------------•--------•-----•-----------------------------------••--------...__.._... •---- ----------------•••--•---------------•--------•---•--•-•.••--- y Date PermitNo. - -•---------•-••-......--- Issued_..................------------------------------------ Date • /� - ... WW- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r .Xvv1tra ivit r Dili l"af larks C �t r r trrn rrntt# Application is hereby made for a'Permit to Construct ( } or Repair ( ) an Individual Sewage Disposal System at: LoeaGtp?�j-Address r Lot No �`a •--- Owner -'�................................•- y'. a .A.�...d.r.e._s_s 7-------- Vho f .Address---•---•--....-•----•--•................... Type of Building Size Lot.faeril _ S feet Dwelling—No. of Bedrooms__:_ --------------------------------Expansion Attic ( ) age Grinder ( ) `4 Other=T e of Building _____..__.. No. of P-I � YP g ----------------- persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ___________________ ----------------- Design Flow..__. 4�_.�•`______...............___gallons per person per day. Total daily flow .__ { _____gallons. WW •--- Width ".` �"�� Septic Tank—Liquid capacity_f_ __gallons Length ...____. ,, ,�*?______ Diameter ______ ___ Deptli�- ,,: ...... x Disposal Trench—No ______________ ____ Width_____...._._________ otal Length____ __________ Total leaching area....................sq. ft. Seepage Pit No.________-`.________. Diameter____ ______________ Depth below inlet__?............. Total leaching area ,_ -sq. ft. Z Other Distribution_ o0 ( ) Posing tank ( ) aPercolation Test Results Performed by-� _____ _. _ :_______._. Test Pit No. L. minutes per inch ► of est Depth to ground water~ i : Test Pit No. 2................minutes per inch Depth of Test Pit......:............. Depth to ground water: ;...__:::.:-_____:_.__ a+' ••••••••------------•--•--....•••-•-•••-------•...................•-----•-•••---•--•••------•-_...-•-•--------•••-•••--•----•-•._....._-----•-•--•-......... Description of Soil__.......................a________.- .................................................................... W -- .._..---•----•------__•--•••--------•••••------- -- ------•••--••-------------------------------•--------------------------------------- •V••.'. _______________________________________________________________________________________________________________________________________________________________________________7._.________.._.......__. .{ Nature of Repairs or Alterations—Answer when applicable--------------------------------------------------------------- -----------------------------------•-------•--------------=----------------•--•--------------••---------------..---------------------------------_._.--•-•--•••-••--•------ :Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in ..,operation until a Certificate of Compliance has been issued by thpe board of health. ..... --•-• ...` ........... •-• --•---.:. :... ---- ......... -- --- Date Application Disapproved f o t e following reasons: ................................................................................... ................................................. . ............•...................................................................................................•................................... i 1.0 Date PermitNo...................................................--.... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF........................................................:............................ Tutifirtttr of Toutpliattrr THIS 1 $6FT(FY, TW1 thQ2peidual Sewage Disposal System constructed or Repaired ( ) by ____...-•✓1W-`---------------------•-�--t�-- --•-----------------•-----_..... E t at....................••--•--•-•- has been installed in accordance with the provisions of TI ,a�f�he State Sanitary C-�e_ae�s in the application for Disposal Works Construction Permit No.......________________________________ dated__-.-____-_-___________-___-_______-__________: THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FU ION SATISFACTORY. DATE..............•••......`? , ................................ Inspector___................ .............................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I ................OF.................................. '� ... No......................... - ....G Maps k ' n rrutit ::Permission hereby granted----------= -.............................