HomeMy WebLinkAbout0031 STOWE ROAD - Health 31 9TOWE ROAD
Marstons Mills
A = 043 — 077 — 003
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TOWN OF BARNSTABLE
LOCATION `�O SJOW c- ,,,L SEWAGE#
VILLAGE ASSESSOR'S MAP&PARCEL p43 0 1'1 003
INSTALLER'S NAME&PHONE NO. B EEXCayc►A i e n L9 M- OL S 3
SEPTIC TANK CAPACITY '1000 \
LEACHING FACILITY: (type) 5 QQ qQ,I OC- 2) (size) 13 n ZS,K 2
NO.OF BEDROOMS
OWNER S cvc v
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
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No. ` Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
(v �tQ�
\
application for Bisposal 6pstent Construction 3permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) [:]Complete System ❑Individual Components
r
Location Address or Lot No. Ro
Owner's Name,Address,and Tel.No.
p �Sfa � G �`��er1 �L1(1C� Sid' ���1- I&6
Assessor's Ma /Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) A 0 gpd Design flow provided gpd
Plan Date 1Z6 9 Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 3 h 2SM qaA chambil , S
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 b i o of a �
e Q Date Co"20—I (f
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. "� Date Issued
�• Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTH DIVISION - TOW.N OF BARNSTABLE MASSACHUSETTS
2 4 2ppYication for Misposal Opstem Construction i3trntit
Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 6wnerr's Name,Address,and Tel.No.
Assessor's Map/Parcel I IS S hen
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
B J / �x c ci r/ a.f tUn 5C)r-y71-Ub5 7g5i
Type of Building:
Dwelling No.of Bedrooms_ Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
v
�De'sTinFlow(min.required) ,gpd Design flow provided gpd
Plan i;}, Date nj Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
f
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) N „
Date last inspected: .
Agreement:
r 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 b s Bo d of e
ne - n - Date w 2 7` �,
Application Approved by r i / �� Date
} v
Application Disapproved by r 4 Date
for the following reasons l/
Permit No. ✓ Date Issued
---------------------------------------------------------------------------
- - - - -
THE COMMONWEALTH OF MASSACHUSETTS /
BARNSTABLE,MASSACHUSETTS
(Certificate of Compliance
THIS IS TO CERTIFY,that th ern-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned( )by �( �/ j�
at i O has been con c in acco dace
with the pry ons of Title 5 and the for Disposal System Construction Permit N
Installer (� �- � �} `� Designer
#bedrooms Approved desiMcn
gpd
'The issuance of this permit sha not be c nstrued as a guarantee that theCsystern willEign)ed.
Date In or
--. ---- ------- --------_---•- ---- -------------------- ---
//�
No Fee
E COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS
Misposai 6pstem Construction Vermit
Permission is hereby granted to Construct( ) Repair( ) rade Abandon( )
System located at
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.
s
Provided:Co stru do r�u t e c pleted within three years of the date of this permit.
Date Approved by
Town of Barnstable
�OptHE Teti Regulatory Services
Thomas F. Geiler, Director
MAS& Public Health Division 1639
; .
�'Areo �s Thomas McKean, Director -�
200 Main Street, Hyannis, MA 02601 N'_
Office: 508-862-4644 Fax: 508-790-6304 X.-
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Date: "i lO- 19 Sewage.Permit# 2019 - Z92 Assessor's.Map/Parcel 043 0"17'9 003 i,,,•,�
r�7"a
Installer & Designer Certification Form
Designer: —D-3.11� Installer: • ExCs:2,kx-0 PEN
Address: pp Box 331 Address: ly 'rco,51_rrW 1_Q
9AArL.J1C -' rOCGc5�t�0.�L
On Z.- 2'17-19 4[3 Ex�Ja. on was issued a permit to.install a
(date) (installer)
septic system at�u sJouis— Rod. based on a design drawn by
(address)
dated Lo • ZS��?
(designer)
_[ I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected andthe soils
were found satisfactory.
I certify that the septic system referenced above.was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any.component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow. Stripout (if required) was inspected and the soils
were found satisfactory. t
' DAVID
9� D.
staller's Si t e) LAHERTY, A.
No. 1211
T
(Designer.' Signat, - (Affix Desig p Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION..
THANK YOU.
q:bffice forms\designercertification form.doc
G
ME
U.S.POSTAGE>>PITNEY BOWES
of ' ti Town of Barnstableled
1 + �
Public Health Division
BARNSTABLE. 200 Main Street ¢ •� '}�• ZIP 0260 0 i
MASS. L� $ 006.80
<rED MPYp`e� Hyannis,MA 02601 ' ;• 002
000336455 JUN, 26. 2019.
7015 1730 0001 4988 1197 I1
RYLANDER, BRETT M
PO BOXi179
NIXIE. 015 FE 1 G007/01/19 t I
RETURN TO SENDER
NOT DELIVERABLE AS ADDRE'SSED
UT>F _ B<C, 92'601400290 1S2 2-03 490-2.6—8 {
• - • • • • -
A. Signature
■ Complete items 1, and 3I ---^
I ■ Print your name a address onit'e reverse X ❑Agent
I so that we can return the card'fo ou.
