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HomeMy WebLinkAbout0235 TIMBER LANE - Health 217,Timber Lane ._- Marstons Mills t r .Commonwealth of Massachusetts y 'itle 5 Oiciainsatio Form Subsurface Sewage:DIsposat System Form-Not for Voluntary Assessments 217 Timber Ln >Property.Address; - Gady ` Owner Owners Name information.1.is7. requiredfor:. Marsions Mills Ma 02648 6423: every page. :Gityffown .. . . . State Zip Code Date of tnspection inspection results must be submitted on this:#arm. Inspection forms.may not.be altered many : way. Rlease`see .completeness checklist at the end.af the farm Important:, A. {nsn ector Information s1w 3:903 1Ntienfillingo1A - . . .. �. ,��--:C- form on the computer,use Douglas A Brown only the tab;key Name of Inspector fomoveyour D:A. Brown Inc.` cursor-do not Company Name , .use-the return . ke,y P.6. Box 145 rrr 11 Company Address Centerville Ma 02632 GitylTown : - : , .. . Zip Co State . de' . .-... : 508-420-4534 SI 4297 Telephone Number r I, License:Nu'm:ber B, Certification t certify that I am a DEP approved system inspector in full compliance with Section I6.L.340 of Trtle 5(31.0 CMkA8.000); l have personally inspected the sewage: I.. I system at the property address irstetl above;the information reportetl.betow is true, accurate and complete as of the time of my inspection; and the inspection was perform based on my training and experren.L the proper function and maintenance of:on site sewage disposal systems. After conducting thls;inspection l have determined that the:systert� 1, Passes 2 . 0 Conditionally Passes 3. r.n Needs Further Evaluation by the La. Approving Authority 4. Q Falls . .r .. .. . r . .r. . . ,.�& r I r .. 11 I ..f L . r �I �L,r, .6 23=19 lnspectors;sig :ure. . Date:. The system inspector shall submit a copy of this Inspection reporf to the:A . L ing Authority(Board of Healtti`or DEP)within 30 days of completing this inspection. 1 1the system has a design fil... . r 1`0,000 gptl or:greater;`the inspector and thesystem owner sha11 submitthe report to the appropriate ";Q regional office of the DEP The original formshould be sen to the system owner and copies sent to the buyer;if applicable, and the approving authority; Please note :This:report:only describes cond tans:at the time of inspection and under the:: conditifons 0f,use at#hat time This inspection does not address how the system:wtii perI.forms` in fhe future under the same or different conditions of use t5nsp dap%rev 7/2Ci/Zd g rdte 5 4fiaa1 nspect+On:form:SubsuifiaCe Sewage DIS 6o System•Page 1 of 18 .. .. . : ` Commonwealth'of Massachusetts Title 5 Official Inspacticn Fir M Subsurface$ewage Dispgsal Svstern.:Form Not for Voluntary Assessments 217 Timber Ln Property Address Gady. Owner Owners Name information is... .. . reiautrea for MarstonsMa ::: 02648 6-23-19 every page CitylTown State. Zip.Code:: : Date of inspection C. Inspection Summary Inspection Summary:Complete 1 2;3,or 5 and all of 4 and 6. .1) System Passes: 1g 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`#ailure:criteria not evaluated are indicated below. Comments At 'time of inspection this system met all passing requirements. This report can not predict the future performance under the.same:or increased usage.This report is not tobe used for bedroom count determination-We.are using information available to us at time of inspec#ion from Board of Health and property owner Z) System:Conclitionally.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 oy the.Board of Health,will pass_ Check the box for°yes", no,,or`not.determined".{Y, N, ND)for the following statements. If"riot determined please explain The septic tank is metal and over 20 years oid*orahe septic tank{whether metal or not)is structurally unsound,exhibits substantial ihfiltration or eAltration:or tank failure is imminen#. 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:structurallj sound, not leaking:and if a Certificate of .Compliance indicating'that the tank is less than 20 years old is available: [] Y 0 _N ND (Explatri below) t5insp,doc+rev 7/26I21)18 Title 5 Offgalinspecho[ti form Subsurfac a Se vage DispasafSystem•Page 2 of B. i Commonwealth:of Massachusetts Title 5 Official Inspection Ftir n Subsurface:Sewage Disposat System Form=Not for Voluntary Assessments 217 Timber Ln Property.Address. Gady Owner:. OwneesName: information is Pequued for. Marstons Mills .. Ma 02648 6-23 19 every page; .-OWTOW6 State Zip Code: Date of Inspection. C. inspection:Summary {coat.) :2) System Conditionally Passes (cunt) Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval i# pumps/alarms are repaired ❑. Observation of sewage backup or break::out or High static water Ievel.in the:distribut+on lox due. to broken or obstructed pipes)or�due to.a broken, settled ar uneven distribution box. System will passinspecton if(with approval,of Board of Health): . ❑ broken pipes)are replaced ❑ Y ❑.N ❑` ND(Explain`below); ❑ obstruction as removed ❑ Y` ❑ N ❑ ND(Explatn below); ❑ distribu#iort'box is eveled orreplaced ❑ Y ❑ 'N ❑ ND (Explain below): The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y'. ❑ N.. ❑ ND(Explain:below); ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain'below):: 3) Further Evaluation is Required by the Board of.Health::: Conditions exist which require further evaluation by the Bo1.arcl of Health m order to deterrnme if the sys#em is failing to protect public health, safety or the envronrnertt a System will pass unless Board of Health-determines in accordance wit h 310 CMR 16.36317)(b);that the system�s:not functioning to`a manner which will protect public health, safety.and the environment. t5insp Coc+:rev 712612018 Fide 5 OtfivattnspectionForm Subsurface Sewage D�sposai:System Page 3 of 18 Commonwealth of Massachuse tts - Title 5 ® ic2�1 `Inspectionarn Subsurface Sewage Disposa#System Form Not for Voluntary Assessments 217 Timber Ln Property.Address Gady owner .:owner's Name information is required for 1Narstons Mil s Ma 02648 6-23-19 every page CityJTown State Zip Code Date of.Inspection C. lnspection Summary {cone) ❑ Cesspool of privy is within 50 feet of a urtace water,. ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b System wail 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: O. .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 an 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'S0 feet or more from a private water supply It*' Method used to tletermine distance: *:This system passes if the well water analysis performed at a DEP certified laboratory, for fecal caliform:bacteria indicates absent and the presence of afrtmonia.'nitrogen and.nitrate nitrogen is eguat 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 F. c Other: 4. 