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HomeMy WebLinkAbout0455 TURTLEBACK ROAD - Health 455 Turtleback-Road -Marstons Mills I t i c Commonwealth of Massachusetts d67 -Ov( Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ire 455 Turtleback Property Address Noel A. Spillane Owner Owner's Name information is t required for every Marstons Mills Ma 02648 8/22/18 -1- page. City/Town State Zip Code Date of Inspection . Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information Shft (3 a�C� on the computer, Michael DiBuono use only the tab key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return Company Name key. 35 Content Lane rab Company Address Cotuit Ma 02635 City/Town State Zip Code 508-364-9587 S113522 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 8/22/18 Inspector'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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 C Commonwealth of Massachusetts Title 5 Official Inspection Form r. i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 455 Turtleback Property Address Noel A. Spillane Owner Owners Name information is required for every Marstons Mills Ma 02648 8/22/18 page. CityfFown 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: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 1500 Gallon septic tank as well as a concrete distribution box and 3 500 Gallon chambers 2) 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form ' l Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 455 Turtleback Property Address Noel A. Spillane Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/22/18 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 ❑ 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 Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Li 455 Turtleback Property Address Noel A. Spillane Owner Owner's Name information isequired or every Marstons Mills Ma 02648 8/22/18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *' This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) 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 t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form �e Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 455 Turtleback Property Address Noel A. Spillane Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/22/18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) 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 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: ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 455 Turtleback Property Address Noel A. Spillane Owner Owner's Name information is every Marstons Mills required for eve Ma 02648 8/22/18 page. Clty1rown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: 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 ) ® El information on the proper maintenance of subsurface Y sewage disposal systems? p 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)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form Not for Voluntary Assessments 455 Turtleback •V� Property Address Noel A. Spillane Owner Owner's Name information is Marstons Mills Ma 02648 8/22/18 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: 1 Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 214 GPD 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L 455 Turtleback Property Address Noel A. Spillane Owner Owner's Name information is Marstons Mills required for every Ma 02648 8/22/18 page. Clty/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: 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 below): 3. Pumping Records: Source of information: Pumped in 2016 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form I e Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 455 Turtleback Property Address Noel A. Spillane Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/22/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information: 8/20/02 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): System is vented at the roof line t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts I Title 5 Official Inspection Form Subsurface Sewage Disp osal System Form - Not for Voluntary 9 p Y to Assessments ry 4 u 455 Turtleback Property Address Noel A. Spillane Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/22/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other ex lain ( P ) 1500 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 42" Distance from bottom of scum to bottom of outlet tee or baffle 30" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is at normal level t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments � 455 Turtleback �u Property Address Noel A. Spillane Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/22/18 Cit !Town State Zip Code Date of Inspection page. Y P P D. System Information (cont.) 7. 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.