❑Addressee
■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery
I or on the front if space permits. I
--"" idress different from item 1? ❑Yes
L.
delivery address below: ❑No
RYLANDER, BRETT M
I =` I
PO BOX 179
I j COTU IT, MA 02635 I
I � III I IIIIII IIII III I II III)III I I III II(()I II I III III 3: ie'type � ❑Priority Mail Express®
❑Adult Signature I
�
❑Registered MailTM I �\
Adult Signature Restricted Delivery ❑Registered Mail Restricted
9590 9402 4798 8344 8737 28 Certified Mail® ppp Delivery
Certified Mail,Restricted Delivery Return Receipt for I
❑Collect on Delivery Merchandise
i 2__Article-Number-(Transfer-from service label) ❑CoI ect on Delivery Restricted Delivery 0 Signature Confirmationym
❑Signature Confirmation I
7 015 1730 0001 4988 1197 ail Restricted Delivery Restricted Delivery
PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt
Town of Barnstable Barnstable
kzftd
Inspectional Services Department AN -►
HARNbTABLE. a`
MAS&39
s63q. Public Health Division
�0
ArFQ �s 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL#7015 1730 0001 4988 1197
June 26, 2019
—RYLANDER BUTT 1V1 - -
PO BOX 179
COTUIT, MA 02635
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 31 Stowe Road, Marstons Mills, MA was inspected on
05/28/2019 by Brett Hickey, 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 facility with standing liquid level at or above the invert pipe (per
Town Code 360-20 h).
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
Thomas McKean, S.. CHO _
Agent of th&B`odid-of Health
Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\3I Stowe Road Marstons Mills.doc
' �• � Town of Barnstable �PT#
Department of Inspectional Services
MASS.` ` Public Health Division
f639.a�
� 200 Main Street,Hyannis MA 02601
Office: 508-862-4644
Date Scheduled Tune
Soil Suit b fity Assessment for Sewage Disposal
Performed By: ( � Witnessed By: J&_61Z_
LOCATIO & GENERAL INFORMATION
Location Address: j Owner's Name:
Owner's Address:
Assessor's Map/Parcel: Certified Soil Evaluators Name:
V Certified Soil Evaluators Email` Z�
New Construction or Repair: Certified Soil Evaluators Telephone# (r ,
Land Use k6 Vlh," Slopes(%) ' Surface Stones
Distances from: Open Water Bodily > ft Possible Wet Area � Drinking Water Well�ft
Drainage Way, ft Property Line > ft Other ft
Parent material(geologic) �Uy � T7epth to Bedrock
Depth to Groundwater: Standing Water i Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment R.
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level
PERCOLATION TEST Dat / Time ff
Observation I
Hole# Time at 9"
r .
Depth of Perc Time at 6"
Start Pre-soak Time @ /�o Time(9"-6") 0 t
r
End Pre-soak
Rate MinJlnch G
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Deep Observation Hole Log Hole#:
Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other
(in) (USDA) (Munsell) (Structure,Stones,Boulders,
Consistency,%Gravel
l V
S - /'Owl
l S' L 0 s
S z.
�k
Deep Observation Hole Log Hole#:
Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other
(in) (USDA) (Munsell) (Structure,Stones,Boulders,
� / Consistent %Gravel
C I
� f
Deep Observation Hole Log Hole#:
Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other
(in) (USDA) (Munsell) (Stricture,Stones,Boulders,
Consistent %Gravel
Deep Observation Hole Log Hole#:
Depth from Surface Soil Horizon . Soil Texture Soil Color Soil Mottling Other
(in) (USDA) (Munsell) (Structure,Stones,Boulders,
Consistent %Gravel
M
Flood Insurance Rate May:
Above 500 year flood boundary No Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of na 11 o urring pervious material exist in all areas observed throughout the area proposed for the
soil absorption system?
If not,what is the depth of turally occurring pervious material?
Certification /.
I certify that on (t /i- D Z (date)I have passed the soil evaluator examination approved by the Department of
Environmental Prot ctio and that the above analysis was performed by me consistent with the required training,expertise
` and experience described in 310 CMR 15.017.
71,11
Signature IV Date
SKETCH: (Or you can attach a separate sheet)
(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
10.�z
(P t
of t T
Town of Barnstable Barnstable
P� Inspectional Services Department AD-M, micaChy
V
t BARNSBLL CA
KAq& Public Health Division
�ATFD MA'S 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL#7015 1730 0001 4988 1197
June 26, 2019
RYLANDER, BRETT M
PO BOX 179
COTUIT, MA 02635
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 31 Stowe Road, Marstons Mills, MA was inspected on
05/28/2019 by Brett Hickey, 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 facility with standing liquid level at or above the invert pipe (per
Town Code 360-20 h).
