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HomeMy WebLinkAbout0051 TIMBER LANE - Health 51 Timber Lane ., Marstons Mills F/R+ r� A = 149 055 J C I Commonwealth of Massachusetts F W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 51 Timber Lane �M Property Address Al Sorbello Owner Owner's Name information is required for every Marstons Mills MA 02648 04/11/2012 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. Please see completeness checklist at the end of the form. Important,When filling out forms A. General Information on the computer, j 1. � V use only the tab 1. Inspector: i key to move your cursor-do not � C3 Brian K. Tilton �') e the reborn Name of Inspector ke . Y y- The Building Inspector of Cape Cod y ? , r� Company Name PO Box 307 Company Address Eastham MA 02642 City/Town State Zip Code 77. gR 508-255-9343 S14392 , Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 04/11/2012 nspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Offcial Inspectio T: ubsurface Sewage Disposal System•Page 1 of ti Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 51 Timber Lane Property Address Al Sorbello Owner Owner's Name informatics is required for every Marstons Mills MA 02648 04/11/2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: All components in place and functioning as designed. 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 structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): N/A t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 Timber Lane Property Address Al Sorbello Owner Owner's Name informatics is required for every Marstons Mills MA 02648 '04/11/2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): N/A ❑ 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): N/A C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 { Commonwealth of Massachusetts W Title 5 Official Inspection Form _ - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 51 Timber Lane Property Address Al Sorbello Owner Owner's Name information is required for every Marstons Mills MA 02648 04/11/2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: N/A **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: N/A 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 51 Timber Lane Property Address Al Sorbello Owner Owner's Name information is required for every Marstons Mills MA 02648 04/11/2012 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: N/A. ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 51 Timber Lane Property Address Al Sorbello Owner Owner's Name information is required for every Marstons Mills MA 02648 04/11/2012 page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 GPD t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 Timber Lane Property Address Al Sorbello Owner Owner's Name information is required for every Marstons Mills MA 02648 04/11/2012 page. City/Town State Zip Code Date of Inspection D. System Information Description: 1000 gallon tank with D-box and (2) 500 gallon leaching chambers with 4' of stone around the chambers. Number of current residents: 4 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 2011-411 GPD g ( y g (gpd)) 2010 -460 GPD Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/industrial Flow Conditions: Type of Establishment: N/A Design flow(based on 310 CMR 15.203): N/A Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A 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: N/A t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 i Commonwealth of Massachusetts m �a Tifin 9; (Iffit%inl Inanar%fine F:nrm e Commonwealth of Massachusetts 4 v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 51 Timber Lane Property Address Al Sorbello Owner Owner's Name information is required for every Marstons Mills MA 02648 04/11/2012 page. City/Town State Zip Code 'Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): N/A General Information Pumping Records: Source of information: Owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 t Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 51 Timber Lane Property Address Al Sorbello Owner Owner's Name information is required for every Marstons Mills MA 02648 04/11/2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Installed in 2003. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1'5" Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): No evidence of leaks or clogs. Septic Tank (locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 gallon tank If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 58"x 8'6" x 4'10" Sludge depth: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 51 Timber Lane Property Address Al Sorbello Owner Owner's Name information is required for every Marstons Mills MA 02648 04/11/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 23" Scum thickness 3" 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 15° How were dimensions determined? Accusludge, Baffle stick and tape measure. 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 levels were normal with no evidence of leaks, back up or clogs, tees/baffles were in place and functioning as designed. No need to pump at this time, tanks should be,pumped at least every three years as regular maintenance. Grease Trap (locate on site plan): Depth below grade: N/A feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 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 Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 I� f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 51 Timber Lane Property Address Al Sorbello Owner Owner's Name information is required for every Marstons Mills MA 02648 04/11/2012 page. Cityfrown 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.): N/A Tight or Holding Tank(tank must be pumped 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 per day Alarm present: ❑ Yes ❑ No Alarm level: N/A Alarm in working order: ❑ Yes ❑ No Date of last pumping: N/A Date Comments (condition of alarm and float switches, etc.): N/A *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 51 Timber Lane Property Address Al Sorbello Owner Owner's Name information is required for every Marstons Mills MA 02648 04/11/2012 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 Oil 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 evidence of leaks or solids carryover, equal flow to each outlet and level. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 i L Commonwealth of Massachusetts ti. W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 51 Timber Lane Property Address Al Sorbello Owner Owner's Name information is required for every Marstons Mills MA 02648 04/11/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: (2) 500 gallon with 4 of stone ❑ 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.): Lawn over top and no evidence of hydraulic failure or ponding. The stone is clean, less than one inch ponding in each chamber. Cesspools (cesspool must be pumped as part of inspection) (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 inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 i � Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 51 Timber Lane Property Address Al Sorbello Owner Owner's Name information is required for every Marstons Mills MA 02648 04/11/2012 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A Privy (locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 51 Timber Lane Property Address Al Sorbello Owner Owner's Name information is required for every Marstons Mills MA 02648 04/11/2012 page. CityrTown 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 DEWELLING NOT TO SCALE 2 1 ' SHED Al-25.5' B1=24 0 L�Q__L 0' 3 A2=20,5' 62=48' A3=33' B3= 54.5' t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 51 Timber Lane Property Address Al Sorbello Owner Owner's Name information is required for every Marstons Mills MA 02648 04/11/2012 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: 10'+ no water encountered 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: 1/06/2004 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Approved system design plans on file with BOH Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/1C Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 1 ' Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 51 Timber Lane Property Address Al Sorbello Owner Owner's Name information is required for every Marstons Mills MA 02648 04/11/2012 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 f +• � Adler-Ln�• ' �` � - j , 5e, � • ' "� - � ° � 51 Timber Ln, Marstons Mills, MA_02648,,-USA �� ;, � � -C '~ ��O! � + � �• Phi' ,"�,,,,�• �� P' tp � � _ •t �`� �\ � yr_ 'QO,. Q Q Apr •+ . to • � a� `�'' ' �. '' (j �L �•'of �J .' -sr z, Q .O` R CA. earth fee, 111 • km TOWN OF BARNSTABLE 6C LOCATION / /YID? L�}>be SEWAGE VILLAGE HAASIvif J%��� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.eI�. SEPTIC TANK CAPACITY 00 O 64l- 6Fx 6 r 4r), s� LEACHING FACILITY: (type)c2- SD©(IAL CWAo'heaj (size) o?S Yl3t NO. OF BEDROOMS BUILDER OR OW�I F,.R rAJte..t Uty 0c'I PERMIT DATE: 6`® COMPLIANCE DATE:ZW 6 -0 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 2W feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by R ���l� �,K = ______o. � � J � �� 3 �� 1 �' i i � i "'� - �i � - -� � �4v?J� S 33 � �� No. ��V Fee 5v— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pphration for �Digpoml *pftem Construction Permit Application for a Permit to Construct( . )Repair( Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. 