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0051 STONE BRIDGE LANE - Health
51 STONE ,-- 125 - 06006 Marst©ns Mills TOWN OF BARNSTABLE LOOATION 51 Sionc. Q 6J lc L►y SEWAGE# 2011. - Z8`7 "VILLAGE (n: yl-1 ; 115 ASSESSOR'S MAP&PARCEL /Z$-t)L-M) INSTALLER'S NAME&PHONE NO. -Q�va EXCpkVCL-J i o✓� y`�1- DG53 SEPTIC TANK CAPACITY /O O O g 0. LEACHING FACILITY:(type) SOpgQ 1 L Jc irz) (size) IS x ZS x Z NO.OF BEDROOMS $ OWNER Saf1- CLAS?C 1 O PERMIT DATE`. $-/L • /G COMPLIANCE DATE: $• Z 3.1 L Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ,41 AZ'�7 �2. 37 O 3 A 3-S"L/ B3• ° �7, �,, Roar Ay' ,� 4tSI �►�,�c. No. � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes appliLation for bisposat 6psfrm COYCBtrUttion Permit Application for a Permit to Construct( ) Repair(✓j Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 41 Sjo nr_ 1Sr i 0(9 C L1U Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel 1&6 C46 ao& �YIm / chacl ,SAp-rAQ6c to Installer's Name,Address,and Tel.No. 13 4V$ EXcaVW- ?"OA Designer's Name,Address,and Tel.No. Iy -TcMSm1-ry Lrj Foresjdcm1_ F'La►.Hc r4q C'rv,01-Mcn4c7-1 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.8. Garbage Grinder( ) Other Type of Building Rcsj ni,a,j No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided i2 y$ gpd Plan Date $- )I - /1i Number of sheets Z Revision Date Title am Size of Septic Tank 1000 Q<x Type of S.A.S. SOD 515 I W C (�Z) Description of Soil Nature of Repairs or Alterations(Answer when applicable) lCqcj.,7 n q Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign Date Application Approved by Date / Application Disapproved by Date for the following reasons Permit No. / 947 Date Issued 1 ,.f q ,No., � Fee /QQ ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes w _ 01pplitation for MiStJO$a �pstem Construction 3permit Application for a Permit to Construct( ) Repair(✓f Upgrade(, ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Jt i 51 o n c S r i d 9 G Owner's Name,Address,and Tel.No. a Assessor's Map/Parcel `ft� M6 CIO& >�' n) � ►cha c i ,$1q rJTA►.1 G C �O Installer's Name,Address,and Tel.No. 13 s $ EXCa Vo �o Designer's Name,Address,and Tel.No. Iq -TcASzrr4 4y C►Xv1or,men-la� Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building R c:5•i j rn A .cA` No.of Persons Showers( ) Cafeteria( ) Other Fixtures R Design Flow(min.required) a3 0 gpd Design flow provided SI? gpd Plan Date g I 1 )L Number of sheets 2 Revision Date Title k Size of Septic Tank 00r)q OL 1` w. Type of S.A.S. �O� q<�L Description of Soil Nature of Repairs or Alterations(Answer when applicable) Boy ►J C Li C q C �. ► n q 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. ,Sign Date - r• li Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 0-!it7 Date Issued IZZI ) G THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by 2 E. 3 E A Ca t/a!j , OA at :! I S-i o n C.-.6 r i of c)c. Lrj has been constructed in accordance g/ with the provisions of Title 5 and the for Disposal System Construction Permit N�/9 ^`�7dated Ul1(p 116 Installer JR ,[; E x caLO(Z0 t ©/\ Designer F I a k s 4 u E"t/ ► or rM c #bedrooms 3 Approved design flow 3 y$ gpd The issuance of thist permit shall not be construed as a guarantee that the system will ctio Ias design Date Z I Inspector -. --No/ !�-�0�-6 /------------------ ---- ----------------------- ----,' -------------------------Fee --r(1--�--------- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pBtrm Construction Vermit Permission is hereby granted to Construct( ) Repair( ✓f Upgrade( ) Abandon( ) System located at S) SJ an c.Jt r J 9 C- L YJ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be omple ed within three years of the date of thl• permit. Date ��1 / Approved b Town of Barnstable ' Regulatory.Services wartsres�. Richard V. Scali,Interim Director !k MARK .`� Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508 790-6304 Installer&Designer Certification Form Date: '9'-2 3 Sewage Permit# 101 G • 2'g`7 Assessor's Map\Parcel.1 Z,s•G Designer: hCrA EAv;rom -a.1 Installer: � 3 EXGayc �i' on . Address: P.O Box, $ 1 Address: 1%A :TC err+L4W �arMo�-�haor� F'oresa olalc. Ex ;o- was issued a permit to install a (date) (installer) septic system at S*1 S�one.b rio�ge L►J based on a design drawn by (address) �r1er�� Ewv ror+�enia.,1 dated (designer) I certify that the septic system referenced above was installed substantially according to =.,the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected.and the soils were found satisfactory. I certify that the septic system referenced above was installed-with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component .:of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. 1 certify that the system referenced above was constructed mi liance with the terms of the IW approval letters(if applicable) OF • goy DAVID D. (Installer's Si ) ERTY, JR. W. 1211 Z3 T a esigner's Signature) (Af x Designer !amp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE � :L IANC E-WILL NOT- BE ISSUED UNTIL BOTH THIS FORM AND AS CARD.ARE RECEIVED BY THE BARNSTABLE PUBLICHEALTH DIVISION. THAN YOU. Q\Septie\Designer Certification Form Rev 8-14-13.doc K w Town,of Barnstable P 9 °?