HomeMy WebLinkAbout0022 TANBARK ROAD - Health 22 Tanbark Road
A=100-019-002
Marstons Mills
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
22 Tanbark Road >
\' Property Address
John C. Murray
Owner Owner's Name
information is required for Marstons Mills MA 02648 June 10 2008
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.
Important: A. General Information
When filling out
forms on the
computer,use 1. Inspector:
only the tab key
to move your Patrick M. O'Connell
cursor-do not Name of Inspector
use the return
key. Septic Inspection Services Co.
Company Name
r� 189 Cammett Road
Company Address
Marstons Mills MA 02648
City/Town State Zip Code
508-428-1779 S1 12855
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. 1 am a DEP approved system inspector pursuant to Section 16.340 of
Title 5(310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Loc proving Authority
I
June 10, 2008
pector's Signature Date I
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.
08-159 Murray.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
rr 22 Tanbark Road
Property Address
John C. Murray
Owner Owner's Name
information is required for Marstons Mills MA 02648 June 10, 2008
every page. Cityrrown 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:
Tank is not in need of pumping at this time, Leaching pit was found ahlf full with a high stain line _
indicating pit has 24-30"of effective leaching.
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not
determined,"please explain.
❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.
System will pass inspection if the existing tank is replaced with a complying septic tank as
approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate
of Compliance indicating that the tank is less than 20 years old is available.
ND Explain:
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
08-159 Murray.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
rr 22 Tanbark Road
Property Address
John C. Murray
Owner Owner's Name
information is required for Marstons Mills MA 02648 June 10, 2008
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes(cont.):
❑ distribution box is leveled or replaced
ND Explain:
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
ND Explain:
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
08-159 Murray.doc-08106 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 3 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
22 Tanbark Road
Property Address
John C. Murray
Owner Owner's Name
information is Marstons Mills MA 02648 June 10, 2008
required for
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria 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_day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
I ❑ ® 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.
08-159 Murray.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 115
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
22 Tanbark Road
Property Address
John C. Murray
Owner Owner's Name
information is required for Marstons Mills MA 02648 June 10, 2008
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy.of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
a 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.
08-159 Murray.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15
Commonwealth of Massachusetts
Uo
Title 55 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
22 Tanbark Road
Property Address
John C. Murray
Owner Owner's Name
information is required for Marstons Mills MA 02648 June 10, 2008
every page. Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes"or"no" as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or 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)]
08-159 Murray.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
22 Tanbark Road
Property Address
John C. Murray
Owner Owner's Name
information is required for Marstons Mills MA 02648 June 10, 2008
every page. Cityrrown State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CM 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 81,000 gal. _
9 ( Y 9 (gpd)): 110 gpd.
Sump pump? ❑ Yes ® No
Last date of occupancy: Currently
Occupied
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of'occupancy/use: Date
Other(describe):
08-159 Murray.doc•06106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
'< 22 Tanbark Road
Property Address
John C. Murray
Owner Owner's Name
information is required for Marstons Mills MA 02648 June 10, 2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information: Tank pumped February 2007
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)
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known) and source of information:
Compliance date: 5/1/89
Were sewage odors detected when arriving at the site? ❑ Yes ® No
08-159 Murray.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments.
22 Tanbark Road
Property Address
John C. Murray
Owner Owner's Name
information is required for Marstons Mills MA 02648 June 10, 2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
2'
Depth below grade: 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):
1'
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
---------------------------------------------------------------------------------------------------------------------------
Dimensions: 8.5' long x 5.2'wide- 1000 gal.