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 455 Turtleback v Property Address Noel A. Spillane Owner Owner's Name information isequired for every Marstons Mills Ma 02648 8/22/18 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) 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 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Level and at normal level 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 455 Turtleback Property Address Noel-A. Spillane Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/22/18 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 10. 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.): * r n in working orders stem is a conditional ass. If pumps or alarms are of g y p 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form - �� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 455 Turtleback Property Address Noel A. Spillane Owner Owner's Name information is Marstons Mills required for every Ma 02648 8/22/18 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 12. 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.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 i c� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u% 455 Turtleback Property Address Noel A. Spillane Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/22/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 455 Turtleback Property Address Noel A. Spillane Owner Owner's Name isrequired for every Marstons Mills Ma 02648 8/22/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 8/28/2018 Assessing As-Built Cards j TOWN OF 13ARNSTABLE LOCATION KS Tr/{� 6At:l� R� SEWAGE# a0.)-Ur ` wl, ivt J/VILLAGE � 1 ASSESSOR'S MAP&PARCEL G6Z- oU/ INSTALLERS NAME&PHONE N0. SEPTIC TANK CAPACITY y S�tlO LEACHING FACILITY:(type) (size) I ax 3y NO.OF BEDROOMS y OWNER /�'1cCAr PERMIT DATE,: COMPLIANCE DATE: 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 leaching facility) Feet FURNISHED BY_��x u?Tn J rOr 9 d �ar- M rrl 1A i " I http://www.townofbamstable.us/Assessing/H Mdisplay.asp?mappar=062001&seq=1 1/2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 455 Turtleback Property Address Noel A. Spillane Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/22/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10+ 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: 8/20/02 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: Test hole data on plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts (o Title 5 Official Inspection Form 10 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments j 455 Turtleback Property Address Noel A. Spillane Owner Owner's Name information is MarstonS Mills required for every Ma 02648 8/22/18 page. Cltylrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ❑ A. Inspector Information: Complete all fields in this section. ❑ B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ❑ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ❑ D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included r t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 ENVIROTECHLABORATORIES,INC. MA CERT NO.:M-AIA 063 4 449 Rte. 130 Sandvwch, MA 02563 508(888-6460) 1-800-339-6460 FAX(508)888-6446 CLIENT: Carol McCarthy LOCATION: 455 Turtleback Rd ADDRESS: 15 Washington Bursley Way Marstons Mills MA Centerville MA 02632 COLLECTED BY: DA Scannell SAMPLE DATE: 7/23/2002 SAMPLE TIME: N/A WATER SAMPLE TYPE: New Well DATE RECEIVED: 7/23/2002 LAB I.D. A 0207506 WELL SPECS.: N/A RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria /100ml 0 0 9222 B 7/23/2002 pH pH units 6.5-8.5 5.76 4500 H+ 7/23/2002 Conductance umhos/cm 500 142 120.1 7/23/2002 Nitrate-N mg/L 10.0 0.70 300.0 7/23/2002 Nitrite-N mg/L 1.00 < 0.004 300.0 7/23/2002 Sodium mg/L 20.0 14.5 200.7 7/23/2002 Iron mg/L 0.3 0.2 200.7 7/23/2002 Manganese mg/L 0.05 0.017 200.7 7/23/2002 Volatile Organics See Report Chloroform ug/L 80 0.54 EPA 524.2 8/1/02 COMMENTS: Low pH indicates high corrosive characteristics. WATER MEETS EPA STANDARDS AND/S SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. ND= None Detected. <=less than >=greater than TNTC=too numerous to count Date �� onald J SSa i L oratory i ector Aug-05--02 10 : 39A Lapuck Lah_ C)r-ator1;.,. _,; , Inc . 7e! 401 9998 P . 02 CERTIFICATE OF ANALYSIS LAPUCK LABORATORIES, INC, RCDni't Moored Per: RLport Wit: : 98.'�15-2�,102 Envirntech Laboratories,Inc. rdeL Number: 1,0272531 Ron Saari 449 Rte, 00 Sandwich, Ma 02%'3 Laboratory ID #: 0172531-01 DAUal U1 w 0207506 455 Turtleback Rd. Collected by: (',u,.;tfbrmr Rfceived,l 47/2512002 Test Parameters ITEM F&SULT -_j_)NITS me(hol# Tutu, 1 LAB.- Organics MTBE ND 0 FPA 524-2 091N/20(.;2 EPA 524.2- Volatile Organics by GUMS ITEM RES11j UNITS NIDL je�t # Tected LAB: Orguisles .1,1,1,2-Tetrachloroethanc NO lq/l. o.s EPA 524,2 68/01/201!