4) .System:Failure Criteria Applicable to A{I.Systems You must indicate"Yes"ar"No"to each of the following for all inspections Yes No:: Baekup:of sewage mto facility or system component due to overloaded or. ❑ clogged SAS.or.cesspoal Discharge or ponding of effluent to the surface of the ground or surfarre waters © due to an.overloaded oc clogged SAS orcesspoot t5msp tloc rev.71262018, Title S(*oat lnspection'Form:Subsu ke sewage Disposal System-Page 4 oE,18 Commonwealth`of Massachusetts Title 5 Official ins ecfic n F r Subsurface Sewage Disposal System Form Not for Voluntary ASsessrnents 211 Timber Ln Property Address lady owner `Owners rVame.: information is reguired.for Marstons Mills Ma 02648 6-23-19 every page Cityf%w State Zip Code: Date of inspection C. lnspectlon Summary (cont.) 4) System Failure Criteria Applicable to All:'Systems: (cost) Yes No 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 thar.6"below invert or available volume is less ❑. ® Ahan ! day flow Required pumping more.than 4 times in the last year.NOT due to clogged or ❑ ® obstructed pipe(s)Number of.times pumped: ElAny portion of the SAS, cesspool or.pnvy is below high ground:water.elevation Any portion of_cesspool or privy rs within 100 feet of a surface water supply or ❑ z tributary to a surface water.supply. Any portion of a cesspool or privy is within a Zone 1 of a public 4atersupply ❑ :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 welt with no acceptable water quality analysis. [This system passes if the we water analysis,performed at a DEP certified laboratory,for fecal cofifornn bacteria indicates absent and the presence o€_ammonia nitrogen and nitrate nitrogen is equal to;or less than 5 ppm ; provided that.no other failure criteria are triggered.A copy:of the analysis and chain of custody must be attached to this form.) The system is a cesspool serving a:facility with a design flow of 2000 gpd Iz 10,000:.gpd. . The system fads l have determined that one or more of the above failure ❑ ® criteria exist as described in,$10 GMR 15:303,therefore the system#ails The system owner should contact the Board of:H6alth.toi determine what will be necessary to correct the failure. 5) Large Systems. To be consrderer! a large system the system must serve a facility with a des ign flow:of 10,000 gpd to 15,000 gp&*: For large systems, you must indicafe either"yes or°no"`to each`of thb follow r g, in addition to the questions in Section C. Yes No . ❑ ❑ the system is within 400 feet of a surface d king water supply. [] ❑; the system is within 200 feet of a tributary to a surface drinking water supply the system is located rn a nitrogen sensitive area(Interim Wellhead Protection ❑ ❑ Area-IWPA).or a mappedZone l of a public water supply well t5utsp doc•rev.71Ztaf20f8 Title 5 MO aLinspechOn Form Subsurface Sewage Disposal System.'.Page 5 af:6 Commonwealth`of Massachusetts �'itie 5 Off. iat I specfi�n 6 Subsurface:Sewage Disposal System Form Not for Voluntary Assessments I,..�1.:..��.��.I--.I..I.I-�..�..�.:::.....�.�.��,.�I I.-..:'.��..:I--.II.'.�I.1....JI.—,w.�.:.:�:. 217 TimberLn .:.Property Address - Gady . ..Owner Owner's Name information is regwred for Marstons Mills Ma 02648 6 23-19:. every page City(rown Zip God tnspecti State.. . e : r3ate of on C. [nspectlon Summary (cunt} if you haue answered.":yes"#o:any questton. n Section C.5 the system sconsidered a ignificant threat;'or answere1. d yes"to any question in'9ection C.4 above the large.system has failed. The owner or'aperator of any large system considered a signiftcant.threa#under Section C.5 or failed :under Section C`.4 shall upgrade the.systern in accordance with 310 CMR 15.304. The system owner should contacf.f .0 appropriate regional office of the Department= 6. `You must indicate"yes" oc"no"for each of the`following for a//inspections :Yes No`: ❑ Pumping nfor at►on was provided by the owner, occupant or Board of Health ❑ Were any of the Systern components pumped out in the previous'tw0 weeks? ® ❑ Has the system received normal flows in the previous two week penod, ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? ® Q Were as built plans of .e system obtained:and examined?(If they were not available note.as NIA)` 0 ❑ Was.the.facility or dwelling inspected for signs of sewage back t)p1 ® ❑ Was the inspected far signs of break outs ® ❑ Were atlsystem components excluding the SAS, locate d'.on site? ® ❑ Were the septic.tank manholes uncovered,:opened,and the interior of the tank` inspected forte cond-ition of the baffles or:tees, material of construction dimensions, depth of liquid, depth of`sludse grid 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: Q ® Determined in the field(if any`of the failure criteria related'ta Part G is at issue approximation of distance is unacceptable)[310 CNIR 15:302(5)j . - .. ::: . . . .. t5in� .dae-rev M6=16 Title 5 Offidal lnspedwn Form:Subsurface Sewage CUfsposaf System!Page 8 of 18 c Commonwealth of Massachusetts Title 5 O is al Inspect ipn or n �+� Subsurface:Sewage Disposal System.Form -Not far Vo4untary Assessments 217 Timber Ln Property Address Owner Owner Mrne:: information is regwred fir fJlarstons Mills Ma 664$ 6-23-1.9 every a e Citylrown . .: .. Zip Co Inspection rY.p 9. State. de Date of Q. System Information 1 Residential Flow.Conditions Number o#.bedrooms(design): 3 Number of bedrooms(actual) 3 DESIGN flow based-on 310 CMR 15.203(for example. 1 I'0 gpd x#of bedrooms) 330 Description 2 Number of current rest dents: :. Does residence have a garbage grinder's ❑ Yes N, o Does residence;have.a watertreatment unity ❑ Yes. ® No If yes, discharge.s to 1s laundrjr on a.separate sewage systems (Include laundry system inspection;`. information in this report) yes: ® No Laundry system inspected Yes ❑ No Seasonal use?'.: El Yes: N61. Water meter readings,:if available last 2 ears usa e d see below _ . Y _ .9 (gP )) Detail. 2017 =4156 '2©18-�--137 gpd Sump pump ; ❑ Yes ❑ No LastAate of occupancy,.:::,. currently :..:. occupied #5rsp d4c;:rev 7128}2(318 7itte S Official tnspedion,Form;Suhsur#ace Sewage Disposal System Page 7 of Is. i Commonweatth.of Massachusetts �'itle 5 Ofisc ai Inspp,dion i=or I Subsurface:'$ewage Disposal$;yssem form-Not for.Voluntary Assessments 1 217Timber Ln Property Address Gad y:: Owner Owner's Name information is requtred.for Marstons Milts Ma 02W 6 2340 every_page. CityTiown State. Zip Code. Date of lnspection D. System Information:(coot.) 2 CommercialllndiMrial Flow C©indittons Type of Establishment; Design Q flow(based on`31 CMR 15.204 Gallons per.day(gpd) Basis of`design flow(seatsipersons/sq.ft., etc). Grease#rap presents ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to Industrial waste holding tank presents ❑ Yes ❑ No Non-sanitary waste discharged to ttie Title 5 system ❑ Yes ❑ hlo Wat&meter readings, if.available Last date of occupancy/use:: date Other(describe below), 3. :Pumping Records Source of information: Was system pumped'as part of the inspections ❑ Yes 1 ..-No If yes, volume pumped: 9aitons How vitas quantity pumped determined Reason for pumptng: tSrnsP doc=tev.7126l2r318 1 rtte 5 orScial fisped on Form Subsurface 5e6Vage prsPOsai System e.Page. 1".1. Commonwealth of Massachusetts - Tide 5 Official `lnsp�ection form Subs.. ub ... Sewage DisposaI System Form Nat for Voluntary Assessments 4 217 Timber Ln . Property Address Gady Owner 7wne�"s Name'. information is required for Marstons Mills Ma 2648 -: 6-23-19 every page :: City(Town State Zip Code . Date of Inspection D. ::-System information {coat.) 4 T e of S stem. vp y . ®.. `. ` eiptic`tank, distribution box,soil absorption system ❑ . ..: Singie cesspool ❑ Overflow cesspool:: ❑ . Pnvy ❑ Shared system(yes or no) (If yes;.attach:previous inspection records, tf anyj ❑ Innovative/Alternative#echnolvgy Attaic a copy of the:current operation and maintenance contract(to be obtained from system owner)and a copy of safest inspection of the IlA system by system operator under contract Tight tank Attach a copy'of the DEP approval- Other(describe) Approximate age of all components; date installed(if known)and source of infflrmation 4-25-42 By.l Holler :... W6re sewage:odors detected when°arriving at the site? ❑ Yes �: No 5 B.uilding.sewee(locate on site plan) :Depth below grade feet Material of construction ::❑ casf iron ❑4Q PVC ❑other(explaIn)- Distance from prEvafe water supply_well or suctions Itne feet Comments(on condition of joints,venting, evidence of leakage;etc.}. .. v 3. .... . . ..... .. .... 660.doC rev,1l26018 Title 5 Offcial Inspection Form Subsurface Sewage 6,i sposal System-Page 9 or 18 tts CorrimohWeaM of Massachuse Twitle 5 Officia4 rnspecfi n ® n Subsurtace Sewage Disposal System form Not for Voluntary Assessments 217 TimberLn :Property.Address Gady :Owner owner's Name. information is required for Marston Mills Ma 02W 6-23-19 every:page Crtylfown State Zip Code.. Date of Inspection © Systeim fnforllnation (cont.) 6 SeptcTank(locate on site plan). Depth below grade fleet 'Material of construction concrete ❑ metal :El fiberglass 0,polyethylene: other(explain) If tank is metal„.list age.. years. Is age confiirmed by a Certificate of Compliance?