� f v�� Department of Regulatory erwicss Health .M%ion date ,� Vl/I 99�9� �'�€7 mAla�:itnx'4,l'flysancs�15A<.?»€�rJI ee �r7 a2a Sctotlului `Brae + ` f d; v t Soil Suitability�#ssess fin i Se ' Os at Wm _d icy,:.:....... ✓ •..✓ 1'r r ^ s� CA . t�tN:aizxnx hxldrE;,w «rj {" Fed , L?r r�r'a Nanu; �' 1 G NEWCONS-UCTION ds TiT vZll Tel phe.er � j .x riles€f.i..V..._._ sum, DizAxw s tiam9 Oil-Water �L eS Any,�,��fi Drinking 7<atiz€Cs�rll Ix _..... ti SKETCH'(Str�e;nan r,dmt siu su£#c,b �iS,.xSisan fat<u;Ica d ilex_ r .Ivvutr nv uKci is pm7iiruay to vH € � i rs.;a[P:En lsrnuni4+atz 4santfl�v+Wxt�;..u�["a}e,_:.�Sl...�l. ...:::.., b ltgoing from Nil F=l . t;.!:t<xa..=rct Seekurzn3-t� ..Essc�tatuhwederY„r .. DETERMINATION FOR SFASONAL,ITIGHWATER TABLE -' '- -E st} t3bzenrc4l..t errin in of,. Iri Depth l*Y.soil m<t7�>' DzpthmivCC}7b4rruxnsideoffohs,hair:_ : in, c.�r.�-�.h;iu•�ierAdjusi3rez�t .... .., ft. Ind ez well#., kue ing rmv-._._ Index Well.lez! kd;fgdor AdGrr)Slml��*f Lr�zl_. Tiwi PERCOLATION Tlr,!!�11 Hole 0 t7e}uSi n£f'en Sera kic-s� �Tiolt uii ,1 .(D Time 0--` sti 'tint?Ptc- ak Rr�Se I�I3r rizr�xt �„ S �+a�it�.h>fi Au�'crz rst�,nE� "ire Nas7;cf! :, MW'F-ci!ns1. - Rddi dcr3tai t€,stag N=41ILt€EYIN sir anal.d t l c xe r f l7 trisiu s Observation Hole Data To Be C:c n t feted on Back *cif percalatlan testis tube o�nduct within ittll'of' wetland,you a aunt r t Oti y the Burnsta le,fCanse aat'san Division at least one(I)meek IvH or to beginning. ' t3 i.>k:.St"ti4"lT?fi1i("€"a'eR'�S.T7f�L` 9O v DEEP OBSERVATION HOLF LOG Hole# . �. t")�•pslh frr,m Snit}rsFr�on ...ril"1'cxii �iYiil{`irlof :itrt {.dfltx ;:. Surface(iu.) sL1ST1Ai,' ($nnselt) hlauling ;5truatittc,Slaw,Hcui<i rs nyy,,!b.Crnvell -: ------------ . � 0-0_ 911 l*t�BS RVATION HOLE LOG G bale#...:_. T.kpiir ftaia S,>il t3�hsaer Soil'I'cxicez '.-lair�alur Se,fl- � i?thar -._ Surface(in.) (USDA) (Mmseli) ibi e.in$ - (Sbucture,slboii 0aaliters. ! . ..... /.... i 3 r ---------- ................... r , DEEP OBSERVATION HOLE LOG Hole"fl .ntvltr fmnr. Soil l:I(Immn Soil Tcmum Soil Calvr Soil - t'sdwr SurfaceGa.) - i{SSbAJ- - { fistns„t33'- t4wliug (9tmrl-Stank=Waildm, [ - - _._... _......... ___.._ .._.. ........ .................................. ......... .......... DEEP OBSERVATION 13Ol,la;LOG .hale# Depth Front Sort Horizon &it T"unc Soil Colo, suit Oche; .. - surface ii:v.) (lisrw) imiauaall Mauling (Struawc.,swocs,.tlouldors.. �'iixici t"iisurance�hte lYlap: \/ . 11xnz Sim year n and tm.tia y "Na Yes S1°'ilfttasftfl vt.ar L+r3surLrY No Ye" Withal C€a Sear ftzaid isawrl it Na Jl' Y s d - Toth ilf Naturaily Wcurrine Pervio�ttg Mater al Does at least Itotlr Fu.l clt avvturail t ncc urn tg,pervi u t na1 Csist All all areas obscr;v cd throughout the area proposed for the s6ilabsorption wstein' Tf not,What is he Acptli of n.ttunlly occurring pe4ous material? certtff cation_ t 1 ceiiil'y that on Q.71date)1 hava passca'tiii soil cvnivatnt ex;bin lion approved by Ole Dcpaument of E vi on n tal Protection and.that the above analysis was p4rtortned be me consistent with i RR Av tl�ie rccyu'ircd wa nr crtl and cc esezib in 3to C'MR 15.0 7, .ti'i,n ttttre Date,`- oFIKWE Town of Barnstable t Public Health Division , • BARN"ABLE, MASS. 200 Main Street - - MP+°0g Hyannis,MA 02601 7015 1730 0021 4989 0229 , C) N a D I cn C- Q o m � V O O 4 I' t V/ m ;Carol-Jo Santengelo,14l,kup �myzlo ;� o O � m I y Marston :.E OF_ 1. G 6 Z 7 ,23. ,jRETURN TO SENDER WWII" DELIVERABLE AS ADDRESSED NAE.L E TO a �µ.. a-•'�'G•�''Xei'�� --��61 __ � _ lll�li��t��:l.. .1.:,� �-{'E.l�- � 4� k SENDER- COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature ' item 4 if Restricted Delivery is desired. ❑Agent X i ■ 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 of Delivery ■ Attach this card to the back.of the mailpiece, 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 I Carol"3o�Sant.4ngelo 151 Stone Bridge Lane 4' s" 3. S T ice ype 'M�rStbnS Mills, MA 02648. 9certified Mall® �riority Mail Express'" � I a, V ,? Registered Return Receipt for Merchandise F ❑Insured Mail ❑Collect on Delivery d, 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number { 7015 1730 0�01 4989 022-9 (Transfer from service abet) P:: xz-. PS Form 3811,July'2013 Domestic Return Receipt j °p SHE Tp� Town of Barnstable Barnstable � ti y``P °* Regulatory Services Department Atftj ed�j BARN TABLE, Ass. ok 039. Public Health Division �0 prf0 MAC A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4989 0229 June 30, 2016 Carol-Jo and Michael Santangelo 51 Stone Bridge Lane Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 51 Stone Bridge Lane,Marstons Mills,MA was inspected on 06/24/2016 by Matthew Gilfoy, certified Title V Septic Inspector for the State of Massachusetts:,- c The inspection of the septic system showed that the system "Fails"under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level, <12" below inlet(per Town Code 360-9.1). You are ordered to repair or replace the septic system within