*2 1,1,1-Trichloroethane ND ug/L (Y5 EVA 524.2 0H/01)20fP2 1,1,2-.2-Tetrachloiroethane NB ug/L 0,5 EPA 524.2 081101,,M12 1,1,2-Trichloroethsne ND ueL 0.5 LPA 5242 08/01 Wi)2 1,1-1Dichforethane ND ug/L Co.5 F.P A 5 2 4.2 09101"202 IJ-Dichforoethene ND kj8/1 0,5 EPA 524.2 03/01/2002 1,1-Dichforop rope ne NY) U&iL• 0.5 LVA 524,2 08,1011002 1,2,3-Trichlorobenzeim N 1) ug/L 0.5 1-.VA 524.2 U8/01 20t'2 1,2,3-Trichloropropm ne ND vg/L 0 5 EPA 524.2 omll))-20Q 1,2,4-Trichlorobeuzene N 1) ug/L 0-5 t-,PA 524.2 -08/0 jl�.1002 1,2,4-Trimethylbenzetie ND ug/L 0.5 EPA 524_1 IN/o I/20o2 1,2-Dibromo-3-Chloropropa ND ug/L 4.3 LTA 524.2 08/G!,­_002 1,2-Dibromoethane(EVO) ND ug!L 1)s UA 524.2 08/0120f)Z 1 1,2-DichWobenzene ND ug/L 0.5 V 11 A 5 2 4.2 �M'0 1/20112 1,2-Dichloroethane ND ug!L EPA 524.2 OKA,,112062 11-Dichloroprop:a1le NND ur/L 0j.5 C-11A 524.2 1,3,54rimethylbenzene ND ug'L EPA 524,2 08,'U 1/2062 1,3-Dichlorabetizene ND og/i- SPA 524.2 1,3.-Dichforopropun(e ND L11A 524.2 1,4-Dichlorobenzene ND u&�L EPA 524.2 Q%i0P20;)2 Aug-05-02 10 : 39A Lapuck L-abc)ratorio�.- , Inc . 781 401 9998 P .03 CERTIFICATE OF ANALYSIS P,ige 2 LAPUCK LABORATORJES, INC. Kwort Prepared For: kepurt Envirotech LAboratories,Inc. 0[d r Number; L0271531 Ron Saari 449 Rtc. 130 Sandwich, Ma 02563 Laborltory 11) 0172531-01 nt-si!riptiulu 0207SO6 455 Turtleback Rdc sumptv M: CCollected by- cumulkler Received; U7125120 1 02 2,2-Dichloropropane N 1) u.--IL FPA 524.2 08/W/20;)2 2-Chlorotoluene ND 0.5 EPA 524.2 09/01/2002 4-Chlorotoluene ND ug/L 05 EVA 524.2 09/01-;2002 4-1sopropyltoluerie ND ug/L 0.5 EPA 524.2 08/0i/2002 Benzene NUUgIL 015 FPA 524.2 flsimnui12 Bromobenzene ND ugil .3.5 EPA 524J 08yoii2002 Brotnochloromethane ND vg/i. 0,5 WIA 524,.' 08/01/201,)2 Broniodichloroethane ND 0-5 Ej,.A 3242 os1ijl,26rQ f3romoform ND ugii. 0.5. EPA 524-7 08/01,201.?2 Bromomethane ND I-,PA 524.2 f)8/1JJi20(,2 Carboraetrachloride ND EPA 5241 08/0 1 P20r 12 Chlorobenzene ND Ug/L 0.5 LVA 524.2 0WW2002 Chloroethane ND ug/L o EPA 524.2 onjo 1120(12 Chloroform 0.54 O's EPA 524.2 08/01,121W2 Chloromethane ND ug/L us EPA S241 08/01/2o02 cis-1,2-Dichlorethen e ND ugYL n.s EPA 524-2 08,'0 1 i20011 cis-1,3-Dichloropropeatc ND ugiL its EPA 524.2 OXY01 11002) Dibromochloromethane ND ugj'L O i EPA 524.2 08!01i2002 Dibromomethane ND kis/r. OTA 524.2 (19/01/20o., Dichlorodifluororviethaile ND ug"I. 0.5 F.PA 524.2 08/01/2002 Ethylbenvtene ND LIC/L cr.5 EPA 524.7 09/ul,1062 flexachlorobetadieve N 1) k1g;l 0.5 EPA 524.2 USI()1/20')2 isopropylbenzene ND EPA 524.2 u6iL EPA 524.2. 68/0 1 0i I M ethyl eneChlori de ND wad. 0 5 LPA.S24.2 091/u I,20w2 n-Butylbenzene ND n-Prop yl benzene ND uq=L cl s EPA 524,2 os/o I Naphthalene ND 0 5 EPA 524.2 see-Biltylbenzene ND FPA 524.2 08/0)120,)-, 1u: 40JA Lapuuck Labora.tor-ies , Inc- - 781 �,4.C)i 9998 F� 04 CERTIFICATE Off, ANALYSIS ► IS Aige 3 LAPUCK LABORATORIES, INC fie port Vre ared 4'or: Rcport Daltil: Fnvirctech Laboratories,Inc. aI__ der Na er• L0272531 Ron Saari 449 Rt.c. 130 Sandwich, Ivfa 02563 Laboratory ID M 0172531-01 ikecriotlon: 0207506 4§5'I urtleback Rd. Sample#: damn►ind ocatinn_ Collected: Collected by: Customer Received: 07i25%2002 : Styrene ND ug'L u.s EPA 524.2 c)8/01 2on2 ter(-Butylbentene ND 05 l.);A 524.2 08ro1r2002 Tetrachlaroethene ND uglif. 0.5 EPA 524.2 uNMU2002 Toluene :NO ug%l. 0.5 ETA 5242 08i01/2002 traps-1,2-IDichloroethene ND ug/1. 0.5 EPA 524.2 ohmi20n2 trans-1,3-Dichloropropene ND ug/L 0.5 PPA 524.2 081101 20u2 i Trichloruethenc N D uwL 0 5 LPA 524.2 08/01120c2 Trichlorofluoromethane ND ugn. 0.5 FFPA 524.2 08./011,205,2 VinylChlorlde IUD ug/L c's LTA 524.2 WOIf20ol- Xylene - ND "pii. 5 FPA 524.2 I M.V/2U1-'2 Approved By: (Lab Mmagcr) This report is rendered upon the Condition that it ii not to he npruduccd wholly or in port for advtrbsiug or other purposes over our signature or in connective:v,! our Frame without special wTiatm permissian.Tote!liahility is lirruited to the invoiced amount.1 he results limed rnfcr mil,y to tested samples find/or app!;c:Ailc CERTIFICATE OF ANALYSIS Page: 1 . Barnstable County Health Laboratory �9ssnctatiss� Report Prepared For: Report Dated: 5/24/2007 Noel Spillane Order No.: G0740557 455 Turtle Back Rd. Marstons Mills, MA 02648 Laboratory ID#: 0740557-01 Description: Water-Drinking Water Sample#: Sampling Location 45 TBt Mm Mills,M Collected: 5/23/2007 Collected by: N.Spillane Received: 5/23/2007 Routine ITEM RESULT UNITS RL MCL Method 4 Tested Nitrate as Nitrogen 1.3 mg/L 0.10 10 EPA 300.0 5/23/2007 Copper 0.12 mg/L 0.10 1.3 SM 3111B 5/23/2007 Iron ND mg/L 0.10 0.3 SM 311113 5/23/2007 Sodium 19 mg/L 1.0 20 SM 311113 5/23/2007 Total Coliform Absent P/A 0 0 SM9223 5/23/2007 Conductance 170 umohs/cm 2.0 EPA 120.1 5/23/2007 pH 6.1` pH-units 0 SM 4500 H-B 5/23/2007 Water sample meets the recommended limits for drinking water of all the above tested parameters. " Approved By- ( irector) 17 C:) as C3' —F3 .. m cn ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory Report Prepared For: Report Dated: 1/3/2007 Noel Spillane Order No.: G0638616 97 Essex Street Summit, NJ 07901 Laboratory ID#: 0638616-01 Description: Water-Drinking Water Sample#: Sampling Location: 455 Turtleback Rd.Marstons Mills,MA Collected: 10/26/2006 Collected by: S.Gibson Map 062 Parcel 001 Received: 10/27/2006 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen 