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HomeMy WebLinkAbout0042 TANBARK ROAD - Health 42 TANBARK ROAD, MARSTONS MILLS A=100-202 No. / Fee �✓ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftprication for Disposal .6pst>em Construction Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System 9Individual Components Location Address or Lot No. iL 'riQNb0kP_K aD M.h , Owner's Name,Address,and Tel.No. T%NA CoRmi Ek Assessor's Map/Parcel 1 OO O aQ Q®")_ 4-x TAsjrbAZ _ kAVS"'q>JS i Installer's Name,Address,and Tel.No. 5 0,J—L'i I _$�c Z 1 Designer'sName,Address,and Tel.No. 5 6W iD G �j TAP ST 5�-s 4 Peig MIA 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) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) RgPLA€6_ 1>--7SQ) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this B rd of He Si ed Date Application Approved by Date Application Disapproved by Date for the following reasons e Permit No. C7M' Date Issued 7 ------------- No. / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppfication for Misposal �&pstrm Construction Permit Application for a Permit to Construct( ) Repair(X Upgrade( )1 Abandon( ) ❑Complete System Individual Components Location Address or Lot No. 4 A "fA)JeAZK Rb M-M Owner's Name,Address,and Tel.No. °T1NA CORI"11 EP. Assessor's Map/Parcel 10 0 lo a 0 C O Z -T 7J iz<. R �h�S JS Installer's Name,Address,and Tel.No. 5 pi-W11 Designer's Name,Address,and Tel.No. CAP GLO(D G GpTag FP U 'GS W., . Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No of Persons Showers( Cafeteria( ) Other Fixtures De%kign Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) RGRn Ad --73v�C 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 by this Board of Health.,, Si ed Date � / Application Approved by Date Application Disapproved by Date for the following reasons Permit No. �D� � Date Issued -------------=---------------'------------------------------------------------ ----------------------------------------------------- � THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY;that the On-site Sewage Disposal system Constructed( ) Repaired(X) Upgraded( ) Abandoned( )by CAPEw lDG e YRJS ES "c— at 4;). TAO 6 M M has been constructed in accordance with the provisions of Title 5 and.the for Disposal System Construction Permit N09ot 5 �/ dated Installer�4nC �Qa s LLB Designer #bedrooms Approved des6fundtiq��� -w * gpd The issuance of is permit shall not be construed as a guarantee that the system wip Date '� I COI ( � Inspector I --------------------------------------------------------------------------------------------------------------------------------------- No. C ��-a' Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION— BARNSTABLE,MASSACHUSETTS Misposai 6pstem Construction hermit Permission is hereby granted to Construct( )) Repair(/� Upgrade( ) Abandon( ) System located at 4-1. T/4N AL 1411�rDk-bMARS-Z3uS M(LjL—S 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. f -'`Provided:Construction must be o_ 1 ted within three years of the date of this pt.Date ��� Approved ul191511:08p p.1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 42 Tanbark Road Property Address Tina Cormier Owner Owner's Name / information is Marstons Miles ✓ MA 02648 7-17-15 required for every page. CityRown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab -• 1. Inspector: key to move your 2 cursor-do not ,lames D.Sears JAMESuse key.the return Name of Inspector s - CapewideEnterprises,LLC =* ` ' � o o � Company Name ��p�� o 153 Commercial Street ','�� 5 u S"P*5-�`\``,\ Company Address Mashpee MA 02649 Cityllrown Stale Zip Code 508-477-8877 31623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails I ❑ Needs Further Evaluation by the Local Approving Authority ' 7-17-15 pector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or i has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the I 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 wifl perform in the future under the same or different conditions of use. t5'au•3l13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 z 0 VSU0 I Jul 19 15 11:09p p,2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 42 Tanbark Road Property Address Tina Cormier Owner Owner's Name information is required for every Marstons Mills MA 02648 7-17-15_ 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: ® 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: The system is a 1000 Gal_ Tank-D Box and pit. 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. 