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Home My WebLink About0184 WAKEBY ROAD - Health'7 No...d... ..:�.1._/... -~�+ Fizz ........... THE COMMONWEALTH-OF P ASSACHUSETTS ' Z 7 BOAR® OF HEALTH ®.dam ate.............OF... 's ApplirFatiun for Ili4puual Works Tom1rartiun Prrutit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: ....�A%� z3 S� .... S � ,�l i•G�.S------------------•• -a .......------'-- ............. ..................................... _. • ......... cation-Address or Lot No. ... -- -----------•-•••-••------•---------- aW --• --_. _-- -------s-o--Q--------__--------------•-_-_--•--------- Own Addre 601KC "............. ...... .� --- ---•---•-••------ .......... Installer Address erg, U Type of Building Size Lot.6554 _'_..Sq. feet �- Dwelling—No. of Bedrooms.......:....................................Expansion Attic (Aw) Garbage Grinder (M) a Other a —Type of Building -------------------------•-- No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures --------•----------------............................................................... ............................................................ Design Flow................ ................gallons per person er day. Total daily flow............................. W Septic Tank—Liquid capacity/ gallons Length.-W.' ength_W.��'.___ Width__��rL' Diameter____..`. -__- Depth_�.�8_-- x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--__---_____________sq. ft. Seepage Pit No-------/----------- Diameter....../5?t.`._..... Depth below inlet.....�a_.'....... Total leaching area.jg4t7.....sq. ft. z Other Distribution box ( Dosing tank ( ) Percolation Test Results Performed by..__�7�-"r _ _____________ _...__._...... Date.......... ��' a { Test Pit No. 1................minutes per inch Depth of Test Pit....j .._...._.. Depth to ground water..... ------•--_--_. fs, Test Pit No. 2....!!! _._minutes per inch Depth of Test Pit... ............ Depth to ground water-----A�M-_-____ ------ ----------------- =•------ ............................. O Description of Soil..----7n_`4/-----o--y--•-7- s C-c�---- �./Z, 'use--- 5-'to5-",�----••----------------------------------------- W -------------------------------------------------------•-----------------------------'-'--------------------------------------------••- ----------••-•-------------------------...................... U Nature of Repairs or Alterations—Answer when applicable._.............................................................................................. Agree ment: e undersigned agrees to install the aforedescribed Individual Se"w, age Disposal System in accordance with the provisions of iI'L U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been oisdq,�oard of health. Signed. .............. 7uP' Application Approved By........... Date -_�- .__...__ ... .......... ads Application Disapproved for the following reasons--------------------------------•----•--•-------•-------------<................................................ .................................. ..... q----•---•-•-... .......... .......................................................................... •-------•---•-----•-•--••-•••--•-----••--•----•-------•--••--• Permit No.._../....�..-...,.I_�-•-----------•---•------_. Issued_....-----•----------------------•---------Dau-----• Date Fps.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... �G` .............OF....^L_/_D. L.� Appliration for Disposal Works Tonstrartion Frrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ....Z�--.'a'-6 �3 Y /mac ' �-✓/+ 7""z -�S ,c-�r G 5 -�=a7--• -`� .... ..... -.... ..---- ................................... --•••-•-•--• . Location-Address or Lot No. -----.-•----- !t— �C =11 s=`� ,„�• '. -�•1 ----------------------------------- ---------.--•---•-------------------------- Own�� Address Installer Address 4�11f Type of Building Size Lot__ 4�-? ......Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic (00s�) Garbage Grinder (,Vc) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures .----•------------------•------.....------------....••--------•--•-•-•------- •-------------------------•---------..........---------..........--•-- W Design Flow.................�5._.___................gallons per person per day. Total daily flow__-_-3x.�� _ .--��'?e.......gallons. WSeptic Tank—Liquid capacity Aa Pgallons Length..-----._... Width.__ `9 Diameter._. Depth._ x Disposal Trench—No..................... IAidth.................... Total Length.............._...._ Total leaching area....................sq. ft. Seepage Pit No......./........... Diameter......A ........ Depth below inlet......4.......... Total leaching area..?��l....sq. ft. Z Other Distribution box Dosing tank ( ) '-' Percolation Test Results Performed by....