2.0 mg/L 0.10 10 EPA 300.0 -1�327/2006 T Copper 0.14 mg/L 0.10 1.3 SM 3111 B {' l l/l i2006 Iron B RL mg/L. 0.10 0.3 SPA 3111E Sodium 49 mg/L 1.0 20 SM 31-1-113 I l/L2006 Total Coliform 0 CFU/100mL 0 0 -MF-SM 9222B 10/27;:E006 Conductance 230 umohs/cm 2.0 EPA 120.1 10/27/2006 pH 6.8 pH-units 0 EPA 150.1 10/27/2006 Sodium level is above the maximum contaminant level. Those on a low sodium diet nzay wish to consult a physician. Approved By)��(76abirector) MCL=Maximum Contaminant Level RL = Reporting Limit Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 E CERTIFICATE OF ANALYSIS ge: 1 404i'6� Pai": Barnstable County Health Laboratory y'S'S,1 ^�' Report Prepared For: Report Dated: 11/3/2006 Noel Spillane Order No.: G0638616 97 Essex Street Summit, NJ 07901 y�,.� Laboratory ID#: 0638616-01 Description: Water-Drinking Watter ,�m ` MWO j Sample#: Sampling Location: I'55 Turtleback Rd.,Barnstable,.MA�1 Collected: 10/26/2006 Collected by: S.Gibson Map 062 Parcel 001 Received: 10/27/2006 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen 2.0 mg/L 0.10 10 EPA 300.0 10/27/2006 Copper 0.14 mg/L 0.10 1.3 SM 311113 I I/I/2006 Iron BRL mg/L 0.10 0.3 SM 3111E I1/l/2006 Sodium 49 mg/L 1.0 20 SM 311113 I I/I/2006 Total Coliform 0 CFU/l00mL 0 0 MF-SM 9222B 10/27/2006 Conductance 230 umohs/cm 2.0 EPA 120.1 10/27/2006 pH 6,8 pH-units 0 EPA 150.1 10/27/2006 �Sodiwn level is above the nraxbnum coutnminant levee Thnse-oir-mlow sod umdiet luny wish to consult a phy_sicinu. Approved By: (La Director) //4-3 � o c: L7 --t t N � MCL=Maximum Contaminant Level RL = Reporting Limit Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 TOWN OF BAARNSTABLE _ 106TION yS5 T�6ACk Rc SEWAGE# aW�' 3SS VIF�GE_10. /N1/I5 ASSESSOR'S MAP&PARCEL ODD INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY S�UO LEACHING FACILITY.(type) 3' aryt, dlj (size) rax 3y NO.OF BEDROOMS y OWNER c.CAe PERMIT DATE: COMPLIANCE DATE: 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 leaching facility) J Feet FURNISHED BY ��Oe,�"f70�t __ f::-Or G O a aye 33 3 a3. 99, 3 � TOWN OF BARNSTABLE L LOCATION 45 ky `#( F � SEWAGE # Z Qn2 —� VISAGE - e��C ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY t LEACHING FACILITY: (type) �-��S (size) �� X NO.OF BEDROOMS BUILDER 0 PERMIT DATE: '� ' 2 —e Z COMPLIANCE DATE: S 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 leaching lity) Feet Furnished by � 1 I �-- , ���� �,F cb$ J 9� �� ` �. -, t� � � �� - a �a _ a 2 � .. t ' a ",�.No. n .'�'.t •. Fee �. �` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:.• 0 I 'PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes YJ Yf catiou for i ooal Stem Cori.5truction Permit Oi Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. j�.S,fTvx71 e gweeAUOwner's Name,Address and Tel.No. Assessor's Map/Parcel Q lv 1 — G O f - f'��✓AJ'rYeNG TPA- UG �L H Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel,No. P£T� f vLG/vi1-,J �� �wSTQve rir-1 J19,f 7 Type of Building: Dwelling No.of Bedrooms Lot Sizeelk gob 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 Size of Septic Tank Type of S.A.S. Description of Soil 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 Certifi- cate of Compliance has been issue this Board of ealt Sign Date's VO Application Approved by r Date Application Disapproved or the following rea o - Permit No. Date Issued Fee ' Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS p Yes UBLIC HEALTH.DIVISION--.TOWN OF BARNSTABLE, MASSACHUSETTS ( Zipplica.tion for )Diopooal *pgtem Congtruction Permit 1 ! Application for a..Permit to Construct( )Repair( )Upgrade(O )Abandon( ) El Complete System ❑Individual Components Location.Address or Lot No.ps ax71 F� ee � Owner's Name,Address and Tel.No. Assessor's Map/Parcel 04 ` Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel No. y��E Cm�l—,,���t�.►� S-00 7��fl/�"� o s V fAve e r,10f,* fo F Y-1 v Type`of Building: Dwelling No.of Bedrooms .3 Lot SizeXV,cee 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 {. Size of Septic Tank Type of S.A.S. Description of Soil Nature of Rep'airslor 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 Certifi- cate of Compliance has been issuedzhis Bo of ealth Sign Date ? Z 4r V. Application Approved b Date pp PP Y Application Disapproved for the following rea on i i Permit No. Date Issued i --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed Repaired( )Upgraded Abando ed )b e- V W Ale!! at has bee -constructed in accordance with the provisions of Title 5 and the for.Disposal System Construction Permit No. "' ted Installer Designer The issuance h h d t t b shall h it this o, s perm sa not construed as a guarantee that the sy to wi 1 unctb�as-as ned. �j f f , Date '�: ji 03 Inspector +�> 1 ► 'i I ' i No. 4 -- ——-----------------------Fee_� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migogal 6potem (Construction Permit /rro, ✓ Permission is hereby granted to Construct( 1/RRepairr( )Upgrade( )Aban4qn( ) System located at 4 S"- `r'u v tk�-�O�C 