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HomeMy WebLinkAbout0046 TREE TOP CIRCLE - Health 46 Tree Top Circle Marstons Mills A= 1.50—033 TOWN OF BARNSTABLE ) LOCATION 4-1&-Tf-ems C SEWAGE# VILLAGEaSSiv�s J41�11 ASSESSOR'S MAP&PARCEL /<-O 3 mg INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /suexiaP rnsg LEACHING FACILITY.(type) i3 tDc� ,t®(3 (size) NO.OF BEDROOMS y OWNER Z:y IL.' PERMIT DATE: 'a5'�` COMPLIANCE DATE: f S 0 1 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachin ility) Feet FURNISHED BY s C , A GIv7 � 131- 23 L41-I.S- 3- 2-3,L-/ Li 10/06/2009 06:44 5084775313 ENGINEERING WORKS PAGE 01 Town of Barnstable Regulatory Services Thomas F.Geiler,Director sum$ I Public Health Division Thomas McKean,Director zoo Main Strom Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 10 16 D 9 Sewage Permit# Assessor's Map/Parcel 150 ^d?3 Ins er&plimer CcrtificatjQR Form Designer: [5; ,*, rl-nW-yYW Address: n. W. Cre a s-Q-c 1 cA Ce-A Address: 1 Q 'SOX 14✓- F&-4-)h�c.L2 M14 11244 C evt+Cry ;!fit- f_j oZ63Z On P A• 5 coo w n I✓►.C, was issued a permit to install a (date) (installer) septic system at �r TO G f. M based on a design drawn by (address) 'R*�) - M C-&r-� f dated -7) I 7!Cq (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include (minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected 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. ZH OF 4144y PETER T. 13ts er s S-I ) McENTEE H CIVIL 3510 Na. 9 1016 /0? De (Designer's Signature) (Affix i8 ) PLEASE ARN ABLE LI T11 N. Of C E VoILL f4ill' BY SE T am PMIC N q:Noffiw fbrM\da*mX=UfiC8d0n fc mdw I�,. _... ......✓ ".�-r yr,. ...r.. .� r ... ^'.-�✓�.'4�. may..,..._�� ..+.-.Y-. �.-_.� .. . .. ,r - .., +, _. .. ... � ,. .. ,., f y 1 No. . 001 (� Fee I� THE COMMONWEALTH_OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH IjI VI - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pprication for Migpogal 6pgtem Cortgtruction permit Application for a Permit to Construct( ) Repair(;.Upgrade( ) Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. 146 4 feC`�c�&e Owner's Name,Address,and Tel.No. I�1w.s��r►s Mo11s z f 1,3sk i Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name�Address and Tel.No. o�sS14s k i3r�v,,,� Nc E.v�,1�ee.��,s fa�c�c d���fZ`T •r�3I3 s- - K0®-7/6 t Type of Building: Dwelling No.of Bedrooms LA Lot Size 4= sq.ft. Garbage Grinder ( ) Other Type of Building _hcos& No.of Persons 2 Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) !0 gpd Design flow provided 1-� Qom ,�_� gpd Plan Date Number of sheets ''� Revision Date Title Size of Septic Tank 1 bod lExPS}t N 9 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) C Nkdc,tl rQ o S ¢� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by thijj1,ctfrd of Health. Signed e52, - Date ` Application Approved by Date l _) © J Application Disapproved by: Date for the following reasons Permit No. �� > Date Issued ^ Z S— 6 s � _, . `r.' ,J .,. .—.+.r. -� ,.,y,."� --....�..`t, •y..,._:.,..�:-� 4�`'�.-.r..r+�".-.+-�.� �? .,re-..-r•...r,�.- .., .—" ' di J { No. O Q 5; . Fee j 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in compute PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppYication for Mi.5pozar *pztem Conotruction Permit 4 e y a Application for a Permit to Construct O 'Repair(V�Upgrade O Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. �te�p L'� t f p Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. lam. ovSi4, r `i3r�.a�N ,v� tr ti��a�Pf�NS GJoc�cs +�v0-47`1 - S 3 tea Type of Building: Dwelling No.of Bedrooms Lot Size ,«? sq. ft. Garbage Grinder ( ) Other Type of Building k("C No.of Persons 2 Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 4 I,(C) gpd Design flow provided L( `I1 Z gpd Plan Date 7//�Ldc, Number of sheets Revision Date Title Size of Septic Tank 1000 EXIStt N cA Type of S.A.S. SFr) rJ,(kt)Sp(_C Description of Soil r Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement:The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by thi�,Bgardfof Health.. Signed tom' -��t�_ " Date _ - Application Approved by '�{ ?: ( ,E ' Date r �� 0 Application Disapproved by: Date for the following reasons Permi�N,o. , A Date Issued 9" jr- 6 —.———.———— ——--— ———— —— ——————————————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO C.-ERRTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired Upgraded ( ) Abandoned( )by ,;f /-A)j C<, h 1(r),xNNI L Nr at G�Ca 1 f inn �ir��r� /�,�a(q(raS� AA- 4 S has been constructed in accordance p p with the provisions of Title 5aand the for Disposal System Construction Permit No. �9-� 03 t10 dated / - S 0 . I I tY Installer )r<< �_ tl �h r ems\ n1C Designer f ^,„��, ,j P i t #bedrooms P�J �, Approved deign ''�oo T/( 'Z �51 gpd The issuance of this pe ( t ha11 not be construed as a guarantee that the system wGi1 Punc�ion as designed !0� Date � Inspector ———————————————--—————— ———————————— No. THE COMMONWEALTH OF MASSACHUSETTS Fee PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Mi5po5al 6pttem Construction Permit Permission is hereby granted to Construct (` ) Repair ( ) Upgrade ( ) Abandon ( ) System located at�Ef G /r-j ,!yVj,//erg :k y i A and as',described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this_ner An. Date 2 S_ 0 ( Approved by Town of:Barnstable. P# f S-,S-�9 . ' Departmentof Regulatory Services Public Health Division Hate . Q sbsp., 200 Mam Street,Hyannis MA 02ti01 Mld� :Date Scheduled 36 0 Time Fee Soil Suitability Assessment for Sewage Dsposal } Performed By: ek/ MC &fie ��, Witnessed By: 101)IV, LOCATION& GENERAL.INFORMATION LoeationAddress � Owner's'Name yt Address 4-6 '[' T C,; -. Mars+apt s �/(/) � a zG � 8 Assessor's'Map/Parcet: 1 0 033 Engineer's Naehe' M .. _ j�cl�r' M.c.�►1-cL �� NEW CONSTRUCTION REPAIR Telephone# SO -71 — -7 Land User= 22Sww1 Slopes(%) 2- Surface Stones Distances from: Open Water Body�1C _ft Possible Wet Area G ft Drinking Water Well �ft�_ g �_. Drainage Way ft Property Line �.p ft Other` ft SR I—, (Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands i'n proximity.to holes) 2 �� l Parent material(geologic) Depth to Bedrock Depth to•Oroundwater. Standing Water in Hole: Weeping from pit Face Estimated Seasonal HIgh Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: - Depth Observed standing in obs.hole: in. Depth to soli mottiva: Depth;to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index.Well# Reading Date: Index Well level�.�.