two (2) years from the date you receive this notification. i Failure.to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH (�35PMaMcKean, R S., CHO ,Age/at-of,the B oard of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\51 Stone Bridge Lane Marstons Mills.doc e Im '. CO OFFICIAL 'a Postage $ r1J Certified Fee O Retum Receipt Fee (Endorsement Required) 6' O Restricted Delivery Fee E3 (Endorsement Required) M Total Postage&Fees Sent Ae ti To ' 0... p Street,Apt. r or PO Box No._'5/ s rl e!J I�`yio Clry State;Zi 1+4 - 7 a stores/�li/l s mi9 �a�`f'8 Certified Mail Provides: e A mailing receipt e A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt maybe 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 duplicaje return receipt,a USPS®postmark on your Certified Mail receipt is required. a 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". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT: Save this receipt and present it when.making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 SECTIONSENDER: COMPLETE THIS 1MPLETE THIS SECTION ON DELIVERY ■ 'Complete items 1,2,and 3.Also complete 77z-� item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse ❑Addressee I so that we can return the card to you. B. Received by(Pnn Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, /! tfol O ,3�� or on the front if space permits. L D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑'No I Cameo/ - oc%del V 5/ Sfonego e Mae q�s*/)s mills 1W 6a&7� I / 3. Service Type I ` 9 Certified Mail® ❑Priority Mail Express'" � ❑Registered .`Return Receipt for Merchandise ❑ Insured Mail ❑Collect on Delivery I 4. Restricted Delivery?(Extra Fee) ❑Yes 2.I 7012 1010 0000 2848 >2183 ys� PS Form 3811,July 2013 Domestic Return Receipt I I UNITED STATES;�PPFT"19 1IXB1M ;;, First-Class Mail y iNJi Postage&Fees Paid USPS I Permit No.G-10 " 3 AUG1 I • Sender: Please print your name, address, and ZIP+4®in this box* I I I I I Town of Barnstable O� Health Division 200 Main Street Hyannis, MA 0260101 I �I �, i �tt+E rp� Town of Barnstable Barnstable Regulatory Services Department AMmadcaC-j IA�N,STABLE, Public Health Division m �fD ram" 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2848 2183 June 30, 2016 j Carol-Jo and Michael Santangelo 51 Stone Bridge Lane Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 51 Stone Bridge Lane, Marstons Mills,MA was inspected on 06/24/2016 by Matthew Gilfoy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed,that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level,<12" below inlet (per Town Code 360-9.1). You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH IMUrFv as McKean, R.S., C O Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\51 Stone Bridge Lane Marstons Mills.doc �Q. �� • ru O it I co Certified Mail Fee Y~p�EWa Services&Fees(check box,add fee as appropriate) � A Return Receipt(hardcopy) $ r� Retum Receipt(electronic) $ Xtmark r3 Vertified Mail Restricted Delivery $ Fie 9 C3 ❑Adult Signature Required $ ❑Adult Signature Restricted Delivery$ N r0 Postage $ '( t-9 Total Postage and Fees $ Sent To a 11 Carol-Jo oSantQngelo v rrC3 nd';1 Stone Bridge Lane -------- -- --- 4 V6� 5&0epfarstons Mills,MA 02648 ----------------•------------- r r r r r rrr•r. Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail •A unique identifier for your mailpiece. --- associate for assistance.To receive a duplicate ■Electronic verification of dellyery or attempted return receipt for no additional fee,present this.� delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service- Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders. Adult signature service,which requires the •You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Servicee, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which •Certified Mail service is notavailable for requires the signee to be at least 21 years of age intemational mail ^ and provides delivery to the addressee specified ■Insurance coverage is not available for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retaiq. C, of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark.If you would like a postmark on, ■For an additional fee,and with a proper this Certified Mail receipt,please present your _ endorsement on the mailpiece,you may request Certified Mail Item at a Post Office-for p_ the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.C electronic version.For a hardcopy return receipt, } complete PS Form 3811,Domestic Retum ` r Receipt attach PS Form 3811 to your mailpiece; IMPOIITANr Save this receipt for your records. PS Form 38009 April 2o15(Reverse)PSN 7530-02-000-9047 �pf THE 1ph'l, 1 Town of Barnstable Barnstable Regulatory Services Department j�`ca�j BARNSTABLE, MASS. -ibg 9, Public Health Division ♦0 m PIED""p�a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4989 0229 June 30, 2016 Carol-Jo and Michael Santangelo 51 Stone Bridge Lane Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 51 Stone Bridge Lane,Marstons Mills,MA was inspected on 06/24/2016 by Matthew Gilfoy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails"under