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. sProvided:Construction st be co �pleted, ithin three years of the date of this p Date: Approved by i TOWN OF BARNSTABLE 1 LOCATION `4 lc� ` _ SEWAGE # (MZ —� VILLAGE �`'�- `�`� ASSESSOR'S MAP & LOT 00 —a$t41W INSTALLER'S NAME&PHONE NO. �VsQkAy SEPTIC TANK CAPACITY c S� LEACHING FACILITY: (type) (size) �� X NO.OF BEDROOMS BUILDER PERMITDATE: '9 ZQ-0"Z- COMPLIANCE DATE: S 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 f on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet leaching lity) Feet Furnished by Qk I w i 2 ) � I COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A . CERTIFICATION Property Address: 455 Turtleback Road 01,� _e0 Marstons Mills MA 02648 Owner's Name: Dave McCarthy Owner's Address: Date of Inspection: October 4 2006 ` Name of Inspector: (Please Print) James M. Ford Company Name: James M.Ford Mailing Address: P.O.Box 49 Osterville.MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the informationAported below is true,accurate and complete as of the time of the inspection. The inspection was perfort d based on my -q training and experience in the proper function and maintenance of on site sewage disposal syste I am a.D approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The syC LEP �sg ✓ Passes . Conditionally.Passes NeecA Further Evaluation by the Local Approving Aut rity. r Fail Inspector's Signature: Date: October 9 2006 The system inspector shalV* a 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 ""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. Title I Inspection Form 1111111,, page 1 I f Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 455 Turtleback Road Marston Mills MA Owner: Dave McCarthy Date of Inspection: October 4 2006 Inspection Summary: Check A,B,C,D or E l 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: 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: 2 i I Page 3 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 455 Turtleback Road Marston Mills MA Owner: _Dave McCarthy Date of Inspection: October 4 2006 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303 1 b that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water — Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ,— The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. — The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 455 Turtleback Road Marston Mills MA Owner: Dave McCarthy Date of Inspection: October 4 2006 D. System Failure Criteria applicable to all systems: You must indicate either"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_. _ ✓ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (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 System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 455 Turtleback Road Marston Mills MA Owner: Dave McCarthy Date of Inspection: October 4 2006 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: Yes No 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(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 455 Turtleback Road Marston Mills MA Owner: Dave McCarthy Date of Inspection: October 4 2006 RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): 4 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: I Does residence have a garbage grinder(yes or no): n1a Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): Lo Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): Pumping Records GENERAL INFORMATION Source of information: New systenn (never punned) Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed on 511103-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 'I Page 7 of 11 OFFICIAL INSPECTION FORM'-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 455 Turtleback Road Marston Mills MA Owner: Dave McCarthv Date of Inspection: October 4 2006 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting, evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 6" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _,other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: _1500 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 101, How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.). Tees were resent. The liquid level was even with the outlet invert. There did not a ear to be an si ns o leaka e. GREASE TRAP: None (locate on site plan) Depth below grade: 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 455 Turtleback Road Marston Mills MA Owner: Dave McCarthv Date of Inspection: October 4 2006 TIGHT or HOLDING TANK: u None (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: allons Design Flow: allons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was level. No solids were present. PU NT CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 455 Turtleback Road Marston Mills MA Owner: Dave McCarth Date of Inspection: October 4 2006 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: ✓ leaching galleries,number: 3-drywells(12 x 34)-per as built card 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.): The alle s were