•--------- -1•�--'=�----- ------•--•---•----- to Constr ct _) S�,Re r ) an d idual e. age pis o `§ystefti 0 f at No....... v' 1 r�l L t ___ ______________ ...__ -♦ _ __________. 4 Street �t�� as shown on the application for Disposal Works Cons uction Permit N _____________ ____ Dated_.... ..._..__,.,�•�_._._._.. r c i Bo o ealth DATE............ -- ............. ---------------- FORM 1255 A. M. SULKIN, INC., BOSTON I' y E FA/J/L Y 3 BE0.2a VM - -- -- - IVO 64,,2B.46E 3 G O/.S�S,4L �/T•--USE /,4G0 eS/JL. . � r � � BOT .4.P-�.d T-UT.4L. 0.4/LY�LoJ-t/= �34 G•,4o, OES/G� �E.2COL4T/a.V.24T�:' � /a�• Z P,ZH OF z PETER °tea SULLIVAN 4-' 2_o,C)co)u FJo 2973 - s TE:Sr'Ile A. 7-Zc/ -/775 10457, a2dUGL -• • 6•aG. BOX /N✓. G,4L• J.� it LFr1C,41 P/T�/y/pZ-D /C�Z,�o S.�P7�'G G�� �,•• W,dts+Ep � /D f�NE •.• /02.2 /oZ. CE.2T/F/EO f7Z-OT pL-441 GP,d4L � .• /,7 92.0 / LE.PT/Fy T.yQTcam- ,yE�Eot/ /NG. A�v�SETQ/1G,� ,QEQU/�E�1�i�/T_S o� TiyL; ,C�EGisr�ecl!-�No.SU.2riEya,P� ,1A,.,9 T- �1•2r.� 1� n; 11 1 J ' \G.V`' \ �t;r � �..�� r•f Tyl:��ti /.s /S!o�-- .3.4fE0 Gov ASV/iY.ST.e- S�K/�.�E,2�oiV,S.rv�UU�-��L1T LSE USEp Mz.9 '�. /t/O G4.2B�1 GE G,2/�C 0E.2 oo I OA/LY DLOk/ _ //OX3 I 71 Ivi OF l�/.S�S,4L P/T•-USE /,41J0 eS'!1L_ . � r F f Mq„ S PETER v SULLIVA r; j �}UDC) � a No. 29733 14 en 7- /775 AW /CL 6 aG, /iYI� BOX /v v GAZ— JA � �dcrr sir�. /oZ,o /oz•ly S-EvrrC .fTGNE G'E,2T/F/EO PG OT ,oLA�t/ «dv ' PL.d,41 S 7 A/o W�4TC� .�/E�Eo v G'Or+lP�YES W/Tx/TiyE S/oE�✓,c/� B,aXTE,e AAvv.fETl�/ao` ,Q�QV/�E/YI�NTS 4� Th'� ,eE6isr�eclJ,G ar✓v•sli.2riEyo,P� TOx�.v OF �/•�7�c/5i.�1-T��C Q�vI� /S ivoT- C�sTF,et��Lt� L4C.aT�.O Y✓/Ti5//�1/ T.S/E �LadOPG.4/it/. JOB-•,/ 1'f Lj,C;QL I \�,'��' ��s ?l G� C ,' Tylt P�Xv /.S �YoT .6AfE0 Gov,4 Al/iY.STle- A07-19E USEp Nj SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. SIgne item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X G2 �J ❑Addressee so that we can return the card to you. B. Received by(Printed Name) Ilk. Date of Delivery Et Attach this card to the back of the mailpiece, C or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No fCN �� IN�iQ?l� 3. Service Type ❑Certified Mail ❑Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. r 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7005 1160 0000 0.191: 0270 (transfer from service label) _ _ PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATEc-N NIA.- ` NOV ;K:'.t a) FW 2 • Sender: Please print your name, address, and ZIP+4 in this box • PUBLIC HELATH DIVISION TOWN OF BARNSTABLE 200 MAINSTREET HYANNIS, MASSACHUSSETS 02601 �e'Cjr:3"� r'�.3C..3".4. i�llFittlflflltfiltlFltfitt�fll.lFltilltSlttttitlt!ll�lfttl3lt� Town of Barnstable Regulatory Services Thomas F. Geiler,Director 9� MASS .� Public Health Division p�ED MA'S a Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 November 6, 2006 Mr&Mrs Weston Bonney 24 Starlight Drive Marston Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located at 24 Starlight Drive,Marstons Mills,MA was last inspected September 201h 2006 by,Patrick M. O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Leaching pit is full to top,has no effective leaching. You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE HEAL H DEPARTMENT as McKean, R.S., C.H.O. Agent of the Board of Health COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS r DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION SOU D Property Address: 24 Starlight Drive y'I Marstons Mills MA 02648 Owner's Name: Weston&Patricia Bonney -w Owner's Address: Same Cj Date of Inspection: September 20,2006 Job#06-261 a.l w cc Name of Inspector: PATRICK M.O'CONNELL ur > 70 Company Name: SEPTIC INSPECTION SERVICES CO. -o Mailing Address: 189 CAMMETT ROAD u' MARSTONS MILLS MA 02648 ' Telephone Number: 508-428-1779 c,n r- � t+7 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ```aogttott►►►q►� -- Passes �� ••.. , .�''�. Conditionally Passes �= Needs Further Evaluation by the Local Approving Authority F HICK _X_ F = M. •.� 'C') Inspector's Signature: Date: 9/20/06 •• F�p. 2, .�` F5INSPEG�O����` The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of I-1 fifthront0%���� DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: Leaching pit is full to top,has no effective leaching. ""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. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 24 Starlight Drive,Marstons Mills Owner: Weston& Patricia Bonney Date of Inspection: September 20,2006 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: Page 3 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 24 Starlight Drive,Marstons Mills Owner: Weston&Patricia Bonney Date of Inspection: September 20,2006 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 24 Starlight Drive,Marstons Mills Owner: Weston&Patricia Bonney Date of Inspection: September 20,2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No —X_ _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ Static liquid level in the distribution box above outlet invert due to An overloaded or clogged SAS or cesspool _X Liquid depth in cesspool is less than 6"below invert or available volume is less than_day flow _X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.[This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _Yes_(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large 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• 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 11 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. Page 5 of 11 d OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 24 Starlight Drive,Marstons Mills Owner: Weston&Patricia Bonney` Date of Inspection: September 20,2006 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _ _X_ 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? _X _ Was the site inspected for signs of break out? _X _ Were all system components,excluding the SAS,located on site? _X_ _ 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? _X _ 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 _X_ _ Existing information.For example,a plan at the Board of Health. _X_ _ 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)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 24 Starlight Drive,Marstons Mills Owner: Weston&Patricia Bonney Date of Inspection: September 20,2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):330 Number of current residents:3 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): Seasonal use:(yes or no):No Water meter readings,if available(last 2 years usage(gpd)): Two years total: 138,000 gal.=189 gpd. 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: Tank pumped 6 months prior to inspection. Source of information: Owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X 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: 1978+/- Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 V OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 24 Starlight Drive,Marstons Mills Owner: Weston&Patricia Bonney Date of Inspection: September 20,2006 BUILDING SEWER:XX (locate on site plan) Depth below grade: 1' Materials of construction:_cast iron _X 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: XX (locate on site plan) Depth below grade: 16" Material of construction:_X_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:8.5'long x 5.2'wide—1000 gal. Sludge depth: I" Distance from top of sludge to bottom of outlet tee or battle:29" Scum thickness: 2" Distance from top of scum to top of outlet tee or battle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations,inlet and outlet tee or battle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Liquid level at bottom of outlet invert,tank is structurally sound with no evidence of leaks GREASE TRAP: No (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: Comments(on pumping recommendations,inlet and outlet tee or battle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 24 Starlight Drive,Marstons Mills Owner: Weston&Patricia Bonney Date of Inspection: September 20,2006 TIGHT or HOLDING TANK: No (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 pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" 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.): Box full to too. PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of I 1 >t OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 24 Starlight Drive,Marstons Mills Owner: Weston&Patricia Bonney Date of Inspection: September 20,2006 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _X—leaching pits,number: One 6x6 pit. leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): Liquid level at ton of structure,nit has no effective leaching. CESSPOOLS: No (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: No (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.