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
Thomas McKean, S., CHO
Agent of the Board of Health
Q:\SEPTIC\"Title V Inspection Report Letters MaiIingTailed or Needs Further Evaluation Letters\31 Stowe Road Marstons Mills.doc
7
WE
Town of Barnstable
+ BARNSfABLE,
Inspectional Services Department
TfD MA'S a
Public Health Division
200 Main Street, Hyannis MA 02601
Office: 508-862-4644
PAX: 508-790-6304 Thomas A.McKean,CHO
Feb 6, 2007
Rev. 4/26/19
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 V
pipe.
❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool
❑ Structurally unsound septic tank or SAS
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)
�fLeaching facility with standing liquid level at or above the invert pipe(per Town
Code §360-20 h)
OTHER
Repair deadline:
0:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc
c Commonwealth of Massachusetts
p Title 5 Official Inspection Form
+= / Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Stowe Road
u'
Property Address
Stephan Sunderlin cr
Owner Owner's Name / ._
information is
required for every Marstons Mills Y Ma 02648 5-28-19 110
page. City/Town State Zip Code Date of Inspection f tY
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. Inspector Information
on the computer, Brett Hickey
use only the tab
key to move your Name of Inspector
cursor-do not B&B Excavation
use the return
key. Company Name
374 Route 130
a Company Address
Sandwich Ma 02563
City/Town State Zip Code
,asxv (508)477-0653 S113747
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system:
1. ❑ Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. 0 Fails
Brett Hickey °"�"�°� er��"�^_� ���e�. ��s 5-28-19
'��uaa ms.us.ze u:azm aaw
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 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 form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: 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.
t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
Commonwealth of Massachusetts '
�m p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Stowe Road
Property Address
Stephan Sunderlin
Owner Owner's Name
information is Marstons Mills Ma 02648 : 5-28-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1), 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:
2) 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):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
c Commonwealth of Massachusetts
{ Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Stowe Road
Property Address
Stephan Sunderlin
Owner Owner's Name
information is Marstons Mills Ma 02648 5-28-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (coot.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ 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):
3) 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.
a. 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:
t5ins .doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
P P 9 P Y 9
Commonwealth of Massachusetts
�v Title 5 Official Inspection Form
�= Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Stowe Road
u
Property Address
Stephan Sunderlin
Owner Owner's Name
information is Marstons Mills Ma 02648 5-28-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ 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.
b. 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.
c. Other:
4) 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
❑ El Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
Commonwealth.of Massachusetts
�n Title 5 Official Inspection Form
=: Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Stowe Road
v
Property Address
Stephan Sunderlin
Owner Owner's Name
information is Marstons Mills Ma 02648 5-28-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (coot.)
Yes No
❑ El Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ Q Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
❑ R. Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ 0 Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ a Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ a Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ El 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 2000 gpd-
10,000 gpd.
0 ❑ 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.
5) 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 CA.
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
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18
.. Commonwealth of Massachusetts
�m p Title 5 Official Inspection Form
III Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
L--
31 Stowe Road
Property Address
Stephan Sunderlin
Owner Owner's Name
information is Marstons Mills Ma 02648 5-28-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered "yes"to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes" or"no"for each of the following for all inspections:
Yes No
❑ Q Pumping information was provided by the owner, occupant, or Board of Health
❑ S Were any of the system components pumped out in the previous two weeks?
El ❑ Has the system received normal flows in the previous two week period?
❑ El Have large volumes of water been introduced to the system recently or as part of
this inspection?
El ❑ Were as built plans of the system obtained and examined?(If they were not
available note as N/A)
❑ El Was the facility or dwelling inspected for signs of sewage back up?
x ?
❑ ❑ Was the site inspected for signs of break out,
P 9
El ❑ Were all system components, excluding the SAS, located on site?
El ❑ 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:
El ❑ Existing information. For example, a plan at the Board of Health.
❑ Q 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)]
t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
�= 1, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Stowe Road
L
Property Address
Stephan Sunderlin
Owner Owner's Name
information is Marstons Mills Ma 02648 5-28-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
3 3
Number of bedrooms(design): Number of bedrooms(actual):
495/GPD
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
Description:
3
Number of current residents:
Does residence have a garbage grinder? ❑ Yes [j] No
Does residence have a water treatment unit? ❑ Yes 0 No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes EI No
information in this report.)