1 �--t rv��ger L_An c Owner's Name,Address and Tel.No. C o Low iaw ciawki�kte , r rho•3ci�5 Assessor's Map/Parcel Q�tS htA;n sT— (yeti,lk�r4R Its Installer's Name,Address,and Tel.No. Desi ner's Name,Address and Tel.No. 3t-Ce hcLv.�k 1', s'�tc 0._-CAec 1VAS;,Acer.:,4 �� (�o-ro S?• fi'3� 1�t�9�n ST Type of Building: Dwelling No.of Bedrooms Lot Size U 6a sq.ft. Garbage Grinder(VO) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow gallons. Plan Date �X i• /9,.)0 6 3 Number of sheets Revision Date Title Size of Septic Tank /f660 C�� ' �x i,%�a�` Type of S.A.S. a�So�G9/ mac/ s Description of Soil, C''41�= s �s v2 O n s6 20 Sa?" S,;r1cy yi �d 7 g"?M cf t 6�A t.� Cu��// Nature of Repairs or Alterations(Answer when applicable) �����/)r✓ PiJ% �0 Ug n�� fit-;..� t� C�eA-s Ano/ 3 i�i%�// �H,4irr.�-2J - o?5'�X /.�. '��Fel� 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 Certifi- cate of Compliance has been iss d by this oard o alth. Signed DateTAic% S o?DO'Y Application Approved by Date Application Disapproved for a following reasons CD Permit No. .200 y(-d Date Issued it O V THE FOLLOWING 1 IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M A�C(, C DATA L�_ s' ^+ \ O No. t I Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Rpplication for Mizpo$al *p5tem COttgtruction permit Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. t-r- ., Assessor's Map/ParcelC. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �j��CC Z�0.CC=.1 ; �+'• ^��-•�Cr,t)C �, �cr,-,.,5 `'U 5�c• ... 1 1 c �l�i^�+.-.Tl, l`1�1 t '1 l'S) �u i Type of Building: Dwelling No.of Bedrooms Lot SizeOi6��� sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow SCE gallons per day. Calculated daily flow gallons. Plan Date oc i ! / c.v 3 Number of sheets Revision Date Title Size of Septic Tank 11060 64 - r x I j Type of S.A.S. ` >U°G��f,. yr, ctic;;s Description of Soil 0 Lf us /� t U ZI- SLb -S�1 %••,,�, -,� i, C i // Nature of Repairs or Alterations(Answer when applicable) -� �'�� /�C''' D`" ` °x os� �r/�/a! J 1` (J P,.\ - n Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore describedon-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 Certifi- cate of Compliance has been issued by this Board ofeHealth. _ Signed Date l .f. ? G U Z/ t J.' ' `L Ic s / r Application Approved by ,�; Date i - y `" � �t..! Application Disapproved for the following reasons l � Permit No. -2 0 U 1 -vu 7 Date Issued ! Vo y --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BAR_NSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(Upgraded( ) Abandoned( by Y at / T,,}1 (- �Fi ,c t/1/;,Ur has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. a 1'0 LI-D 1T 7 dated I/ U V Installera, Nacc: Designer 901-0 The issuance of this permit shall not be construed as a guarantee that thetsyystin',wi11 function as designed. f Date R n l o u l Inspector --------------------------------------- No. .2 Q0 Y — U 0 7 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS - ligogaY 6potem Construction Permit Permission is hereby granted to Construct( )Repair( k1lUpgrade( );A,bappdon( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. n Provided:Co 1 struction must be completed within three years of the date of tlrs.,permit. Data: ' i'!;' `� Approved by r4 T6WN`0F BAR-NSTABLE EC / SEWAGE #Q(DILQQ�r LOCATION vII.LAGE �,42Sh�h� � ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. &: a SEPTIC TANK CAPACITY -O 661 LEACHING FACILITY: (type)t � 0VC Cr/A� 1 (size) �� �[13v + Ovcr p� . NO. OF BEDROOMS BUILDER OR OAR ZMAE PERMITDATE: �`® COMPLIANCE, DATE: 6 Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist - within 300 feet of leaching facility) Feet Furnished by I I R � -43 a I 109 ZR o/ 33 L@ffl ON � � III s SEWAG SIT N0. VILLAGE Z37fell(lj INSTA LLER'S NAME i ADD S BUILD R OR OWNER DATE PERMIT ISSUED ` /- ----------- y DATE COMPLIANCE ISSUEDc_., �,�. � .era . ._ -} `� ✓' �I .�' _ ��� �' � > ` �t��L�i�v� -. 