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 structuraJly � unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass i 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 0 NO(Exalain below): i t5ins•M3 TUe 5 Ofidai Inspection Form Subsurface Sewage Disposal System•Page 2 of 17 i I EI Jul 19 1511:09p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 42 Tanbark Road Property Address Tina Cormier Owner Owner's Name information is Marston Mills MA 02648 7-17-15 required for every page. Cityrrown Stale Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumpslalarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cunt_): ❑ 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): i I ❑ 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): i i 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 l 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 Q Cesspoor or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 151ns•3113 Tide 5 ORdal Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Jul 19 15 11:09p p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not fior Voluntary Assessments 42 Tanbark Road Property Address Tina Cormier Owner Owner's Name information is required For every Marstons Mills MA 02648 7-17-15 page. CityrTown State Zip Code Date of Inspection B. Certification (cost.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *` This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 pprn, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: i 1 I I I D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: I I Yes No ❑ 0 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 I due to an overloaded or clogged SAS or cesspool 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool a ® Liquid depth in cesspool is less than 6" below invert or available volume is less day flow than 1/2tfAns•3/r3 The 5 OMded Inspection Four[Subsurface Sewage Disposal System-Page 4 of 17 I I ul 19 15 11:20p 0.1 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 42 Tanbark Road Property Address Tina Cormier Owner Owner's Name information is Marston Wills MA 02648 7-17-15 required for every _ page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped; ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® 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 N 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 nno"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. [Sins.3113 Title 5 Official Inspection Form.Sibsuface Sewage Oispcsal System-Page 5 of 17 Jul 19 1511:21 p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 42 Tanbark Road Property Address Tina Cormier Owner Owner's Name information required for every Marston Mills AAA 02648 7-17-15 page. Cf y/Town 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? ❑ 0 Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example,a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15-302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): NA Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 I 151n6-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposel System-Page 6 01117 j Jul 19 15 11:21 p p,3 CommonweaM of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 42 Tanbark Road Property Address Tina Cormier Owner Owner's Name information one Marston Mitts MA 02648 7-17-15 required for every page. City/Town State Zip Code Dale of inspection D. System Information Description: The system is a 1000 Gal. Tank D. Box and pit. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system? (Inctude laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2013-41,000Gals g ( y g (gp )�' 2014-36,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: _Present Date 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: [Sins•3M3 Title S Official Inspection Porno Subsurface Sewage Disposal System•Page 7 of 17 Jul 19 15 11:21 p p.4 gt Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 42 Tanbark Road Property Address Tina Cormier Owner Owner's Name information required for every l'tlfarstons Wks MA 02648 7-17-15 page_ ClWrown State Zip Code Dale of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA 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 i ❑ Shared system{Yes or no) (if yes, attach previous inspection records, if any) � ❑ Innovative/Alternative technology.Attach a copy of the current operation and I maintenance contract(to be obtained from system owner)and a copy of latest i inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval'. ❑ . Other(describe): I15in Inspect on-3M 3 Title 5 Oflfaal onspeon Form:Subsurface Sewage Disposal System•Page B o117 i i Jul 19 15 11:22p p,5 Commonwealth of Massachusetts Title 5 official Inspection Form is Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 42 Tanbark Road Property Address Tina Cormier Owner Owner's Name information is required for every Marstons Miiis MA 02648 7-1 7-15 page. City(Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1989 Permit # 89-38 7-2015 New D Box. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 34" 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.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) it I If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Cal. Precast H-10 311 I Sludge depth: !I! i t5ins•3113 - -n9e 5 O1Flctaf Inspemion Fcrm:SubsWam 5e ge Disposal System•Page 9 of 1T I i1 i 1 I Jul 19 1511:22p p.6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 42 Tanbark Road Property Address Tina Cormier Owner Owner's Name information is required for every Marstons Milts MA 02648 7-17-15 page. City/Town State Zip Code Date of Inspection D. System Information (cost.) Septic Tank(cost.) Distance from top of sludge to bottom of outlet tee or baffle 27 Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tank at working level. Tank and cover's at 2' below grade. Inlet tee, outlet baffle. No sign of leakage or over loading. 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: hate Mns•3113 Idle 5 Official hspedon Form Stbsurtaoe Sewage Disposal System•Page 10 of 17 Jul 19 1511:22p p.7 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 42 Tanbark Road Property Address Tina Cormier Owner Owner's Name information required for every Marstons ARrfrs MA 02648 7-17-15 e page. Cityrrown Slate Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions Capacity:p ty' gallons Design Flow: gallons per day I Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No i Date of last pumping: Date I Comments (condition of alarm and float switches, etc_): I i l i i *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No i I5ins.3113 Title 5 Official Inspection Form:Stbu face Sewage Disposal System•Page 11 of 17 I f 6 Jul 19 1511:23p p,g Commonwealth of Massachusetts Title, 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 42 Tanbark Road Property Address Tina Cormier Owner Owner's Name information required for every It+Itialrstons MUls MA 02648 7-17-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): D Box is WxiT-T below grade w/one line out. Box is new 7-2015 w/cover at 6". 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.): " If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): I i If SAS not located, explain why: I i I I i t5ins•3113 Tine 5 Oftid2l Inspection Form:Subsurtwo Sewage Dis I Sy stem ystem•Page 12 al 17 4� t i i Jul 19 15 11:23p p,9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 42 Tanbark Road Property Address Tina Cormier Owner owner's Name information required for every Warstons Wits MA 02646 7-17-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Typetname of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is a 1000 Gal. Precast pit. Pit at 55' below grade w/cover at 28". 3'water in pit. No sign of over loading or solid carry over. j Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer i Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No 15ins•3113 Title 5 otriciat Inspection Form:Subsurtaw Sewage Disposal System•Page 13 017 I E i i I i Jul 19 15 11:23p p.10 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 42 Tanbark Road Property Address Tina Cormier Owner Owners Name information required for every Marstorrs Otis AAA 02648 7-17-15 page. Cityrrown Slate Zip Code Date of Inspection D. System Information (cunt.) 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.): t5ins•3113 Tide 5 Official Oispecdon Form:SubsWace Sewage Disposal System•Page 14 or It i i i Jul 19 15 11:24p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 42 Tanbark Road Property Address Tina Cormier Owner Owner's Name information required for every Marstiors Mffls MA 02648 7-17-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet_ Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately o � 13- V; 58- 15ins•3113 TWo 5 Offidal Inspac6on Fort Subsurface Sewage Disposal Systam-Page 15 of 17 Jul 19 1511:24p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 42 Tanbark Road Property Address Tina Cormier Owner Owner's Name information is IlRarstons IR►4ilfs required for every MA 02648 7-17-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water 45' 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: pate ❑ 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: U. S. G. S. Well S D W 253 You must describe how you established the high ground water elevation: U.S.G.S. Well SDW 253 at 49'w/3'4' ADJ. Bottom of pit at 10'-6"below grade. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•31`13 Title 5 Official Inspection Forth:subsurface sewage Disposal system-Page Is of 17 Jul 19 15 11:24p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 42 Tanbark Road Property Address Tina Cormier Owner Owner's Name information is required for every Marstons Mills MA 02648 7-17-15 page. cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C. D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I i i I I I t5ins-3113 Title 5 Official Inspection Form:Subsurrace Sewage Disposal System-page 17 of 17 i p' Ilk APR 011, COMMONWEALTH OF MASACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS �- DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Govemor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 42 TANBARK RD. MARSTONS MILLS, MA 02648 fA100 P202 L042 Name of Owner ED GENDRON Address of Owner: BOX 8 BUZZARDS BAY MA.02632 Date of Inspection: 4/7100 Name of Inspector: JOHN GRACI l am a DEP approved system inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636 Telephone Number: 608-664-6813 FAX 608-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes _ Conditionally Passes _ Needs Further yEvajluiBy the Local Approving Authority Fails Inspector's Signature: Date:4/9/00 i The System Inspector shall s mit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this Inspection.If a system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS "The inspection Is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life" ' THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS FOR PROPER MAINTENANCE.THERE IS A GAS LINE LYING OVER THE LEACH PIT COVER. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 42 TANBARK RD. MARSTONS MILLS, MA 02648 M100 P202 L042 Name of Owner ED GENDRON Date of Inspection: 4/7/00 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: , X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all Instances.If"not determined",explain why not. nLa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was Installed within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. n/a Sewage backup or breakout or high static water level observed In the distribution box is due to broken or obstructed pipes)or due to a broken,settled or uneven distribution box.The system will pass Inspection if(with approval of the Board of Health). _broken pipe(s)are replaced _obstruction is removed _distribution box is levelled or replaced n[a The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if (with approval of the Board of Health): broken pipe(s)are replaced a _obstruction is removed ri f revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 42 TANBARK RD. MARSTONS MILLS, MA 02648 M100 P202 L042 Name of Owner ED GENDRON Date of Inspection: 4/7/00 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nLa(approximation not valid). 3) OTHER n/a revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 42 TANBARK RD. MARSTONS MILLS, MA 02648 M100 P202 L042 Name of Owner ED GENDRON Date of Inspection: 4/7/00 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below Invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped 0. _ X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No - X the system is within 400 feet of a surface drinking water supply - X the system is within 200 feet of a tributary to a surface drinking water supply _ X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMr?15.30412).Please consult the local regional office of the Department for further information. revised 9/2198 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 42 TANBARK RD. MARSTONS MILLS, MA 02648 M100 P202 L042 Name of Owner: ED GENDRON Date of Inspection: V7/00 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health. X _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X _ As built plans have been obtained and examined.Note if they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. X _ All system components,excluding the Soil Absorption System,have been located on the site. X - The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: i X _ Existing information,For example,Plan at B4O,H, X _ Determined In the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)) X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. , s i 1 revised 9/2198 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 42 TANBARK RD. MARSTONS MILLS, MA 02648 M100 P202 L042 Name of Owner ED GENDRON Date of Inspection: . 