�„ Adj,factor, ,e., Adj;GroundwaterLevel PERCOLATION TEST bete , Thne Observation Hole# t Time at 9" Ti c l me at 6" Start Pre-soak Time @ V�?QY'S'}` CASe Time(911•611) End Pre-soak $c.wi c ✓ a}{-� Rate Min Site Suitability Assessment Site Passed Site Failed: Additional Testing Needed(Y/N) Originals Public Health Division. Observdtion Hole Data To Be Completed on Back----=-" ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Bamoo0e Conservation Division at least one(1)week prior to beginning. QAS EPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE ._ 1 LOG Hole# # Depth fom Soil Horizon Soil Texture Soil Color Soil Other Sttcface;(fn.):_ (USDA) (Munsell) Mottliag (Structure,$tones,Boulders:. v 7. DEEP OBSERVATION HOLE LOG Hole# Depth tram - So1l Hori on -Soil-Texture--_ _ .Soil-Coley. Soil Other. Surface.0n:)" (USDA) (Munsell) Mottling (Structure,Stones,Boulders Consi ten d SGu�P DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Zb�30 A S� 10 2y/t 3v. yg 6 5r✓ to�r2s/� C, iW q4-)'yq C Zs •S �/7 DEEP OBSERVATION HOLE LOG Hole# -4 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(ia.) (USDA) (Munsell) Mottling (Structure,Stones,,Boulders. F�� 5c l 2 r,' Y �-3 _ 5 Ci s 2 s S Fioo'd Inhura>1ce Rate Mall _eC` No Yes; Alxive 500_year flb4d boundary_ �_- _ ... - - - Within SOO-year,boundary �: No Yes with 100 year flood boundary No Yes Dentlt of,�lttturall Occurrme Pervious Material .�_ Does at least four feet of naturally occurring pervious material exist in all areas observed thro4ghoutrtht3` area proposed for the soil.absorption system? If not,Whit is the depth of naturally occurring pervious material? _�.,.._..... I certify thaf'onIkk (.date):I have passed the:soil-evaluator examination approved by the De artment of Environmental Protection and that the above analysis was performed by irte eonsistentwtth the required°tr ,expertise and experience d"escnbed'in lO CMR 15.011. Date Signature . O-�%tV--n 1PBRCFORM.DOC r Terral'ilter,I.I.C. } P.O.Box 227 10 Main St. s Sturbridge,MA 01566 Tel: (508)347.5508 ( )347-7263TerraFilter Pax:(508) 347-9857 July 23,2009 Peter McEntee Engineering Works, Inc. 12 W. Crossfield Road Forestdale, MA 02644 RE: Particle Size Analysis (Alternative to Perc Test Test Pit#3 46 Treetop Circle, Marston Mills, Mass. Dear Peter: Below are the results of the particle size analysis from the sample submitted for the above referenced property. The analysis was performed utilizing the hydrometer method of Gee & Bauder (1986) in Methods of Soil Analysis, Part 1. Physical and Mineralogical Methods, 2nd Edition. Sand Silt Clay (2.00 to.05mm) (.05 to.002mm) (<.002mm) Portion Passing 82 0% 16.4% 1.6% #10 Sieve USDA Soil Textural Classification: Loamy Sand MA Section 15.243 Soil Classification: Class I Based upon the DEP's Title 5 Alternative to Percolation Testing Policy for System Upgrades, the following effluent loading rates apply: Un-compacted Soil 0.660pd/sf Should you need additional information, or require further testing services, please do not hesitate to contact our office. Sincerely, Mark Farrell, Soil Scientist 6 TerraFilter,LLC. P.O.Box 227 10 Main St. Sturbridge,MA 01566 TebrraFffter Tel: (508)347-5508 (508)347.9857 Fax:(508)347.9857 May 20,2009 Peter McEntee Engineering Works, Inc. 12 W.Crossfield Road Forestdale, MA 02644 RE: Particle Size Analysis (Alternative to Perc Test) 46 Treetop Circle, Barnstable, Mass. Dear Peter: Below are the results of the particle size analysis from the sample submitted for the above referenced property. The analysis was performed utilizing the hydrometer method of Gee & Bauder (1986) in Methods of Soil Analysis Part 1. Physical and Mineralogical Methods,2nd Edition. Sand Silt Clay (2.00 to.05mm) (.05 to.002mm) (<.002mm) Portion Passing 89 5% 9.6% 0.9% #10 Sieve USDA Soil Textural Classification: Sand MA Section 15.243 Soil Classification: Class I. Based upon the DEP's Title 5 Alternative to Percolation Testing Policy for System Upgrades,the following effluent loading rates apply: Un-compacted Soil 0.74gpd/ ? 7, Should you need additional information, or require further testing services, please do not hesitate to contact our office. Sincerely, Mark Farrell,Soil Scientist • e -mod 6AJ VI $ 25.Oa 012-1 101 Commonwealth of Massachusetts Title 5 Official Inspection Farm Subsurface Sewage Disposal System form-Not for Voluntary Assessments, 49 TreeTop Circle Property Address Patricia H. Michallyszyn Owner Owner's Name information is required for Marston Mills Ma 02648 July 15 2009 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Frank DeFelice cursor-do not Name of Inspector use the return key. The Building Inspector Company Name 53 Maki Way Wareham Ma. 02576 t a ,men Cityrrown State 781-254-4825 ,5 1 LA C3 9 0 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that tie - information reported below is true, accurate and complete as of the time of the inspection. Tire>.inspgkion 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 16.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority f July 15, 2009 II Inspectors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewa a isposel System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form e► Subsurface Sewage Disposal System Norm-Not for Voluntary Assessments 49 TreeTop Circle Property Address Patricia H. Michallyszyn Owner Owner's Name information is required for Marston Mills Ma 02648 July 15,2009 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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. Check the box for"yes","no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 TreeTop Circle Property Address Patricia H. Michallyszyn Owner Owner's Name information is Marston Mills Ma 02648 July 15,2009 required for every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ 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 0 ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ��r ) 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 15ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 p Y rY 49 TreeTop Circle Property Address Patricia H. Michallyszyn Owner Owner's Name information is required for Marston Mills Ma 02648 July 15,2009 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/a day flow t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 TreeTop Circle Property Address Patricia H. Michallyszyn Owner Owner's Name information is Marston Mills Ma 02648 July 15,2009 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to.a surface-water.supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. � ) 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 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•0908 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 TreeTop Circle Property Address Patricia H. Michallyszyn Owner Owner's Name information is required for Marston Mills Ma 02648 July 15,2009 every page. CitylTown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(if they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and_occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 330 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): day gal per t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 I Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 TreeTop Circle Property Address Patricia H. Michallyszyn Owner Owner's Name information is required for Marston Mills Ma 02648 July 15,2009 every page. Cityrrown State Zip Code Date of inspection D. System Information Description: 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 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy' present Date PA 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: t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth.of Massachusetts Title 5 official