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 24 Starlight Drive,Marstons Mills Owner: Weston&Patricia Bonney Date of Inspection: September 20,2006 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. Starlight Drive ater Service Driveway :ti:/,:,:.tin•.t?v}:•}r%}:%}:;:;:titiv,..:\r::.v?:?:::?'v::?::.: {.:. .t .a ...C:.w:.•.v4 „{ :�ii�l:4M1:i�:ii%%'%n•%r�{';%:'{'i::}r'r,:•,:;�i�"�' ::{.t::^:'::}{ry{�•.•.:p ?}�.f.}??}}::4}:y:t'>t:•. Sid•?•.:v:r.t..,y:.vt...i. 4 x 27 43 1 33 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 24 Starlight Drive,Marstons Mills Owner: Weston& Patricia Bonney Date of Inspection: September 20,2006 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: 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: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: A perc test will be performed prior to repair to determine groundwater elevation. m OCT 2219� 9 �. COMMONWEALTH OF MASSACHUSETTS N EXECUTIVE OFFICE OF ENVIRONMENTAL DEPARTMENT OF ENVIRONMENTAL PROTE 1 ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 A WILLIAM F.WELD TRUDY COXE Governor Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Lt. Governor Commissioner M k . ` O(D SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A Lo'r- d y V CERTIFICATION Property a4 ��.���.,i Dvl_ �t�aa�i�s 1-�,l�s • Pro Address: � Address of Owner. Date of Inspection: q,24`S t�Lt•y� (If different) Name of Inspector: M it-"r Nt-\ L I am a DEP approved system inspector pursuant to Section 15.340 of Title S(310 CMR 15.000) Company Name: r L Mailing Address: Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the.time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: APasses Conditionally Passes Needs Further Evaluation By „e Local Approving Authority Fails \f Inspector's Signature: Date: \ V The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. _ INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: 1 have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. CO NTS: 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. Indicate yes, no, or not determined (Y. N. or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20)years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound,'shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Pace t of io SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) . Property Address: Owner: Date of Inspection: B]SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken. settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health. safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERIIIWES THAT THE SYSTEM IS NOT FUNCTION ' G IN A • MANNNER WINCH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONIIE>\T: 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 V1'ILL FAIL UNLESS THE BOARD OF HEALTH (AN') PLBLIC WATER SUPPLIER, IF APPROPRIATE) DET ILNUNTS.THAT THE SYSTEM IS FUNCTIONLNG IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has.a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile.organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or..less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 or to SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property.Address: Owner: Date of Inspection: D] SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an 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 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds. ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design (tow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No 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 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. • •1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: anti Owner: (VirLr'W. Date of Inspection:�` Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yet No Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as pan of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. Existing information. Ex. Plan at B.O.H. Determined in the field (if an of the failure criteria related to Pan C is at issue, approximation of distance is unacceptable) _ Y [15.302(3)(b)) I (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: kc4kit4w ' Date of Inspection: �R�( �(CJ� FLOW CONDITIONS RESIDENTIAL: Design flow:3 p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents: Garbage grinder (yes or no):� Laundry connected to system (yes or no): Seasonal use (yes or no):_6.3 Water meter readings, if available(last two(2) year usage (gpd): N Sump Pump(yes or no): . N Last date of occupancy:: COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: ¢allons/day 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: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PU11iPL11G RECORDS and source of information- Nu k�.