4/7/00 FLOW CONDITIONS RESIDENTIAL; Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual): Total DESIGN flow: 330 gpd Number of current residents:3 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: n/a System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system(yes or no)(if yes.attach previous inspection records,if any) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank . Copy of DEP Approval Other:n/a APPROXIMATE AGE of all components,date installed(if known)and source of information: THE SYSTEM IS 10 YEARS OLD. Sewage odors detected when arriving at the site:(yes or no) NO revised 9098 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 42 TANBARK RD. MARSTONS MILLS, MA 02648 M100 P202 L042 Name of Owner ED GENDRON Date of Inspection: 4/7/00 0 BUILDING SEWER:X (Locate on site plan) Depth below grade: 30" Material of construction: _ cast iron X 40 Pvc _ other(explain) Distance from private water supply well or suction line: n/a Diameter: 4" Comments: (condition of joints,venting,evidence of leakage,etc.) THE SYSTEM HAS TOWN WATER. SEPTIC TANK: X (locate on site plan) Depth below grade: 24" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 1000G L 8'6"H 6'7"W 4'10—' Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness: 4" 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: n/a How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS. GREASE TRAP: _ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level ir,relation to outlet invert,structural integrity,evidence of leakage, etc.) n/a revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 42 TANBARK RD. MARSTONS MILLS, MA 02648 M100 P202 L042 Name of Owner ED GENDRON Date of Inspection: 4/7100 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:N/A Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:X (locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) THE DISTRIBUTION BOX IS STRUCTURALLY SOUND.SYSTEM SHOWS NO SIGNS OF FAILURE. f PUMP CHAMBER: _ (locate on site plan) j Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: i` ;z (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a x , i revised 9/2198 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 42 TANBARK RD. MARSTONS MILLS, MA 02648 110100 P202 L042 Name of Owner ED GENDRON Date of Inspection: 4R/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(1)LEACH PIT leaching chambers,number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetatiun,etc.) THE LEACH FIELD APPEARS TO BE FUNCTIONING PROPERLY,THE SYSTEM SHOWS NO SIGNS OF FAILURE. CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a i Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 9/2198 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 42 TANBARK RD. MARSTONS MILLS, MA 02648 M100 P202 L042 Name of Owner ED GENDRON Date of Inspection: 4/7/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) mog 41 I( II c M ail l FOC e revised 9/2/98 Page 10 of 111 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 42 TANBARK RD. MARSTONS MILLS, MA 02648 M100 P202 L042 Name of Owner ED GENDRON Date of Inspection: 417/00 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet+ Please indicate all the methods used to,determine High Groundwater Elevation: _ Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) UGSS MAPS AND CHARTS.12+FEET i revised 9/2/98 Page 11 of 11 2 TOWN OF BARNSTABLE LOCATIONS Ida SEWAGE # VILLAGE ASSESSOR'S MAP LOT 1 CO -2-0 INS'CALLEK'S NAME & PHONE NO._ �P`��r'� SEPTIC TANK CAPACITY 4�0 o LEACHING FACIL,ITY:(Cype) r NO. OF BEDROOMS �PRIVATE WELL.OR UBLIC W A'C BUILDER OR OWNER DATE PERMIT ISSUED:--- v DATE COLIPLIANCE ISSUED_ VARIANCE GRA14TED: Yes Na ''�' s-�34 l AN ✓,jam �: �� No............. Fizic 7,-� ............... THE COMMONWEALTH OF MASSACHUSETTS EOAR®•__gF HEALTH ��� 0 w'✓----- .oF...............�'.:-.......-...... ........--------------------------------- Appliration for Dispaii al Mirks Towitrurtiun .exam# Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal System at: r /yc. ,b ✓R/J.tao Location �dne dr" r",---a* G IZCt,v� �7. 0� ��' S/G °r �E�%re?�►�.f L�� ..................................................... ................................... ..........--........................... - .Y -------------------------------------••------- Own�; % Address .......N Installer Address d Type of Building Size Lot---- .......Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures _______________________________ __ d •----- Design Flow............... per person per day. Total daily flow_.____._.__3_ 3___.____.__._. W -----•-•---gallons. Septic Tank—Liquid capacity. M_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 ) '—' Percolation Test Results Performed by ,,,,V�._.__��� F'� �p_4___W4UNF7 /a/s—h.....I Date Test Pit No. I___ ......minutes per inch Depth of Test Pit___" ............ Depth to ground water----/4 n -_____- Prq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil..... F'�1u y..............-/✓ via ``�� x U ••-•-••---------•--•......................................--•-•••••••-•-•-•••-••••-•--•-----------------••---•--•••----•••--•••••-------•-•--•••-••-•--•-•-•-•-•-•-•••---•••--••-••---•-•-•-••-------- W ---------------- ------------•-•-•••--••---••---••-•---•••-•--------•---•---------•••-•-••••••••••••--•-•--•--••-•-•-•-------------------•--•-------•-------•-•--•-•••-•----•--------------..__...