d and clean. No scum line was resent. A video camera was used or the ;--t7ection. CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): PRIVY: None (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.): 9 I w• Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 455 Turtleback Road Marstons Mills MA Owner: Dave McCarthv Date of Inspection: October 4 2006 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. `c. 0 A � O a ay` 33 a 3 a3 �g 3 10. J �s Page 11 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 455 Turtleback Road Marstons Mills MA Owner: Dave McCarthv Date of Inspection: October 4 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 15 +/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: tonoQranhic and water contours mans Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Usinz Barnstable to o ra hic and water contours mg me the ma s site. were showin a roxintatel 15'+/-to round water at this This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 Fee—----- - ------- BOARD OF HEALTH TOWN OF BARNSTABLE 0(pplicat ion for Vell Con5truct ion Permit Application is hereby made for a permit to Construct �4 Alter ( ), or Repair ( )an individual Well at: -J '� Tln.rGe ,a�tc.t rr f f�. ----ram -- ©�'"��— Location — Address Assessors Map and Parcel Owner -- Address — *ad*IV Z-Ce-6 ii0tee_!-e.- -_--------- Installer — Driller Address Type of Building Dwelling -------- --_-- Other - Type of Building - No. of Persons.--- Type of Well— 4f ------ — Capacity-----10 4-• --= —— Purpose of Well-404M �! Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until Certificate of Compliance has been issued by the Board of Health. Signed ✓"'`�•� ---_— — —�'/`..7 Application Approved By --- jiZ� date Application Disapproved for the following reasons:--------------------=-------------- ------- ---date Permit No. — Issued-- - - --�.`,- ----------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( Altered ( ), or Repaired ( ) Installer C at_ 'roc has been installed in accordance with the provisions of the Town of Barnstable Board of Healtthh Private ProtectionWell l Regulation as described in the application for Well Construction Permit No W C�—a�Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector---------------- --------- i � 4 No.---- ------------ Fee------q'------- % BOARD OF HEALTH TOWN OF BARNSTABLE Application-forlVell CootructionAermit Application is hereby made for a permit to Construct 4 Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel —G A R yLa 4 /I C 1y �GyASH�uG7"o�UL� G .+ �a� Owner - d ti ter Ze_ _ I (f �5� ------- Installer — Driller Address Type of Building ` Dwelling ---- --- __—- --- Other - Type of Building-=-------------- i No. of Persons-- ____ Type of Well =— Capacity- -�d -- Purpose of Well- Agreement: Agreement: The undersigned agrees to install the afcnedescribed individual well in accordance with the provisions of The Town of Baistable Board of Health Private Well Protection:Regulation - The undersigned further agrees not to place the well in operation until,a Certificate of Compliance has been issued by the Board of Health. G a� Signed �-y"'''-`"� �-�z. ��- _— -- -/-�__— d ate Application Approved i PP B date Application Disapproved for the following reasons:'~ - —, - =----- --- j -- date --- Permit No. - - — Issued----=----- --.� = = --------------- date BOARD OF HEALTHi— TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (1, , Altered or Repaired ( ) by--- --- __— _-- ------- ----— Installer at 0C has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Prot ction Regulation as described in the application for Well Construction Permit No�-�(-12_Dated ��-t= THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--_ __ Inspector-----------------_ —_---_____ BOARD OF HEALTH TOWN OF BARNSTABLE ell ion 3permit No. 22_ t' Fee- -� ----- Permission is hereby granted — --- ----- ------------ to Construct ( ), Alter ( , or Repair ( ) an Individual Well at: No. t c —-- -�-�' �l F Rat'L IC ��" - �—�� \_----------------------------------------- Street as shown on the application for a Well Construction Permit No.- �2�C�2 ` � ---�_ Dated-- L��� ---- ------------------- G S Board of Health DATE— Topography s FromT.O.B. G.I.S. Design Data NOTE: h i F T G tt ` :.. . Finish Grade Single Family-4 Bedroom _ > With NO Garbage Grinder Daily Flow=110 x 4= 440 GPD F Filter (,2 to Compacted Fill fd{ Fabrl: --: PRoPose� \ Ct� Septic Tank:440 GPD x 200%=880(GPD t =:; Use 1500 Gallon H-20 Septic Tank •N f Vat-in" /2 - Poo Stone ' ` o ~-Mystic— \ Leaching Area r ' 1 Lake k t f , 440 GPD/0.74=595 SF Required up ` Sidewall=2(12'-10"+33.512=185 SF, Leaching w w. 7q 1'QoPOS�D ( Bottom Area= 12'-10"x 33.5'=430 SF a Chamber Double Iwos�h2ed Y �'" ab ' } 615 SF Total Provided Stone Locos' —� 4-10 Leaching Chamber Design ly lrv' All Pipes to be Schedule 40. Use 3-500 Gal. Leaching g Chambers in a � LOCUS PLAN X 12'-10"x 33.5'Washed Stone Field as Shown. CROSS SECTION O F C H A M B E R Scale: 1:12,000 ` NOT TO SCALE. Assessors Map 062 Parcels 001 & 004 Groundwater Protection Zone: GP Flood Zones: C / � �' DWt-w>•!