{attach a copy of certificate) 0. Yes::[� No Dimensions, 150 H-20 per�lan: Sludge:depth.: Light to moderate:: Distance€rorn top of sludge to bottom of outlet tee,or baffle Scum thickness light Distance€rom top of scum to top of outlet tee or baffle z. Distance.frorn:bottom`of scum to bottom of'outlet`tee or baffle How were dimensions determined? or pole Comments(on pumping recommendations; inlet and outlet tee or baffle condition structural integrity, liquid levels as:relateo to outlet invert, evidence of leakage, etc,) I always recommend pumping at time of transfer for maintenance and:every 2-3 yrs there after for maintenance. i54nsp.dnc•rev,7f2sm g Tifle 5 t)ffiaa Inspection Form Subsurface Sewage Disposal System-Page 70 of t8 .. Commonwealth of Massachusetts ,- Title OicJalnspecti ®ram w :: .Subsurface.Se wage Disposal System:Form-Not for Voluntary Assessments :. , 217 TimberLn .. . Property Address Gaily Owner . owner's Name information is required for MarStons Mills Ma 02648 6-23-1.9 I very page . . :: Citylfown. I. 11:. State: Zip Code Date of inspectiorx D System Information. (cone) 7 Grease:Trap(tocate:on site plan) Depth below grade feet . : Material of construction concre#e1. ❑ metal Q fiberglass . 0 polyethylene Q other;(explain) .. - Dimensions.. Scum thickness Distance from top of scum to top of out letaee or baffle Distance from bottom':of scum to bottom of outlet tee or baffle Date PA.`last pumping; Date .Comments(on pumping recommendations, inletand outlet tee.or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence 0 leakage, etc rj .) .8 Tightoe Holding Tank(tank must be pumped at:#ime of Enspection}(locate on site plan) Depth below grade. Matep.rial of corstructi+3n concrete [� metal fiberglass [] ptaiyethyleCe other(exL:rplain} .Dimensions: .: •.Capacity gallons Des*gn F1ow : gallons per day t5msp:cioc rev._7/28720t8- : :Tice 5. dal Wpectio�Form$cibsurface S9urage Disposal System-.j '1 1.1 orl8 . . Commonwealth of Massachusetts . I insctc � Fora . Tile 5 fcua p '- Subsurface Sewage Disposal System form-Not for Voluntary Assessments .: 217 Timber Ln .. . Property Address Gatly Owner Owner's Name: informafion is required-for Marstons MilIS Ma 0264$ 6-23-19 euery:page corrown state. Zip Code Date of Inspection D ..System t iformati©n (cunt} 8 :Tight or Holding Tank(cont.} Alarrn.present ❑_YI.es ❑ No Alarm.level Alarm in working order, ❑ Yes .I.❑ No Date of'last purnpmg: Date Comments (condition of alarm and float switches;etc} ''Attach copy of current pumping contract(required) is copy attached? ❑ as ❑ No 9 Distribution Box(if present must be 1�0eriod}(locate on site plan): Depth of liquid;level above outlet invert A,,1 C1. oIo mrrients (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:). :`Box was functioning.}properly at time of inspection . : .. f5inap:doc eav:7r26/ lb •: at InVaa'io Sewage disposal Syste r Page 12of 18 : .:- LL LL Tdla 5 Fjffi6 p Form Sui�surface m f Commonwealth of Massachusetts r Itle 5 fficialinspectton .Form Subsurface Sewage Disposal System Form-Not'.or Voluntary Assessmen#s 217 Tmber Ln Property Address. Gaily owner: : :::Owners Name information is required for Marstons Mills Ma 02648 6 23A9 every page. CityfTown... . Zip Co Inspect State: . de. Date,of ion D. Systern Information (coat.) 10..'Pump.Chamber(locate on site.plan} .'-.Pumps to working order_ ❑ Yes ❑ Nod �:A[aO aworking.order ❑ Yes ❑ No* Comments(note condition of pump chamber, conditi- f pumps and appuit. nces, etc- ff pumps or alarms are not in working order, system is a conditional pass 11:`:Soil Absorption System(SAS}{locate on site plan, excavation not required:} $f SAS not located, explain why viewed by camera Tyis pe.': ❑ leaching pits number. leaching chambers: number. 2 ❑ leaching gallenes number ❑ leaching trenches number, length leaching fields number, dimensions ❑ overflow cesspool number ❑ innovative/alternative system TYPe/name of technology: t5msp:doc rev_7126/2dt 8 Tithe 5 wdat frispecGon Form:Subsurface:sewage Disposal Syste o Page 13 of 118 1. •t Commonwealth of I.Massachusetts Subsurface Sewage DisposakI I System Form-Nat for Voluntary Assessments - . 217 Timber Ln Pr-,1.Addcess Gad�r Owner owners Name information�s : required for - Marstons iV i s Ma:: `.02648`.` 6 23=19 . every::page. Ck own Stafe Zip Code Date of Inspection D S. stem lnf©rmat�on (coht Y ) 11 :$oil Absorption System (SAS)(eont) Comments.(rote condition of soI.il signs of hydraulic failure, level of ponding,damp soil, c L. ondi#ion of .Vegetation, etc) o clear signs of failure or'surcharge at time of inspection 12_ `Cesspools(cesspool must be pumped as part of inspection):(locate on site plan).: Number and configuration DeptF top of liquid to inlet:invert Depth of solids layer Depth::of seurn layer: Dimensions:of cesspool Materials of construction Indication of ground.vlra#er inflow :: ❑.:Yes 0 N'o : Comments(note condition`of soil;signs of hydraulic failure, level of ponding,condition of vegetation . etc.): ... . tsinsp_doc rev 7ml mia Tive 5 of Cial inspsoon Form'Subsurface:Sewags Disposal Sysiern. Page 14oi 1a Commonwealth of'Massachusetts Title S O icta1 Inspection:f c rm Subsurface Sewage Disposal System Form Not for Voluntary Assessments F. 217 Timber t_n Property.Address Gaily Owner Owner's Naive information is required for Marstons:Mtlls Ma 0264$. 6-23-19 every page Gitylrown. ..: Zip Co Inspep State de Date:of ion D. System Information (cunt 13: Prwy(locale:on site`plan):. ;Materials of:construction bimensions Depth::of solids Comments(note condition of soil, signs''of hydraulic failure, level of ponding condition of vegetation etc) d. t5rn*doc rev:71267 nis.'. Tilte 5:Officaat Inspection Form:Subsurface Sewage Disposal system•Page 15%o 18 i Commonwealth of Massachusetts r T tle ficia nsp tWn Forte Sulbsuiface Sewage Disposal.System Form-Not for.Voluntary:Assessments' 217 Timber Ln Property Address P .. Gaily Owner Owner's Name information is required or Mai stops:Nlitls Ma. 02 8: 6-23-19 every:page. CityrTown. State Zip Loft Date of inspection D System Information (cont. ... 14 Sketch Of.$ewage::Disposal System: Provide a view of the sewage disposal system,including ties to at Ieast two permanent reference. landmarks or benchmarks.Locate all wells wi#hip 100 feet. locate where public water supply enters the buidmg. Check one of the boxes below ❑ hand-sketch in:the.area below ® drawing attached separately`.: b. �I i5 ni;i,.c rtw 726/26is Title 5 otil al tl soeifion Form:$ub&irt 66$sro &Disposal 8ystem•Page:96 of ttf . Commonweat#h a Massachuset#s - t1e Offici f inspecf on ft rrn .= Subsurface Sewage Diisposaf System Form Not:for Voiuntary:xssessments. (.. I. ". 217 Timber Ln .. Property.Addres& Gaily Owner: Owners Name information is required for. : Marstons Mills Ma :.02648' 6 2319 every.page. GitylTown State Zip Code Date of Inspection D SysteL. m tnforrna#ion (coat ) 15. Srte`Exam .. . _. Check Slope O Surface water Check cellar ® Shallow wells Estimated depth to high ground water 12 ft+ -- feet Please Indicate all methods used to determine the high ground water elea.vation ® Obtained frorrisystem.design plans-on record . 