-••-•- UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ ---•---------------•----•---•--•------•-------•------------------•----------------------------------•-•-----••--•----------•----•-•-----•-•-----...-----.__--•......................................... Agreement: 4 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with v--. the provisions of f-i il T!'1.l�� of the State Sanitary Code— he u rsigned further agrees not to place the system in operation until a Certificate of Compliance has issue b th' b and of e lth.Signed.................. � • ...._, _._....-••---•••-----•-•-•-••••-••••-•- ......k/�� / ate¢ Application Approved By... "= :. DaceV Application Disapproved for the following reasons:.......... ................................................................................................... -----------------•---------...---•-----�p ------------•--p------•-•----•--.....----------•------.._._._....._••-•-••...-••----••••••••----•••-•---•--------------•--•-•-•-•--_••••-...-----------••••-•--- Date Permit No. 4 !_------- .. Issued--•---- � ilste No..c � -•: Fimic .76'............. THE COMMONWEALTH OF MASSACHUSETTS B0ARD__9F HEALTH ApplirFation for Disposal Works Tomitrurtion Prrutit Application is hereby made for a Permit to Construct (41') or Repair ( ) an Individual Sewage Disposal System at: ................rIy� l'n,v gn.c.. !L!�, �C,,r�� _..---..._-----------•------••............. ---.........•. Location-Addre✓ or t Ao. C. �!c'C ....;�C l(J ('P. P. B, l,Sd?P 5/..' �-- -v Ft�{,.r(�.C� a J p bie S� townej SG.1 Address N Installer Address Type of Building Size Lot.._I/d-�a_._.........Sq. feet 1-1 Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures --------------------------------------------•-----------•-----•••--•---•--•-•----•••--- ----•--•--•••............................................... W Design Flow.............................._.-------------gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity_:tAl ?_gallons Length................ Width................ 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 ( ) '-' Percolation Test Results Performed by z' <c" `"l.:f__' C A& ; _..._._.__ _ !??'- ! W - Date.. Test Pit No. 1....^__.__------minutes per inch Depth of Test Pit .................. Depth to ground water----ZVI."'--__----. (s. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---___------___________- ----- -----------•--------------------------------------•------------------------ O Description of Soil----- �a I u ..........................' _......... ..-----�-..151� t 5 V --•••-•-••••--•-•••-••••-•------•-•----•-•----•------•-••-•••------•--••-----------•-•._.....•••----•••-•--•---•-•••----•--•------------•-•-•--•--------•---........................................... 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 iIT .w. p 5 of the State Sanitary Code— . he undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued'b th- bard of lth. 1 � 1 Signed C: .� c,at:r 1 / � ........... ..... -------- . / --"j�-----r_.,.' Date Application Approved By..�_.c.:...:.:........ T T ---------•---••-•------ Da................ Application Disapproved for the following reasons:................�_. .................•----------•-------••-----•----------•-•-------•---•----•------.......--------._...........-••---•---•---•----•---•-•-----••------------•-----------••••----•----•---•--••-----._..... Date Permit No.--�`��- `3� Issued 1 �1 L�r.. _--7j�.......----- --------COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... .?"!''1...............OF....... :. ......................................................... C�rrtifiratr of Toutvliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) b ----------- ..................................................�,< S ` ;-,,A . ' ....•-------.....------------------------------..........------------------------------------..........----•-•-----•--------- nstaller at.............�-u-......--••-'tf.....................JVaa,t.........-------........----j-- ........ a:u+A W............�.-..c......--•--------------.._..------------ has been installed in accordance with the provisions of TIT 11; 5 f_The State Sanitary Code as de•crjbed in the FE............. dated--------�---�7 — /------------- application for Disposal Works Construction Permit No.__..r�' ._.s _ f THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ' DATE.... .�.:..7..� t•'..i Inspector J='�---��_ . (/ °.............` �% .. THE COMMONWEALTH OF MASSACHUSETTS r BOARD QlZ HEALTH No.0jO F.. --.'..................................................................... ................ FEE.... ............... Disposal Work, ToatstrurtWu rrmit-• Permission is hereby granted...il:... `........ `-- ---.--��.-.