Inspection Form 7 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 TreeTop Circle Property Address Patricia H. Michallyszyn Owner Owners Name information is Mars required for �ton Mills Ma 02648 Jul 15,2009 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: present owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-09(08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts 4: r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 TreeTop Circle Property Address Patricia H. Michallyszyn Owner Owner's Name information is Marston Mills Ma 02648 July 15,2009 required for every page. Cityfrown state Zip Code Date of inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: as built plans 6/18/97 Were sewage odors detected when arriving at the site? ❑ Yes [D No Building Sewer(locate on site plan): Depth below grade: 20"feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: na feet Comments(on condition of joints, venting, evidence of leakage, etc.): Joints structurally sound, no signs of leakage Septic Tank(locate on site plan): Depth below grade: 14"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: 18' t5ins-09/08 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 9 of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 TreeTop Circle Property Address Patricia H. Michallyszyn Owner Owner's Name information is required for Marston Mills Ma 02648 July 15,2009 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cons.) Septic Tank(cont.) Distance from top of.sludge to bottom of outlet tee or baffle 16" 1" Scum thickness Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of out tee or baffle 13" How were dimensions determined? physical Measerments,Manf. specs. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank structurally sound liquid levels ok no evidence of leakage , recommended pumping tank. 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts _ Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 TreeTop Circle Property Address Patricia H. Michallyszyn Owner Owner's Name information is required for M arston Mills Ma 02648 July 15,2009 ,. every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): C ight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: 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 t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 TreeTop Circle Property Address Patricia H. Michallyszyn Owner Owner's Name information.is required for Marston Mills Ma 02648 July 15,2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): small amount of carryover, D box level, D box structurally sound, no sign of leakage. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .'p 49 TreeTop Circle Property Address _Patricia H. Michallyszyn Owner Owner's Name information is required for Marston Mills Ma 02648 July 15,2009 every page. City/Town State Zip Code Date of Inspection D. System Information.(cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: I F�L-A-V-A (Lj) ® leaching ILLes number: ❑ leaching trenches number, length: ❑ leaching fields. number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): normal soil normal vegetation, (grass)no signs of hydraulic failure, no damp soil, �y► 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 t5ins•09108 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 TreeTop Circle Property Address Patricia H. Michallyszn Owner Owner's Name information is Marston Mills. Ma. 02468 July 15, 2009 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): ',,J�Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09108 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 49 TreeTop Circle Property Address Patricia H. Michallyszn Owner Owner's Name information is required for Marston Mills. Ma. 02468 July 15, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (coat.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system,.including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately VXY oC- �Aoo5e� le 4D f, oil t5ins•09f08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form-Not for Voluntary Assessments �y 49 TreeTop Circle Property Address Patricia H. Michallyszn Owner Owner's Name information is required for Marston Mills. Ma. 02468 July 15, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells C� Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts r r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 TreeTop Circle Property Address Patricia H. Michallyszyn Owner Owner's Name information is required for Marston Mills Ma 02648 July 15,2009 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 w THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. ""67 W.Al.........OF........��zt!S Apphration for Uhipavi al Works Towitrnrtinn ramit Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal System at: ... _q....T .F...T.6 C�.t�. ! ................................ ....................................................Jr -_.....---•--••--------------........-•------- Location-Address or Lot No. -• 6-1 .._4 Q_l�l :,...._. ._V-..z ... 4�'�__TU i;T t_E FI c K Pp......'r!R S.T_.Q:hl�_..!I?/BLS• Vol �) Owne+~ o Address C3a�(r$ Installer Address UType of Building Size Lot.............U____o___-Sq. feet �-, Dwelling—No. of Bedrooms..................Z.......:..............Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............... No. of ersons.....___._.............. Showers a � � g-•----•---------•--•------...--•-------------P ---- ( ) — Cafeteria ( ) Otherfixtures .... •--------------------------•-••----------------------------------------...--------•--..._-----••. W Design Flow........................�`r5...........gallons per person per day. Total daily flow.._.........3.3_0....................gallons. WSeptic Tank—Liquid capacity_XuR.D.gallons Leng`h..$.'.-..6.*'Width... Diameter--------..... Death................ x Disposal Trench—No........_0'.._l. Width....... �/ Total Length....... ,Total leaching area-------'`�°'-_--:�/__&q. ft. Seepage Pit No........ ...... Diameter-__---kX....... Depth below inlet.................... Total leaching area........__........sq. ft. z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by._.._l Q.. %. _T__ 111f 1'�ef ....... Date... �.985l Test Pit No. I-------tl.....minutes per inch Depth of Test Pit------2........... Depth to ground water........__.9._....... f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water................... Description of Soil '.S...S..--- . +4_INI..a SU3_ry o 2L i----'- �------------------�/=V�-------------�`1LJ�_�t�ir1 v51.9.t'yb--------------------••----••--•--•---•-------•---------------....----•-•------------•----••---------------•-----•---------...-----------------------....------------....---------- W x ------------------------------------------------------------------------------------------------------------------------------------.................................................................. 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 iITYLE '. 5 of the State Sanitary Code— The undersigned further agrees of to place he system in operation until a Certificate of Compliance has been issued by "boa-d of health. a ► , ig ..... ........ ... ..0.... 7 Application Approved By......... ---- . --• - --------- --------------------- ........ -............. Date Application Disapproved f the f ollo g reasons:......................................--------------..............---......................................... ..................................-................................................................................................................................................................. ..._ Date PermitNo......................................................... Issued........................................... Date --•--•------------------- f ............._............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ N..........OF....... '................................ Appliration for Disposal Works Tontrartion Prruat Application is hereby made for a Permit to Construct (/) or Repair ( ) an Individual Sewage Disposal System at: 17 ..`.� .....J. r....�.. I _C 1 f= .............................. ..•-•-............•....... U..........�.. ....... ...-•- -------......_. ...... - Location-Address or Lot No. ............. 4)'1 T o iZ C i-l_)j ri c r, I?a. ji l s-S R T v W. /11/4 4C.S lil'44. _..... •--• - -. .............................................. 6`/ c rW1 ............................ Owne._r �17 .. ..l.........••... ............................................................. -------....................................Address........._............. ....--------- ....... G Installer Address Type of Building .........c t __ o _. g Size Lot .. ..t . Sq. feet Dwelling—No. of Bedrooms.....................3 ....................... Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers � YP g -=-----------•-----...__.... p ( ) — Cafeteria ( ) d Other fixtures ................... Design Flow....................... ............gallons per person per day. Total daily flow............. .?....................gallons. * Septic Tank—Liquid capacity.�.�-`:..gallons Length..r-''.�-. Width..`/ �. Diameter........... Depth...... ....... x Disposal Trench—No........�`_._�. Width........ .....�/ / Total Length......'f Total leaching area.............k sq. ft. 3 Seepage Pit No....... ..... Diameter.... ........ Depth below inlet.......--....._. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1/ '-' Percolation Test Results Performed by..._/ f.�� .�....�.....�G�f.N!`....--•--. Date._ '�l.l...-._�7._�.� y Test Pit No. I.......a.....minutes per inch Depth of Test Pit.................... Depth to ground water............ 44 Test Pit No. 2.........._.....minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 •---•--•..........•-------------------••-•---....----•-...........••••........•--_..,_;-r....--- O Description of Soil............ L- S -S L u y r-c........Sv s S o I,- i S. a - �l' 1=/Ai/: T D EJ3 I vr�r • ----••-•-•-...-- -------• ----------------------------•------------------------------•------•--------•---- U ......� �V�� -----•------------------------•--........---------.......---•-------•----•-•--------------•------------------------•---•---•-----------. 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 TIT!TIE 5 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. lg � ' = ----------------- Application Approved BY---.... Date ......-•-•— Application Disapproved f o t he f ollo 'ng reasons:............................. ............................................••--•--•-----•--••-•-•-••---••----••••--•....._._......-•-•...-•-•-•---•---••-•------....-------•-----•-•--................................................. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... (Intifirate of Tompliatta T.Afff-IS TO CERTIFY, That the Individual Sewage Disposals-S tem co tr cted ( � Repaired ( ) by - �--•------- ` j............................................ ...-----. :............. ........................... ,�,. _ 1--si aller has been installed in accordance with the provisions of TITP 5 oaf The e State Sanitary Code as described in the application for Disposal Works Construction Permit No _.`l... .. ............. dated--.............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH <� - ......................................OF............................................................................. No. ................ FEE........................ iprurku ions ionftnitPermission is he eby granted .....------ - �'L ' ` ......................... an I dual Sewage Disposal System to Construct R �r �r / Street as shown on the application for Disposal Works Construction Permit N -_.____-__• Dated.......................................... DATE............................. Board of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS Per-nit Number: Date: 1. Completed by s HIGH iGROUND-WATER LEVEL COMPUTATION Site Location: S ��_ Z( _Z,:��) Lot No. Owner: Add ess: Contractor: Address: Notes: I STEP 1 Measure depth to water table to nearest 1/10 ft. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..r/ 7 /bey date i STEP 2 Using Water-Level Range Zone ' and Index Well Map locate site and determine: A) A roPriate index well . . . . . . . . . . . . _ PP _ B) Water-level. range zone STEP 3 Using monthly report"Current Water Resources Conditions" F determine current depth to ' water level for index well mo y r STEP 4 Using Table of Water-level Adjustments for index well STEP 2A current depth to water level for index well (STEP 3) , and water-level zone (STEP 26) determine water-level adjustment . . . . . . . . .. . . . .. ' STEP 5 Estinate depth to high water by subtracting the water- , level adjustment (STEP 4) from measured depth to water level at site (STEP 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Wo �. - - 9� �9 No. /� 3 /v O O Fee THE COMMONWE LTH OF MASSAC $ Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for riopool *p.5tem Construction Permit Application for a Permit to Construct( )Repair(Z4pgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. /-C& ,JJ jo Owner's Name,Address and Tel.No. Assessor's Map/Parcel T � InstallName, Address,and Tel.No. ?—7 Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow .3-�b gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs-or Alterations(Answer when applicable) i ✓✓ -� � a *'� ,�, , Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued is Board of Health. Signed Date 6 ^/4— f 7 Application Approved by Date Application Disapproved for the following reasons Permit No. �� Date Issued TOWN OF BARNSTABLE LOCATION ��/ �✓t.P-c- d-v� C� SEWAGE # Sr 7 VELLAGE - - .� �-�n ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �l--A -7 $^� SEPTIC:TANK CAPACITY 10-V-t1-1 - LEACHING FACII.]TY: (type) y'�- size) �-Sx 3 2 NO.OF BEDROOMS 3 BUILDER OR OWNER Qj PERMIT.DATE: [© /(v 'Q 7 COMPLIANCE DATE: U Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge 6 Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by _ 9 Ye � J t 5E S 0 . z M� , / 5j O(eq 0 — ee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 01pprication for Dfgpogaf *pgtem (Congtruction permit Application for a Permit to Construct( )Repair( 4. grade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 7/ / % Owner's Name,I ddress and Tel.No. Assessor's Map/Parcel Install�"' Name,Address,and Tel.No. ?