< C�-- -?_..-..�.............. Date___.-_-�!/z W ,.a Test Pit No. I................minutes per inch Depth of Test Pit..... 2......_... Depth to ground water.....P�''�__.__._.. riq Test Pit No. 2.._.G ...minutes per inch Depth of Test Pit....1Z._.....__.. Depth to ground water------ ._____- O Description of Soil........ZR c- Lj' G/ - -------------- - - ----------------------------------------------------•-------------------- x 7"�r' Z. 0- i ' TsIS let-A4•-r ��._'_jZ'.-...�'_ C 'S 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 TITI-E 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. Signed...................................................................................... ................................ Date Application Approved By........... .. .k.___._ .�...,c.��_ :.._-- 1-- Date Application Disapproved for the following reasons:--------••----••-•-------•-•-••---------•--------------•----••--•---•--•-------•--•----•---•••-•----......__..._ ---------------------•------------•----•--•-•-------•---•--------•------•-----•------------••-------.......------•-----------•----••------••---------•--•------•------•••--•------------••------•-------- Date Permit No.............:a.== I� I...---•-•-••---•---.._.. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH !g'. Ns.........OF............. ;L) .�r+z;a.Q.r! (................................... (Enrtif irate of Tontpliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (),,-) or Repaired ( ) by ..... Installer at. ��' —��? llf_G -.�.._. .� t 12:4------..... 4... �!------------•--------------------------------•------......-----------•----------- has been installed in accordance with the visions of fili74- 5 of The State Sanitary Code as described in the u application for Disposal Works Construction Permit No------ __: ...........,1-7-_.__...... dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT.THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........: E?1.1`<. L............OF..........1 ?� �� 9� ....................................... No...`... l� FEE...... . ....... r Disposal Works Tontriulion rgrmit Permission is hereby granted...........yR-............ . - _ -............................................................................. to Construct ( �or Repair ( ) an Individua, Se rage sal System .� y �1 R at No....................... f .....U.= :..----1 '' l?. .� ......tr't^� ��.,... IN, L ,7 J Street as shown on the application,for Disposal Works Construction Permit No......_tl� Dated.......................................... ........................•----•--•---....-----•------------------•---------•••----...•---•-----.....----- Board of Health DATE............................................................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS APPLICATTIJON FOR PERCOLATION T'LST AND OBSERVATION PITS LOCATION ( ` +mac �oac� NO. 0 7/79 7Z VILLAGE r'ldrs �,.� �p��5 _ DATE l�� 9 9Z APPLICANT FEE )�0c) ADDRESS TELEPHONE NO. (Non-refundable ENGINEER 016 L _TELEPHONE NO. *77e 1/`/L Z DATE SCHEDULED N��,/, {� /55 L /p,- ) /4^ (Applicant' s signature . . . . . . . O O . . O . . O . . . . O . . . O O . . . O O O . O O O . . . . . . O . . . O . . . . . . . . O . . O . . . . . . . O . O . . . O O . . . . . . . - ASSESSOR'S aP & LOT NO: SOIL LOG SUB-DIVISION NAME DATE_ /A�A a- TIME /o.oo .4,41 EXPANSION AREA: YES.NO �S�Z-r��/L-. ,� y ,4,� 7)G ENGINEER . TOWN WATER_PRIVATE WELL BOARD OF HEALTI EXCAVATOR SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes) NOTES: N TP Z M v PERCOLATION RATE: TEST HOLE NO: ELEVATION: TEST HOLE NO: Z ELEVATION: 11 1 2 2 ToP So- c. , S u CS 5a-7 G 5 5 10 10 11 11 13 RJ �-'',�' ' �- 13 14 14 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD_)�_LEACHING PITS LEACHING TRENCHES Y UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION (ORIGINAL: COMPLETED IN ENTIRETY BY P. E. AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT 6 N Fee O. ,�.. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for IDi5po.5al 6p6tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. arcM kk�V,-�N vx�eK Owner's Name,Address and Tel.'No. Assessor's Map/Parceloq3_ 9—S Installer's Name,Address,and Tel.No. c 6rf Designer's Name,Address and Tel.No. V� dC� 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 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) Ar.