--_�-._..... �+� ......................................................... to Construct'J) or Repair ( ) an Individual Sewage Disposal System ' at No.......c•-t`-'-l-....../YG...........?m,r a w_ feo)i �.+ • s %,dam s �.sc. (5 ...... . .....-•----•-----------•••••----••-•-----...•--•----•-----••••-••--••-•------•---•---•......-••-••-- Street C� as shown on the application for Disposal Works Constructte Permit No.! �` .._ Dated._._�_`�.7..�?................. 2,' 1 C.I L.l_� t - / J S Board of Health DATE ..... -- - ---------= ' FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS SHEET 7A Or 7 �IAA�A♦IM.MI e/rIM - Low w nMerr ea.A=®a MARTONS MLLS ra ® o r�Mn Ir 0[Slfi CCLAlN5:w LOClI710M YAP S rt' �mm lAr P"R 4r WL 49 Pa Put -UlL z,- i ML) der.AMr A{e.IAt ew IIAtI 1/r Al R r NM I Acam am w own am mm MOM AKA-KM�lnI ; WL - 111110ALL AKA 1•k GL/LI. ��_ Ma AKA -I&QAL/Lf. • R[ U AIIM CMAQIr(OOTM .ILO.. a.' TOM1.0)+ItT(rlras) ' 1� IMMM.I.IL RAW UMOM Cl1PAMT' mo e., 011171111111700" ti QMie sox NOTES: ® 1. ALL eMOMIMIMW AM MATMMLQ MINL OMPOlel 70 aL•L UM QMLON SEPTIC TANK "A1110 FFM M&M WACEAa NOW&a i aA[ m L r-I ♦ 1 = I 3 ALL WAMwe trtr a noon�Mwl Q[MIa1Mrt m I >r I ♦ 3 AMr NANXM=a UM TO wen wow 10 am= SEPTIC SYSTEt4 PRm C MIALL K RORTAM M PLAM ♦ ALL OMeOR71R 0r TK I.MTARr svwmm MIML et cowmE AM w M.LL OOT1011 Cf TEST aIOLE a WNWA Ie w tOlt0.l0 was Mr AK I/IOO ON WA n"-W O a PMMIQ AKA; M-U aeIII.M LEACHING PIT DGILL U um 1 an M to rT.or sww to L MMtORK AM%0Wft OM MOL M LM.M j .MMM PMIAI MOMOa jf-M P6AM/31N-10 i LOT N0. ELEVATIONS LEGEND: ma sror Mt7wwoM m ELEV. TW F107TI8 109 110 ttt 112 113 174 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145'11146' 147 148 149 a/Ilwna am o PFAVA•14AOMM PIT OCA71 p r.O.FOUND ! A 74•s 7t.s 71.0 Ira 7d•0 ?(o 7•.0 74 a 741E Ifs 7ta ,Z. T,.s eO,P M.! a.! •L. s10 �,t eo• - p1.0 9L. t I f NO PoloM`IA, ,or I 7bf ro 74.E 7f.6 7fo 74• 714s 7y,J lea 71ro 77.E 7s.o 76.3 7is 7�.0 140 Tsai 7d.o; ;71.5 74. p A MiranuIaammawl MOM"T l B 7e•9 H.e 6" 641 664 of.* 61.t 7L5 7t.0 7>e 73.0 744 74.0 ^7t; ."s 7as 7M 10.1 -*4 70.E - -4.e 7M ,s• ,Av ! lk f �.6 7f1 76L Tsf Its 71Ss 1i.4 7f.5 741 7s.1 7YA ?lA 714 H.4 :µ.S i!s H.o 74v B C 70 A , 611.1 es.• eA1 e17 74.1 1 7L2 'AT 79.7 7t.7 74.3 7l.7 1e•i jis 71.t 7%.1 77.0 1%6 'R.1. - 71.7 77.7 71.i US 70.11 *11 11.7 7f t 7i� 7f.s 4 710 1t.6 71.1 71. 614 �K wss N•7 9s.7 C D 70.0 H., (,o.e 614 L0•4 67.0 bb 70 71.0 7t.5 7W 7"4•0 70.5 1e.0 17-0 71.0 76.0 1te 77 7L.e - 77.3 70 7 ,. 0 71.1 •I$,4 Al 70•0 10.0 7Gf 7}0 7§4 7b.o 74.4 7" 134 784 110.q 6s11 i,t..o 64.0 6 6.0 7ks D E Las bfa (,!3 Lt.4 6.4 71.3 lss 13.; 7i9 1l.3 1f.t sls 7h.! 7a1 7>.t► T13 766 - '►2j 77.3 1 7!. bA 11610 7r.4 &f.6 � � a LA1,0 7t4 n.• 11, 1.4.1 '14.1 71.5 7t.1 11•e Jr.• e1.•bf.b N•3 H•3 7k; E F ete 614 eql 1.1.• A,f•t Las H.6 7..e 7►.l 7t.) 7t•r ,f.1 7f 6 7A.{. 7e.r 7717 771 77.1 116 - 77.1 771 74 6 7i 1/ 79•7 7 . 7v.7 M.6 f44. 71.L 7t.6 73.1 14.7 744 73.1 1.e 70a, 6"1 1,46 Ls.l 71r1 F G 1.1.5 ets 6s.0 a.0 ef.v L7. &t o -M.! -7L0 77.E ,r.o 75•s 7s.0 W.• 7ws 7e.3 7tf 71.0 77.0 1f.!< - 77.0 77,0 74.E 141 ,..! 7t.0 Ust 645 e4.5 -11.0 hs o 745 7�r 6111.9 64.5 M.4 e9.0 H e}f LS•4 s1•• 57.0 91.0 .60 04•9 e41 eso LL.o Ko s7.g 61.0 H•s -n•f "-9 71,9 1-X0 76o Ks - 71.0 71.0 ess bT•4 6.l•f K•o r1• 636 tr35 Ls,o e�. � i s sso G►! boo 1a 7.e.o es.i 14.5 bs.fj 6bi ITLJf rt.o r4o H J f4r APPROVED: BOARD OF HEALTH ys.s f6•o s•a WS szo ps "l 6W MOP Me 6up a.. ef.5 es.. 66f 67.S 61AP 1,Ee Los - 67.0 K.5 Ltis es.s eo.f Ace 1 61.1 91.11, 51.9 Wo e>:.f 6#v 641E H.o 63.E bt,o 6Lf 60•9 Jpf 41s ' 1.0 fo.0 io.o i K 7r•0 7/6 72.0 ►ao µ. 1P.o 11.0 71.3 7!•6 -Mg 7l.t a•o 77•f 140 143 Tfs 1... Mi m ev so.. 1/•S - btlo 1yw• S s.3 71s74�f 74.E 7!•o s3 7S-S 70.0 7L 7�1 770 V- 7'4% 7*3 7i 1. f�1.� 110.0E 1t.. l4.o K L 78•0 71.5 As.o esv h.) H.0 10.1 7t.. 7e.c 144 7t,0 70.9 77.0 7t.0 7M0 74•0 740 71•0 74.6 71.0 - 1fd 71.0 71.0 �.• 7•.f 74.E 7}I 7t4 71.0 7!f 7I.1 0 7so 7.e 7f.s L 7Vls 7" >t.o MD 70.0 7tf 7kS M 72•0 71•o i7s K.s e1e Ns Two 7tt.9 1t.0 1 X4 1 14 s 71.0 7.•to ns me 760 71.I st.► 7I.9 7E0 - 76,9 77•0 >e*o 1 no 7Is o '74J 1t.• 7t.6 71.0 713 7 .07f0 70.4 74.4 7f•o 7r. I ' 44•f Ito 7t•5 Al N 1t.0 71 a eaI efA we 70.9 7a0 71.3 71 0 7b!FAf10.I F111F174 1 710 7s 0 74 4 14 4 710 - 71,IT, I I w/ 711E 77.0 7e.o 0 7 71.o 71•S a-f 7No 7I•f 7+f 1f.0 b,J 7f•1 1♦3 1i.o 71e6 1LS N - f 7s.0 .es.o 61.0 7►.S' 1 12 INITIAL ISSUE UCT NO- DATE DESCRIPTION I BY PERC TEST 1 PERC TEST 2 PERC TEST 3 PERC TEST♦ PERC TEST 5 SEPTIC SYSTEM DESIGN LOT 116 LOT 125 LOT 131 LOT 749 LOT 746 MARSTONS MILLS WOODLANDS aao. sL eaw.asL•M .+W •w ea - AI. 4.1 .1.Mt A AIM MR - w)AIM Irl MlM�i� w)Ale yt M w Ia1R IM.e.1Va M1M BARNSTABLE, MASSACHUSETTS rMO e..1u■.R ~t•.wR Mt...�.►..R .a WOODLANDS ASSOCIATES REALTY TRUST re1.lMR n1e w w Ml.11.ryMMt 1ORAM ell.w>MR MOM::yM0* re eAI�M Ml•11M.M MMr MeR w.vR...M SCALE: 1- 40' JOB NO. 1333/MTIC •M w MR.rM RAae/Me MR ML e e ' MAW«. �w.A 0I . 