2"
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle
28"
Trace
Scum thickness
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
14"
How were dimensions determined? Measured
08-159 Murray.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
Commonwealth of Massachusetts
r Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
r< 22 Tanbark Road
Property Address
John C. Murray
Owner Owner's Name
information is required for Marstons Mills MA 02648 June 10, 2008
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet,tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Liquid level was found at bottom of outlet invert, tees are intact and clear. Tank is not in need of
pumping at this time.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
08-159 Murray.cloc-08106 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 10 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
22 Tanbark Road
Property Address
John C. Murray
Owner Owner's Name
information is required for Marstons Mills MA 02648 June 10, 2008
every page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank(cont.)
i
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
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
0"
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
No solids or high stains.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
08-159 Murray.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
'l 22 Tanbark Road
Property Address
John C. Murray
Owner Owner's Name
information is Marstons Mills MA 02648 June 10, 2008
required for
every page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
® leaching pits number: One 6x6 pit
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Pit was found half full with a high stain line 8-10"above current level leaving 24-30"of effective
leaching -
08-159 Murray.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
r� 22 Tanbark Road
Property Address
John C. Murray
Owner Owner's Name
information is Marstons Mills MA 02648 June 10, 2008
required for
every page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Cesspools(cesspool must be pumped as part of inspection) (locate on site plan):
I
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.):
Privy (locate on site plan):
Materials of construction:
' Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
08-159 Murray.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15
. Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
22 Tanbark Road
Property Address
John C. Murray --
Owner Owner's Name
information is Marstons Mills MA 02648 June 10, 2008
required for
State Zip Code Date of Inspection
every page. Cityrrown
,
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties
to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.
Locate where public water supply enters the building.
yl�
37 48
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Water
Service
Tanbark Road
Commonwealth of Massachusetts
_ Title 5 Official .Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
22 Tanbark Road
Property Address
John C. Murray
Owner Owner's Name
information is Marstons Mills MA 02648 June 10, 2008
required for
every page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
30
Estimated depth to ground water: feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
® Accessed USGS database-explain:
USGS topo map and town GIS
You must describe how you established the high ground water elevation:
Town groundwater contour map shows water below el. 35 and property above el. 70.
08-159 Murray.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15
Town of Barnstable
FTHE Tp�
Regulatory Services
gpRNSTAB g, s' Thomas F. Geiler,Director
MA-
16 9. �•� Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS
DISCLAIMER
This septic system inspection report was completed by a private inspector who is certified by
the State of Massachusetts, Department of Environmental Protection.
Although the Town of Barnstable Health Division received the original or copy of the report;
this Division does not warranty the functionality of the septic system in the future nor does
this Division agree with any technical observations and interpretations contained within this
report.
In addition, by receiving this report the Town of Barnstable Health Division does not
automatically approve the number of bedrooms listed within this report. The actual number
of bedrooms approved at a particular property would be listed on the "Disposal Works
Construction Permit".
If you should have any questions regarding this report, please contact the certified Septic
System Inspector who conducted the inspection.
QASEPTIC\Disclaimer Private Septic Inspections.DOC
TOWN OF BARNSTABLE
LOCATION AaM,vibe-rlc 5ZJ SEWAGE#^ ;�
VY�LAGE 1M. t�iltS ASSESSOR'S M/AP&PARCEL
Ih1S;E£�NAME&PHONE NO. °�rti`c k �` o ,
SEPTIC TANK CAPACITY /000
LEACHING FACILITY:(type) Puff (size) 1000 �
a
NO.OF BEDROOMS �:�j
OWNER 'SDIA n M y(`na✓
PERMIT DATE: COIiALLOW-E-DATE: J- Sp 'ern wlOA
Separation Distance Between the:
Maximum Adjusted Groundwater Table tothe 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
37 48 "a
23
8
1
1
Water
Service
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Tanbark Road
TOWN OF BARNSTABLE
SEWAGE # 8&
VILLAGE m/q ��fc,')� /YI�'Jl.� ASSESSOR'S MAP & LOT -1 9
INSTALLER'S :NAME & PHONE NO.T,- j 2>S c.c)))
SEPTIC TANK CAPACITY /060
LEACHING FACILITY:(tyre) (size)In (2 _.
NO'. OF BEDROOMS_PRIVATE WELL OR PUBLIC WATE
BUILDER OR OWNER-g.0-fin)
DATE PERMIT ISSUED:
DATE C011PLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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Fim......... s ...._
THE COMMONWEALTH OF MASSACH(tSETTS
BOAR®_ OF HEALI0H
WAt f<niss48C I�
-------- ----- --------------------
OF.............