1 ... •\ t TOWN OF BARNSTABLE "ATION' - CTION . VL.LAGE MLj I AASSESSOR'S MAP LSO INSTALLER'S NAME&PHONE NO. ¢ tlInnu rhvi + I N SEPTIC TANK CAPACITY ® W S - / W yhh LEACHING FACILITY: (type) k OQ Ojo n, I t- (size) �1J 1 NO.OF BEDROOMS 3 i 0 in BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well 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) i Feet Furnished by l a a PfA 2A At u I � Op �o yi No.. .�.... F�s...:�.�...�. THE COMMONWEALTH OF MASSACHUSET'rS 1 BOAR® OF HEALTH �j• 3 ' Appliration for U44poiial Work.5 C omtrnr#iun Prrulit Application is hereby made for a Permit to Construct (/or Repair ( ) an Individual Sewage Disposal Y System at ... r�l ....... ...... .......... ..-------°---•-�-©--•-..................----•-•------••--•-•............-•--- Location-Addres ner Address a -••- - Installer Address z/ d Type of Building Size Lot.'^�_ .V________Sq. feet U �, � Dwelling—No. of Bedrooms________________________________ _Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building �✓ _._..___ No. of ersons_________-,............... Showers ( ) — Cafeteria ( ) p., YP g ------ -•--- P a Other fixtures --------------------------------------------------------------------------------------..----------------------------------•-----•--•---•--......---- W Design Flow.............$ _.:__.__._.____________gallons per person per day. Total daily flow........ . ....................gallons. WSeptic Tank—Liquid capacity/daCQ.gallons Length__9. _-____ Width_S___-_.___ Diameter________________ Depth................ x Disposal Trench—No_ ____________________ Width___`.................... Total Length..__.____________ Total leaching area____._._._____..sq. ft. Seepage Pit No-------/-.......... Diameter._ ®__-_______ Depth below inlet___6______________ Total leaching area_2?o_.-:sq. ft. Other Distribution box ( )Z Dosing tank ( ) 1 � Percolation Test Results Performed Date__e "/�'_ ?� �a Test Pit No. I_g4r.minutes per inch Depth of Test Pit..../Z......... Depth to ground water_.YZ_/_.......... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------------------------------------------------------------------------------------------•--......................................................... 0 �� Description of Soil-----�?.-�-��-----•---------l`�-----�SL��--�Ot�....-------------------------------------------------------------------•------------- v - r`J �Zie, ------------------------------------------------- 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'TT LEI, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee ssued by the b r of health. Signed...... ............................................. .........................._.... Date o 49 Application Approved BY -•-- �`' '--------•---•-------------••--•----•-- m2--"---e.,/.-----••-- Date Application Disapproved for the following reasons---------------•---------------------•--------------•--------................................................. •-----------------------------------------------------------------------------------------------------------•-•-----•-•-••---••-•-------------•------------------••--•--------••-----------•-•---------- Date c PermitNo......................................................... Issued------- •-•-•--••----•-•---- Date /�- L //I L •- ' F�s... ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Biipngal Vorkg Tonitrurtinn Vamit y Application is hereby made fora Permit to Construct (/ or Repair ( ) an Individual Sewage Disposal System at: _ 8� Z' ..............�1 - ..-•-- �---•-----•-C'-----------------------•--------------------..........------. Location-Addre s or Lot Now Q�c1..4.. 00, ................................ .,... 'sc � A .��_._... i rr�ourril �... ... ner '' Address!.. nstaller Address Type of Building Size Lot.Z,0��..(-VZ.Sq. feet Dwelling—No. of Bedrooms.....-3................................Expansion Attic ( ) Garbage Grinder ( ) p„, Other--:',,-Type of Building ........ No. of persons..:.._..C............... Showers ( ) — Cafeteria ( ) QI I Other fixtures .................................. W Design Flow............SS.......................gallons per person per rday. Total dailX flow........ -R.CC?.....................gallons. WSeptic Tank—Liquid capacitAPO-_gallons Length__9....M..... Width.-.-E........... Diameter................ Dept ........... x Disposal Trench—No. .................... Width...._._.._...._.... Total Length.................... Total leaching area___........_....�_sq. ft. Seepage Pit l�o-----_�----._-____ Diameter-,�.............. Depth below inlet-_�.............. Total leaching areal'?0.._-.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed B3� ' �v/�!J �JK: 7.' Ssoc. Date..��__.��_.