1#checked, date of design plan reviewed 672019 I. Date ❑ Observed site(abutting propertM.y/observation hole within 150 feet of SAS) ❑ Checked with local:Board of Health=explain ❑ Checked with local excavatofs, Installers=(attach documentation} ❑ Accessed USES database=explain You must 1.describe how you established the high ground water elevation design plan : Before idling this lo ISM pectoa Report,pease see Report Completeness Checklist on next page. ... . t5uisp doc reV.7126f1018:::. :. Title S;O ioil Inspection FOM Subwftw Sewage Disposal Systeiii Page l7.or 16 _ � . . . . .... I I Commonwealth of Massachusetts Ti t1� 5 Official I sp ctio Corr Subsurface Sewage Disposat;System Form Not far Voluntary Assessments. .:: 4 ..:.-... . ...: 217 Timber Ln . P.roperty.Address :,: Gady Owner Owners Name information is 9. _required for.. : Marstons Mills Ma 02648 6 23-19 every:page Citylrown State Zip Gode Date of Inspection E. Report Completeness Checklis# :Compl!ete ait applicable sections of'this form inclusive bf ® A inspector Information: Complete all fields In thi section ® 8.;Certification:.Signed'&.Da.ted and f 2, 3, or 4 checked ® G:Inspection Summary. 1 2, 3,or.5 cornpteted as appropriate 4:(Failure Criteria)and.6 (Checklist).completed .. System Information For 8 Tight/Holding Tank—Pumping contract attached For 11 .4 Sketch of Sewage.Disposai System`drawr on pg!°16 or attached For 15;Expianation of estimated depth to high grountlwater included .. . . ISrtspdoc rev:7f2612018 Title 5 offioat Inspection Form:Subsurface Selvage.Disposal System Page 18 of 18 . z TOWN OF BARNSTABLE L4CAT10N17 Y : ��ic SEWAGE# , .¢ t .. VILLAGE :. Was GO ,Lt 1l t.� ASSESSOR'S MAP&PARCEL Ltyf INSTALLER'S NAME&PHONE NOp :/tam_A', _ AI> SEPTiCALvx CAPACITY t LEACHING FACILITY f typed NO:OF BEDROOMS OWNER . ��tJt it .' PERMIT DATE - tJ 6I,- C 1VIPDANCE DATE f Z. Separation..Distance Between.the Maximum lusted Groundwater Table to the Bottom.of Leaching Facility % 1pF.. Feet Private Water.Supply Well and.Leaching Facility(If any ells exist on site or:Within 200 feet of leaching facility) � �� Feet Edge of Wetland and.Leaching Facility 0l anvuetlands e�cist u thin 306 feet of leaching facility) —� ♦4 Feet FURNISHED.BY ViArA-A 5 6� lre*ai mww A is 2 ,. t7 � 3 - ATa Flj 1-j+ rMMG swim" �ALL r` f �. f �°is 7 1�1�•���° r cag i Rc" - k i Errti .v 4 L F � �� �L ' " L T Clpri F 4? '3 +.:'�Ci ,�Z. 1356 sift C� 4a, p s» RED 3 ED tEa3 sOa??EIOi#+?.St✓: 2 swk j} p er ti 0�- t MASTER BEDROOM BALCONY / 2 i'l0'x .1.Y.l0' c k BEDROOM r ��• pal i LINANGROOM I � 20'6"x 27'4' rt BATH , w - E OFFICE 4 �•--w-....-..i. 8'8" x =2'4- VT F r�� &rM N4,j5 Mu"Roo" Z. ..sar k Pt,.A fDA-;-Dii POWERED BY ,m s, matterport TOWN OF BARNSTABLE LOCATION 2I 7 / I MP eX- 97- SEWAGE# 201 2— / ( VILLAGE Mha&rodS A, l UJj ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&&PHONE NO. -f}�rtit� I nL.Lr--T SD 'il •C) O SEPTIC TANK CAPACITY I S00 5A LEACHING FACILITY:(type) LC--!!�W (size) c )t S-co �{ NO.OF BEDROOMS 3 OWNER 'DAh + Arm PERMIT DATE: 30 1 C MPLIANCE DATE: S-131 I Z Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 7 f Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) A Feet �FURNISHED BY UfMi — C.1 0 -[.�ifL PL A l� OF REF 12— Ai woo-a A 3 z-T- 1 2� Amu 1 i- 2 'z37- 3 �F8 L4 ® �-o ._ too---- No. THE C OMMONWEALTH OF MASSACHUSETTS FEE _ BOARD OAF HEALTH lbw IV OF P��IRN'2XP,BLt!' APPLICATION FO DISPOSAL SYSTEM CONSTRUCTION PERMIT Application fora Permit to Construct (Repair ( ) Upgrade ( ) Ahandon ( ) - VComplete System ❑Individual Components Map/Wuccl4t ddress +Z g_ w3o Jv H 0L'Lt1� t UN �- caller's Name Design rs Name Address Address Telephone 8 Telephone 4 Type of Building: 1>&4C'F_ Lot Size•2o,Z 50 Sq.feet Dwelling—No.of Bedrooms 3 Garbage Grinder ( ) Other—Type of Building No. of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required) 3O gpd Calculated design flow gpd Design flow provided 341 gpd Plan: Date J i`L Number of sheets Revision Date X -A Title CaE. :1D)-5 Fe,S44 r->iESt, G Description of Soil(s) 4' 10 S-A�VV L A,M- SflA t-�2'1 -)'20 1h• t 5rwv>w/ 10 0i 1241J£i Soil Evaluator Form No.)aW Name of Soil EvaluatorE L Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS ►2 �I.1`1 �� 7j"ate 5 ,1Z_T$\Ny, The undersigned agrees to ins II the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and er agrees not I ce the system in operation until a Certificate of Compliance has been issued by the Board of Health. • z S= ) Z- Signed mDate FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 y r•... ,, r•.�siF+M �!f,. i S"•k r..vYti'�"'.+r"k�^.+i /•ry v`1 x i'. ..Cr. l�tF�f/--..�r•t',. ''F#.-{ '.�✓Y _ .. I ^.,3 .�y�., k^N� ...�..l e^ ''1r ,y.. -+to � r• 'r'iJ '•�• tell"' --.a+..� ,y,._. J �.-r.,.. - , 061) Nti THE COMMONWEALTH A A . *, FEE �F O M SS CHUSETTS «. r _ BOAR 6 OUF- H`E-A LT�i _ t M 7 ecOF > A APPLICATION FO DISPOSAL SYSTEM CONSTRUCTION PERMIT Application I'or a Pennit to Construct ( ) Repair ( ) Upgrade ( ) Abandon,( �) - Vompleic System Q Individual Components 02 C&Iot NMI GNp** . N P N i_u ateun J (1411c s Na„e Pf'\i5 L- �..N, .3 )\AY1, . . ..,..,,.... Map/P;ucrl# 3': % t• A el dkr's Name r Desi n rs Name 14,1 R1d R 1 'DA } )V1>Im- P6 RT 6-A ; 5 '1 eta Address Address . 1. 'S'C$-'7'3"t - 631 7 -7$-313-`P`S'`_T - �. Telephone# , • Telephone# a . "Type of Building: 1�IE'5)D.6IJ ZE Lot Size 2 0)2 5 D ..Sq.feet Dwelling—No. of,Bedfooms 3 Garbage Grinder ( ) Other—Typeo f Building No.of persons Showers-( ), Cafeteria ( ) Other fixtures Design Flow(min./required) 3 30 gpd Calculated design flow 39 gpd Design flow provided t4f) gpd Plan: Date 3 ! 7 0 l 1 Z, Number,of sheets Revision Date 1�( Title 5tW A\GE :D 3Fo54K.- T>ESto ) C, , ? Description f Soil(s)� O- 10 S fiNAy woIAM92')4 •ZI �oF1►0.11 S Ar(A 2'I -120 �`�' C r Soil Evaluator Form No.T_CoW 4 Name of S- il-Evaluator E AZIJ!A74 l' Date of Evaluation 3 2*�, 17, DESCRIPTION OF REPAIRS OR ALTERATIONS -?_g'pLA C�( 7�1•)r1C� S i l�' -j The�undersigped agrees`to instill)the,,above described Individuairiewage Disposal System in accordance with the provisions of TITLE 5 and f er agrees not to pl ce the system in operation until a Certificate of Compliance,has been issued by the Board of Health. Signed -Bate v le" FORM I - APPLICATIONFOR DSCP DEP APPROVED FORM 5/96 t No •�+ '� ,_, THE COMMONWEALTH—OFMASSACHUSETTS FEE - F= t gf;Y.NSTKt-IE BOARD -OF HEALTH ,.N CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed V,Repaired( ),Upgraded( ),Abandoned by has been installed in"accordance with he ovisions of 310 15. 0 rtle 5) and the approved design plans built plans relating to application No. " dated . ,A�,,roved Desi`'n Flow__�� � d ..P g (gpd) , 47, Installer Designer: Inspector N ate J r The,issuance'of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No. ;THE COMMONWEALTH OF MASSACHUSETTS y :FEE BOARD OF"HEALTH r ': IN DISPOSAL SYSTEM CONSTRUCTION PERMIT - Permission is 1 ereby granted to Construct ( Repair ( ) Upgrade ( ) Abandon ( ) an'individual sewage disposal system at L _ 1 i?S / S 1V1 l tlY described a in the application for Disposal System Construction Permit No. 'dated— Provide t d- v ru do shall be completed within three years of the date of this per bl�lt l diti0 s +1st be met. Date "/ Board of Health r 'FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W Homs&WARRENTM' PUBLISHERS- BOSTON a 1! Town of Barnstable °Ft ram, Regulptory Services ti , Thomas F. Geiler, Director I * BARNSTABLE, " MASS. Public Health Division Ep 39. 6. Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: O+�A� 3�20 z Sewage Permit# 20%Z— 111 Assessor's Map/Parcel I 'f9 Installer& Designer Certification Form Designer: Ftai— LAUTjFLgq Installer: .1�. 4.u-M Address:. 