.......--••-------------
-- -- ---
� lir�ation for Diu as al ur Toti,utrnrtiun rrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
... -/--•- ..
---•------------
Locatio Address _.... No -
.............. ............................. . ................... ---------
Owner Address
arz1 srar�� �o� i ---------------•---
Installer Address U Y L,t Type of Building t. Size Lot.../-__Y.-7--_J__.__--•----__Sq. feet
h., Dwelling—No. of Bedrooms---.-_--------------------------------------Expansion Attic (Y) Garbage Grinder (//)
04 Other—Type of Building ............................ No. of persons................j!.......... Showers ( ) — Cafeteria ( )
dOther fixtures ....................................----•----------- •••---•-----•--•••-•••••'I.---•-------••--••-•••-•-•--...•--•••----------.......-------------•--
5.5
W Design Flow.................... ____ _______________gallons per person per day. Total d�tiily flow._.._.......*..............................gallons.
WSeptic Tank—Liquid capacity_l'M..gallons Length................ Width......sl_-------- Diameter---------------- Depth................
x Disposal Trench—No..................... Width.................... Total Length............. Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet...........[....... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.�F?o r EC��.....)JFL7.......... nr Date__.!' �5 _. 5,_____________
„.a Test Pit No. 1..._�._a-_-minutes per inch epth of Test Pit•-®a:_ _.��... Depth to ground water----rvo!.R--_---_.
(i Test Pit No. 2................minutes per inch Depth of Test Pit................ ... Depth to ground water------------------------
---------------------------------
----
Description of Soil_________ ______�
7
W -----------------------------------------------••--••------------------------------------------------•------------------•--•--......------------•-------------•----------------------------•------------
-------------------------------------------••-••--------------------------------------------------------------------------------- 1---•--••----------------•----•-••--•-•-••------......---------_------
'' U Nature of Repairs or Alterations—Answer when applicable.........................�___-__._..
J
------------------------------------------------------------------------------------•--...---•------------------------------...---:------------•----------------------------------------....._..-------•
' Agreement:
The undersigned agrees to install the aforedesc ed Individual Sewage Disposal System in accordance with
T!'1c--�
the provisions of T IE u.: 5 of the State Sanitar Cod The undersigned1�further agrees not to place the system in
operation until a Certificate of Compliance has e su by.th oar of health.
gne = . ...... �I................................. ....a`�a ............�`--=� ..
Application Approved By... .. ___ ............... __�`�`..............
_
- ----...•----------------�I----------- Date ............
Application Disapproved for the following reasons:...........................................- ,I-------------------------------------------------D-------•--------
1t....Permit No.----- ------------------- Issed.........- __ .....Date
w JJ
No.-11_ _:. 11.� Fxs
..........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
Q,a,,;. nRNsr43C (r
...... .............OP............................_............................................................
Appliration for Iliaspimal lVarhij Cf1ia7„strurtiun fIrrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
1Rn33/si2d( a�t) l�rtJ;tnrStc
L �^
Locatio Address or at No.,
.....................— _........_._.._............_... .....
. ...:...........-•----------......:_.•.....-----•------•.................._.........--
` � t Owner S,�j Address
a =...... = ......................... .........-----••-••-------.....•--....---•.............._
Installer Address
d Type of Building ,� Size LotJ± 0 _._._____Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic (Y) Garbage Grinder W)
`04 4 Other—T e of Building No. of persons............................ Showers — Cafeteria
a Other fixture
W Design Flow...........................................gallons per person per day. Total daily flow__........ _3 ........................gallons.
9 Septic Tank—Liquid capacity)OP...gallons Length................ Width................ Diameter_---_-__-____.__ Depth................