�._�O a - i ¢.... a Test Pit No. 1 G�--__minutes per inch Depth of Test Pit..../Z..,...... Depth to ground waten./a______________ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------------------------••......-•-•-••. -------------•------•-----•.._.....---•--................................................................ DDescription of Soil----. _''I.E'----•- / --- _.,-------------------------------•--•----------------------...-------•-•------------- x x -----------------------------------------------------------------------------------------------------------------------------------------------........................................................ U Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- N Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE, ^ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee ssued by the b ,ar of health. Signed....... :.. ..... ....:..:: ............................... .......................... Date Application Approved By--- ---- -- . . • ----•--•-•••.................•----••..... Dati t' APPlication Disapproved for the following reasons-----------------------•---------.....------------------------....------------------------....•--..._............ ---•-----------------•-------•--..........------....--------•----•--••-----------...........-----....----•---------•--••-••••--•------------••-••-•-•••-----•-----------------•-------••--•••--.....-•-- Date PermitNo...........................................7----------. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS 'f_ BOARD OF HEALTH 040 ........./......... ~�....OF..... 1/:,�T��. �- :............... TatifirFatr of ToutpliFanrr. THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by .- .r ^a- Install r,o.. . es at...... ------- ,,.y A — --------------r'� . ---•-•.4------- ------�� -------------•-----------•------------------------------------------ has been installed in accordance with the provisions of 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit N _.1�/_ dated_... ........................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRVED AS A GUARANTEE THAT THE SYSTEM, WILL FUNCTIONeA�ISFACTORY. DATE.......... Inspector � �� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .OF.....�.�..AdIZ4j.�% � GL= v 0.�''.... FEEI.J-�, '"..�.d-_............- i rya ttl nrk Tn mtrumduitt panfit Permission is hereby granted........6 t .......... -------------------------------------------------•-----.........---•--.......... to Construct ) or Repair ) and Individu 1 Sewage Disposal S stem atNo.......... ..... .............. i t Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... j_ f rd of Health DATE=-•-•--•---•---•.....-- ...............•-•-----•--•-------------....... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS February 18, 1981 We are aware that water from the well at Lot 30, Timber Lane, Marstons Mills, was tested on February 9, 1981 and February 17, 1-81 and revealed nitrate counts of 7.3 and 5.0 ppm. This count is considered high, well above- the average in the Town of Barnstable. ell Water containing 10 ppm. , or over, in nitrates is not con- sidered safe for human consumption. The buyer of the property_ is aware of the high nitrate count and is wi ling to proceed at his own risk in erecting a dwelling and consuming the water. i DIt-is -highly recommended that the owner have the water tested on a quarterly basis. The Tom of Barnstable Health Department assumes no responsibi- lity for the potability of the water. SIGNED: i� c ( ealtor WITNESSED: i oFTHE ram, Town of Barnstable Regulatory Services * BARNSTABLE, y MASS. g Thomas F.Geiler,Director i639. ♦� A Public Health Division Thomas McKean,Director 367 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 September 17,2003 To Whom This May Concern: The property known as Lot 30,House#51 Timber Lane,Marstons Mills has always been a 3 bedroom house, is a 3 bedroom now and shall continue to be a 3 bedroom house. There is no problem in permitting the property for a 3 bedroom Title V septic system with the proper engineered plans. Sincerely, Donna Z.Miorandi, Health Inspector 14 (a COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS A f DEPARTMENT OF ENVIRONMENTAL PROTECTIONL4 1 ` a: A F kEC O FAILED INSPECTION AUG 2 3 2003 e c'O�M s� v`o TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION--OS-T Property Address: 51 TIMBER LANE MARSTONS MILLS 02648 L30 Owner's Name: JANEY LEYDON Owner's Address: 51 TIMBER LANE MARSTONS MILLS 02648 Date of Inspection: 8/1/03 Name of Inspector: (please print) JOHN GRACI,INC. Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 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 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 sses _ Needs Furth valuation by the Local Approving Authority X Fails Inspector's Signature: Date: 8/1/03 The system inspector shall submit a opy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspectio . If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments SYSTEM FAILED TITLE V INSPECTION. LEACH PIT WAS FULL OVER PIPE AT TIME OF INSPECTION. PIT HAS NO EFFECTIVE LEACHING LEFT AND NEEDS TO BE REPLACED. ****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. Titla. 5 TncnPrtinn Fnrm 6/1 Snnnn 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 51 TIMBER LANE MARSTONS MILLS 02648 L30 Owner: JANEY LEYDON Date of Inspection: 8/1/03 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: SYSTEM FAILED TITLE V INSPECTION. LEACH PIT WAS FULL OVER PIPE AT TIME OF INSPECTION.PIT HAS NO EFFECTIVE LEACHING LEFT AND NEEDS TO BE REPLACED. 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. n/a 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: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a 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: n/a Page 3 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 51 TIMBER LANE MARSTONS MILLS 02648 L30 Owner: JANEY LEYDON Date of Inspection: 8/1/03 C. Further Evaluation is Required by the Board of Health: _ Corditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance n/a "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 51 TIMBER LANE MARSTONS MILLS 02648 L30 Owner: JANEY LEYDON Date of Inspection: 8/1/03 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z 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 4 MONTHS AGO INFO FROM OWNER. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] YES (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ 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 lI 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. A Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 51 TIMBER LANE MARSTONS MILLS 02648 L30 Owner: JANEY LEYDON Date of Inspection: 8/1/03 Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks X _ Has the system received normal flows in the previous two week period X Have large volumes of water been introduced to the system recently or as part of this inspection ? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out'? X _ Were all system components, excluding the SAS, located on site? X _ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information. For example, a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] S Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 51 TIMBER LANE MARSTONS MILLS 02648 L30 Owner: JANEY LEYDON Date of Inspection: 8/1/03 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents: 3 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO n Water meter readings, if available(last 2 years usage(gpd)): n�a— �.rj v Sump pump(yes or no): NO �� Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): 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/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: 4 MONTHS AGO INFO FROM OWNER Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons-- How was quantity pumped determined?n/a 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) _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): n/a Approximate age of all components,date installed(if known)and source of information: 1981 -ASBUILT Were sewage odors detected when arriving at the site(yes or no): NO Page 7ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 51 TIMBER LANE MARSTONS MILLS 02648 L30 Owner: JANEY LEYDON Date of Inspection: 8/1/03 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition(f joints,venting,evidence of leakage,etc.): �.. I TOWN WATER 0-16\ �;� bee(1 d%se— I \'nccta SEPTIC TANK: X(locate on site plan) Depth below grade: 12" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: L 8' 6" H 5' 7" W 4' 10`1 Sludge depth: 1" Distance from top g of sludge to bottom of outlet tee or baffle. 33 " Scum thickness: 1" 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 were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL SEPTIC TANK COMPONENTS ARE STRCTURALLY SOUND AND FUNCTIONING PROPERLY.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. 