44 C*.n-rV j EaJ 'VR.t v C Address: 1 �h anl Jgt, Zo k_ EE. ft*1b W k C.A . M.0. o 2Sal MmeroNs n%,ws, M4 0'44e On tt S0 ZaiZ /4y"e —I Sori GiusTrt. was issued a permit to install a (date) (installer) septic system at 217 T%mi&e_ LA c based on a design drawn by (address) N• eAaL. Lpwow dated 3/1 o/1 Z (design ) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) was inspected and the soils . were found satisfactory. . J�k of VQ�sq 0 HARRY tiN -Z EARL T4 Installer's Signature) LANTERY, JR. H ,o •p No.26575 p FSS70NAL (=S � gnatur (Affix Desig tamp Here) PLEAURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL. BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAof6ce formsWesignercertification form.doc Town of Barnstable ' Department of Regulatory Services a Public Health Division NAM Date rEo a� 200 Main Street,Hyannis MA 02601 Date Scheduled �j f Z Time. Fee Pd. -0 Soil Suitability Assessment for Se age Disposal Performed By: Witnessed By: Location Address 2 LOCATION& GENERAL INFORMATION 1 '7 l j im a tR L -,J • Own Na -DW t aMy GAAY, S. Addres Assessor's Map/Parcel: ( y' / En in is Na E � Lr Ry NEW CONSTRUCTION REPAIR V Telephone# (4-313- q•7 Land Use: RE 5-1 OC N of Slopes(%) I ° C Surface Stones Al l� Distances from: Open Water Body ✓\ 600 ft Possible Wet Area' 1 5 O ft Drinking Water Well 17 ft Drainage Way 5 O O ft Property Line 7 �} O ft Other IV A ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands In proximity to holes) P L 5I'DEVCt GnR-A GIL -®Taw 2 IE -4 F 4 "71 NO C-0 Parent material(geologic) GLACI � . OV-r\'/ASH DepthtoBedroek Depth to Groundwater. Standing Water in Hole: A Weeping from Pit Face VA Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in ebs.hole: in, Depth to sQII mottles: In. Depth to weeping from side of obs.hole: In, Oroundwater Adjustment f. Index Well# Reading Date: Index Well level :_ Adj.factor Adj.Groundwater Level,, PERCOLATION TEST DWJ/p2 I e Thne l :3 0 Observation Hole# Time at 9" Depth of Perc ' 3 O Time at 6" Start Pre-soak Time("? Time(9"-6") End Pre-soak 2.4 SA1.S /I O M t'► -S ` Rate Min./luch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) t) Original: Public Health Division Observation.Hole Data To Be Completed on Back-------- ***If percolation test is to be conducted within 100"o£wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sdil Color Soil Other Surface(in.)� (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Consistency,%'Gravel) 10- 1.0 0—A S�Np`NjA 1 �D RJR 14/3 IV o 10 21 Ls°A 1"OyR 5)4 NO . 27/-120t C M-C 5AND0 2-5 Y 6/,4 lJo f o C� DEEP OBSERVATION HOLE LOG Role# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) S + (USDA) (Munsell) - Mottling (Structure,Stones,Boulders. Consistency,3o Grave 0 'f B.B ONE 0P)Vt WA 10O`/e IZ 27 Bw � 0YR3)4 27�-I � C M CSAN1 2,5 - 4/4 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. ConsistencZ Tg Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Cositn Flood Insurance Rate Map: -Above 500 year floodboundary No -Yes Within 500 year boundary No Z, Yes _ Within 100 year flood boundary No. Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? t If not,what-is the depth of naturally occurring pervious material? Certification OF, ; • I certify that ons'JNt�l 9'QA7. �3 fiat the soil evaluator examination approved by the Department of Environmentalc�do Nthat irk, bove analysis was performed by me consistent with . the requirred tra ning,a erd ex per esj� d in 310 CMR 15.017. v t.Arl? IR. ti " .1 a- s h Signature -� 5 Da. NAL �\ Q:MPTlMERCFORM.DOC Sp,s ark C r•�-5- RoQM vTtLi-r ------------- , 'i 71 t � ......-. _._.. - _.-_ __,.--.. -._�-_- _. i _ t t,.r..L,F! ( 1300 ! i I 73 7� . I 7 L V 1J I U L, I 2 0 7 � � I --- -- - - ...._..__..._.--- ---.._ ... --- - - �, T7 I��i L V 1Q6 - -Roots. G ZEr- Gtib.ys Glbser 's r- - 7 3 �}GGGSS��Y /rPA F f I ' 36neoor� `t Town of Barnstable Health Inspector �FTNE 1p� Office Hours do Regulatory Services 8:00-9:30 Thomas F.Geiler,Director 3:30—4:30 BAMSTABLE• Only MASS. 1639• Public Health Division ♦� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT QUESTIONNAIRE 1. General Information: Address: 235 Timber Lane; Marstons Mills, MA 02648 Map 149 Parcel 044 Name: Amy L. Gady Phone: 508-428-6030 2. How many bedrooms exist on your property now? 3 Are you planning to add any bedrooms?NO 2a. Please include a copy of your floor plans for the entire property. 3. Is the dwelling connected to public sewer? NO If the dwelling is connec lie sewer, skip questions 4-9 below. 4. Location of dwelling i L'VSID or OUTSIDE a Zone of Contribution to public supply wells? 5. The dwelling connected to E-n ONSITE WELL WATER 6. Is a disposal works construction permit on file? YES f 6a.If yes, how many bedrooms were approved according to this permit? 3 Bedrooms. ' cn 7. Were any building permits obtained for construction of additional bedrooms? ca � 8. Is there an engineered septic system plan on file at the Health Division? YES 9. Has the septic system been iIspected by a DEP certified inspector within the last t vo years? YES r7 rn ------------------------------------------------------------------------------------------------------ FOR OFFICE USE ONLY TO BE SIGNED BY A HEALTH INSPECTOR/AGENT ONLY The Public Health Division has no objection to--�f bedrooms at this property. Signed: - - Date: A Inspector(Print): L, Q;/health/wpfiles/a7nnestyapp t r Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments yr Subsurface Sewage Disposal System Form Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information �1 Important: f When filling out 1. Property Information: forms on the = VA'D , C)LA q computer,use 235 1 Timber Lane � 1 only the tab key Property Address to move your Estate of William Liebermann cursor-do not use the return Owne me key. 235 1 Timber Lane Owner ddress Marstons Mills Ma 02648 Cityrrown State Zip Code Date of Inspection: 12/20/07 Date 2. Inspector: James Holler Name of Inspector Holler& Son Construction Co. LLC Company Name P.O. Box 702/9 Hi River Road Company Address Marstons Mills Ma 02648 City/Town State Zip Code 508-420-0280 Telephone 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 ❑ Nee Further Evalu ti by the Local Approving Authority 12/20/07 Inspe tor's ignature Date The sys em 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. Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M B. Certification (cont.) 2_35 (217)Timber Lane Property Address Marstons Mills Ma 02648 City/Town State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: e B) System Conditionally Passes: ❑ One or more system components as described in the Conditional Pass section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 City/Town State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection 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 ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Sve 1 Subsurface Sewage Disposal System Form M.- .. B. Certification (cont.) 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 Cityrrown State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (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 ❑ y p p b c ate 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 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: Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 'Commonwealth of Massachusetts u Title 5 Official Inspection Form Not for Voluntary Assessments y` Subsurface Sewage Disposal System Form G Ar 6 B. Certification (cont.) 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 City/Town State ZipCode Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection 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 '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: 1. ❑ ® 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. Yes No 1:1 ® 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. Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 235(217)Timber Lane Property Address Marstons Mills Ma 02648 City/Town State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection 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. Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts u Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. Checklist 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 City/Town State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection 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)] Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 City/Town State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Well 9 ( Y 9 (gpd)): i Sump pump? ❑ Yes ® No Last date of occupancy: Current 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: Last date of occupancy/use: Date Other(describe): Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M D. System Information (cont.) 235 (217) Timber Lane Property Address Marstons Mills Ma 02648 Cityrrown State Zip Code Estate of William.Liebermann 12/20/07 Owner's Name Date of Inspection General Information Pumping Records: Source of information: Occupant Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? sight glass Reason for pumping: Occupant request Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Approximately 22 years, Occupant Were sewage odors detected when arriving at the site? ❑ Yes ® No y f Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments y., Subsurface Sewage Disposal System Form H V � D. System Information (cont.) 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 City/Town State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: 6 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 7 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of ❑ Yes ❑ No certificate) -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1500 gal Sludge depth: 1 foot Distance from top of sludge to bottom of outlet tee or baffle 3 feet Scum thickness 3 inches Distance from top of scum to top of outlet tee or baffle 2 inches Distance from bottom of scum to bottom of outlet tee or baffle 14 inches How were dimensions determined? sludge judge Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M D. System Information (cont.) 235 (217) Timber Lane Property Address Marstons Mills Ma 02648 City/Town State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped at Occupant's (new owner's) request for routine maintenance Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of.last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form `y Not for Voluntary Assessments Subsurface Sewage Disposal System Form M D. System Information (cont.) 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 City/Town State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day. Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box{if present must be opened) (locate on site plan): Depth of liquid level above outlet invert zero Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): no solids Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ,M yY Subsurface Sewage Disposal System Form D. System Information (cont.) 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 City/Town State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection _Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: One, 1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields . number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): liquid level in leach pit is only about 1.5 to 2 feet deep Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 r Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 4,M D. System Information (cont.) 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 City/Town State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection 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 Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 Cityrrown State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection 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. i i 1 I 3 � cis - � 3 Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts u Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 4„M D. System Information (cont.) 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 Cityrrown State Zip Code. Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: Used USGS Topo compared to MIW29 well water depth and determined water elevation at property to be at 28 feet deep, bottom of leach pit is 13 feet deep, therefore seperation to water is 15 feet. Liebermann Inspection.doc•0312006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 ti Town of Barnstable 0,F INE A yP� o� Regulatory Services ,.NFrAB Thomas F. Geiler, Director MASS. `0g AT�p1.(A Public Health .Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-8624644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information Important: When filling out 1. Property Information: forms on the computer,use 235 (217)Timber Lane only the tab key Property Address to move your Estate of William Liebermann cursor-do not Owner's Name use the return key. 235 (217) Timber Lane Owner's Address Marstons Mills Ma 02648 CityfTown State Zip Code Date of Inspection: Date 0/07 2. Inspector: James Holler Name of Inspector Holler&Son Construction Co. LLC Company Name P.O. Box 702/9 Hi River Road Company Address Marstons Mills Ma 02648 Cityrrown State Zip Code 508-420-0280 Telephone 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 Ek"Veeds Further v Lluation by the Local Approving Authority 12/20/07 I spe or'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 t.-ie 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. Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 E Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M B. Certification (cont.) 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 City/Town State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection 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: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass' section need to be replaced'or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �H B. Certification (cont.) 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 City/Town State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection 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 ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts 4 u: T6tle 5 official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M B. Certification (cont.) 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 City/Town State Zip Code Estate of William Liebermann 12/20/07 Owners Name Date of Inspection C) Further Evaluation is Required by the Board of Health (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. d the SAS is within a Zone 1 of a public water ❑ The system has a septic tank and SAS an 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 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: Liebermann Inspection.doc^03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form wM B. Certification (cont.) 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 City/Town State ZipCode Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: 1. ❑ ® 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 El 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. 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. Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form a Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 City/Town State Zip Code Estate of William Liebermann _ 12/20/07 Owner's Name Date of inspection 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 0 ❑ 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. Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. Checklist 235 (217)Timber Laie Property Address Marstons Mills Ma 02648 Cityrrown State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection 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? El ® 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? Z ❑ Was the site inspected for signs of break out? 0 ❑ Were all system components, excluding the SAS, located on site? 0 ❑ 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)] Liebermann Inspection.doc•0312006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M D. System Information 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 City/Town State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 2 Number of current residents: Does residence have a garbage grinder? 