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No-----------_--_-- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
i s (c rtrtyf� F 6v4G-� i a
Percolation Test Results Performed by e -------;•-•-••------•---•-•---•--•-----•--•----- Date--=----� 6--- ----- . --------
aTest Pit No. i-__f 2-__-minutes per inch epth of Test Pit..1."?_:.5-..._... Depth to ground water....^^ Gn tr•--_-_ .
r%, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water_..-___---_-____---_-_--
04 ---•------•-----------------•- •••••--•---•--•--••---------------•----•----._........----•-----------------------------------•••...-•--••---•••------------
0 Description of Soil------.... ....... tA4 .....Pf/A c t.i
.------•-----------------------------------------------------------------------------------•-•-------------
x
W ------------------------ •------•---------------•------------......•--------------•--------•------•-------------••-......----•---------•----•••-•-----------•------•-----------••--•-••-----------------
UNature of Repairs or Alterations—Answer when applicable----------------------------------------------•----------------._----------_----__••_---_--__-.
-•--------------------------•-•----••-----•-----------•-----•-------•-------•--.................•-•--••-...-•••••.•••----------•-•---••-----••--...-----------------------•------•--------•••---•-.•--••
Agreement:
The undersigned agrees to install the aforedescRed Individual Sewage Disposal System in accordance with
the provisions of ': t[E 5 of the State SanitarVn'�
Cde— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b -ssued by the boar+�of health.
Sign d_- -- /_ -. c .
l {
Application Approved BY ' J�= LL'.-'-- f '-- :.....--=� ------•---•-..•...................•...-- z-r//pJ r3
r✓ Date
Application Disapproved for the following reasons____________________________________________________________________________________________________•...___...--
.....................................................--•-• -- ------------------------------•-•------------------•-------------------------------------------------------------------------------
cc Date
Ik Permit No.... ---��--/-------------•-------- Issuer-----•---•------------------
------------- ------
LS_..
r'
THE COMMONWEALTH OF MASSACHUSETTS
BOAR OF HEALTH
e� N a i,#/4 C.t t
........................oF.....:� ..`.`....................................---...............................
�rrtif iratr aaf falaanplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (" ) or Repaired ( }
by---------------- ___I. 'hs ; s C a C t S s..!
_ Install -
at------------------------------------------------------------------------------------------;----•---------- ----•------------- -----•-.............................................................
has been installed in accordance with the provisions of T TIE o//�� The State Sanitary Code desc •bed in the
application for Disposal Works Construction Permit �'o. !>.___ .(?__f............. /Vl� Vs ...........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE®AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector..............;.---.......------------------....--•-•---•------•--....._......•-----
THE COMMONWEALTH OF MASSACHUSETTS.
BOAR OF HEALTH
...........oF......r.�
N . e
J, �'
.. FEE. .�.........---
r ; �iraaal aar�a Ouaanstratrtiaan motif
Permission ip�hereby granted.. 5 ..
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
C.eT i� f?�4A� rc: ,'oEa ,t rr�,�.sxti s Nla..e S
atNo..............................--•------A / •
Street // "f/ -
`?as shown;on the application for Disposal Works Construction Permit No..7ln. Da ed.�` 9. �:
r A� ` ...
_..........
•. ;. 1 . ................................ _
� € � �� -a of Health ---•--•----•--•-•-'--•-'-
r
g
DATE.. '. "- f _--1����-'�� ,...--•-------•-••-
FORM 1255 "HOBBS i WARRE C- SHERS + e•
ao . SHEET .7 OF 7
MARSTONS MILLS
. LOT 130 .
raw w ..
won \,
h LOT 129.
LOCATION MAP
it r
i
:�t
p►A 77It 6 it ,7 LOT 12
WIN w
b
try ' `i - lip
r� i ..