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(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a I Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 51 TIMBER LANE MARSTONS MILLS 02648 L30 Owner: JANEY LEYDON Date of Inspection: 8/1/03 TIGHT or HOLDING TANK: (tank must be pumped 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(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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 WAS VIDEO INSPECTED AND APPEARS TO BE STRUCTURALLY SOUND PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): n/a R i Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 51 TIMBER LANE MARSTONS MILLS 02648 L30 Owner: JANEY LEYDON Date of Inspection: 8/1/03 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a 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: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): LEACH PIT HAS NO EFFECTIVE LEACHING LEFT IN IT.PIT WAS FULL AND PONDING AT TIME OF INSPECTION. SAS NEEDS TO BE UPGRADED. CESSPOOLS: (cesspool must be pumped as part of inspection)(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 inflow(yes or no):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 Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): n/a 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 51 TIMBER LANE MARSTONS MILLS 02648 L30 Owner: JANEY LEYDON Date of Inspection: 8/1/03 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. t L g Qect A s � s 13 AA 1 AC�3 AD�( day in Page 11 of 1 I OFFICIAL INSPPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 51 TIMBER LANE MARSTONS MILLS 02648 L30 Owner: JANEY LEYDON Date of Inspection: 8/1/03 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 12+FEET ii s�v� 1 � A 5 �CD i' r l� 5S 9b t � o ILI 9 o - /M be Ki 143 January 6, 1982 Mr. Dick McNealy 65.2 Main Street Vest Yarmouth, Ma. 02673 Dear Mr, McNealy: You are granted a variance because you installed leaching pits on Lots 31 and 32, Timber Lane, Marstons Mills, 134 feet and 131 feet from wells in lieu of the required 150 feet. You installed the leaching pits in violation of Town Health Regulations and Regulation 15.02 (8) , of 310 CMR 15.00, the State Environmental Code, Title 5, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage. You are officially warned that any further violations will re- sult in the suspension or revocation of your Disposal Works Installer's Permit. Very truly yours, X) . .._..� Ro ert . Wilds, Chairman NAe--- Ann J aug H. V. Inge, . D. BOARD OF HEALTH TOWN OF BARNSTABLE JMK/mm DickXcXea t W eabor 652 a V tnc�t. Varrnout4 12aread-c%a.mac4uaetta 02673 U y4 0 a� l��Il�Ki� • _ . r j�• i.}, ` - .•'• � \' k ,.. 'S ..S '`` .. ��� ram/©/'`?,��_YJ - l' + / ' ,,,.'- is V • .,. w. Ysr y A ' ;, pw'x,T -' -�/J ��!.1/.Q/�---�• ��� Y {�.1 ., .s ..• i:' ati 15 'Fi�5 �,�s Fp� y F .. - • • - i i f '.s a `t y n• • •" w ~ 'ee �,y, F !� Ss '.,.�w $ ;t r �z.,..�Ii� s F�c�j , � -. ' - , �' `' w 4 + Fey a `- `1• ' vvf 1, T ,. January 6, *]:982; ; I , • - ' -" � Aj'g�A ' F.;fc t r t `e '�4�. t , ;t ^. .^ .a � • •Mr6Dick 'McNealy '652 Mairi Street, . West Yarmouth, Ma. 026.713=v Dear Mr. McNealy:, °•:;: You are;granted 'a'r variaincer because ..you. installed •leaching -pits` on;'Lots 31, and .32,.. Timber Lane,t�Marstons Mills; 134 feet and = -. , l31 ';feet from ,wells `�.n: Dieu of the rok.6ired 1.50 'feet:; :You installed the,,leaching 'its' inviolati.on of .Town 'Fieal'tht :_ .',, Regulations and Regulation '15.02 e(S Y of `31:0.^-CMR, I-5.00 i the ,- `State Environmental 'Code,`; Ttle`',5, `Minimum .Requirements, fo'r,the k Subsurface Disposal of Sanitary'`Setaage. :y You are'yofficially.'warnyed that any further ;vi.olations =_siilk'ieW sult in the suspension or,revocation,-of ,your 'Disposal ,Works installer,'-s Permit. r , Very 'truly yours, ' - ' its .•,v.i•4 A .. A, t' ! ,,.. r '..a,, � :� ~ Robert M. ..Childs- , Chairman f ,.�� ,s r+ ,c. .. a ..•c' to rt ',4 a ' Ia. r�� .e �.. .. Y - .- -.Ann J' baug {. H�•N ^ , .LnTe • ,D. •s- .` t i.`, s ra 0 w µ t 4 ; BOARD',OF -HEALTH , <I F TOWN OF .BARN3TABLE ,' ;zw j. j e '�: e l "a ,.y' ,1 ;i � S `•� .. f - Aa � { . .. , ;pU , r " . .�. .„ r " raw i •. i. H.. h.�• ... •j .^ yr - •.t L 'tt �� � f , • , • a x • 'D ic k a(cXea t (W ea 6o r 652 tne�t.a W.YarmoutA CDapead-NaaaacAumth 02673 M71771-7931 4-36.3 -- Ac i- Y _lei A 00, l �O • A A6 Zv !o 6 g /17- / 1 '/1� r ]- 4 oo Saappc DjST, T'�k a 1 L•�' ," . /�►t i- �'fox r•�. oig — — qgt ,ram .s c I I Aol 3 8 SZo y4. 7 S e. -- ®" < c 1 /I/,gA/yOL S CO!/Eoe.S To •BF B!//GT TO G(� )"!y/A/ pq7-10 A- pit irl, 111171100 rcfi%a%FT /o" '=�z"P �9.s To N E ?lo.S4 ;'`',o�rc��%s�r �CrC 9�►.oS' 578 0 e n : 4 ,e ors r :;a N /.vvEeT :to; G19LCoA/ /�vvE S.. o /avE� �,O py'� 3 /�Zo , o s E•�r/C .Ti9�/.