(s ! Setbacks: Front: 30' Side: 15' 1 ' ? If Encountered Remove&Replace All Rear: 15 l — € Unsuitable Soils Within 5'of the Outer \ ll Perimeter of the System- 0 - F I 7G. NOTES / e rin n FG' O:b 1• Water Supply For This Lot is a Private Well. Well to be Installed in Accordance%with the / 1 l Latest Revision of The Town of Barnstable TH2@ / Board of Health Regulations for Private Wells. - 1500 Gallon Top El. Cog PP 2• Location of Utilities Shown on This Plan Are A rox. / M Septic Tank (z":;� s.. At Least 72 Hours Prior to Any Excavation For This I -� Bot.El. CG Z _ Pro,ject The Contractor Shall Make The Required Notification to Dig Safe(1-88S-344-7233) 1 - Bedding as I u 3• The Contractor i.s Required to Secure.:'ifalarupri:ate ( r Per Title 5 1 Permits From Town Agencies For Construction t 20 ` f�RovN:� �`t' Defined by This Plan I �TH-t Mery FPO+ T.O, n1RP 4. Install Risers to Within 12" of u DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Finished Grade L O I `1 + W Not to Scale M S. All Structures Buried Four Feet or ore or Subject � y•FJ� ACHE:- / -4 To Vehicular Traffic to be H-20 Loading. ' 6- Septic System to be Installed in Accordance With f 310 CMR 15,00 Latest Revision And The Town of Barnstable Board of Health Regulations v Perc Test P-10,251 Date 5/20/02 7, All Piping to be Sch.40 PVC ' SElnc. P.Sullivan B of Health David Stanton Q[ Test Hole 1 �: k10P 7Z 1 \ ` ` i3 7-48" E Sand W/Some Silt 10YR4/4 .;. \ 48"-89' B Sand W/Some Sift } 10YR5r3 SITE PLAN PETER 4 89"-132" C Sand W/Some Silt l No Mottling 10YR 6/4 i SULUVAItf PROPOSED IMPROVEMENTS ? d No Water Encountered W.�J j Perc @ 60" 25 Gallons in 8 minutes C. AT =a Class 1 Material Less 2 minutes per inch i1 455 TURTLEB ACK BAC ROAD Test Hole 2 V MARSTOl\S MILLS � t"= y� �Y � � � 0-'SCA �� G�4 1"-40" E Sand W/Some Silt 10YR4/4 SULLIVAN ENGINEERINGCOZ 40"-72" B Sand W/Some Silt 10YR5r3 72'-120" C Sand W/Some Sift No Mottling 10YR 6/4 OSTERVILLE, MA _ DATE: �ll,�� I l, 7002 No Water Encountered l l - ' <t € T.O.B. G.I.S. Design Data NOTE: Topography is From T.O ' Single FamilyFinish GradeL'_—�4.'0B~p. v "d ^Y r'1•;; ' j -4 Bedroom �.,' µe,•�li' ''^ With NO Garbage Grinder Z Daily Flow=110 x 4= 440 GPD q Filter �_ ' td{mz o M Fabrlc Compacted Flll •:; I -: (QC Septic Tank:440 GPD x 200%=880 GPD O EA I PRoP s _ . wr�L ; f Use 1500 Gallon H-20 Septic Tank (o N M 1/8-1/2 �. �^ _ Pea Stone 4�` , . r r" _,igPstic—Sow 'o:e \ � Leaching Area Lake ,,,; , 11 I *{ k f r Required 440 GPD/0.74=595 SF Re , 9 Sldewall=2(12'-10"+33.5')2=185 SF Leaching M ? OPDS7=b - - 3/4 -I �'-- 71 j Bottom Area= 17-10"x 33.5'-430 SF Chamber =l p4�\VE a Double Washed / 615 SF Total Provided Stone ti Local Leaching Chamber Design ly ,b / t All Pipes to be Schedule 40. Use x / 1 3-500 Gal. Leaching Chambers in a LOCUS PLAN / r 12'-10"x 33.5'Washed Stone Field as Shown. CROSS SECTION OF CHAMBER Scale: 1:12,000 a ' NOT TO SCALE. - � Assessors Map 062 Parcels 001 & 004 Groundwater Protection Zone: GP Flood Zones: C P1�OPdSED Setbacks: �� Dwt-uwc� o Front: 30' Side: 15' I ? If Encountered Remove&Replace.All Rear: 15' Unsuitable Soils Within 5'of the Outer t Perimeter of the System ti t F.G. �G. NOTES :L(� L Water Supply For This Lot is a Private o P. e Well. rl rl nWell to be Installed in Accord ance• w.�e rth the / Fill— Latest Revision of The Town of Barnstable Tw2� Board of Health Regulations for Private Wells. _ 1500 Gallon C Top El. _ 2• Location of Utilities Shown on This Plan Are Approx. .r M Septic Tank �'-?•= - at Least 72 Hours Prior to AnN'Excavation For This d l ri :r.`:> +' BOI.EI. ( : 7 _ Project The Contractor Shall Make The Required j n ^;o` :.cr ' zo Yl _ ,f•�: �` Notification to Dig Safe(1-888-:,a4-72331 Bedding as a. 3. The Contractor is Required to`+:•cure Approprisge I / 1 } c. e 5 Permits From Ta«n :ir enc;c� For Ca nstructrr r. Per"7i11 � ov tY � �• .P - N Defined "o' _ cThi�ds Plan TH 1 , f z r��N EOM T,O.�• (C}it? 4. Install Risers to Within 12,, of DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Finished Grade L-0 i y t - �. All Struct ures s Buried Four Feet or More Iorc or Subject Not to Scale To Vehicular Traffic to be H-20 Loading. 6. Septic System to be Installed in Accordance With 4 310 CMR 15.00 Latest Revision And The Town of ~ Barnstable Board of Health Regulations e a Perc Test P-10,251 Date 5/20/02 7. All Piping to be Sch. 40 PVC f r t SElnc. P.Sullivan B of Health David Stanton Q Test Hole 1 7z 1 -3 � 0"-48" E Sand W/Some Silt 10YR4/4 48"-89' B Sand W/Some Silt 1 OYRSr3 :kOF SITE PLAN 89"-132" C Sand W/Some Silt .No Mottling 10YR 6/4 �n®�/�A R i'�j � No Water Encounter PROPOSED IMPROVEMENTS ME Encountered • 3 Perc - MOF T @ 60" 25 Gallons in 8 minutes AClass I Material Less 2 minutes per inch 455 TURTLEBACK ROAD CIVIL Test Hole 2 MARSTO NS MILLS r 7C (o kl t .i to J 0..