LOT 31
,off,
LOT 137 aw>.��� `� t���-
i 11 LOT 12IVA
4 b
SLOT IDS A• Ob&6
¢ -'L01`�2Y ' �y�oo LOT 123 `
1 I i �� 4 r �- \ LOT 126 n.m w
f+r X l 74• b x t ,}'4 �¢ I o t �. LOT 13 \ nrw s
/ LOT 149
LOT 136 as 4• so / .;
4
LOT 13K �1 y T 122
� _ � �• tif. � �� '1s ' LOT •�,
rAsa . '• .. - S. `/ ' yi 102w it Val
• / / / d I I - '�• rs'd' 7t
LOT 107 LOT 148 /� �° b > f4' I i 1 `j t'
7tao, ��p /°40T 147� / ,salt I e t �1!W
\ \ ��� 's �� LOT 119 L
'LOT 141 `\ o rv� rmoo s
`_ `\\t *A t I' t I'y `_ • " \' �,0 J a �L 14 ; t A 's 10 Tiao} 1 :w \ �L LOT 120
rom s / 'IL ib �� �
LOT 117�� 'ia -[ romo Ill
sox , -1 LOT 43\\ _/�' ; �, \ ►` .{romps ". Jr *4 `o t
' .14 v
.4' a y° l' -- :I.5" M'r 7A oF'I Pot_ Sall, v µ t. Ls wp
i 4, / ', LOT 115 so• �. 6N vwu0t mw4 -tvsr. RGsdvT&.
145. ."
� .. ` x''; tt,sari *"or 7A OF 7 rtDtt: •LarirsND' .
lot Lot s66 i t% YoT �� Um"s
\
ON
to `\` 4•� �. / LOT 11 M r LOT it8
o ,� �. romo tr
1A till
• 1o1 y
' u • LO 114
•~ yti LOT it '" i4mrts a •6 o.f..rw Igoe E GAM*M JS
+a�a � ., ra rs is
leir 3 11 29 88 FINAL BLDC. AND SEPTIC LOCATIONS PAL
\ 9 \�M N '•1 �1 p t4 LI ..
_ 11 8 BUILDING OCATION PLAN DON
1 10 12 88 INITIAL IS ELK
yydir}�� 10'e '11, N0. DATE DESCRIPTI By
BUILDING LOCATION PLAN
�-
MARSTONS MILLS WOODLANDS
Ill
LOT 109 +°•T•�': i BARNSTABLE, MASS CHUSETTS
WOODLANDS ASSOCIATESIMAITT-TRUSCC
`\ SCALE: 1, 50' J08 N0. 1.338/r
LM, MREDGE & WAGNER ASSOUA INC.
nmlms UNMM INOoln RAN® Un>nINR10!!
88o wm MAIN STREET CENTLRV= ILA 02632
y
SHEET 7A OF 7
a vLrr MaA rNLAN
e 'r rM weer►osaae r•w�
i.RR_
CARER
MAR510NS IOUs l e Ta p ® OWL ® ® DESIGN Cwi�ALCULATIONS:
RaMR 1 A 1 - TOTAL OOtsposAL or
un
(�M OALAMAAY x •1 ]30 NUN ,GAT
ON
RE9t�LfD SEPDC TAN(CAPACITY LOCATION MAP LIT-- ML 4 Vpa rya rt r o�e rR �•l
Nr ONION I/r ra rt.
IL/•LM �� � ACTUAL S SEPTIC TAN REM
r LA+w v LEACHING AREA KD NK
SD= AKA OAL./t/.