�&s System pumped as pan of inspection: (yes or no)_) If yes, volume pumped: Gallons 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 614 Owner: Date of Inspection: o` c' BUILDING SEWER: V (Locate on site plan) Depth below grade: , v Material of construction: _cast iron_40 PVC_other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:IIIj (locate on site plan) tl Depth below grader Material of construction: concrete _metal _Fiberglass _Polyethylene_other(explain) If tank is metal. list age _ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: V UG VA., Sludge depth: w Distance from top of sludge to bottom of outlet tee or baffle: 32 Scum thickness:" u Distance from top of scum to top of outlet tee or baffle: lG y Distance from bottom of scum to bottom of outlet tee or baffle:—Lq How dimensions were determined: Comments: (recommendation for pumpin . conditio o inlet and outlet tees or baffles, depth of liquid level in relatio to outlet i ve s[ruct 1 in[ rity, evidence of leakage, etc:) U P El �'`t GREASE TRAP: (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 battle: ` Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity. evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 i J , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: &JA Date of Inspection:0 ( \C%t TIGHT OR HOLDING TANK:_(Tank must be pumped prior to, or 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 level: Alarm in working order_ Yes. _ No Date of previous pumping: Comments: (condition of inlet tee. condition of alarm and float switches. etc.) )ISTRIBUTION BOX41's (locate on site plan) ,,, Depth of liquid level above outlet invert: 5 ti I VA ovS� T'iv T" X �jtK,` Comments: (n to rf I vel and distributi n i e al, evidence of sol�'ds carryover, evid a of leakage into or Qut of box, etc.) ���LZn ��) ��t9 L�1)ON Luz �lc� f Y� a�LC� [c Iu��..� PUMP CHANT BER:_LA- 3 (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: aZ k1 Owner: K Date of Inspection:C(\96\S b SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible. excavation of required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: (oX S leaching chambers, number:_ leaching galleries, number: leaching trenches. number.length: leaching fields. number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (not ucontion o`�f soil. signs of hydraulic failure, level of ponding, condition of vegetation, etc.) W , CESSPOOLS: Oil (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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:A=v (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.) (revised 04/2S/97) Page s or to SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Add Owner: Date of Inspectioh: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) fly_ aj 41 3 33 \ 63" N q t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: +T Owner: ( (a Date of Inspection: Depth to Groundwater ZFeet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators. installers Use USGS Data Describe in your own words how you established the,High Groundwater Elevation. Must be completed) (revised 04/25/97) Page 10 of 10 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION a RECEIVED n n voV y0 JUN 2 9 2004 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS _ SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 24 Starlight Drive Marstons Mills MA 02648 Owner's Name: Anthony Polselli - Owner's Address: Same Date of Inspection: June 21,2004 Name of Inspector: PATRICK M. O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and exp i' � ncc in the proper function and maintenance of on site sewage disposal systems.I am a DEP dpprol syste inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: N���\(�ti10F11111/j��� ca ���` ••�•u•••• ///// at cti!. X__Passes ��V///� ��•� •• p�i� Conditionally Passes 'yG% Needs Further Evaluation by the Local Approving Authority s t � n p '-' Fails = E L s U- Iwspec is Signature: D Date: 6/21/2004 _ ��i���� IINSPE 7�sys�► inspect�r shall submit a copy of this inspection report to the Approving Authority(Board of Hea 01 DEP)within 30 day�,s of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments: Observed 8"effective leaching in pit, recommended treatment to lower liquid level. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 24 Starlight Drive,Marstons Mills Owner: Anthony Polselli Date of Inspection:June 21,2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: XX_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: Page 3 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 24 Starlight Drive, Marstons Mills Owner: Anthony Polselli Date of Inspection: June21,2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(6)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 I 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 detennine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 24 Starlight Drive,Marstons Mills Owner: Anthony Polselli Date of Inspection: June 21,2004 D. System Failure Criteria applicable to all systems: You must indicate"yes" or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool —X— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow —X— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. __ —X— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone I of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. —X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (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 forma _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 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. 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 11 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: 24 Starlight Drive,Marstons Mills Owner: Anthony Polselli Date of Inspection: June 21,2004 Check if the following have been done. You roust indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _X_ 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? _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? _X_ _ Was the site inspected for signs of break out'? Were all system components,excluding the SAS, located on site? _X _ 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 ? _X 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 _X_ — Existing information. For example,a plan at the Board of Health. _X_ _ 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)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 24 Starlight Drive,Marstons Mills Owner: Anthony Polselli Date of Inspection: June 21,2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder(yes 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): Seasonal use: (yes or no): No Water meter readings,if available(last 2 years usage(gpd)): 2002—79,000 gal. 2003—66,000 gal.=199 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMM ERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,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: Tank pumped every two years Source of information: Owner Was system pumped as part of the inspection(yes or no): No If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_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: 1984 Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 24 Starlight Drive,Marstons Mills Owner: Anthony Polselli Date of Inspection: June 21,2004 BUILDING SEWER: X (locate on site plan) Depth below grade: 1' Materials of construction:_cast iron _X-40 PVC_other(explain): Distance from private water supply well or suction line: 25' „ Comments(on condition of joints,venting, evidence of leakage,etc.): SEPTIC TANK: X (locate on site plan) Depth below grade: 16" Material of construction:—X—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: 8.5' long x 5.2'wide—1000 gal. Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 27" Scum thickness: 2" Distance fi•om top of scum to top of outlet tee or baffle: 7" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Baffles intact and clear, liquid level at bottom of outlet pipe GREASE TRAP: No (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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 24 Starlight Drive, Marstons Mills Owner: Anthony Polselli Date of Inspection: June 21,2004 TIGHT or HOLDING TANK: No (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 pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" 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.): Liquid level at bottom of outlet pipe,no high stains or solids present. PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 24 Starlight Drive, Marstons Mills Owner: Anthony Polselli Date of Inspection: June 21,2004 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits, number: One 6x6(1000 gal.)pit. leaching chambers,number: leaching galleries, number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: _innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): 8"effective leaching at time of inspection. Recommended treating to increase available leaching capacity. CESSPOOLS: No .