5 ❑ 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 Well Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Current Last date of occupancy: 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: Last date of occupancy/use: Date Other(describe): Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments , M Subsurface Sewage Disposal System Form D. System Information (cont.) 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 City/Town State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection General Information Pumping Records: Source of information: Occupant Was system pumped as part of the inspection? ® Yes ❑ No 1500 If yes, volume pumped: gallons ` How was quantity pumped determined? sight glass Reason for pumping: Occupant request Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Approximately 22 years Occupant Were sewage odors detected when arriving at the site? ❑ Yes ® No Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form ' M D. System Information (cont.) 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 City/Town State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: bet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 7 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of ❑ Yes ❑ No -----certificate) --------------------------------------------------------------------------------------------------------------------- Dimensions: 1500 gal Sludge depth: 1 foot Distance from top of sludge to bottom of outlet tee or baffle 3 feet 3 inches Scum thickness Distance from top of scum to top of outlet tee or baffle 2 inches Distance from bottom of scum to bottom of outlet tee or baffle 14 inches How were dimensions determined? sludge judge Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M D. System Information (cont.) 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 Cityrrown State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped at Occupant's (new owner's) request for routine maintenance Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M D. System Information (cont.) 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 Cityrrown State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert zero Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): no solids Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M D. System Information (cont.) 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 City/Town State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: One, 1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): liquid level in leach pit is only about 1.5 to 2 feet deep Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form CAM D. System Information (cont.) 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 CitylTown State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection 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 Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Lieberman Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M D. System Information (cont.) 235 217 Timber Lane Property Address Marstons Mills Ma 02648 City/Town State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection 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. i i � I I A a '4;3 2 3 � f5 J 3+ v Z S7 S `4Z L Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts . Title 5 Official Inspection Form a Not for Voluntary Assessments Subsurface Sewage Disposal System Form H D. System Information (cont.) 235 (217)Timber Lane Property Address Marstons Mills Ma 02648 Cityrrown State Zip Code Estate of William Liebermann 12/20/07 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: Used USGS Topo compared to MIW29 well water depth and determined water elevation at property to be at 28 feet deep, bottom of leach pit is 13 feet deep therefore sepetation to water is 15 feet. Liebermann Inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 Town of Barnstable �pF 11HE 1pk y�P ti� Regulatory Services Thomas F. Geiler,Director plEo��a Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-8624644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. 4 In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. -The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. L 0 CAT:;4 SEWAGE PERMIT NO. /m �e/� L VILLAGE Ma-es INSTA LLER'S/ NAME & ADDRESS t U'I L D E R OR O W NgR DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 7-3/' 7 �` ._ � a•--� Gam. _�.. . � , o� ^� � ?�_� _. v�,3" ' r 4 No.63- ... Finz...../ .... -.... (�9 THECOMMONWEALTH OFH HEALTH TS BOARD O 4� ./� ... --....OF......... . ,CAS... AVVIiratinn -for 4%gasal Marks Tonfitrnrtinn Vamit - � A IJ V Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ............... ----•-------•----------•----------•--- ........................ ............................. Loc n-Ad r�.20 No. 'arx� 11..t�.nes.1 r 1') �s "� �'1 Fls ---------- ,<. caner Address -------- ----- Installer Address d G Type of Building Size Lot...9__�_.__J.........Sq. feet U Dwelling tZNo. of Bedrooms...-----------------------------------Expansion Attic (n'u) Garbage 11 Grinder (jJv6) Other—Type of Building ............................ No. of Persons.....�.----...____-___--_- Showers QI,-) — "afeteria ( ) P-4 Other fiat res -i W Design Flow........... ...............•_______----__-_gallons per person per day. Total daily flow-----------__........_.;:_------+,_---------gallons. WSeptic Tank l-Liquid capacity_1600--gallons Length................ Width................ Diameter---------------- Depth...----__-.----- x Disposal Trench—N _____________________ Width-------------------- Total Length.................... Total leaching area-.--.--._-__---_-___sq. ft. Seepage Pit No......__-_____-___ Diameter.................... Depth below inlet... .._.... .._. Total leaching a Dosing tankrea._._:__________sq. ft. z Other Distribution box (� ) ( ) �� �- Percolation Test Results Performed by----------------------------------------------------------- _. Date-----------------.---------------------. Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water...._._._.._._.......... (1 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground P4 water--.-.--..-_-_-__-_-_..__ ---•----.---• ---------------- �o y -•---•• - 7------- -------------- escnpttonoot 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issue by t e board Qf health. jl�gn . -• --------------- -- � 7:Date Application Approved BY ------------- - --- -- --•--•---••- � -46! . ­-- --- ---- ------------�7----.. Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- ---------------------•------------- ---------------------------------------------------------•-------------------••--. •--------•-••-------...----------------..._...----------------•-••-•-----•------- Date PermitNo......................................................... -Issued----- ,l '7 t---•---•--..... Date o ........ FRic......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD 9f HEALTH .....__0F........ Appliration -for Uhipmial Works Towstrurtion Vrrmft Application is hereby'made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ................T'14WISA, ........................................ ................... ef.