Laundry system inspected? ❑ Yes 0 No
Seasonaluse? ❑ Yes [E No
Water meter readings, if available(last 2 years usage (gpd)): See below
Detail:
**2018- 60,000gallons 2017- 72,000gallons**
Sump pump? ❑ Yes ❑Q No
Last date of occupancy: currentDate
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
Commonwealth of Massachusetts
�o p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Stowe Road
Property Address
Stephan Sunderlin
Owner Owner's Name
information is Marstons Mills Ma 02648 5-28-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
NA
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: Owner- date of last pump is unknown
Was system pumped as part of the inspection? ❑ Yes ❑■ No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
c Commonwealth of Massachusetts
�v Title 5 Official Inspection Form
±_ 1? Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
L:
31 Stowe Road
Property Address
Stephan Sunderlin
Owner Owner's Name
information is Marstons Mills Ma 02648 5-28-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
El 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):
Approximate age of all components, date installed (if known)and source of information:
1990 per plans
Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No
5. Building Sewer(locate on site plan):
11811
Depth below grade: feet
Material of construction:
❑ cast iron ❑■ 40 PVC ❑ other(explain):
Town water
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18
i
c Commonwealth of Massachusetts
�m Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Stowe Road
v�
Property Address
Stephan Sunderlin
Owner Owners Name
information is Marstons Mills Ma 02648 5-28-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan): p
8it
Depth below grade: feet
Material of construction:
❑■ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
1000gallons
Dimensions:
1211
Sludge depth:
2411
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
4"
Distance from top of scum to top of outlet tee or baffle
12if
Distance from bottom of scum to bottom of outlet tee or baffle
measured
How were dimensions determined?
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
The tank was in working order at the time of inspection. The tank is in need of pumping
at this time and should be pumped every two years for maintenance.
t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
�= 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Stowe Road
V�
Property Address
Stephan Sunderlin
Owner Owner's Name
information is Marstons Mills Ma 02648 5-28-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on site plan):
NA
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
NA
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
I Capacity: gallons
f Design Flow:
gallons per day
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
Commonwealth of Massachusetts
,lp Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Stowe Road
Property Address
Stephan Sunderlin
Owner Owner's Name
information is Marstons Mills Ma 02648 5-28-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
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
9. Distribution Box(if present must be opened) (locate on site plan):
orr
Depth of liquid level above outlet invert
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
The d-box was in poor condition at the time of inspection.
t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Ito Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Stowe Road
Property Address
Stephan Sunderlin
Owner Owner's Name
information is Marstons Mills Ma 02648 5-28-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
10. 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.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
)
El leaching pits number: (1 6'x6' pit
❑ leaching chambers number:
❑ leaching galleries number:
❑ leachingtrenches number, length:
g
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
I ❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
cam, Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Stowe Road
Property Address
Stephan Sunderlin
Owner Owner's Name
information is Marstons Mills Ma 02648 5-28-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
The SAS was in hydraulic failure at the time of inspection. Pit was backed up into
riser when viewed.
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
NA
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
.y
Commonwealth of Massachusetts
�. ,p Title 5 Official Inspection Form
+ gal Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Stowe Road
u
Property Address
Stephan Sunderlin
Owner Owner's Name
information is Marstons Mills Ma 02648 5-28-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy (locate on site plan):
NA
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
c0� Commonwealth of Massachusetts
Title 5 Official Inspection Form
1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
I P'
31 Stowe Road
Property Address
Stephan Sunderlin
Owner Owner's Name
information is Marstons Mills Ma 02648 5-28-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
14. 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
Rear
A B
III -
A1 2t}
A2.28'8"
A3.41'
B1.21'13"
B2.31'
63-35'
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
I, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
t�
31 Stowe Road
Property Address
Stephan Sunderlin
Owner Owner's Name
information is Marstons Mills Ma 02648 5-28-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
9 Check Slope
■❑ Surface water
i❑ Check cellar
❑■ Shallow wells
No GW 4' below SAS
Estimated depth to high ground water:
feet
Please indicate all methods used to determine the high ground water elevation:
El Obtained from system design plans on record
2-8-1990
If checked, date of design plan reviewed: Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
A plan on file at the local Board of Health was used to determine high groundwater.
f
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7/26/2018 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
a
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Stowe Road
V
Property Address
Stephan Sunderlin
Owner Owner's Name
information is Marstons Mills Ma 02648 5-28-19
required for every
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
❑■ A. Inspector Information: Complete all fields in this section.
■ B. Certification: Signed & Dated and 1 2 3 or 4 checked
❑■ C. Inspection Summary:
1 2 3 or 5 completed as appropriate
, , P
4 (Failure Criteria)and 6 (Checklist)completed
W D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
TOWN OF BARNSTABLE
LOCATION LO'V 3 i) SEWAGE #
i
VILLAGE l�ep, , ji0` .\ � ASSESSOR'S MAP & LOT
KINSTALLER'S NAME PHONE`NO.,�\ketjt—_-+j ChAA& ek e `11\y�i lZb
c
SEPTIC TANK CAPACITY ,corn
s
LEACHING FACILITY:(type) (size) i,� 0 C�
NO. OF BEDROOMS Z PRIVATE WELL QICPUBLIC WATER
BUILDER OR OWNER *cc�� �h1�`7
DATE PERMIT ISSUED: 'L-�\,A It,
,sATE COLIPLIANCE ISSUED:_
VA LIANCE GRANTED: Yes No
LOT I
s 1
ii _ II
A Vy1
No..., L1�..-.SD Fxs.....���..'"-
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
-�104J..............OF..... .p.1 -r w1v....................................