'e a a O rt MIM see •1Ml *' �' EAR a Mi RRHM-ft OAR or UL 7LR� MR Or IOL WT OAR a Ill TOT M 0 ♦.Q¢ , MTIOM h AJMMC M71ptm.r + w7mc m.r ■illdM 0r 4.at Wr Q IOL Wr MA• b M G l I M71ot' 0 nOA/ORATE 1LI0t/MO POOAIM RAR SL_MAIO P61MATM MRLMA4 - IT A.Ar� P010"UM RAIL i�A/M MR SL MI/t101 .�Q.0 f PERCOLATION SOIL TESTS Un ==Gl a TAM JZXU INC. - � us�t t1t10.1S iT�1 11f!w1aNe Bag In= UM SrRW CENTZRV= MA tuels,z ora f w. SHEET 7 OF 7 Lam JIF Ar MARSTONS MILLS LOT 130 aaa s LOT 129 nwo: LOCATION MAP f 1!,I 1 ell 401 - .iq,e OT �\ y� LOT 12� If /4,974 s i LOT 31LOT i/ ` 15p �4 ,p� ♦ 137 er tyli !\ y" h • �S LOT d LOT 106 �' 1 1 3 �+ v ``" 0. —0, LOT 123 LOT 128 \�� Mm s �L 'ia►°o ` / ail h ; < ��' /1. It �^ aza L_ t4� ( 14b `f;1 1' LOT 13 LOT 149 law fa * ^Y LOT 136 poi 1 35•9. _ 10 LOT 134 'l NI�� /+* 1 LOT 122 j asa t � „y ,� '� 1� � LOT r 21 ` LOT 107 �' LOT 146 / '� I �edt :�I N '�\ is ^ �. �s+0° N` pd lam: •' " / .. *.b > 140 0 fell r pG , I 01a "O ` - rLeo• .eIOT 147' ` i!� ., , LOT 119J1111111 t r s10,9 'LOT 141 e. `��I 1 •r Tn lars ` .. ► ( po 1 �JI 1 I ..i ( � . a yf.0 J a LOIN 4 Y =e tOT Jai \`� '\ 'PAS ►a°� I�IIy �l� '�'� locos 1i `. 1P>e� LOT 120 \ , f •� I Y '` '1` '�> '�� ;, � LOT 117..\ a pt loetao s s er u 1 • bj y r �4,0 LOT)143`1' '• ` s`v�loco s fy ( 1!4 1 I .:kl DVSs . 10390 ad / a 1�m' • \�� �r. 1.bfBE *OMT 7A or-1 Fo1C Solt. 1.lry ^v4b \'! �' 6 v ► / 4 LOT 115 so• ' -► �'� - -�o�Anw4 -mar. s. 45 '`�/ �' 1 t 11�'�lam w � 0 $ �� �e a.Mf sftiiT 7A oI •yOWND• . / 1 1 LOT 1465 cm v i 1 LOT 108 11647.4W y ( I�•i 1Is 1L 118 i!. LOT 11b p M tff0os / lei1 `1 °• '�����' I /' 1} y. LOT 114 iaTrnig :\T' LO 114 ` 1a a .. 1400e `1 .a I ,� la a Os .o.t..+.r a.1 eowe E •.ed+no,.1s r 1ti 0 1 I 3 11 28 B8 FINAL BLDG. AND SEPTIC LOCATIONS PAL no ! K - 1 10 2 INITIAL ISSUE ELK NO. DATE DESCMPTIOR I BY ON PLAN �� \••~� �' 1:1 MARS ONSG MIOLLS�WOODLANDS \`11 LOT 110 BARNSTABLE, MASS CHUSETTS LOT 109 WOODLANDS ASSOCIATES US SCALE: 1 50' JOB NO. 1338 18VY, EIDME & TfAGNO AMOMfb INC. � Dams ume mm um un RlRiA! 1189 I= Um SfRW CENTERV= MA OW32 --- r` (V - - - - - - - - - - - - - - - - - - 4 N �'} 12 UNHEATED ATTIC 71 CA ASPHALT OR FIBERGLASS ROOF SHINGLES OVER APPROVED SHINGLE BACKING OVER 1/2" EXTERIOR PLYWOOD EXISTING 2x8 CEILING JOISTS CONTINUOUS RIDGE VENT @16"O.C. NEW 2x8 RIDGE BOARD ' EXISTING BEDROOM � i NEW 2-2x10s FLUSH WOOD 2x6 RAFTERS@16"O.C. �� HEADER ABOVE w/JOIST 3/4"PLYWOOD SUBFLOOR I HANGERS CLEARS AN 6'-0" NEW 12"R-38 LI EXISTING,2x10 JOISTS Q 16"O.C,--- a I — NEW 2-200s NEW 2x6 EXTERIOR WALLS - I w HEADER w/J019T � i• INSULATED w/5 R-21 F.G. HANGERS INSUL. i a w EXISTINO 2x4 EXT. -- NEW 1836 DH JO NEW 1836 DH WALL- SECTION -- i WINDOW WINDOW REMOVgD @ NEW PLYWOOD SUBFLOOR TO ENTRY II MATCH EXISTING OVER 2x10 T-6" I i i i 2 X 4 BEARING W NEW 2x6 EXTERIOR WALLS P.T.JOISTS @ 16"O.C.w/ I STOOP w/STEP(S) w/R-21 INSUL JOIST HANGERS EXISTING LIVING ROOM TO GRADE 51/2"R-21 J EXISTING 3-2x8 P.T.WOOD BEAM w/ BEAM ANCHORS 2 X 10s @ 16"O.C. 12'6" T-0" 12'6" EXT.PLY.&TERMITE 32-0" SHIELD -- i� 1 I -- FLOOR PLAN - I i XI•STING BASEMENT 12"0 CONC.FILLED ' SONOTUBE TO MIN.4'-0" ' BELOW GRADE,ON 24" -'— BIGFOOT FOOTING ' L— J •. .. ...,. ... .. 6 MIL.POLY VAPOR BARRIER ..... ». 2'-8r X 2'-6"X NON-ORGANIC EA " BUILDING SECTION : _.. �... . _ �w _. _„ ____ ... .. __........._w.... ._ _._.... . _........__ .- NEW 4X8 RAISE ..... .... .... - _... BOARD.&..bQ ....................k.......................... .. ..... �, ..... w, .. .......M_� �.,.� .... ......... M.... _ 1 ..,. SI 1{NCL€SLUR::. . ..... ..... ............................................................. .................... ............ .... ..... El .......... ....... ...- ❑❑❑ lim M ff .......... .........._ .._...... ......._ .. ......... .......... ..... ..................................................................................................................................................... ..........................-................................-........................................................................ ...... ......- .. ._ .......... ...._.... ..._ ..... .... ..........- ............. __... NEW CEDAR CLAPBOARD P.T.STOOP @ 4"T.W. TO MATCH Lw/STEPSTO EXISTING GRADE NEW 3'-6"x 7'-0"FOYER FRONT ELEVATION � PLANS FOR FOYER ADDITION DATE: APRIL 20 2016 PROJECT : ADDITIONS&RENOVATIONS G REYWING DESIGN BOYAR RESIDENCE SCALE: 1/4"= 1'-0" 42 TANBARK ROAD,MARSTONS MILLS 131 QUAKER MEETINGHOUSE ROAD, EAST SANDWICH, MA 02537 ®2016 Greywing Design 508 888-0886 www.greywing.com (508) 888-0886 Al rights reserved.No copies may be made by any means without express,written permission. PROJECT NO: G160414 SHEET: A OF 3