(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: No (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.): n I Page 10 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 24 Starlight Drive,Maroons Mills Owner: Anthony Polselli Date of Inspection: June 21,2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Starlight Drive w�h �Z 1000 gal tank 1000 gal pit 1A Page 1 I of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 24 Starlight Drive, Marstons Mills Owner: Anthony Polselli Date of Inspection: June21,2004 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 30 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: Checked with local excavators, installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el.40 and topo map shows property above el. 80. „ YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1'FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: % Q7016 Fill in please: APPLICANT'S YOUR NAME/S: opt a f i G BUSINESS YOUR HOME ADDRESS: l �7Y T �Yli r5r h2 lfs arE2fr� F , r� / LEPHONE # Home Telephone Number 7 9-1 �26 -`I7 Y? 3 4 Y �FY;�RVM`L'R,d �h kt3 u' NAME OF CORPORATION: TYPE OF BUSINESS 'NAME OF NEW BUSINESS. errvc/-a /urn IS THIS A HOME OCCUPATION? _Y NO MAP/PARCEL NUMBER (Assessing) ADDRESS OF BUSINESS a?q �v When starting anew business there are several things yo u must do in order to be in compliance with the rules and regulations of the own of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 20D Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has in orme ny permit requirements that pertain to this type of business. orized Signature** MUST COMPLY WITH HOME OCCUPATION RULES AND REGULATIONS. FAILURE TO COMMENTS: 2. BOARD OF HEALTH MUST COMPLY WITH ALL This individual haitiforme�d pe� r�quirements that pertain to this type of business. MUST MATERIALS REGULATIONS Authorized Si nature* COMMENTS: 1 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of.the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: t r s' LEGEND - �" Old Falmouth Rd 53G°32'43"W �-- �3�}—fr PROPOSED CONTOUR 125.00' sy�p '� �g PROPOSED SPOT GRADE moss P o` ,�° * - �° - 97EXISTING CONTOUR c e LOCUS 102,76 x EXISTING SPOT GRADE Z TEST PIT �, �'%�.•...�� � �" of �/ v _ ©� ra W EXISTING WATER SERVICE 40v of G EXISTING GAS SERVICE EXISTING S.A.S. . ..-.--.�.._f�a,,- TO BE PUMPED & � faGS O>~ f€A II ._ �T 1 29' UGW UNDERGROUND WIRES ° 01� St FILLED WITH SAND TP-2S . 0 BENCHMARK Route 28 kEC 610 LOCUS MAP N.T.S. EXISTING SEPTIC TANK a .� �9 TOP OF TANK EL. 38.78� D— INV,(OUT)=S)7.45 l GENERAL NOTES: _.... Sdy 1: ALL _CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL ' `J BOARD OF HEALTH AND THE DESIGN ENGINEER, wOECK 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, 111LE V, AND ANY APPLICABLE. LOCAL- RULES AND, REGULATIONS. / „. . , .. 3. THE SEWAGE DISPOSAL, SYSTEM SHALL NOTE BACKFILLED PRIOR TO INSPECTION AND APPROVAL' BY THE BOARD OF HEALTH AND THE ji / NO F24/ / /l.i'i 1100 DESIGN ENGINEER. a .` y ' i i `�� 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING %'GA ►GE //,/ I f gTY6 N FROM THOSE SHOWN HEREON__SHALL BE REPORTED TO THE DESIGN / $ ENGINEER BEFORE CONSTRUCTION CONTINUES. S. ALL ELEVATIONS BASED ON ASSUMED DATUM, T.O F° - 101.65' /" t q, o i r' Fs. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOOD THE FAILURE OF ' THECONTRACTOR OR OWNER TO NOTIFY HE LOCAL BOARD OF Z HEALTH FOR PROPER INSPECTIONS' DURING CONSTRUCTION. E... _. /.AKF4T... -/�. t 7. WATER SUPPLY PROVIDED BY TOWN WATER, P 3ENCi1MARK. JTI'��W�AVI\ ELEVATION - 100.0- as THERE ARE NO ABUTTING WELLS LOCATED WITHIN 150' OF THE S.A.S. (ASSUMED DATUM) 9. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED L ) .> TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. .. . �. 10, IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY J ?� THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING j CONSTRUCTION. 