, pptiratiun for Uhipaii of urku Tonstrurtiun rprutit
Application is hereby
1�made
(�for a Permit to Construct (v") or Repair ( ) an Individual Sewage Disposal
System at, -31
—.J (1 - ....... 4 07— 3
• ocation-Address or Lot No.
........... ... .T2 N -s4: . ..---.........-•-•-----........ --•-•-----------•-----..�9 -.F....-1�`A...--•--------••----------•------..
O ne Address
a �E... ....._.. ..G�' ............. .................. y._..........................
Installers, Address
g — k.:®.l•...Sq. feet
U Type of Building Size Lot..____.
Dwelling—No. of Bedrooms...T ...................Expansion Attic ( Iql Garbage Grinder (0o)
aOther—Type of Building ............................ No.' of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ............................
W Design Flow................................X7..gallons per person per day. Total daily flow.............................a 1 Q....gallons.
WSeptic Tank—Liquid capacityiCV-V.gallons Length____-_,••____--• Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.-__.0A�. '... Diameter.......... _®... Depth below inlet.....4............ Total leaching area... ® ..sq. ft.
Z Other Distribution box (%4 DosmR tank ( )
Percolation Test Results Performed by... .4*X&F M�..-..�J`.t�7�_!��•.�•......._..r...... Date.._�'�:•..���.��. �.....
a Test Pit No. 14 S'F AA-1- minutes per inch Depth of Test Pit----- Depth to ground water.........................
fi Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water...-.-_--__.___----__--.
----------------- -----•............................ ......•••.-• --•-•------......-••...............-•------•------••--•---••••--- .................
O Description of Soil-------QnA.' -.� � .4
x . y 5 _ . .
O..VE44 a
c.�
UW --------------- ------ ------------------••-•-•••••-••••-•---••--•••••••••••----------•----•••-••----•--••-•••--------•-•------••••--•-------•--•••-•••••••-•--•••-•--•......--••-••••................
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 Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Complie has been issued by the board of health.
Signed -------.` . .. . ---------------------------------------------
-----------------------------------
Dace
Application Approved By ........ -- e� .................................. -----91-0
Da
Application Disapproved for the following reasons: ------ --------------------------------------- -------------- ------..-
- ------..... ........................................
. . --- Issued Permit No. ._ 5�..:. Da e
3
No.- .-�.?•--... � FRs.....,1f1 ..:"..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..... ..............OF...... L ----------------------------------
Appliration for Dhip oal Works Tomlrnrffou ramit
Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal
System at:
cation Address or Lot No.
Sr
-•-......... ... - - ---
O jne Address
Installer Address
Type of Building Size Lotlg�. � ....Sq. feet
Dwelling—No. of Bedrooms___ ..................Expansion Attic ( Garbage Grinder (Wo)
pa., Other—Type of Building _____________•_...•-__- .... No. of persons............................ Showers ( ) — Cafeteria ( )
a
d Other fixtures --._--•-•-..•_._ allons er erson••..........--•...... ... ---••--•--•--•-•••................
W Design Flow........................... g p p per day. Total daily flow..............................9. .0---gallons.
WSeptic Tank—Liquid capacitylPW.gallons Length................ Width........,------- Diameter---------------- Depth................
Disposal Trench No ... ............. Width.......I............ Total Length.................... Total leaching area..._ .._.sq. ft.
Seepage Pit No _ ?! ___.. Diameter.......... Depth below inlet..... Total leaching area.. ...sq. ft.
Z Other Distribution box (% Dosing tank ( ) _
'-' Percolation Test Results Performed by._._. .e_ _? $ � Date__ " _ t f _�.....
,aa Test Pit No. lttSOI? ninutes per inch Depth of Test Pit-----C 6....... Depth to ground water ....................
GT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
................ .. .................... $
D Description of Soil -. - ?_ ... `.. 4�.t - �¢ 'r� '= 1. .. . )•e in.ft
x
W
UNature 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 Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compli e has been issued by the board of health.
Signed ------.... --r......... .......................................
Date
ApplicationApproved By .. ... ..- .n -------------------------------------------------------------------- -------�..: '1- �o
Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------------------
--..... ----------------- --------- --- - ---- . -- ------------------------------------------- ---........-------------------------------------
Permit No. ......... 45_7- .0..................-- Issued ..-----------------------------------------------------Dare
Daze
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
74—
, f '!L< OF .-- _ --s;�� --------------------------------------------------
GErttftrate d Q-11ompltttnre
THIS IS O CERTIFY, That the Individual Sewage Disposal System constructed (}�) or Repaired ( )
by -----------------------=S: _. ..... ...........B-- -----------------------------------------------------------------------------------------------------------------........................................
\\� Installer
at ......... ........�.. --- -- --------------- --------------.....------...... .. ......----------.................................------
has been ins led in accordance with the pr isions of TITLE 5 of e State Environmental Code as described in
the application for Disposal Works Construction Permit No- ----------- ---�_- -50.---- dated -------------------------------------------.---
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATI FACTORY.