L - ""meue AOTY(eoT o��r'4' Dx e,•
Lima
DISIROUTIO N y M MNTNNY
Box NOTES
® 1. ALL SUPOO 41OW AND NATIONALS SMALL COeDIM To OXCLE
TRIE S AND THE TOWN or-A&WELMI RLILES AM
QOIAATIONS fOR THE SOMMACE DISPOSAL OF S[NAOL
T000 GALLON SEPTIC TAW L r-1 r I r i E De1W M T rt•9MD oR�TS SMALL K GROUMT 70
. I D• 1 3 Y MASONRY LIMITS USED TO§MM OOVIDIS To GRAN
SEPTIC SYSTEM PROFI F ANSMALL K MORTAL IN PLAOL
ALL COIlGONTS 0 THE SANITARY SYSRM MALL K CAPA•LE
WIN I sALa BOTTOM OF TEST HOLE K11■ 1STANOMo N-10 LOADING 1JbI TMET ARE LRIM OR
WHO TO fT.OF DRIVES OR►ANON AREA& U-20 LOADING
LEACHING PIT ,SMALL USED 11000 a WITHIN tD rt. a
Or D1SV-
& HORIZONTAL AND 1LRRCAL CONTROL SM LEVY.OJOI
a Shama n D NOTESOOM M1Amij Cut nAM 1336-10
LN
ELEVATIONS LEGEND:
FINAL SPOT ELEVATION C= _
106 107 108 109 110 ill 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147� 1481 149 a�TAN aDIM
O.FOUND. PRIMARY E LEACHING AT O
r. A 70.,3 7t•5 71.0 1bo 7bo tIo 7t•e 7I.e 74f 90.9 76a 77• aB.f so.• M•s •Le o PERK TEST
I01
b� el 01•0 Aye. - 001•0 01.0 Vf 710 74.5 70,4 7s:o 74.s 114.0 7s•o 71.0 A IEZRVE Lrwo•No wt H
74.7 741.0 74.0 76.s s 7f.o 7fo 72•0 1p.o 7hs 17M1.o 7Ja AD OW(XISID .GI Note
B 7o•9 61.4 66•0 641 Lid 0.0 61J 7L4 7't•0 711.9 73O 74•e 76•0 77.s -"S W 78.1 7s4 MS. - 70,.o 760 713.4 7}f 7I•i 71If 71.L 1 7"11*4 7t.0 71M.s 74.4 79F.6 744 73.1 72.1 ?t 4 74 04A µ,3 is5i: `4.0F I.o B
C 11 y 693 65.6 Me* i17 &4,11, 7L2: 7L7 71.7 7t:1 74.1 7f.7 1&.16 77.1, IVII 70.14 77.4
77! 7►.L - 77.7 77.7 1714 74• '1L3 7t•i 71.3 70•ti fir.! 71.7 7!•f 71<.L 7s.z -y4t,73a. 7t.Y 71.1 71. 644 1 ".1, vft, 64.7 l C -
i
I D 70.0 N•e 1 L9.7 bit 60•10 $7.5 i4o 7Le 7Lf 7t.5 7s.f 74.0 7P.5 140 117,9 77.4 ie.0 na 174 7LO - 77.5 77.4 7F.e o 71.1 -ft 71.! 70.0 D
4 10.0 7l,f lyo 7s•4 73.0 74.4) 75.4 it4 7(•1 10. N•1 N,v.o o s.� 10.5
E 44•U 1re4 0.5 i9.4 99A i> ' &&* bw 1 71.3 7ss U-3 7b.9 7f•3 76.6 7c•s 711.6 7s1 .7" 715 71.6 - "..'S 77.3 7 7 b.lq 7eA 7s•%, 70.1 41•6 N,q,o 71.4 1t.a 7t."j 74.1 74.3 73 3 7t.S. 71.9 F.6 w.ti K.6 i4.4I E
F 61e 6e4 6,0.1 N.s.S N,s.s Lxt, H.i 794 -41 794 7t,j 7s•N. 7f.1 7f.N, _ 77.1 77.1
7s7 77.1 7.1.1 Te,O 74.(. 7i•Y 1 79.1 7cI.7 N•i N•i 71.L
lt.i 73.1 74.7 744 7s.1 11.6, 7►.N. K•& &4*1 as.l� �7s•I F
G N•f ib•s 6,5.0 111,e Me (,7•e .x0 7e•5 71•e1•5f 77 7 .s its 1.0 17.0 i - 7S 1.0