the guidelines of 1995 TITLE V(310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level,<12" below inlet (per Town Code 360-9.1). You are ordered to repair or replace the septic system within two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH omas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\51 Stone Bridge Lane Marstons Mills.doc Town of Barnstable saxtvsr�st.E, • b 9. ,� Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA'02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) -o Leaching facility with standing liquid level at or above the invert pipe (per Town -Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments C_ 51 Stone Bridge Lane z Property Address Carol-Jo Santengelo Owner Owner's Name information is required for every Marstons MIIIS ✓ Ma 02648 _ 6-24-16 page. City/Town State Zip Code Date of Inspection GJ1 00 Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms s/# X1949 on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew Gilfoy use the return Name of Inspector key. B&B Excavation „Q Company Name 374 Route 130 Company Address r Sandwich _ _ Ma _ 02563 City/Town State Zip Code (508)477-0653 S113640 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 6-24-16 _ Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System/•Page 1 of 17 4 ~ Commonwealth of Massachusetts a= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 51 Stone Bridge Lane Property Address Carol-Jo Santengelo Owner Owner's Name information is required for every Marstons Mills Ma_ 02648 6-24-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 1 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: 13) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 51 Stone Brid a Lane Property Address Carol-Jo Santengelo Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-24-16 page. CityFrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 51 Stone Bridge Lane Property Address Carol-Jo Santengelo Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-24-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes. No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 Stone Bridge Lane Property Address Carol-Jo Santengelo Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-24-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. I ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .N 51 Stone Bridge Lane Property Address Carol-Jo Santenngelo Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-24-16 page. CitylTown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (Actual) 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Ll&ns-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 51 Stone Bridge Lane Property Address Carol-Jo Santengelo _ Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-24-16 page. CityTrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: 2015- 34,000 ag llons 2014- 35,000gallons Sump pump? ❑ Yes ® No Last date of occupancy: CurrentDate Commercial/Industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 51 Stone Bridge Lane Property Address Carol-Jo Santengelo Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-24-16 page. CityFrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner- last pumped approximately 2 years ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® Other(describe): Tank and pit t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 51 Stone Bridge Lane Property Address Carol-Jo Santengelo Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-24-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1990 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): — Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 14" feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000gallons Sludge depth: 101, l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 Stone Bridge Lane_ Property Address Carol-Jo Santengelo Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-24-16 page. Cityfrown State Zip Code Date of Inspection D. System Information (coat.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 26 Scum thickness 6 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 12 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.): Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank is not in need of pumping at this time but should be pumped every two years for maintenance. Grease Trap (locate on site plan): Depth below grade: NA feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 51 Stone Bridge Lane Property Address Carol-Jo Santengelo Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-24-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: — gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 51 Stone Bridge Lane Property Address Carol-Jo Santen eg to Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-24-16 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert NA Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M- 51 Stone Bridge Lane Property Address Carol-Jo Santeng_elo Owner Owner's Name information is Marstons Mills Ma 02648 6-24-16 required for every _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 6'x6' ❑ 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.): Leaching was in hydraulic failure at time of inspection. Pit was full over invert elevation. SAS will need to be replaced. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 51 Stone Bridge a Lane Property Address Carol-Jo Santengelo Owner Owner's Name information is Marstons Mills Ma 02648 6-24-16 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: NA Dimensions Depth of solids — Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) i t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 51 Stone Bridge Lane Property Address Carol-Jo Santengelo Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-24-16 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately DRIVEWAY FRONT REAM; B All-12' B'I• 2'6" A -25' B2- 32' A3- 3 4' 03-36' t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 51 Stone Bridge Lane Property Address Carol-Jo Santengelo Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-24-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: No GW 156" feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 5-14-90 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: - Perk on file with BOH. n k+ Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 51 Stone Bridge Lane Property Address Carol-Jo Santengelo Owner Owner's Name information is required for every Marstons Mills Ma 02648 6-24-16 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 oFt"E rqy, Town of Barnstable * MUMSTnsr.E, Board of Health P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,RS. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. November 1, 2004 Mr. Michael Santangelo 51 Stonebridge Lane Marstons Mills, Ma Dear Mr. Santangelo, Your request for a variance to operate a mobile food operation in the Town of Barnstable without operating from a fixed licensed food establishment, (as required for providing daily [or more often] cleaning, service, obtaining water supply, and for obtaining food supplies), is not granted. Operation from a fixed licensed food establishment is specifically required by provision 105 CMR 590.009 (B)(12)the State Sanitary Code and by the local Board of Health Regulation PART II, SECTION 1.00. It is necessary to comply with these requirements to ensure that the mobile food unit is properly cleaned and properly serviced at a licensed facility and at a location which is properly zoned for this type of use. It is also required to ensure that the unit's food and water originates from an approved source. When you are ready to apply for a permit to operate a mobile food operation in the Town of Barnstable,please submit the name and address of the fixed licensed food establishment which you will be operating from,in writing. Also, please call a health inspector at(508) 862-4644 to arrange for an appointment for an inspection of the mobile food unit. The Town of Barnstable also requires every mobile food unit shall be supplied with hot and cold water,under automatic mechanical pressure (not under manual pressure). Refrigeration units must be supplied with thermometers and must be maintained at proper temperatures. The handwash station shall be supplied with dispenser soap and paper towels. The person serving foods from the unit shall be properly trained and certified in food safety and sanitation(e.g. ServSafe or equivalent). If you should have any questions,please call (508) 862—4644. PE RDERV7 BOARD OF HEALTH Wayn Miller, M.D. Chai an *IHElp� DATE: 3 Jy �O FEE: * BARNSTABLE, MASS. REC. BY 9� 1639. ArF° �a Town of Barnstable SCHED. DATE: Board of Health %?/w 200 Main Street, Hyannis MA 02601 Office: 508-8624644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Wayne A.Miller,M.D. VARIANCE REQUEST FORM LOCATION p PropertyAddress: f te- woec�( CD 0-- CG - Assessor's Map and Parcel Number: Size of Lot: Wetlands Within 300 Ft. Yes Business Name: No Subdivision Name: APPLICANT'S NAME: Pho Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME L CONTACT PERSON Name: ' C��- 7 /p n Name: Y A (s- Address: J r�� �a� Address: ors s rn, LS Phone: 2 / Phone: VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) f--��O �: , v L� � a .t -va0 s /r ree�►l-"5 v krLiL' SS f�27 -No tid- of 11 L-tor U,bf 0,46au'-Q U Se WORK: House Addition ❑00000 House Renovation ❑ Repair of Failed Septic System ❑ FFo,, „ d�- Sf C`-11 „ )roa da S e �S9 ) " e completed by office staff-person receiving variance request application) �,��oo G�C� Please submit copies in 4 separate completed sets.. a SvPj•kc,lel/ copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) _ Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only], outside dining variance renewals [same owner/leasee only], and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) _ Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne A.Miller,M.D.Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Susan G.Rask,R.S. Q:\HEALTH\Application Forms\VARIREQ.DOC SPECIAL STATE LICENSE Take care of your license. Hawker Or Ped16r Lost license will not be replaced. Fee: $60.00 No- 1.05084 A Display$2.00 Licensee: Michael Santangelo M4r Mamttwnwralt4 of Agssar4unetb 51 Stonebridge Lane DIVISION OF.STANDARDS Marstons Hills, MA 02648 ONE A3FIBURTON PLACE, 803TON lug t AUG 19 2005 Expires: .................. ............................................ • . ............ .. ................................. Daate .... ,..>. .... . . Above portion must be worn in a visible and conspicuous manner on outer clothing. Ir tt Immu .unto all to whom these presents come, that the above-named person is hereby licensed to go about as a HAWKER or PEDLER in.all the Cities and Towns in this Common- wealth, and to sell or expose for sale or barter any meats, butter, cheese, fish, fruits, vegetables, or 'other goods, wares or merchandise; except jewelry, furs, wines,.-spirituous liquors,.:small arti- ficial flowers or miniature flags. This license is not valid .until after the licensee has endorsed his usual signature,in the:space provided in the margin hereof, and the license isdated and stamped with the official .stamp or signature of the Director. The portion of the license indicating the license number, licensee's name and the date of expiration must be worn in a visible and conspicuous manner on outer clothing, c . otherwise he will be liable to the same penalty as if he had no license. ....................... . ......... Director of St THIS LICENSE IS NOT TRANSFERABLE } Jr/ e7071/567-lee ZIA4,/i ✓ TOWN OF BARNSTABLE. L?:CATION 1,,z;7 SEWAGE # '163 VILLAGE LLS ASSESSOR'S MAP 6z LOT INSTALLER'S NAME Sr PHONE NO. 771"3 6ol 6 SEPTIC TANK CAPACITY I�bO L7 g ei LEACHING FACILITY(t7Pe) --a5r L ( ?l� (size) 1.Ek 64k . 8 rlNO. OF BEDROOMS PRIVATE WELL OR UBLIC WATER BUILDER OR OWNER C f0��r* J✓�.�1 r%i-�tP �.�P DATE PERMIT ISSUED:, _507/�� DATE COMPLIANCE ISSUED; VARIANCE GRANTED: Yes No I 34 ZS� 11 ,fl o ob Fiz THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................OF.. Appliration for 11isposal Works Tonstrartivit ramit Application is hereby made for a Permit to Construct (X) or Repair an Individual Sewage Disposal System at: ......................... !��..... ..................... io dgX, or Lot Owner -1_�.............. a �r 7----- .................................... QX ---------- Ow er Address Installer er Address Type of Building Size .....Sq. feet U 'I ....... Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder kv?) Other—Type of Building ............................ No. of persons-__._._..___________________ Showers Cafeteria Other fixtures Design Flow........--I. .......................gallons per person per day. Total daily flow.........*SV-..' __._____._____._.___gallons. 124 Septic Tank—Liquid capacityA gallons Length Width�.� ._. Diameter________________ Depth..67-'-e.." Disposal Trench—No......*.............. Width___._._..._.___.._._ Total Length____..____________._ Total leaching area....................sq. It, Seepage Pit No------/------------ Diameter......4?......... Depth below Total leaching area..?:��Z.sq. ft. Other Distribution box (X) Dosing tank ( ) Percolation Test Results Performed by.!64���- e4 :7_6�-- ' 4Z, e.W..e- Date._.��AL4&/_g............... Test Pit No. I---_Z......minutes per inch Depth of Test Pit----e;.;;?......... Depth to ground water..-,A�F_.......... rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit______._________.___ Depth to ground water_._____________________. 0 a ........*-----------------------------------------*------------*----------------------------------------------------------*--------*---------*-------------- Description of Soil.... -e-- ?--4-1 ,, —-,....................;�....................... :::5r .... ............................ UA ;..... ........................................................................................................... ....................................................................................................................................... ----------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in acc d- e with L 0 to PI c the provisions of 5'Pf Rj State Sanitary Code— The undersigned further agrees to plac th tem oper on until a Certi -C.4mDliance ha.<?Qdh�issued bylLi ot Lb-0-16 of health. . ..... . ....... .. . ....... ............ ...... ........ ...... Date ApplicationApproved By...... .. .. ........... ............. .. .. ..... ..... ........................................ Date Application Disapproved for the following reasons:.............................................................................................................. ................................................................................................................................................................................7........................ Permit No._.... ............... IssuedL............................................Date........ Date 0 ,12 No..2.2 C)()C�— 1, Fps. ......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ✓<��, a... . .................. "-'"'s'�:..:' - >'- Gc.- •az�aS { Appliration for Disposal Works Tonutrttrtion Vernfit� Application is hereby made for a Permit to Construct (k) or Repair ( T) an Individual Sewage Disposal System at: �...