-7 Q-.OaV« Designer's Name,Address and Tel.No. Type of Building: Y Dwelling No.of Bedrooms 3 Lot Size sq ft. °� ,,Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Sizes f Septic Tank h1 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) iN Y- Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by-�is Board of Health. Signed /AA 4 Date Application Approved by / Date Application Disapproved for the following reasons Permit No. - lw& Date Issued THE COMMONWEALTH ORMASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CER�T_FY, that the On-site Sewage Disposal System Constructed( )Repaired ( �pgraded( ) Abandoned( )by at h constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. y at Installer Designer The issuance of this permit shall not be constr ed-as}a guarantee that the system will function as designed. Date Inspector Inspector -- —� ——————— A � ��o� ---------3Fee `---- No. j THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS %fgpont *pgtem Congtructfon Permit a Permission is hereby granted to Construct( Repair( )Upgrade( )Abandon System located at �l �- - ` and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of thi erm t B �, + Date: "�� - 7 Approved by D NOTICE: This Form is to be used for the Repair of Failled Septic Systems Only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL. WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, hereby certify that the application for disposal works construction permit signed by me dated 1 1 , concerning the property located at C � meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED : DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER" [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. I C� 8 `f Qom- ' 7/9/0 DAT2t---------- - PROPERTY A o o R E SS: 4 9_Treetop Circle------ _Marstons Mi ------------ Mass ------- _—.._ .. On the above data, I Inapeoted the septlo ayitarT at the above address. This syslem consists of the following, 1 . 1 -1000 gallon septic tank. 2 . 4-2 ' infiltrators 23 'X11 ' X2 ' See page 10A ( As Built ) 8a3ed on my In3pecilon, I cortlfy the following oondlllona; 3 . This is a title five septic system. 4 . The septic system is in proper working order at the present time. 5 . Pumped the septic tank at time inspection. Heavy scum & solids layers were present. Company; Jo2 •yh_p .__Nacomb•r_& Son , Inc , Addle 3a ---Box- 66-__-_- - ------- __Contervi Ile L S _02632-0066 T?113 CCRTIFICAT10N OOC9 NOT CONSTITVTC A OVARANTY OR WARRANTY (JOSEPH P, MACOMBER & SON, INC, Tank,�QiI►p9oIi-Liachll#ldI Pumped G Inl,tallfd Town Sfwfr Connicloni P.O. Box 66 CinlfrYlllo, MA 026324M rrs 333a M-6112 RECEIVED JUL 3 0 2001 TOWN OF BARNSTABLE HEALTH DEPT. r t 0 ,per �, �� .\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION y TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM . PART A CERTIFICATION Property Address: 49 Treetop Circle Marston Owner's Namexar A. Jennings Owner's Address: Same Date of Inspection: 01 Name of inspector: (please print) J.P. Macomber .Ir Company Name:Joseph P, macomber & Son Inc Mailing Address: Box 66 Centerville Ma 02632 Telephone Number: 8-775_a338 CERTIFICATION STATEMENT I certify that 1 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 SS ction 15,340 of Title 5(310 CMR 15.000). The system: _4 Passes _ Conditionally Passes _ Needs Further Evaluation by the Local Approving Authority _ Fa Inspector's Signature: Date: _ ,�1 The system inspector shall mit 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. Notes and Comments ++ describes conditions at the time of inspection and under the conditions of use at that This report only P Y time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 Page I Nee 2 of I 1 E ; 1 4 OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:49 Treetop Circle Mars tons i s, ass. Owner: Karl A. Jennings Date of lospectioo: 7 9701 lnspection Summary: Cbeck A,B,C,DorE/AlgWAY complete all of Section D A.=Systempasses. I have not round y information which indicates that any of the failure criteria described in 310 CMR I 5.3C3 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Com rents: The septic system was upgraded 6/18/97 A new leaching area was instaiiect. 6116191 see page B. System Conditionally Passes: One or more system componenu 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. Zlb 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 uidicating that the tank is less than 20 years old is available. ND explain: .,10 Observation of sewage backup or break out or high static water level in the distribution box due to broken or obsovcted pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipc(s)are replaced obstruction is removed _ distribution box is leveled or replaced ND explain: V 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: 2 I Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 49 Treetop Circle Mars tons Milis,Mass. Owner: Karl A. Jennings Date of inspection: 7/9/01 C. Further Evaluation is Required by the Board of Health: Conditions exist which require hLnher evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. I. 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: AV Cesspool or privy is within 50 feet of a surface water Cesspool or privy is witbin 50 feet of a bordering vegetated wetland or a.salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, If any) determines that the system is functioniog in a manner that protects the public health, safety and environment: 4A The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or rributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone I of a public water supple. ,04 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 90 feet but 50 feet or more from a private water Supply well". Method used to determine distance I "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are rriggered. A copy of the analysis must be attached to this form. 3. Other: 3 f Page 4 of I I ' OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:49 Treetop Circle Marstons Mills,Mass. Owner:Karl A. Jennincfs Date of lospection: 7 9 01 D. System Failure Criteria applicable to all systems: You must indicate yes" or"no" to each of the following for all inspections: Yes No ackup 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 V,,,vot7L7- 47d-/e9 ire. >mf ,PA Liquid depth in_css 41 is less than 6"below invert or available volume is less than 'h day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number — ��y of times pumped y portion of the SAS,cesspool or privy is below high ground water elevation. portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface ,,Water supply. Ay portion of a cesspool or privy is within a Zone 1 of a public well. �y portion of a cesspool or privy is within 50 feet of a private water supply well. y 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 collform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this forma V6 (Yes/No)The system .fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303. therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design now of 1o,0o0 gpd to 15,000 gpd. You must indicate either'yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ Z 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 11 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 loge 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. 