744 73.5 7•i lt•o h•s Hs 64.s ib0 7t•e ? •0 745 740 7s• ls.o 7r•s le•f Lis G6. i4.51 9., o G
H 4" iL4 Mete f7•e s1•e 61.0 ss•s .oNte 7 . 71.0 .0 9•s 14.f H•0 &S-s III ifo vssq.51NA•f Lyo 6ks Nho Ze ta.o bs.6 e4.5 4t.f 545 Jiff L.t 4o H APPROVED: BOARD OF HEALTH
J Ste yes fs•o eie rwo STso p.s ied &W st•o NL• 1&%5 vs.e sf.5 sa.e Yi.f 9,7J L7o (,7,o L4•'1 _ N7e Li.S itif s3.f to.5 st.e 4o•S 51•t f4.0 i1•0 tE.S LTAe N.4 c4.e N.3o yt,0 N.LS p.5 Jbs 44.s Lo � .� wio.0 J
Saw AMR
K 71•a 7/8 -P.O. 110 Lae 7e.0 11.0 73.5 136 7Mkf 7r.1 U-0 77-F Ito iq3 7}s t•.• ev. yo 71.5 - P.O Sae 17.s *,3 71.s 74•! 751 73.0 79,1 1S.S 71F•o 7(,• 711 770 7s.1s I 7.1•6 74.3 1 114 0 v 10.* �t.� I14.0 K
L h.s 71•5 te.o i►o N) 0-co7e.1 76.e 7#6 74.f 7r.0 7J•f 7Z0 77s 79e 74•e 79.6 7q•e 74.► t►.o - 71.5 '71.8 71.e 7Z,• 7s.S 74f I" 71's 71.0 73! 7I.7 -4,0 7" 7LO 7f.s I 7hs 74e 7Lo 1l.0 70-P 7LA'7T.S L
M 71•o 41.0 Lf•s il.o NS 740 79.9 71.0 W.5 145 70.0 7s.s 77.s 7&070e 74. 74•► 7Lq 7Zo 7ws 7Ze 7�.0 7s s s•f J4377.0 7r• 76. .47 . 1so 7 . s ,o. .
I710J it.s M
N it.e 7L0 i7.1 bf0 Lf.o a 70.0 71s 7So 74N3:7Mt� 7Ae 70.6 lay 760 ;60 74.4 74.4 b e 77.0 74.i 75.0 h.S N; 7s.9 i43 7i•o 7s o 1• ! S" I'7 S N[ . 0i 7Tolcy 73.T 73.o 7s•f
1 12 9 88 INITIAL ISSUE MCT
NO.I DATE DESCRIPTION I BY
PERC TEST 1 PERC TEST 2 PERC TEST 3 PSC TEST 4 PERC TEST 5 SEPTIC SYSTEM DESIGN
LOT 116 LOT 125 LOT 131 LOT 149 LOT MARSTONS MILLS WOODLANDS
�• D. .In
� �a BARNSTABLE, MASSACHUSETTS
Ale NWeaRt•/OM NUTI w•Ali 1"p
Ale eAt i
t•Ale NIM•NL >•w NM•Na IN
INMe•ARr RON•ARmM Noah••AM AR MI•Ue•AHWN= NY•NII••ATA GMM
*.,,,,,� "e �� WOODLANDS ASSOCIATES REALTY TRUST
w•/•�O ••e No•ne.AM G weAa Nwe o/•MeE ��MIM MI/•�
ar WAK WNW MIEANI,Re RAW IMWNE SCALE: 1' s 40' .MOB NO. 1338/aTM:
•NMe •we NOT NNw a TLIW ALIs CAM was gR/NR va
no m7m r ONO as WIN r min -as MASS
N M •7' ►Auc
b o ..
DATE Of DK TE VJ" DATE Of SOIL WOVE" DAR Of WL TM MA DATE OF VOL TEST I&" Om Q SOL TEST NIA• n rYVO•+{
ITwem SIT A Ate+'° WI -
PERCOLATION eY A��� rTK3SEA DT A r 4• •4 ITMOSm DT A WARN ID/OSED s rw BY A
PERCOLATION RATE=(_NNILANON PUtOOLATMIN RATE SL�•/1�M PERCOLATION RATS yy_NKANOM PERCOLATION RATE-SLNDL/MOI PDICOAlm RATE AJ_wLAcN
PERCOLATION SOIL TESTS UM, MMGE & IrAGMM OOCU INC.
mm man Baths n=i un totlnms
889 WM MAIN BTRF.ET' CIIE'r=VMZ NA 02032
I
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