DATE------------ /.. -- - -------------------- Inspector � '
--- ------- --------
i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............ 1.......OF........ .....................................................................
/ �--
No.... �.............. FEE•--C�Q_...-•----
Rapos irk n Juan rrmi
Permission is hereby granted............ ....
Z
to Construct ( ) or Re air ( an In Ividual Sewage Disposal System
---------------•----------------------
Street
as shown on the application for Disposal Works Construction Permit No._ Dated._.. _. _..._.__..�....'ne.Q..._..
q � 'y t�..........................
r
�y
Z l� Board of Health
t
DATE..--------------•-•• �_...... ,.
:..
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS - ^£„
DESIGN DATA
SINGLE"FAMILY - 3 BEDROOM 4
NO.GARBAGE DISPOSAL I /o o,G z
DAILY FLOW = 110 x 3 = 330 G.P.D. 3 0•G n
SEPTIC TANK = 330 x 150% = 495 G.P.D. °o..
USE 1000 GAL. TANK LQT 3 4
18,5orj s.�' so.00'
DISPOSAL PIT - USE ( I ) 1000 GAL.
SIDEWALL AREA = 150 S.F. t "
150 S.F. x 2.5 = 37.5 G:P.D. •� o " "
BOTTOM AREA = 50 S.F. 42'f
50 S.F. x 1.0 = 50 G.P.D. ` �a't "`' q,.a
TOTAL DESIGN = 425 G.P.D. 0 ? q'` Lo-T 2
TOTAL DAILY FLOW = 330 G.P.D.
PERCOLATION RATE : I" IN 2 MIN. OR LESSTl
°� 3
cu9 y:'
TEST HOLE # 3viz,
VM/7'n/ESS Al YE 71AC
Miz . BAULY B.o.H rou30 of BAZJSTAP31_ Q�'� ►� 5 3�;»s: . .
F.G. = 9i ' TOP FND.=q 2..5'
Cl_ 9/'3
it , � F.G. =r 5/7
� _ l
LoAM
c-L,873 SCHED. 40 P.V.C. :°� INV. 8$'
1000
4' 1000 GAL,rN
4 DIST- INV, GAL. INV,
o BOX. .. 6' 87 S' ;°• '
LaYCZS �S EACH PIT SEPTIC
M cn oo WITH I` TANK
SA040 3/4" TO 87,Z' INV,$74'
el C,PAla I I/2 07E : _rAJvETZ.7" * BESONED T<i�3 M47L�z��L a rti
GI PROFILE '_�,�' f'
SS
NO SCALE �. 4 �. 3
"'IX TEIR
�o.24�
EL 75 «
No WA7Ee I�:� ' , ',
ENCouNTejLap *2
CERTIFIED PLOT PLAN
-
A CERTIFY THAT THE PROPOSED FOUNDATION LOCATION M, R5'?"o ;�!,�!.;
,SHOWN HEREON COMPLYS WITH SCALE DATE
THE SIDELINE AND SETBACK
REQUIREMENTS OF THE TOWN OF PLAN REFERENCE
BARNSTABLE AND IS NOT LOCATED L_oT .3
WITHIN THE FLOODPLAIN, PL Jg� 46`7 PG-. �3
DATE : BAXTER S NYE, INC.
.THIS PLAN IS NOT BASED ON AN REGISTERED LAND SURVEYORS
INSTRUMENT SURVEY AND THE OFFSETS $
CIVIL ENGINEERS
SHOWN SHOULD NOT BE USED TO OSTERVILLE, MASS,
DETERMINE LOT LINES. APPLICANT 'J'oHN 't>E:LAt4q
APPLICATION FOR PER(:OLATION TEST AND 013SERVATION PITS
LOCATION NO. �
VILLAGI3 DATE /
APPLICANT /� FCs13
(Non-refundable)
ADDRBSS ' BLBPHONB NO. QZ
BNGINEBgj(3
—4yBLBPII B NO.
DATE•SC,HBDU LBD •®"" '� 4-1 Oq
(Applicantlgn tut's S )
.. . .. ...................................:..... ..................................................................................
ASSBSSOIL"9•MAP•6� LOT NO:
SOIL LOG
ID
SUB-DIVISION NAME ST3W U6,nc'( sS" DATE TIME ,)-rkn
EXPANSION ARBA:.YBS V' NO _ M�/lx} L r 0,iL. TiQc. ENGINEER
TOWN.WATER ✓ PRIVATE WELL M 11. �,Aag--'i BOARD OF HEALTH
CortS •. BXCA iATOR
SKBTGIlo (Street name, etc., dimensions of lot,.exact location of test holes anal percolation tests,
locate wetlands In proximity to test holes)
NOTES:
cz-
IJ
• 'a .
• p®�� •5�•9�zt '
, .