=�. ✓F: . ':=�= `=== - ...• tea •w�i+rS; .S --•--------••-•-------•' 'f r -••-•--------...__ ---------- -•----- ---------------------- Location-Address or Lot No. .._.....`Cay�I �! x1... .l y... xl�t ........ 76.5 Falmouth Ra:.�_..Hyannis,r':?lli r0260T �•�-� ! .�^ caner Address a ,...,t / �� 1�e....e7 Installer Address j Type of Building �-, Size Lot__�'��5'_K-:......Sq. feet aDwelling—No. of Bedrooms........-=...............................Expansion Attic ( ) Garbage Grinder a Other—Type of Building ____________________________ No. of persons......,..................... Showers ( ) — Cafeteria ( ) Other fixtures W Design Flow........�'� ________________________gallons per person per day. Total daily flow-------- .. _ gallons. Septic Tank—Liquid ca.pacity:� '.gallons Length A.- -":_. Width¢�".__ Diameter_____________--�Depth_�`�_� ' W Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area...............I Sq. ft. Seepage Pit No...../------------- Diameter...... Depth below inlet_;.!�7.__. Total leaching area__�.'�'__�_..__sq. ft. Z Other Distribution box (k ) Dosing tank ( ) '-' Percolation Test Results Performed by�� r'.e r!?' -.. .C�- �` .-_-- Date... /- �__..._______�.......... ,aa Test Pit No. 1....x-.......minutesperinch Depth of Test Pit... ........ Depth to ground water---tf�`!____ ------ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 .-------•••------•....-•-----•••--•-••-----------•••---------•------------------•--•••••••-----••••--••-•-----•--••----•-•--------•••-----•._..._..•---••---- 0 Description of Soil- - `dam-, �`v�l'.- ' '�4 fC -_C__ ��---4.'- ,, ' ..................................................r l�c1s cr /� 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 State Sanitary Code—The undersigned further agrees not to place the system in oper ion until�ert iiea� mpliance has been issued by the board of health. Signed ............... Date Application Approved By.. ._ :_. _ c._.._ Application Disapproved for the following reasons________________________________________________________________________________________ = -------------•........ Date Permit No.... _.__ ... -�....�---------------- Issued............................ .-----•--------------- Da THE COMMONWEALTH OF MASSACHUSETTS /BOARD OF HEALTH . � �. ................... / ......OF.. / - nTrrtfrate of TontpliFr THI I T CERR`TII F/'Y, Th/aa-y}� t�/e.I{�'1'yidual' Sewage Disposal System constructed ( orRepair .by '�. V"7C .if-i•+r.1_-/t/ __X. ................ at----ar••Lr�-'I"" `.�. """'l_ l:/1 ` � ._.... has been installed in accordance with the provisions of TAT' f The State Sanitary Code as described in the application for Disposal Works Construction Permit No- -_ ...... ------- dated________________________________________________ THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS OARD OF HEALT l � �i��o��tl ko �o�tstr ion �erani JFE .... Pe rmission ' hereby granted__:-_______ _____________ •• ' to on (- or epaar ) a_In ividual�Sewage Dis oIS Systat No..-- ,j �t� Street/ / / P' '20 as shown on the application for Disposal Works Construction Permit No.�__ __RL.2_---Dated.____ -_ �_. __._..._____ ...._..-----•--••-----•-•----•...•--• \ PPP-------------- , DATE................t!' ' CCS T.................................... \ rd of-Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 1 r' i AsBuilt Page 1 of 2 TOWN OF BARNSTABLE LOCATION ( ' -' � WSJ i2d►L l?Q.fp6C L-�(- SEWAGE VILLAGE f4kr 5T&J p I L6S ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. \J �Pc�(�Jil)tL` 7��"3��� SEPTIC TANK CAPACITY Ion L75 LEACHING FACILITY:(type) rI<•&A51 16A<44 �l (size) 1 6tb rs,+t ENO. OF BEDROOMS PRIVATE WELL OR UBLIC WATER c BUILDER OR OWNER C DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED_ VARIANCE GRANTED: Yes No 3� 36' http://issgl2/intranet/propdata/prebuilt.aspx?mappar=125006006&seq=1 6/27/2016 S ! TOP OF FOUNDATION COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM PROFILE Flaherty Environmental Services BROUGHT TO WITHIN 6 OF FINAL GRADE ,�--- EL. 56.0' EL. 55.0' „ (not to scale) INSP, PORT W I 3" OF GRADE CLEAN SAND P.O. BOX 89 2" of,1" to 4" DOUBLE.WASHED Yarmouth Port, MA 02675 .# 4" CAST IRON or EQUIVALENT PEASTO r R GEOTEXTILE EL. 54.0 508.362. 1657 MIN. PITCH 1/4" PER FOOT FILTER FABRICE ,• : •. ••• 4"SCHEDULE 40 PVC PIPE 4°SCHEDULE 40 PVC PIPE /"/"///' Flow LINE ° ' VENT IF REQUIRED (fiist 2 to be/e'vel) a. ------- 30' 5% —► 5' 1% .. EL. 51.2'f L.EXISTING 0 14" cm_� • . • . ..; 0�.. '; 'O: ° ' O�O np 000°o°ooc EL.EXISTING '—� __� °000°0°0°°0 0 ����- �rti❑p p o°o°o°o°c EL.52.1' 0°00000 0 ° o°o° ❑LJ LJ® °°°00000c 0 0 0 0 0 0 o p q p'O o°0°0°0°c EL.50.7' ° o°o°o°o°o°o° 00000000C 2.0' EL.50.53' o 0 0 0 0 0 ❑❑ R 0 0 0 0 0 0 0 o O•Q O O p 0 ©. 0°0°000°c— GAS BAFFLE EL.50.5' oo°0000000 00°0°0 ❑., ❑ 0 0 0 0 °O°O°000°O O°0°O° • •d' .° �000°0°0°C '•."e - H-20 0 0 0 0 0 0 0 <• a 0 00°0°0c EL.48.5' rw (D-BOX) SOIL ABSORPTION SYSTEM 1 : .,�'g.