4 Pa;e 5 of I I ' OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PrDperty Address: 49 Treetop Circle Mars tons Mills,Mass. Owner: Karl A Jennings 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, luding the SAS, located on site ? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of me 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: Yes no ,/� Existing information. For example, a plan at the Board of Health. d _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)(310 CMR 15.302(3)(b)) 5 } } 7 Page 6 of I I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 49 Treetop Circle Marstons Mills.Mass. Owner: Karl A. Jennings Date of Inspection: 7/9/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms):,�Xx F Number of current residents: 9- Does residence have a garbage grinder(yes or no): AO Is laundry on a separate sewage system es or no):.tb [if yes separate inspection required] Laundry system inspected(yes or no): S Seasonal use: (yes or no):.g,0 � ,� Water meter readings, if available(last 2 years usage(gpd)): Q2J� Jd 5 '— Sump pump(yes or no):� Last date of occupancy: �' COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Wj1 gpd Basis of design flow(seats/persons/sgft,etc.): AM Grease trap present(yes or no): tj Q Industrial waste holding tank present(yes or no): ,W Non-sanitary waste discharged to the Title 5 system(yes or no):&0 Water meter readings, if available: Last date of occupancy/use: VA OTHER(describe): ,yR GENERAL INFORMATION Pumping Records % Source of information: Was system pumped as part of the inspection(yes or no): S If yes, volume pumped: gallons--How w q ann pumped determine /YMSjJ/JQ�Z Reason for pumping: AJ 2aw V CMAOr "/CTf� TYP 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 At Attach a copy of the DEP approval Other(describe): /0 Ap roximate age of all com onent date inst led (if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): 6 Page 7 of l l OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 49 Treetop Circle Mars tons Mi s,Mass. Owner: Karl A Jennings Date of inspection: 7 9 01 BUILDING SEWER(locate on site plan) Depth below grade: av Materials of construction: cast iron /40 PVCJ,�ftther�(explain): 16 9 Distance from private water supply well or suction line: Comments(on condition of joints, venting, evidence of leakage, etc.): Joints appear ti ht.No evidence of leakage.The system is �a,00 A�au vented through the house ven . 9S SEPTIC TANK: (locate on site plan) Depth below grade: 1� Material of construction: Y concrete,tlj metalCLfiberglass polyethylene "other(explain) did If t4n1: is metal list age: _ is age confirmed by a Certificate of Compliance(yes or no)x&(attach a copy of certificate) ,I ,r n Dimensions: Y� n�r Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bonom of scum to bo m of ou let tee or ba e: How were dimensions determined: ,.}� Ar /0. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump the septic tank every 2-3 years. Inlet & outlet tees are in place.The tank is structurally sound and shows no evidence of leakage. GREASE TRAA'(b(,Vlocate on site plan) Depth below grade: Material of construction:X)4concrete.1metaW.4 fiberglass4/�polyethylene4y other (explain): ,tJt9 Dimensions: AA Scum thickness: Distance from top of scum to top of outlet tee or baffle: IVY Dis ance from bottom of scum to bottom of outlet tee or baffle: 41,o� _ Date of last pumping: V,00 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease trap is not present. 7 i Page 8 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 Treetop Circle Marstons Mills.Mass. Owner:Karl A. Jennings Date of Inspection: 7 9 01 TIGHT or HOLDING TANK:,&(tank must be pumped at time of inspection)(]ocate on site plan) Depth below grade: Material of construction: concrete & metallyfiberglass,10 polyethylene,L/ other(explain): Jlf, Dimensions: x1h Capacity: gallons Desien Flow: A154 Alarm present (yes or no): Alarm level: _�� Alarm in working order(yes or no): Date of last pumping:6 Comments(condition of alarm and float switches, etc.): ig —or-Fioiding tanks are not present. DISTRIBUTION BOX: zif present must be opened)(locate on site plan) Depth of liquid level above outlet invert:A 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.): Distribution box has one lateral.No evidence of solids carry over.No evidence of leakage into or out of the box PUMP CHAMBERt4fY—(locate on site plan) Pumps in working order(yes or no): A larms in working order(yes or no):29 Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): PumrZ rhamhPr is not nrPGPnt 8 i Page 9 of 1 I ' OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:49 Treetop Circle ars ons Mills Owner: Karl A. Jennings Date of Inspection: 7 9 0 1 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: System located_ See page 10A Type 4 aching pits, number: _ c leaching chambers, number: A2Q 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..): Loamy sand to medium fine sand.No signs of hydraulic failure or ponding.Soils are dry.Vegetation is normal. CESSPOOLS (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: . 6 Depth—top of liquid to inlet invert: iVy Depth of solids layer: Depth of scum layer: Dimensions of cesspool: �Jf� Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Cesspools are not present PRIV *A/,f-(locate on site plan) .Materials of construction: Dimensions: Ity Depth of solids: ld�l Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy is not present. 9 i Page 10 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 49 Treetop Circle ars ons MiTT—s—,TAass. Owner: Karl A. Jennings Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the se.vage 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. l I: r ,I / O • Q ,I ,1 A C. -...�'.:�' .• Y M . tom+, �.eIIY" s�: . ,r r ck:z. b,�R`' 1,�5.n yr>,s�� .,G- s. : ; '.. H.. u••; i nS a - TOWN OF BARNSTABLE LOCATION Ze1 �✓t e�_ 6-ro CL� SEWAGE # 7 — 4 VILLAGE_ c�„_t- ASSESSOR'S MAP & LOT5� INSTALLER'S NAME&PHONE NO. .�, -;;� g q SEPTIC.TANK CAPACITY LEACHING FACILITY: (type) L4size) ;;t. NO. OF BEDROOMS__ BUILDER OR OWNER PERMITDATE: 10 14' 9. 7 COMPLIANCE DATE: Separation Distance Between the: Maximum.Adjusted Groundwater Table and Bottom of Leaching Facility - Feet Private Water Supply Well and Leaching Facility (If any wells exist i on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of.leaching facility) Feet Furnished by i i Q J i fr.