OLATION RATE.: Le5S 7hq Zturnrn /'cc /�►ct{
HOLE NO: ' •ELEVATION: 9/.3 o TEST HOLE NO: ELEVATION:
2 2
3 Sv35o�C� 3
AP 1 4
e 9 ,
. 10 -LA 10
cad. 9.3 12 12 r _
13 No 13 I
14 14
15 15
16 �•' 16 .
ABLE FOR SUB—SURFACE SEWAGE: LEACHING FIELD ✓LEACHING PITS
r LEACHING TRENCIIES /
ITABLE FOR SUB-:SURFACE SEWAGE. REASONS
.: ENGINEERING PLANS MUST SHOW NUMBER. ASSIGNED ON PERC TEST APPLICATION
,INAL: COPIPLBTED IN ENTIRETY BY P. E. AND RETURNED TO BOARD OF HEATH
= RETAINED BY APPLICANT •�
r
TOP OF FOUNDATION COVERS TO BE wATE GHT AND c `-
DEL. 58.0' EL 56.0, 9ROUGHTTO Y ,'HiN 6"OF NAL GRADE SEPTIC SYTE
�'ROI�ILE
not to le INSP. PORT W 13" OF GRADE Flaherty EnV/f0/7/7�e/7tc7I
4"CAST IRON or EQUIVALENT 2"of "to "DOUBLE WASHED CLEAN AND Services
MIN. PITCH 1 4"PER FOOT P� ONE OR GEOTE EL. 56.0 P.O. Box 331
as SCMED LE 40 PIPE 4"SCHEDULEFI�T_ER FABRIC
40 PVC PIpE---- Harwich, MA 02645
W LIN
774.994.1166
ri.'• '� 1' 1.795 Ifli812�g�l ..
' VENT IF RE UIRED
EL
.:
4
''�j • ;•is y<' .; FFLE 52. 3' 000°00°°°0°0 0 0 0 . 00000000c
L 000°o00 0 0 0
00000 0000
(/tL20 D-BOX) e
0 0 0
y,•�• x , EL 52.7' 00000000°0°00°000 000o 00000c
e
.,.,r�,,y !:�..,ti�•. 0°°0°000°0°00 0°°0°00°0 � � 00°00°o00°e 2.0'
0 0 0 0 000000 �a .' 0000o0o0c—
000 GALLON SEPTIC TANK 6"CRUS D STONE OR STALL Z%ET TEE 1 � : ••' :• ' 0°0°0°0°e
MECHANICALLY COMPACTED asOVE OUTLET INVERT SOIL ABSORPTION SYSTEM ° ° ° ° EL 50.7'(DATUM: ASSUMED)
EXISTING f
(2) 500 GALLON H-20 CHAMBERS
a 0 f DOUBLE WASHED STONE WITH 4'STONE AROUND IN A 5.2'
12.83'X 25'X 2'CONFIGURA7rON
BOTTOM OF TEST HOLE EL. 45.5' EL. 45.5'
USGS ADJUSTMENT: N A LOCgT/ONMAP
GROUNDWATER ELEV: N A
TH
/ 40 , � � Rd.
00 56
LOCUS
ED
0� EXISTING NTS
LOT 3 3 BR EXIST. S.T.
18,507 SFf
DWELLING LP tH OF AI
O� �,�
MAP 43 LOT 77-03 DECK T� DA (�.
32.4'1
TH-2 (b O cs F
CAUTIONI SEE NOTE #6I
166.0p.
LEGEND I 9.4' Q DATE.a2S&o19 REV/s
19.4'
GAS LINE vo
WATER
EXIST. ELECTRIC BENCHMARK: SITE AND SEWAGE PLAN FOR
TOP OF FNDN
99 EXIST. CGNTGMRS EL. 58.0
B A B EXCAVATION,INC 1
'——------ 99 Pip, CGNTGtltS � ' S6
— — UNDERGR TO UTIL, STEPHAN SUNDERLZN
31 STOWE ROAD
s (MARSTONS MILLS)
r SCALE: 1" = 301 BARNSTABLE, MA
REF•PB 467PG 63
y� PAGE I OF2
i
1
................................................................................................. ........................................................................................................................................................................................................................................................................................................................................................................................................................................... ................................................................................................................................................................................................................................
GENERAL NOTES
DESIGN CAL CULA TONS
SYSTEM DETAIL Flaherty Environmental Services
1. ALL PRECAST COMPONENTS TO-BE H-10
P. 0. Box 331
RATED UNLESS OTHERWISE SPECIFIED.
NUMBER OFACTUAL BEDROOMS 3
DISTRIBUTION BOX(ES)AND ANY
Harwich, MA 02645
COMPONENTS WITH ANYAN77CIPA TED
GARBAGEDISPOsAL UNIT NO 774.994.1166
VEHICULAR TRAFFIC TO BE H-20 RATED.