•'•, .?;,,:•a••''': • .1000 GALLON SEPTIC TANK 6"CRUSHED STONE OR MECHANICALLY COMPACTED ; � ) 500 GALLON CHAMBERS 5, " ' � � 2 (DATUM: ASSUMED) EXISTING 3,, �„ WITH 4' STONE AROUND IN A 51 4 to 111 DOUBLE WASHED STONE 12.83'W X 25.01 X 2'D CONFIGURATION EL. 43.5' BOTTOM OF TEST HOLE EL. 43.5' LOCATIONMAP USGS ADJUSTMENT: N/A 54 LOT 4 GROUNDWATER ELEV: N/A No TH 18,792 SFt MAP 125 LOT 6 53 m Race Lane BENCHMARK: � TOP OF FNDN EL. 56.0' LOCUS SHED_ EXIST• S,T• NTS EXISTING ' 3 BR O ���ZN DF MgSS wDWELLING DA O O N 21 GARAGE +.•'.....;.,•.:..:: ----- . � 465' GtSTERF. O SqN► ARC Q� 0 v v�� J TH-1 ' TH- DATE:811112016 REVISED: A:Z' 0 54 205.57' CO xj SITE AND SEWAGE PLAN 53 FOR B & B EXCAVATION, INC./ MICHAEL SANTANGELO 51 STONE BRIDGE LANE SCALE : 1 30' MARSTONS MILLS, MA REF:PS 447 PG 44 PAGE 1 OF2 ............. ...... .......... ....... ... ........................ ... ....... ............. ................... ........ ................................................................................................................................................................................................................................................................................................................................. .......................................................................................................... GENERAL NOTES DESIGN CAL CULA TIONS S YS TEM DE TA IL Flaherty Environmental Services P. 0. Box 81 1, ALL PRECAST COMPONENTS TO BE H-1 0 Yarmouth Port, MA 02675 RATED UNLESS OTHERWISE SPECIFIED. NUMBER OFACTUAL BEDROOMS 3 ti 774.994.1166 ALL COMPONENTS WITH ANY ANTICIPATED VEHICULAR TRAFFIC TO BE GARBAGE DISPOSAL UNIT NO H720 RATED. 2. THE DESIGN OF THIS SYSTEM DOES NOT TOTAL ESTIMATED FLOW ALLOW FOR THE USE OF A GARBAGE (I 10 GALIBRIDA Y X 3 BR) 330 GAL./DAY! GRINDER. REQUIRED SEPTIC TANK CAPACITY 660 GAL. 3. MUNICIPAL WATER IS AVAILABLE. 4. ALL CONSTRUCTION TO CONFORM WITH SIZE OF SEPTIC TANK 1000 GAL.(EXISTING) 310 CMR 15.000 AND ALL OTHER APPLICABLE LOCAL, STATE AND FEDERAL SOIL CLASSIFICATION 0 0 CODES AND REGULATIONS. 12,83' 5. INSTALLER/CONTRACTOR TO REVIEW& DESIGN PERCOLATION RATE <2 MINAINCH . 7- VERIFY ALL ELEVATIONS AND DETAILS EFFLUENT LOADING RATE 0.74 GAL.IDAYIFT2 AND REPORT ANY DISCREPANCIES TO DESIGNER PRIOR TO CONSTRUCTION OR LEACHING AREA 25' ASSUME ALL RESPONSIBILITY, (2)x(25.01+ 12,83)(2) = 151 SF 6. INSTALLER/CONTRACTOR IS 25.0'x 12.83' =320 SF RESPONSIBLE FOR MAINTAINING SAFE 471 SFx 0.74 =348 GPD WORK AREA, VERIFYING ALL UTILITIES AND NOTIFYING "DIG SAFE" USE(2)500 GALLON CHAMBERS WITH 4'STONE (1-888-344-7233) 72 HOURS PRIOR TO AS DIAGRAMMED IN A 25.O'X 12.83'X2'COIVFIGURA TION CONSTRUCTION. . 7, ANY CHANGES TO OR DEVIATIONS FROM RESERVE LEACHING CAPACITY NIA THIS PLAN MUST BE APPROVED IN WRITING BY FLAHERTY ENVIRONMENTAL SERVICES AND LOCAL BOARD OF HEALTH. 8. FINISH COVER OVER COMPONENTS IS NOT TO EXCEED 3'PER 310 CMR 15.000 (NTS) UNLESS SHOWN PER PLAN. 9. ALL ABANDONED SEPTIC SYSTEM COMPONENTS TO BE PUMPED DRY AND SOIL EVAL UA TION P;ff 15-12-5- FILLED WITH CLEAN SAND OR REMOVED TEST HOLE#1 TEST HOLE#2 AND REPLACED WITH CLEAN SAND. Evaluator- David D.Flaherfty Jr.,RS,REHS Evaluator F*,9,9 David D.Flahe*Jr.,RS,REHS 1 OALL COMPONENTS TO BE PROVIDED SE#2755 SE#2755 DA BOH Witness David Stanton,RS BOH witness: David Stanton,RS WITH WATERTIGHT ACCESS PORTS Date. August 10,2016 Date: I August 10,2016 WITHIN 6"OF FINISH GRADE. F 11.ALL SEPTIC TANKS, DISTRIBUTION TH-I ELEV 54.0' TH-1 ELEV..54.0' BOXES AND PIPING TO BE INSTALLED WATERTIGHT. 011-19. FILL 0"-191, FILL O/STf 12.NO KNOWN WETLANDS OR WELLS ITA- WITHIN 100 FEET OF PROPOSED 19"-29" A LS 10YR 312 19" 29' A LS IOYR312 LEACHING. 13.THIS IS NOT A CERTIFIED PLOT PLAN 29"-37" B LS 10YR 516 29"-37' B LS 10YR 516 AND UNDER NO CIRCUMSTANCES IS THIS PLAN TO BE USED FOR ZONING OR F77PERC SITE AND SEWAGE PLAN BUILDING PURPOSES., 37"-126" C CMS 2.5Y614 37"-120" C CMS 25Y614 'Icertify that on November 12,2002,1havepassed FOR 14.LOT IS SHOWN AS ASSESSOR'S MAP 125 5%GRAVEL 5%GRAVEL the examination approved by the Department of LOT 6. Environmental Protection and that the above analysis B & B EXCAVATION, INC./ — has been performed by me consistant with the MICHAEL SANTANGELO 15.LOCUS PROPERTY IS LOCATED WITHIN required training expertise,and experience described G.W.ELEV.NIASTONE BRIDGE LANE G.W.G.W ELEV.NIA in 310 CMR 15.018(2). AN AQUIFER PROTECTION DISTRICT 5 (ZONE 11). BOTTOM TH-I ELEV. 43.5' BOTTOM TH-2 ELEV. 44.0' MARSTONS MILLS, MA PAGE20F2 .................. .................................. ............... ............................. ... ... .......... ... ............................ ................................................................................................................. ........................... ................ .......................................................................................... - - - --------------------------- ............................. ........................................... ........................................................ ................. ........ .. . . . .......... ........ .. ................