{»ii row LO ATION �?t SEWAGE. P.ER T NO. r-l- 77/ar-�-Fr --:E2 VIL AGE1 Q � G L S A IIER'S -J4 ME i ADDRESS C', [�kRD ('oA S U I L D E R R OWNER DATE PERMIT ISSUED v 'l DATE COMPLIANCE ISSUED e if i t 1 Page I I of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 49 Treetop Circle mars tons M111s,mass. Owner,:Karl A. Jennings Date of Inspection: SITE EXAM Slope '03 Surface water Check cellar Shallow wells A-0 Estimated depth to ground water feet Please indicate (check)all methods used to determine the high ground water elevation: Q brained from system des i son record- If checked,date of design plan reviewed: 1� served b ttin roe / servation hole within 150 feet of SAS) 'J� C cked with local Board of Health-explain: ��ri��9� ,05 l�l Checked with local excavators, installers- (attach documentation) _Accessed USGS database-explain: You must describe how you established the high ground water elevation: Used Gahrety & Miller Model 12/16/94 11 k,•nrnr+.-nrr�r-.-ram- rnrmr•rrnn.s�.n sir•rrermn�+++serr�+.+r+n++nm�++�'�nwn w•e .�r�+-�+-:..-..r...' TOWN OF Barnstable BOARD OF HEALTH 0 SUBSURFACE SEWA(;F I)ISPOSALSYSTEM INSPECTION FORM - PART D •- CERTIFICATION -•rn-r••.-•.:.-T..i�-.-rnmr.+n•n•�nr•w+r.es+ran�m-r-.c•r.���wwwr-�+w+vwo�+ww�r�n� ,wn •'.,-r,-•r--„ _..,� -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 49 Treetop Circle Marstons Mills,Mass. ASSESSORS MAP, BLOCK AND PARCEL # 150-63 OWNER' s NAME Karl A. Jennings PART D - CERTIFICATION NAME OF INSPECTOR _Joseph P. Macomber Jr., COMPANY NAME Joseph P. Macomber &'"ion Inc COMPANY ADDRESS Box 66 Centerville Ma 02632 Strvvt Town or City Staty LlP COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 ) 790 _ 1578 w CERTII•ICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete as of the time of �inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Chec one : System PASSED The inspection Irhich I have 'conducted has not found any information which indicates that the system fails to adequately protect public healLh or the environment as defined in 310 CMR 16 : 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which I have con tcted has found that the system fails to Protect the ptiblic health and the environment in accordance with Title 6 , 3.10 CMR 16 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signature Date " ne copy of this e t.ification must be provided to the OWNER, the BUYER ( where applicable ) and the DOARD OF HEALTJI, * If the inspection FAILED, the owner or operator shall upgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 3.10 CMR 16 , 306 , partd .doc 7y '1 p N ':� 4) LOCUS TOP PG 45 BENCHMARK head �9$ (Assigned) my m j 0 r- : g1. � � m TOPFIELD DR �^ OLD STAGE EX1S77NG SEPTIC TANK rs ,III, -o RD (To REMAIN) VEGETATED WETLAND ,\II, LOCUS MAP TOP OF TANK, EL.=95.41t NOT TO SCALE 1NV.(IN)=95.08t(VERIFY) � ,111, 94---\ LEGEND ——100—— EXISTING CONTOUR x 100.98 EXISTING SPOT GRADE V" —6 H.1hf-- OVERHEAD WIRES ------- --- --------- --- ��' s ,- `\�_�g6 G EXISTING GAS SERVICE + 86 X ____--8S W EXISTING WATER SERVICE = 9' •.x i 46262 - TEST PIT \oc 6�� 9 125 00, E A- 9 919 4 BENCHMARK 18 99� 84S S EXIS71NG CESSPOOLS (APPROXIMATE L OCA TION) t�} ,O�O TO BE PUMPED, FILLED Wl TH D SAND A AND ABANDONED `o+ ®9j9Po 1 SHED G 98,10 p >( feq e Zoe k .i �o LOT 17 = OTP-2 20,000f S.F. \:3 �v", �._,� Map 150 Parcel 33 Ok k J e��j �� �. 96,2 O •`, ! 3 �•7/8 Y- 96co 9 -4? 1 u� •� •`•�. PATIO CIS / G -E PORCH l� - STRIPOUT— / `~I%��) / 97.70$ o TO EL.=88.0t v (SEE NOTE 11) // �� / EXISTING co,�I / lr ,� 20, HOUSE (#46) "95 v / �yl 6/ T.O.F.=98.52E �s V 8.S 97.65 95 � 43 '9 9 X 97.42 O �8 PA VED DRI VEWA Y m 9� 125 0 O' LAMP Z �d9e 46?�20" £ 9 or op�P�ent O,o c /� T 96 CC C �1 `` 9s •S� MAssq�ti PETER T. PROPOSED SEPTIC SYSTEM UPGRADE PLAN M c w E N MARSTONS MILLS, MA • 35,09 46 TREE TOP CIRCLE, A R£GIST 10 Prepared for: Ronald Zylinski, 46 Tree Top Circle, Marstons Mills, MA 02648 WETLAND DELINEATION F ENG Engineering by: SCALE DRAWN JOB. NO. VACCARO Environmental Consulting Engineering Works, Inc. 1�=201 P.T.M. 136-09 P.O. Box 955 DATE 12 West Crossfield Road, Forestdale, MA 02644 CHECKED SHEET NO. Sandwich, MA 02563 (508) 888-5855 (508) 477-5313 1 7/15/09 P.T.M. 1 of 2 i 1 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:94.78 FOR A DISTANCE OF 15' AROUND THE + . PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT INSTALL INSPECTION PORT OVER END UNIT T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE COVER SET TO 6" OF GRADE CHARCOAL EXISTING F.G. EL.=97.1 f F.G. EL: 95.t F.G. EL: 95.8-97.0t VENT ff MAINTAIN 2% GRADE (MIN.) OVER SA.S. l ' L = 45' L = 6'(MAX) INSPECTION ® S=1% (MIN.) ® S=1% (MIN.) PORT 4"SCH40 PVC 4"SCH40 PVC 6" '�"I 6 6.5" TO 'a" INVERT INV.=100.74 48' LIQUID �� ADD INV.=94.63 PROPOSED IN 3 ROWS OF 8 UNITS AT 6.25'/UNIT = 50.0' GAS BAFFLE INV.=95.08 D-BOX INV.=94.40 q SOIL ABSORPTION SYSTEM (PROFILE) EXISTING SEPTIC TANK ESTABLISH VEGETATIVE COVER BACKRLL WITH"dEAN NATIVE OR PERC SAND TO TOP OF CHAMBERS NOTES: BREAKOUT EL.=TOP EL. 1) CONTRACTORSHALL VERIFY ALL EXISTING PIPE TOP ELEV.=94.78 FILTER FABRIC OVER UNITS INVERTS, PRIOR TO INSTALLATION. INV. ELEV.=94.40 (RECOMMENDED) 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE BOTTOM ELEV.=93.56 II III11111►mmI ON A MECHANICALLY COMPACTED SIX INCH CRUSHED STRIPOUT TO EL.=88.0t 2.83' STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 4' MIN. ABOVE BOTTOM OF 3 INSTALL INLET & OUTLET TEES AS REQUIRED. T.P. EXCAVATION OR G.W EFFECTIVE WIDTH=8.5' . EXISTING SUITABLE 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE MAX. G.W., EL=88.3 (TP-3 & 4) = MATERIAL AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. USE 3 ROWS OF 8-11" STANDARD ADS BIODUFUSER UNITS WITH NO SEPARATION BETWEEN EACH ROW & NO STONE SEPTIC SYSTEM PROFILE TYPICAL SECTION N.T.S. OCT.s SOIL LOG DATE: APRIL 30, 2009 (REF#12,550 SOIL EVALUATOR: PETER McENTEE PE(SE#1542) WITNESS: DAVID STANTON R.S. HEALTH AGENT ELEv. TP-1 DEPTH ELEV. TP-2 DEPTH 96.9 A 0" 96.3 A 0 SANDY LOAM SANDY LOAM 21" 6-h-47P0LYSE.AL.INKLEM " 1 OYR'3/3 10YR 3/3 2" 2" 96.2 g" 95.6 g" B SILT LOAM B SILT LOAM 10YR 5/6 10YR 5/6 ' 93.9 36" 96.3 36" C1 SILT LOAM W/BOULDERS W/BOULDERS (DENSE) (DENSE) 10YR 5/3 10YR 5/3 90.9 MOTTLING 72" 91.3 60" (V Top View Section C2 7.5YR 5/8 C2 `/ FINE SAND F-M SAND D-�OX 2.5Y 6/4 2.5Y 6/4 SAMPLED FOR 87.0 STG. GW - 102' SIEVE ANALYSIS 86.9 120" 86.3 120" SIEVE ANALYSIS RESULTS: SAND-CLASS 1 (0.74 GPD/SF) 75" WEEPING GW ® 96", STANDING GW 0 108" ELEv. TP-3 DEPTH ELEv. TP-4 DEPTH 96.3 FILL FILL 0" 96.3 0" 94.1 A 26" 94.1 A 26" SANDY LOAM SANDY LOAM 10YR 3/3 10YR 3/3 I _I 93.8 30" 93.8 30" 1 76" B SILT LOAM B SILT LOAM PROFILE T 10YR 5/6 10YR 5/6 92.3 48" 92.3 48" C1 C1 SILT LOAM/TILL SILT LOAM/TILL 10YR 5/3 10YR 5/3 11" 88.3 MOTTLING 96" 88.3 MOTTLING 96"' 6.5" TO 6.4" C2 7.5YR 5/8 C2 7.5YR 5/8 INVERT FINE SAND FINE SAND 2.5Y 6/4 2.5Y 6/4 �--34" � SAMPLED FOR SIEVE ANALYSIS SECTION END CAP 84.3 144" 8&3 144" 86.3 SIEVE ANALYSIS RESULTS: SAND-CLASS 1 (0.66 GPD/SF) 11" STANDARD (H-20) BIODIFFUSER UNIT NO STANDING GW OBSERVED, MOTTLING AT 96"(EL.