2. THE DESIGN OFpq�s
SYSTEM DOES NOT TOTAL ESTIMATED FLOW
ALLOW FOR THE"USE OFA GARBAGE
(110 GALIBRIDA YX 3 BR)
GRINDER. 330 GALADAY
3. MUNICIPAL WATER IS AVAILABLE. REQUIRED SEPTIC TANK CAPACITY 660
GoqL.
4, ALL CONSTRUCTION To CONFORM WITH
SIZE OF SEPTIC TANK 310 CMR I S.000 AND ALL OTHER 1000 GAL.(EXISTING) 25'
APPLICABLE LOCAL, STATE AND FEDERAL SOIL CLASSIFICATION
CODES AND REGULATIONS.
S. INST ALLERICONTRACTOR To REVIEW& DESIGN PERCOLATION RATE <2 MINJINCH
VERIFY ALL ELEVATIONS AND DETAILS 7—
AND REPORT ANY DISCREPANCIES To EFFLUENT LOADING R4TE
I.DA y/FT2
DESIGNER PRIOR TO CONSTRUCTION OR a 74 GAL
ASSUME ALL RESPONSIBILITY. LEACHING AREA
12.83
(2)x(25.0'* 12.83)(27 151 SF
6. INSTALLER/CONTRACTOR IS
RESPONSIBLE FOR MAINTAINING SAFE 25.0'x 12.8.3' =320 SF
WORK AREA, VERIFYING ALL UTILITIES 471 SFx 0.74 =348 GPD
AND NOTIFYING "DIG SAFE"
USE(2)500 GALLON H-20 CHAMBERS WITH 4'STONE
(1-888-344-7233) 72 HOURS PRIOR TO INA 12.83'X25,CONFIGUR4TIONASDIAGR4MmED
CONSTRUCTION.
7, ANY CHANGES TO OR DEVIATIONS FROM
THIS PLAN MUST BEAPPROVED RESERVE LE4CHING CAPACITY IN NIA
WRITING BY FLAHERTy ENVIRONMENTAL
SERVICES AND LOCAL BOARD OF
HEALTV,
8. FINISH COVER OVER COMPONENTS IS
NOT TO EXCEED 3'PER 310 CMR IS.000
UNLESS SHOWN PER PLAN. (NTS)
9. ALL ABANDONED SEPTIC SYSTEM
COMPONENTS TO BE PUMPED DRY AND
SOIL EVAL UA TION
FILLED WITH CLEAN SAND OR REMOVED
AND REPLACED WITH CLEAN SAND,
7ESTHOLE#1 Tpr#lg.W
Evaluator TESTHOLE#2 TpT#19-58
10.ALL COMPONENTS To BE PROVIDED DaWD.Flaherfyjr.,Rs,REHS Evaluefol-
SE#2755 D 011 D Flahe*Jr.,RS,REHS
a 02
WITH WATERTIGHT ACCESS PORTS 80H Witness: Dawd S7j?nft7,RS SE i55 OF
BOH K07M.- DaWd swtw,RS.Date-
WITHIN 61'OF FINISH GRADE. Jum 18,2019 Data. JZM 18,2019
DAVI
1I.ALL SEPTIC TANKS, DISTRIBUTION
TH-IELEV56.0'BOXES AND PIPING TO BE INSTALLED
TH-2 ELEV.M& FLA R - J
WATERTIGHT.
0--14- F/U
IZNO KNOWN WETLANDS OR WELLS ( ir-14'
FILL
WITHIN ISO FEET OF PROPOSED
#STS
LEACHING,
14'-18' A SL IOYR212
14'-18' A SL foyR22. NITA
13.*HIS IS, ,NOT A CERTIFIED PLOT PLAN 2��9
AND UNDER No CIRCUMSTA IS THjS
NCES 18'.34- a A IOYR514
PLAN 70 BE USED FOR ZONING OR 18'-34' 10Y• R 514
BUILDING PURPOSES, 7 cot*that on
November 12,2002,/have passed
DRAwftw tof WAGE PLAN
N AS ASSESSOR IS MAP p 43 EnwmftMwt81 Pmie Me awmIneffon approved jw me
14.LOTISSHOW cibn and that ft above ana&ub SITE AND SE
FOR
LOT 77-03. 34'-126' C MS 2.5Y" Ago been Peffwned by nw conamw wo ft
IS.LOCUS PROPERTY IS LOCATED WITHIN 3C- C US 2.5Yff m9uftd&afdv awwfte and averkncedasaffiW
8 & 8 EXCAVATION, INC./
In 3 10 MR 15.018(2A• STEPHAN SUNDERUN
AN AQUIFER PROTECTION DISTRICT
(ZONE 11).
31 STOWE
0.W ELEV.WA ROAD
G.W Ems'WA
BOTrOM M I ELEV.45.5'
(MARSTONS MULS)
BOTrOM TH-2 ELEV 46 0'
BARNSTABLE, MA
........................................................................................................................................................................................................................................ PAGE20F2 DAM&2512019
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