-1., O BY J� /� M1 L/ r 1i-� l = �10 1"40" E Sand W/Some Silt 10YR4/4 SULLIVAN ENGINEERING Cot 4a'-72" B Sand W/Some Sift 10YR5r3 OSTERVILLE, M. 72'-120" C Sand W/Some Sift No Mottling 10YR 6/4 i DATE: JZ.'I Y 11, 2002 i. No Water Encountered I D Y'H VT �r-r saes aa�yr 3 r-o• rt s•� 6p b A p D N b5i�� `� AWE gyp' �■/g•■ � a WON. Ran t°v'r-�`Si. L rKr AKuaK �w. ALL R; WurM'.��°rovare' ' cAF'ea - n x+�o`Pr u■irWon IL■oLT■.u`K"io rKKKcrow p�A� _ �O`� � ���•�� �9 ■6 r I■fJ! VATKM roOTOlO■TO Re/rlcTa'Is CORLT!<T■w R••f■ARs■AP/-T. ■e Dyll� 6i F nu■no■Au Ar�dc•■•AA�y�mW�'.. GARAGE ... 1. m�p ooal R r-■yr r-■v* 14 yr T- yr } { GARAGE • , • O�t�'LOCK i ] Mto11AR_Q'AA-'f_OQ,r,IJfLlfOlt r TORA■Oa DOOR■ . M UNFINISHED pKp-� �■ y■R s STORAGE Y IQW4AAEVTfo llp�rAmomm 4 ��m R Aj pTA RIAC���oj n �ARR• ( h<U� TTVG P;0G Z M 11 .= < • - Qa Q ♦ 1 eAR•�ORYd 4' L 2 u wJu E N L e�w �R■ATggRrlr.M io V (�J_ "T.•W+S- 0=T. M1lAKMRYAT OM O O_0(n p[p�♦ p�pAly A� Q W Z ` KY n'AT DOOR Or■YMG■ Y� ^ IKtn •f�F-Q LOG TIM TO T Z V� + oR T' °■ Q = F-W ar aF � a \ O BASEMENT NOTES: Of w Tor A o ■ a T f�W.W.'JI ` � P � rr ry rr r-r r-a ► OOIltR KOOK AMM WOKR ALL rARALL/L rAlH1q■■ r-r l-► L'o' vo a Da■T Gr M M r MWLO CaMG OR DOITAC7®16L. - Y',yr ( O art JOMT■AIONG■A11■No■am CnLYRR NIY. �� OpK�RAD�y�RWroY ■ T �TLA"m u bp5 �-O IINMMI lstwt l aK■YM nm A rap ?m 6 u ."Tm i T.rROYCa O ■"NM ft M AT RRO■Or■T ■■AN.T . 6 ! I.WE RRUCrdRALL DRAINIK"M�RyI�OeCwJ�ITTPM Or ALL aTRNRK�ICw OOWI MUYbArXYr RI ■'if �� oMfTi�Fc T f.*. 3 R p•aA�p� M -C L FAIL• • � � O 0 jig Vf ly Vr Yy fK• {'y Vr !-P f-N.V! f-x Vt' Id1 Vf i'b Vt' r- of sv of r-r r�yr z-r EE . W 1 3 uu xaca ucx �rn r ] Ulu IUU w wa tr,.uce a,.ry. r C RASTER = �o F �6 CLOSET y Q PLUM HIARTH atrec ner pOOp ` w g ux� xi a aex r a{ ♦-i v* aw Tr GREAT ROOM 414» ouak LAUNDRY t a Y OC p r.air T twdr-rys KITCHEN �: �� �,���� ��d• s 4 ,w f i,; ikd 9� �ggfll q sue{yr r- v* -c rur -r mp BEDROOM r-P » ITv� t+ �nn<Vooa !el8�ldll�K$��l� S °a «4 to cvu -s ■I n eOwnc rn• CLObE t!R AREA ST °or�"a "4uiwui»"!XXTw Z Q� uu � � � DINING ROOM 1 ► �• !-y ro i•a Q� sac aTE► 4 CAR GARAGE J V Q Q f�ueccw 44X21 i Q. G � ENTRY c • ddd um ] POYER «�n auam �Ar�.'a�a�oo x�i�i PT tL w r:v rn 4, o tA= ,V-J •�a'�' °i�K1 p w a s p F ucx xen uu J LA DaO W N t ``° r• b fi� r 1 SCREENED 6 PORCH an rrr'. 7aG a uoSFra ` ' i a z F O r 7 ] Q i' araer LL LL F P r f-0 Y r-t VT !�• P-T 6 • Mr=xua-i6imm- a Q � Q r S�S ffi k o - A B b v� A r-f b/4 f-T --------- moo 1442 CD STORAGEQ ♦ ---------------- ---------------_.------------------------------------------ ot °ea� P BEDROOM 44 b STOR SAGE rNO1oTR,r.o'� I�oa � �e�F�� oor Ili �a�i t!1!M ,ply HALL �bii> IaliS�m f•-f s/r ati v-I yr v-�yr aK r�r aw HALL I��Id�Qy�'� E��� r-s vT •1 + STORAGE2 ___________ r 0 , r a BEDROOM a3 C.T.1 OFFICE i• J •• Q a ♦ IL O • F Wry Q= • • • l]l� Louo O W r� ----------- m N r+yr r+I/f' �a• *�vji p o ro rao I/r a�tT r-o v-v tH' '•, Z W fV 7 N uW.Y LL L w W Q F < a 6® O �1I♦t�yS�I�ap[p��4,iyy, �oa�aa"` • - :It•OG Wteii OT/f�iii!`MOTf�D`.� • �i""oye oi/a�ufaotn. frali ■ q B O E i a COIl70C101r RmGi V"Ii yy 7�00'H1,14tJ< ■i r r v sao■wr n� e n OiL\1CM 'RF CL+ f2a ,,,a a.,, r� EE . W-W (/] �C�CCOIIG lLOOR� I --- ----------° '--------- am wm y D U F3 cn rn� >tr, s pu iwa uu uu -a,a uu a.a aw, an: ma r w*oM�a+ar CIOUM �e a�uiww noon aa,eu err.eAr. � 7 fill - CO.,�. ro FADCA a yr C w nemnra Q «.,81 = a V BCC O ��Y u o H W Q Q Kim W j �.co.o nose IU - z eoavr � - -------- -- PD"40—"————— ------------------------------ wiou .o,un. �� V a�.on wmea wow p 9'ACWM "van :d � . ma < i 0-------- -- --- -- ----------------- ------------------------------------------ r wron wuoa moor r■c,ms oTOM r 6f wn w�oa o000 � — ------- �MflASTJMle ------ --------------- Qom • r N E q goo RAM TEN aW uRe TRAI TM- CORTW"wzw v[IR t 0 A&F N T RO01 SHISMA Jll rm i Ir � �F� .V.•cam Ne1.DE6 - KOOK DOD WRIS/ �n - ---------- - ---.---- .O v �e F771TON UNDOW N.AM ]K) )K) 4 ]K) d ]1K R� r1¢aJ 00 smomm Lsf YYEp�I ' -------- 1.MT H4Y1] oil � lE lop I I C.x]WmiE R.10.YRRT A.MNLT Reor.N.e]. N . Qo <Q UW� vas Da TRIM FTD.w BRAD Z Y N ] i RED TRIM.PM V BRAD-0 U � Du TRIM FTD.E/BEAD F UV z j W�u .yr CROW NeEBEp woe 11­ exmRaraooR --------------------- -----—ue— %,Oft TABLE W =t-F;VV _ Rc.PAEaA.FM f—ILLL _ oaisn ewn Eoum. .IIO.N N Y.IR W LESS j. uTTmot �OfD OAEA.I Doer. �L OfE EOFI4T,FTD. r CROW"LOC. ]61 .y�uYv�sa NO FRIUM W DEAD V ----------------------- ———————�Lf44e6� 6 OTYPICAL EAVEgG O IZ w • � � Q . y Ai ^vaaur Aa ° COMTNW° 190M VWO ° •fPI ALT•o°'awwf f str Cox f/•ATHf4 N.YOM°►M!n ry T .0 —MOO IOGti rf11L a s ° T �°• STORAGE v.rr SAM& a r rMW x[� �p� W I1LY111of1 fYTTiR .0 �•Oe°M rf b 12 • ° o�utp E.gg i Tu°' STORAGE - BEDROOM 83 ; ��� Juif'AX "fM��016 r�e•�v�Rs vr��r�Mto°x ————— Ycoa°neae� EE BOOR —————— ---- a4 Ea e yr COIL Y.A'rW Z�7 U MASTER MASTER SCREENED PORCH MASTER MASTER w BEDROOM BATHROOM BEDROOM BATHROO ENTRY DINING VM Mir O�� S FOYER 54 ROOM r A.{ vrar�• .s�L°°� " yrTtp►Lira � � •¢4a —— Otllf.D A �11 WW�D.M T jb BASEMENT ` GARAGE BAY GARAGE BAY rOTTO11. 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