- ... ..................................................................... L Allre'ss —a, —_ i,,)I o. . N_L6---------------------------------------------Owner Address ............y�jar _r. - ......................................... ----- ..s.....Ma.I5.5... ................................................. Installer Address + U <[1 Type of Building Size Lot ..... Sq. feet DwellingiZNo. of Bedrooms__3-------------------------- ----------Expansion Attic Garbage Grinder (#I,) PL4 Other—Type of Building ---------------------------- No. of --------------- Showers (;L) — Cafeteria P4 Other fixtpres ----------------------------------- ------------------ ----------------------------------------------------------------------------------------------- W Design Flow----------5-------------------------------gallons per person per day., Total daily flow............................................gallons. - iY4 Septic Tank 4.-Liquid capacity-100-0--_gallons Length________________ Width_.___....._... Diameter_--.-..-._._-_ Depth.._--.-.__----- Disposal Trench—No- --------------------- Width.............._.._.. Total Length-----_--_....._..._. Total leaching area--------------------sq. f t. Seepage Pit No-------I----------- Diameter.................... Depth below inlet. Total leaching area------------------sq. f t. Other Distribution box Dosing tank ( ) ��f - — Z -/-.<--7-7 Percolation Test Results Performed by----------_ ...... ----------------------------------------------------- Date--------------------------------------- Test Pit No. I................minutes per inch Depth of Test Pit.-----_-_________-.- Depth to ground water.._---_-.--.--.---. -- ;4 Test Pit No. 2----------------minutes per inch Depth of Test Pit..__._............. Depth to ground water--.-.-. _-._--_-.--_-- ---— ----- 1 04 -----------------;y ...... -- ------------ ------------------ -- Description of Soil..-- - ---- ........... --- --- -------- ----------7-- ---- -------- ��_7_-.42............), U -;a-d.... --------- ---X6;P__-.j---------------- ------------I------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable-----------------_---------------------------------------------------------- ------ ------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. gned.... .... ------------- .............. Application Approved By----------- . ... . .......... _-----)--_--/--.- ---1-�--a-l7 7--- Date --- Application Disapproved for the following reasons:------------------------------------------..................................................................... ......................................-------------------------------------------------------------------------------------------------------------------------------- ---------------------------- Date PermitNo-----................................................... Issued.------------------------------------------------....... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ............. . ................................................... If Trrftfiratr of W"I'llmlifiana THIS I�S TO CERTI17 Tyral the n-id�ivi/dI.1'Sewage Disposal System constructed el_') or Repaired... ... .. by.- A......... ......... ------------------------------- �L------------------ -------- Installer at... ... . ....... -- has bee installed in accordance with the provisions of A e X1 of The State Sanitary Code as described in the application for Disposal Works Construction Permit Nc &1V1 -.,&d------------------ dated----- ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRADAS A GUARANTEE THAT THE SYSTEM WILL FUNQJION SATISFACTORY. lz7 ...... ............... ...........DATE........ ­�------------------------------ Inspector. - ---------- ---- -_-----_----------------__-_--- THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH 4OF ......................................... No.._ ......0.)..... FEE... spoli rkivla r 110 1!1 r,rmit Permission j,) hereby gr d aate - s-_ ------- --- ­ --- --- -- - ------------ .. ......................................... to Constr t &-J ors Pep vi u ewa an J,ndi isposal stem a -- - -- ................................ Street as shown,on the application for Disposal Works Construction Per Na.. ated..... -7- -------------------- -4 --------------------- -Board.o al th DATE........................... :­.-----------------------........................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS A" J� t �p � � � '�y+ ,��y " /JfIR! • i�L!//'�:,]'-%'tom �ry rah ,` �� t � �.� ,rid pJ 07 �� 1I`•�'�Z'.�?!► ,s� �W C� -y� �,, L.+'?� • „ i -,f ` '�` tj may` �'� � H� , `n,l ( ` I s Q �1,. ,, �7d � o ` • w �P�j" MASS -j EVERETT N,CKLE N77 ` I:T3230 �SSIO N A L ECG rzy - f �C R}T I' F i E} D P:L ®-T P L A N -o c A r! o:N= /l�,q,e77 _. .�. . ' SCALE ./ 30 D.A`.TE .��9 . 3/, 7.7 OE ��C�x.t G>� a�" /Jr7•.�,�/5s"r'ti ` i IR E F E R f N C' G'o ,zo , / , r A'T Gg�92^�s 'rq�3GE%,.E�EC7�ST/2�/ 1 H E . E V" C" R T:,I Fj,Y `,T H A{T, .T.. H E .`8 U i"L D I N E1G 4 t_ A N DST,U R V ` . S H O' T H l:$' P.1. A N.` `I S IL O C=A,T E''D `O'g THE rp N`'D A'S SHOYVN H.ERE-ON R;A THAT IT �o� r CON`F O, A '�T>O THE gOMI;,Pd6 ® Y =; LAWS t' W M E N C tJ+.N'S T1sR U C:T E D." MONAHAN.JR. 13660' A- S,,S ® :C �''� T �.-S y t� Y� �+•'• , r G Q IST'E��L9¢�' s N'•+ -R E G I-StT E'.R E D;, EtN;,G t E>eL,E E R S i5 tG M D,-CAA P`E QtF,F i`CE B tiJ i t_:0 l N G 12 A 5 'Wo U'T E 2 8 ��. /z. S:O U T.H ---------- !o c K C RACE LANE � 1 \n'tNT F1 LTE R y �� I �-i G2 EI_ I �c� I00.b tKI S_'r NG GR �L C- -t--- -- A C cE S S w 6 EeZ LEV EL Z ' M► 3' t:M Ax c ov M) _ C 0\1 o LOCUS o i I >•► oTF:ST ACCESS Ibni S d - 1;500 GA IF OR L 1-1 k � 'P£nsraNE 5E?7) c TANK (►� zc� � qS' NF��� g7.3 (H 20) --= 1=L • ^c�'C12Ugrtt<A 5Tc7NE - z 57 � „� ►�e� s; E LOG U S Der, P, DF� 9VOp - + rA 11`I- I O MIN --- JA+L T _rE DE'-'r - I CJ F- O f3 ia LO\A/ EL gg,g NOTES: 1. Disposal System to be constructed in strict accordance with PRO T-11 -_�� )) 13:P C�SAL SX ST rL PI\ - --- - --- -- --- _.___ Commonwealth of Mass. Environmental Code - Title V. I 4 (Nor To SCAt� j 2. This plan is for the sole purpose of construction of a septic system. 3. Contractor to call Dig-Safe 72 hours prior to beginning of excavation. S4017'30"W ody i 14. 74 S41*00'10"W ��� 155. 27' 4. Existing pit to be pumped out, filled with sand and abandoned. } 7 02' .I i �:61'j ��d� / 5. Existing Septic tank to be pumped out and crushed. o e sloo' ' 6. Contractor to field check Invert at foundation. 60.3 7. Bench mark is assumed Elv. 100.0 on top of CBDH @ front right of � o \ r` lot. 4.3'- po y � 123 \\\239, °j.;,,;;,,,,,� Gf, o cry PvM� I� 8. APN is 149 / 45 for the Town of Barnstable. R/ADE r \ r , r1 \\\ \ \\ \ ` \\\ \`\ \ \\ .J \ PILL w 0 0� ' ,• sing �y �, I� 0 9. Locus is served by Town water, two Abutters are not (see plan). 61.0 TPA 3' t:1�I q - os\\:� � 10. The plan 'ew is based on survey by Stephen J. Doyle, PLS. 1710 Q� z1.s ,\\jam\\ �• _ 10.0' L 11. Replace e sting septic tank with a 1,500 gal. H-20 tank; install Tees � . ,.• o , �;.. w �~ 1 oa D13 2 D s�A and gas baffle per Title V. 12. Use 2 - 5 x8 x2 H-20 leach chambers with 4 of W to 1 / Double o y ATRIUM. �y washed stone all around with filter fabric on top. 0 21.5' CARP�h Pv Q t �� A I s I` CI 16 R C SE Rom , T+P _ !-i F_A°-_T H N CY E N T D/-\T L _ ---- -- `'v' 0�6.974' 1 --- Ex� �CaC� .!'ELL - , � E S�' f��r �� del*R 2_7E 5r 40' 7'30"W 170. 00' \1 \ �� �o� HARR I 9g9�.O13 [—j .,SpjN DYrJ i � To EARL LA TERM, 1R 6NETIMBlF G . I I T r < 5 M!N /I N /oTS N i 3'N �LE V 5 C/\ � Ain, . '.r' L_ Dl\ ! L\I FLU W _ I I a 3 = 33 0 3, 1 '0\ i� T- h 0,1 IL. ;�LC` ,��� r�ED�vI 5E TI C T ro �f ='!',N� � , D t\v 17 A\TA`1 GAD'/ � 1 h.S I 3 30 C7•1P,D, X 2. (o b 0 GF\L a . - I „+ ] 1 of/J 3R,�YEL 2 L'�t�t f 1�1ZS�,V !v\!L\- ,M �\ a Ni L - (11\CI 11 !`1 a 1\r !X C �) , r'\. `S, N �� 5 ____.__..._....__._..----- _ _ _- P . J 4 U SE - 5X8 Utz P,C.. CONG.CH- \Y\B1R3W14 ' STONE _ ',-� I°'� 1�XISryr�G CO i�4ToU Z r! `�`�3!E�R '_ C�7- ECTWF_ 1-7PI I-i 2,0 X C-I)�t H Pz CH . _50LU7 G N `a X O:I�� 231 ���, , �33- � Nol-1� �Jol•120 _go.o FlCZM �I�I� 7�L_ CONSUL T O T AL CAP)`\ i�. y - -"�' - 3-4 1 GALS , h1bL_C_R�SaN 0ATE= 3llC-4 12 0W G. 31 oZ f ., _004