=88.3) MODEL 11" STD. DESIGN CRITERIA 76 NOTE: UNIT CONFIGURATION AND AVAILABIUTY SUBJECT NUMBER OF BEDROOMS: 4 BEDROOMS EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY DIFFER SUGHTLY FROM ACTUAL PRODUCT APPEARANCE. SOIL TEXTURAL CLASS: CLASS I SIDE WALL HEIGHT 6.4" DESIGN PERCOLATION RATE: 8 MIN/IN OVERALL HEIGHT 11" 0=0 DAILY FLOW: 440 G.P.D. 4640 TRUEMAN BLVD DESIGN FLOW: 440 G.P.D. OVERALL WIDTH 34" HIWARD, OHIO 43026 GARBAGE GRINDER: NO 9.2 CF LEACHING AREA REQUIRED: (440) = 666.7 S.F. CAPACITY (68.8 GAL) ADVANCED DRAINAGE SYSTEMS, INC. .66 EXISTING SEPTIC TANK: 1000 GALLON CAPACITY (TO REMAIN) PROPOSED SEPTIC SYSTEM UPGRADE PLAN PROPOSED D-BOX: 1 INLET, 3 OUTLETS (MINIMUM), H-10 RATED 46 TREE TOP CIRCLE, MARSTONS MILLS, MA USE 3 ROWS OF 8 - 11" STANDARD ADS BIODIFFUSER UNITS W/ NO STONE FOR AN S.A.S. WITH DIMENSIONS 8.5' x 50.0' Prepared for: Ronald Zylinski, 46 Tree Top Circle, Marstons Mills, MA 02648 SIDEWALL AREA: NOT APPLICABLE Engineering by: SCALE DRAWN JOB. NO. BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.7 SF/LF OF BIODIFFUSER) Engineering Works, Inc. NTS P.T.M. 136-09 24 UNITS x 6.25 LF x 4.7 SF/LF =705.0 SF 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.66 GPD/SF x 705.0 SF = 465.3 GPD (508) 477-5313 7/15/09 P.T.M. 2 of 2 I Fityish gr,Xde above and adjacent shall sbpea min.of 2%away from system 4 diam. cosy iron or Schedule4OPVC pipe (tight joints). y 1 20 min. distance (.building to edge of leaching syst'ern) 10'min.dist. LET 51 s L4TA-- As ` I nystbl�f d4'X to tLbe M,(�t { J-0 t 57 t q ai 4V44 = aeon �¢8'r`1 �.� 0 �h first-Floor: lev. e* l✓ �'� � _ • f. A 52:� t, MANHOLE C019'f~�t A� �r8+�I.#a� .n+ . . r q FI'NISHEQ GRADE p�etoldtl � 12 Mox. covert i . r C4T*AgCt `L 02 Removable aou�.r 2 S=. 0 05 T t k��t + d ll�fcc.t rt .' "`- ► ... Removable , �.-- k . 9�r,oicov S=.of213, 4' X 8 0—TES M"F. Li uid..levei level r �'? __ _ J� a o a a . , LOT 59 n. O -- -- --• i a �+o a 'o°m° o 0 o c e tl°" IRkL Tc 3 aj cc -.. _ DFSTN N p OT 5 i w'; m m - SEPTIC TANK �n i . B4Ox rn M. i• „ c �. v - ao Bottom Elev= 4-_5 t�1 I 3 . t u u I000GAL. — n � - - -- - - - - -co- - - - - - - - - - - - - c�!L � � - - br -- -- .—. i i dal • �J I'�r��jt�{n} r cu PROFILE x . Not to scale t '►. `11� CRI'1 E t A z „•x . kMtS7L�.1v � t L Nu 18 .R{ DROOMS. 3-Jeg vglen to 33Q 1? NONE TrEppA�GA SdMj�SALNI NOTES r YL A F l G1 R>= ► ITY REQUIR.t.Q„3; GALS/DAY. �. .�, ,.,.�, .-- �;. .�.-•� „ � T w.,max ;• 4 • � , , � , - 1)NO CHANGE TO TI-qS-SY�'T'E�IA SHALL B�MADE UNLESS -fop C ,�' ;yII E t4 klyA ,PROF'OalE:p _ SQ. FT. APPROVED41N WRITING BY HOWESand,NlcGRATH, INC. 4118 L1 40' W)D�) 2)SU8JFCT TO INS E` TION DLJAII46 CON f�tOCTION BY M TT i jREA $ED :2� SQ. FT. BOARD OF H LTt# AND H(�MI SQ�ui Ott . ATN,IN ,. l�� RRD LIG CA'PAC'fTY 4 ALLOlV5/DAY. 3)HE1/Y CQIiIS{"RUCfi10�{'1^OUIfr11VT, SMALL N T TAV �. - --* --� - n • ._. .G ' lIC OV 9DISI SAL.SYSTI M Ir1LiR"CI G OR AFTER CON TR T 7N, ww ,.--. .- ;F "LY- TOWN', 4)( POSA'L SYSTEM "R)BE CONSTRUCtED IN ACCORDANCE " WITH..TITLE 5 OF TRIG STATE .£NVIRONM�IQL CODE. I k e I ,9 'm;NG.' 5)A.COPY F THEtSE PLANS MUST BE KEPT ON 'SIT E {lrl�;;MARK HYD SPN. AT LOT 51-52 EL.=50.00 ASSIGNED L+� DURING THE"T{M! OF CONSTRUCTION. 6)A COPY OF Tl ESE PE_ANS tAUST BE FURNISHED TO TkS NTRACTOR CONST tUCTIN.G, T#E DISPOSAL.SYST �� PRUj�4SEo SPAT 21,��VA;TI(?nt r p , )1 OR iI�CKI*1 . T1i fi,QN7 CTOR.SHALL t40T I FY _ :.._ ., -- _ _ - . o WLX l and Al1C �T i fNC.`Aid "THE BOARD OE HEA1TlE# -.: N_ 2 AGE!NTTOINSPEC, TftE' SYSTI`M A5 CONSTRUCTED, I�E�IS� IaRO�"ALE, "I�Q 1=k�W(�iFFUSSt�,f� r ►i 1 Elegy.'` ''t)e th Sbi s' EIew D l I:A 8) L tN''IHAZAif2Ct-?.ONE C r� ) - _ Ir CIS 5EPT1 SY`S. i' J a 9 1t0"ING QIST IC�T_ _ _. _.� ._ � . LOAM ..:.. __�___ ._ _. ._ � I.f3)TNT-NQFF H Ai I~tOWt+IS DEffJYEiJIFf flA RECORDED P{_AW #)& .,., , D t 'ScA . kQ 6y Ch by SUBS( fL N, t , pp�.l" 3LIEO TNI NQRI'ki=AR1JrW:�.�FIALL I�I4T t1; Ec. � © $i• i fiOR ORIEN'I�Af tON ON-SoLAA HEATI'NG- PURPOSE S. l 5.5 455 . .P1*A �;�z��' •t TtTL F R �FERE�SCE . CN , C FINE ...,_..,._. � �� DATE OF S fL TEST M AY 7 ,� t98 4 O "PLEASANT PLACE.�SU :VI 1 �'�;l OT T�19E�`OP TO C T TAKE . .BY R08ERT Ufa` MANN $ E T N G OF LAND IN MAR IVIE D I U M RESULTS WITNESSED pY J O H N J A C 0 8.1 S SAND C T RAT 1A1,/INCH: �SAa Nl/� f'� 9.0 42 QW GRo ._ t�iBONA`; 1"= Ioo' SE'P' "� S_t✓t1 _: utne " GROUND WATER 4 9EL D �•-- � -. GR UND- (mA f ti p tt "_' % ! aN t WATER ASSE' OR MAP�J` i ;A> r Alloutlet pipes from the distribution box shall be set level for at least 2'from the box. OUTLET KNOCKOUTS ALTERNATE ALTERNATE INLET OUTLET p f'' I NL OUTSET - -f� t + OUTLET KNOCKOUTS { INLET / 1 i. _._ _ -"'"�GUTLET I -!�f PLAN 5, 3,1 I' ! - r ' I 1 -- - -- All access manhole covers f z' 6" PLAN � I ---" 6a• � Conc. cover or septic tank, I i distribution box and/or leaching system _. ALTERNATE shall have covers set within 12' of finish — T. �3" INLET ALTERNATE grade or cis directed by the inspecting i �'-3 ' OUTLET authority . INLET -►- ` � � j 1�- OUTLET - I 2"min. ___.__. ( �_ �.,= STEEL REINFORCED PRECAST CONCRETE Metal frame &cover or 6"min. v �4" 3 OUTLET KNOCKOUTS + precast concrete cover. �_ ,S` n d A.. a i.•�••. _- 6 Precast concrete riser, S E C T 10 N ELEVATION 6 6 concrete block or ,1 „ c brick masonry. 3 --Removable covers— 3 i E`�6" TYPICAL PRECAST EC SSA E •ST CONCRETE oDISTRIBUTION BOX -4�—_`3 min.clearance required'':: — 11 INLET INLET ---.— ;2'rnin.inlet to outlet 6 mm. J" _4 _� 13 ----- Tee V_. OUTLET ____... - - - ' min. ..._Liquid level---, �_._ _.-____._-_" ..t.— _ _ - ..�r min.- COW11 _._ X _.._._ _ _ __...__ _.._ 5-7 _. - _ DATE D E SCRI P T I 0 N Drawn by Checked by 4 -0 _ 4�-0�� min. - _ _._ - REV I S I ON S min. _—.______._ _- _ ____ --.- PLOT PLAN - DETAIL SHEET -- SYSTEM'--- F PROPOSED SEWAGE DISPOSAL SYS 11 , 0 0 A T - 31 _- - -- FOR P 0 L C A R 0 C 0 N S T CO. INC. ELEVATION SECTION CROSS SECTION LOT 57 TREE TOP CIRCLE MARSTONS MILLS,BARNS TABLEMASS. 4� TY'PI CAL 1000 GALLON SEPTIC TANK / H-10 LOADING SCALE' n shown. DATE: MARCH 6, 1984 ;t. f and mcgrat h ,inc. ��`• � •4`:`.�^'�� SCALE : 3/8" = I'-d' civil engineers and land surveyors 220main street "'':=♦�.- ,. c NOTE : DENOTES DIMENSION OF H -20 LOADING DESIGN falmouth,ma.0254o Checked b 548-3564 Drawn by_ v OB N- 8 af-2 DWG.N° 14'/,?�90 SHEET 2 OF 3 p a B — le"x 2y• A r I I I ( ! ! IR mdvable C�ncfete 4 —0 I _ C veer I dRFIKpu7 FOR T ADD IT IONA l- 'FLXAV IF REQ'D /NS,WCZAON COI/£R 4£T.4,/4 - - - -- --- i > - - - l- L PLAN VIEW Z B �-- 4 _ 0 I y-I 8 _ 0 INLET --- _- --- _. -� � E E Ti. /) CON .4ET s000ps (4 24 OAYS ® ® 2) DE5/6N LOAD/KG 6040 p54 Knockout Knockout Knockout 3) WE/GNT Zy00 /bS Removed Removed Removed 4 0'I �•-� 8 OI ---� INLET— m Q: s _ ° - -- YE C: l C -J -J Knockout i Removed All knockouts Removed ( for LEACHING FIELD installation) SECTION 8 -B SECTION A - A TYPICAL FLOWD1 FFUSOR® - DATE DESCRtPTtON Drawn by Checked by NOT TO SCALE - - RE.VISIONS PLOT PLAN - DMA LISH ET OF PROPOSM SEIWAGEaSPOSAL SYSTEM FOR Pot(�ARO CO4$T CO. INC. .,� �,✓ `N SOT 57 TREETOP C I FtCLE )4� MARSTONQMI -LS 6A"TA8LEE MASS, U SCAi_E._I' =40 _ ISATE: M.AY A - _I2pi h�o WWi and mC �aff),d�tC. r•® DENOTES REGISTERED TRADE MARK . g 1Tr-f cirri I engineers and land suryeyars 200mom street 154 -- - " �. hEeCk ?�!3 IVI �n b`it .,x f ouch,rAa. 02540 QrOwn b MJUJ W le SHEET 3 OF 3