1 11, WHERE REQUIRED, CONTRACTOR SHAL0-REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. 51 CO . APN 100-043 AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3). 1)RJ` YVA`� 12, CONTRACTOR SHALL EVALUATE STUCTURAL INTEGRITY OF EXISTING 20,000±5f Mqs� SEPTIC TANK PRIOR TO CONSTRUCTION. ✓ Q� fly 11 THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY o PETER T. J' AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. McENTEE CIVIL 11 25.Oa `` No. 35109 PROPOSED SEPTIC SYSTEM UPGRADE i N3 °32'43"E �` Y� Fss ��� 24 STARLIGHT DRIVE, MARSTONS MILLS, MA Prepared for: Weston Bonney, P.O. Box 912, Barnstable, MA 02630 if. G-_ ,� ! _............................. . ..... . .................. ... - `7L�d-� � EDGE Of Engineering by: Surveying by: SCALE DRAWN JOB. NO.CLEARING sod �� EnglneeftWork HOOD SUBVE'Y CROUP 1"=20' P.T.M. 152--07 d y 12 West CrossHeld Road 18 Route 6A t Forestdole. MA 02644 Sandwich, MA 02563 DATE CHECKED SHEET 5TARLI G H T DRIVE i (508) 477-5313 (508) 888-1090 6�12�07 P.T.M. 1 of 2 2 � 1 NOTE: TO PREVENT BREAKOUT, THE PROPOSED I FINISH GRADE SHALL NOT BE < EL:96.0 T:O.F .' cL F.G. EL: 99:01 _ (EXISTING) -PERIMETERTOFCTHEFS.A,S,AROUND THE EXISTING FiG• EL: 99.9%P(EXISTING) /� F.G. EL: 99.1 a MAINTAIN_2% MIN SLOPE OVER S.A.S, 4 SGH 40 PVC PERFORATED PIPE NTH_ _ SCREW CAP SET TO WITHIN 3" OF FINISH INSTALL RISERS OVER INLET & OUTLET INSTALL RISER OVER D-BOX TO 2-55Qp,.CA"N t. 4bl CABERS GRADE._TO ,SERVE AS INSPECTION PORT, TO WITHIN 6" OF FINISH GRAPE WITHIN 6" OF FINISH GRADE IN S 81.5 WIIH..-,T N:_.A S •' �' INSTALL RISER OVER CHAMBER _. L =32' i L=4' SHOWN ON PLAN AND SET COVER - -- A - 4 SCW_ 4Q PVC GRADE 4" SCH 40 PVC _-.-. _ __. IN OF FINISH __ — ---- _. . " � 70 2 8 � .. EXISTING - . ,� 14" ® S� 1% (MIN.) e' S= 1% (MIN.) _ ® DOUBLE WASHED STONE b 48"_LIQUIb 2' EFF. DEPTH a p (OR APPROVED FILTER FABRIC) INV:=g6.17 INV,�96.00 8�®�i r.. LEVEL 1/2„ ADD GA5_ 4 5.21 4 EXISTING BAFFLE . O-BOX f _ _.... - DOUBLE WASHED INV.=97.45* STONE EXI1833,N.Q. .OQQ QrAL414 .SEPTIG__7ANK (SEE NOTE 12-SHEET 1) f INV.m-95:50 - - R TOP CONC. ELEV:-96:3 - - BREAKOUT ELEV.=96.0 NOTES: 1 CONTRACTOR SHALL VERIFY ALL. EXISTING INV. ELEV.=95.50 --- A7,10 PIPE INVERTS PRIOR TO CONSTRUCTION: i e2) D--BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV:=93:50 --- GRADE ON A MECHANICALLY COMPACTED SIX 2 x 8 5' _ 3' INCH CRUSHED STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2), 5' MIN. ABOVE BOTTOM OF H7�� EFFECTIVE LENGTHft 23.0'3) INSTALL INLET & OUTLET TEES AS REQUIRED, T.P. EXCAVATION OR GA 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE: NO G.W: ENCOUNTERED BEACHING 5YSTEM...SECTION �) SEPTIC SYSTEM PROFILE BOTTOM OF TP EL. $7.4 (TP- N.T,s. (3) 6" DIA:OUT'LETS DEIGN_ CRITERIA y t21 NUMBER OF SEOROOMS: 3 BEDROOMS 0 " r ,\ SOIL TYPE: CLASS I 8' ` 'S i \ _.._. 4 DESIGN PERCOLATION RATE, 5 MIN /IN; T 2" `\ aOILr L"nG DAILY FLOW: 330 CPA H-10 LOADING DESIGN FLOW: 330 G.P:D D--Box \ GARBAGE GRINDER: NO "•---..- \ 0 \ DATE: JUNE 7, 2007 (p=11 769) EVALUATOR: PETER - _. - - LEACHING AREA REQUIRED; (33O = 445.9 S•F. `a01L EVALUATdR, PETER MLENTEE F�,E:, C,S.E: �. WITNESS: DONNA MIORANDI -y HEALTH AGENT 74 _.. _ \ �� EXISTING SEPTIC TANK: 1000 GALLON CAPACITY (ESTIMATED) -. ®I®�0903M0ERIM§! - 33• EIeY,_. p. epSr+ Elev,. pt- N ® _.- mo — -- o" — : _ U_$E 2 ,5a0 LLD( LEACHING CHAMBER$ IN SERIES �IB) A SANDY LOAM $g,$ D" A SANDY LOAM SIDEWALL AREA: 2/13.2' + 23,0' X 2 = 144.8 S.F. 19YR 3/s3/3 \ 1oz" s SANDY LOAM beta .e - - b" BOTTOM AREA: 13.2' x 23.0' = 303.6 S,F 10YR LOA SANDY LOAM �g ro ne,b c l 3s' 10YR 5/5 TOTAL AREA: 448.4 S.F. 4• KNOCKOUT c DESIGN -FLOW PROVIDED: 0:74(448.4) = 331.8 G.P.D, " KNOCKOUT 04• KNOCKOUT 62" DEC �� P�24 ROPOSED SEPTIC SYSTEM UPGRADE M-C SANDMARSTO N S MILLS, MA 4" KNOCKOUT TARLIGHT DRIVE, 2;5Y 8/a MSC SAND _ / 2 SY 8/4 Prepared for: Weston Bonney, P.O. Box 912, Barnstable, MA 02630 ' 'i ' f Surveying b SCALE DRAWN JOB. NO. / � L � �O 2�'% / Engineering by; Y 9 Y. 500 GALLON CAPACITY, H�10 LOADING j !i' / / / •, ,���/ 87,5 138" E n8erin Work�t ROOD SURVEY GROUP N.T.S. P.T.M. 152- d7 i 87.4 ._ _�- - 138" NO GROUNOWAtER OBSERVED 12 West Crossfield Rood 18 Route 5A CHAMBERS DATE CHECKED SHEET NO. �•�•-- - J.A.S. LAYOUT Forestdale, MA 02844 Sandwich, MA 02563 PERC RATE �2 MIN/IN, ("C" HOFi2gN •• fP 1) (508) 477-5313 (508) 888-•1090 6/12/07 P.T.M. 2 Of 2