� /i✓UE•e 7- Z�� ' '� [pj.c G!/ `7 S N E O .5 70•�E n 6 Ile), 6�9.2 B-Q G E p_ —D? EG E v �B o r To rs�c P R 0 F I LE OF SANITARY DI SPOSAL SYSTEM NOT TO SCALE DE S I G N DATA BEDROOMS • CONSTRUCTION OF SANITARY DISPOSAL DESIGN FLOW 330 GAL ./DAY SYSTEM SHALL CONFORM TO MASS . LEACH RATE -w—Z . MINJINCH ', ENVIRONMENTAL CODE TITLEM d,• PROPOSED LEACH CAPACITY ' AND THE TOWN O F '�'�' '�J`�7 'f 'B'G HEALTH REGULATIONS. ` '4 27 GAL. DAY t SITE PLAN SHOWING' PROPOSED CONSTRUCTION FOR ,(�,i'�, � .�,f� Ly / .�r"" APPROVED 19 _ SCALE: "f3`� ` DATE } BOARD OF HE ALTH REFERENCE �E/err' moo' u A..•�'` ,� ..DATE AGEN T '` ssfc JOSEPH M. , AN 4AYMOtID 136!0 J . M. MONAHAN: JR. $► ASSOCIATES 40 alsre o fi A�4 REGISTERED LAND SURVEYORS & ENGINEERS } • 1'o51 MAIN STR E ET DENNISPORT, MASS. 02639 TOP FNDN. AT EL, 73.55' SYSTEM -PROFILE 'BEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT P4q- 6" OF FINISH GRADE A.H. OJALA, PE <qNf ACCESS COVER (WATERTIGHT) 70 ENGINEER: Locus MINIMUM .75' OF COVER OVER PRECAST /� WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM S -~` 72.0 WITNESS: AM WHITE, RS 2" DOUBLE WASHED PEAS ONE ! DATE: l 0l6/03 I 1 r-V 70.9 RUN PIPE LEVEL ,. I FOR FIRST 2' 3' MAX. PERC. RATE = < 2 MINZINCH =R EXISTING GALLON SEPTIC * 69,4' I 10951 69.5 f CLASS SOILS P# {: TANK (H- 10 ) BAFFLE oc>oo 68.72' CJ CJ C-1 M !� 1� C� o E 68.89 68.6 C7 LO I� d GI L 0 ® E-1r- 4' OUNDR6" CRUSHED STONE OR MECH cl I-1 0 M 0 IO L� F-I lgg2 C� C7 Cl C� C) CJ t� a� 66.6 Q ELEV. COMPACTION. (15.221 [2]) - 0" 71.6' f. DEPTH OF Flow = 4' 1 % SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE A I( �_ % SLOPE) TEE SIZES: �LS/ ( � UNSUIT. . INLET DEPTH = _ 10 „ 1OYR 2/1 OUTLET DEPTH = 14" 4 LOCATION MAP NTS SL.;' FOUNDATION~ EXIST SEPTIC TANK 31 D' BOX 14' LEACHING : , UNSUIT. ASSESSORS MAP 149 PARCEL 55 FACILITY 5 10YR 6/6 *THE INSTALLER SHALL VERIFY THE 20 LOCATIONS OF ALL UTILITIES AND ALL C1 BUILDING SEWER OUTLETS AND ELEVATIONS PRIOR TO INSTALLING ANY PORTION OF SILT LOAM SEPTIC SYSTEM unlsulT. 2.5Y 6/6 52" ' 67.26' (� 61.6' C 2 1 V 5' REMOVAL OF UNSUITA19LE SOIL REWIRED MCS & AROUND PERIMETER OF LEACHING FACILITY, GRAVEL COBBLES DOWN TO SUITABLE SOIL LAYER. REPLACE LOT 31 WITH CLEAN MED. SAND. 77" 2.5Y 6/5 65.18' PERc C3 jR MCS I 20 ELEC TRANS PAD 120" 2.5Y 6/5 61.6' I CATV RISER LOT 30 _ NO WATER ENCOUNTERED NOTE: BENCHMARK ,� ^ 20,642 SFt CORNER OF BULKHEAD i ELEV-=72.2' '' / 1 s ," '1�Ih lcAPPROXIMA:TE NrV I � SEPTIC DESIGN: (GARBAGE DISPOSER IS NC __ .2 aI I nWFD > UESIu!•i �'�u'.�: Lir�rw�iivS 41v i�F _Ju0 GPv 2. MUNICIPAL WATER IS EXISTING �cQ ) 79 USE A 330 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. ' q 70,87 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 j SEPTIC TANK; 330 GPD ( 2 ) 660 5. PIPE JOINTS TO BE MADE WATERTIGHT. 4 TN ti 27 USE A -1(100 GALLON SEPTIC TANK (RE-USE EXISTING) 6, CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. j 1,82 1.96 '� �,�' ENVIRONMENTAL CODE TITLE V, O %K LEACHING: 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT 2(25 12.83) 2 (.74) D'SOX-{-71,78 112- TO BE USED FOR ANY OTHER' PURPOSE. ' E ,'71.70 SIDES: � I h of ' 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 ' PVC. 72,c3 Cr 25 x 12.83 (.74) = 7 i L7 71.67 EAI2ING � BOTTOM: ExIST, logo GALST tP� 71.45 ' 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT �0 7 0 TOTAL: 472 S.F. ��GPD ST (RE-USE} INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED ��, , 7a55 JGti ' USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH. i' 71.57 �' EQUAL WITH 4' STONE ALL AROUND 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING LEACH PIT <' DECK EXISTING .40 LEACH PIT �� DWELLING TF-73.55' 4'04 '�QC ,,0��' L. G E N D TITLE SITE PLAN 11.26 f�P S � } 7142 71.97 1 �q��Fa � / 100.0 PROPOSED SPOT ELEVATION OF DEAD s *70.44 51 TIMBER LANE 15" Pi ES .94 �� TEL 0,32/1 10Ox0 EXISTING SPOT ELEVATION 70,67 � TERMINAL /' IN THE TOWN OF: 100 PROPOSED CONTOUR ( MARSTONS MILLS BARNSTABLE ONE- `� '` -- 100 EXISTING CONTOUR 7a,37 DRIVEw \ �' PREPARED FOR: JANET LEYDON /+70.21 }-�0 26 .-k7o 78 -/ � 20 Q 2.0 40 60 BOARD OF HEALTH 76 1 MA SCALE: 1" = 20' DATE: OCTOBER 19, 2003 LOT 29 /+ 70.11 � APPROVED DATE i r , 10 �� oft 508-362-4541 ` =70,08 fax 508 362-9880 TEL Chown cape engineering,, inc. Z OF Mq RISER 0/a pv`'� ARNE H. c�GJ, �l� OF M43' )<69.86 CIVIL ENGINEERS p,1ALA ti f LANn SU �V'RE'Y ORS o.31M LA l CONC. COVER ;I # Na 348 POSSIBLE WELL 0,56 939 main at. yarmouth, ma 02675 A N AL s. DATE 03-334 Al