&NyN"n S..i 2,s- l .,a rt, A- "k V a �. J' 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 oard of Health. Signed11= Date S Application Approved by Date y�� Application Disapproved for the 191lowing reasons ' C AJ Permit No d 0 3 — Date Issued -----------=- ----- No. Fee _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 2pplication for Zi!6pogal *pgtem Construction 3permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ��'� li.k+-I(.eby (1�. Owwner's Name,Aiddress and Tel.No. F Assessor's Map/Parcel O _ ,1��( Installer's Name,Address,and Tel.No. n -}— ' Designer's Name,Address and Tel.No. u r + V� JC fora\�ec�5�- Cph%)� Type of Building: r 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 '' k Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations{Answer when applicable)". Ak SA . r-e TI I; VVA-> kAlk-l- � N T ?V11i QCrt L VJ� b��GA r.rAfiltw 4� i V�TtT•"��nc.�\Ova 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-thi oard of Health. Signed / Date °. Application Approved by A)- S• Date Z C1 03 Application Disapproved for the 91lowing reasons K.� Permit No. 2 DO 7? — Date Issued 1 THE COMMONWEALTH OF MASSACHUSETTS h sQ ke_ BARNSTABLE, MASSACHUSETTS =` TO w �h^k Certificate of (Compliance THIS IS TO CE , tE=iT96=:d' ag Disposal System Constructed( )Repaired( )Upgraded'( ) Abandoned )byi 6 M has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.—— dated y)t/ JJ Installer Designer The issuance oft s pe t shall not be construed as a guarantee that the system o signed. Date Inspector ---------------------------------------- No. 2 00 3 , /J S- Fee J - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwiopogal *pztem Construction Vermit Permission is hereby granted to Cof'ns,t ct( ) epair( )Upgrade( )Abandon( ) System located at ) N t ,, r� 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 era�nit. Date:_ / O Approved by �•w SCHE'OVE !J-'^ — PEAS WC l 1 .i OVTEtT ,., 1rASfIED sToxE . f0• YIN. CAL D•10X `: , SEPTIC TAN! LEACH P I T ITfO PROF!L E :NOT TO SCALE r` •TRAFFIC BEFF/C N +_ iL LOAD$. "�'. to e� l o • �.,� 'E' •� 1 1 � IJJJFI � � 1 •'' f J r J 1 i J ` Rfsflt l•E :�, a' PIT l J ; I D•!oX r/2• STONE ' I 1 �l000 oAE^ •' t IN, I / 1 I J 11 1 I 1 ti� ;�v: B. ��• RR SPIKE IN 12': 11 1 1 1 J , I �9, �,�� .._--EL.• 1 r r.ss 1 I r Y •r. � w G, r. .. 144' I r a �' Si 1 • ,. 34.4V344 ; w ~ L o r 30. . At 1.W. CORNER CBI#DY loo.oo i. f2 vr0 ROAD WIR LOCATION Lp-v 3o ;SEWAGE # -(/7 VILLAGE � � A. ASSESSOR'S MAP & LOTO Ll 3=O INSTALLER'S NAME & PHONE NO. Q,J SEPTIC TANK CAPACITY (, LEACHING FACILITY:(type) PL` (size) ��o0o NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER [�A-4 (` DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 4 - 0 �-� Lo fit►o dv WN OF BARNSTABLE LOCATION to uJ(i � XjV SEWAGE # VILLAGE W%c4P St,u V L 4S ASSESSOR'S MAP & LOT6gB--G� INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY �� Ow LEACHING FACILITY:(type) PIT (size) NO. OF BEDROOMS _�> PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER NA r�'l.t�t� r DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No Cv �.- 4 H. � Ll TOWN OF JMTABLE gL- u�at.6 LO4f91-ION SEWAGE # Z`43 b VII.I:AGE ASSESSOR'S.MAP & LO �� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS �b� BUILDER OR OWNER PERMITDATE: 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 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 ACJ 1� &Act Li uc AA A � AC 41 i If 6b Y 4 r �� t COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION 4 „ J d M A� Q I� V! TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 184 WAKEBY RD MARSTONS MILLS,MA 02648 Owner's Name: TIM SHEEHAN Owner's Address: 184 WAKEBY RD MARSTONS MILLS,MA 02648 Date of Inspection: 4/20/01 DECEIVED Name of Inspector: (please print) JOHN GRACI MAY _ 9 2001 Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 TOWN OF 13ARNSTABLE HEALTH DEPT. Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes _ Conditionally Passes _ Needs Furth r valuation by the Local Approving Authority Fails Inspector's Signature: Date: 4/20/01 The system inspector shall submit 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 now 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 THE SYSTEM PASSES TITLE V INPECTION. RECOMMEND PUMPING THE SYSTEM NOW AND EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. ****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. Page'2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 184 WAKEBY RD MARSTONS MILLS,MA 02648 Owner: TIM SHEEHAN Date of Inspection: 4/20/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: THE SYSTEM PASSES TITLE V INPECTION. RECOMMEND PUMPING THE SYSTEM NOW AND EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined" please explain. n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 184 WAKEBY RD MARSTONS MILLS, MA 02648 Owner: TIM SHEEHAN Date of Inspection: 4/20/01 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(l)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance n/a "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: n/a 1 Page 4 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 184 WAKEBY RD MARSTONS MILLS,MA 02648 Owner: TIM SHEEHAN Date of Inspection: 4/20/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped n/a. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.) _ (Yes/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 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—I W PA)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. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 184 WAKEBY RD MARSTONS MILLS,MA 02648 Owner: TIM SHEEHAN Date of Inspection: 4/20/01 Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection '? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site 9 X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X Existing information. For example, a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 184 WAKEBY RD MARSTONS MILLS,MA 02648 Owner: TIM SHEEHAN Date of Inspection: 4/20/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use:(yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CM 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons-- How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1994 Were sewage odors detected when arriving at the site(yes or no): NO Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 184 WAKEBY RD MARSTONS MILLS,MA 02648 Owner: TIM SHEEHAN Date of Inspection: 4/20/01 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 12" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6" H 5' 7" W 4' 10"" Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle:31" Scum thickness: 4" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING THE SYSTEM NOW AND EVERY TWO YEARS. GREASE TRAP: _(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a e or baffle condition,structural integrity, liquid levels as related Comments(on pumping recommendations, inlet and outlet te to outlet invert,evidence of leakage,etc.): n/a Page 8 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 184 WAK:EBY RD MARSTONS MILLS,MA 02648 Owner: TIM SHEEHAN Date of Inspection: 4/20/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/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.): n/a PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a f Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 184 WAKEBY RD MARSTONS MILLS,MA 02648 Owner: TIM SHEEHAN Date of Inspection: 4/20/01 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: nla n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT WAS EMPTY AT THE TIME OF THE INSPECTION.THE PIT HAS NOT HAD MORE THAN T OF WATER IN IT. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate.on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soils, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 184 WAKEBY RD MARSTONS MILLS,MA 02648 Owner: TIM SHEEHAN Date of Inspection: 4/20/01 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. fj�,clC 4 p CA A 600 OC f� S6b eA I g 6C �� Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 184 WAKEBY RD MARSTONS MILLS,MA 02648 Owner: TIM SHEEHAN Date of Inspection: 4/20/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12+FEET w��F,s',*`-A �a'�'� ,:.-+- `-��,�'i� �e.�""a',_ - '�z^*,�,..'^;�'��`N�a�� `+'�" �`�c� ��F:'�.„yxT y wy..�:��,:• .:�,� �� ••^� ' I LOCATION �pT ljJaJ� �,`1 YL4 SEWAGE # h VILLAGE Una' ASSESSORS MAP &-LOT (�L D INSTALLER'S NAME & PHONE NO.;;. 4e-7I '3 S SEPTIC TANK CAPACITY �c LEACHING FACILIT� Y;(t �i (size) l NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC.WATER BUfLDER OR OWNER t DATE PERMIT ISSUED -DATE COMPLIANCE-IS:SU.ED•. VARIANCE GRt1NTED. N Yes o / di 7 /WI� Ll • F � - o r �-c Sep,-05-01 14:28 BARNSTABLE HEALTH DEPT 5087906304 P.O9 Town of Barnstable Regulatory Services • BARNsrAELE. y$ MASS `eg Thomas F.Geiler,.Director, 1639. Public Health Division Thomas'0cKean,Director 367 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 DATE: RE: /may 4c/a"y Al c&= I-tom j �,7/0 The Barnstable Health Division has reviewed the Title 5 septic inspection form for the above referenced property. The fbllowing comments listed below are deficiencies according to 310 CMR 15.300 and the Town of Barnstable Health reputations. Please re- inspect the system, if necessary, complete a new report fcrrn or revise the pages pertinent to the deficiencies listed and resubmit the report to this office within fourteen(14) days: C4.G lc l,.i L /a.l ,v,/yL 41.,_ +J - T— 2 LL,`17'- COr dao d.d- �9y�'rn c�. /�Gt�t lCe[�Ct 1 `'��i�•, �� p d 0. sepdrf,doc Page 5 of 11 e OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 184 WAKEBY RD MARSTONS MILLS,MA 02648 Owner: TIM SHEEHAN Date of Inspection: 4/20/01 Check if the following have been done. You must indicate "yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site'? X _ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge and depth of scum? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X Existing information. For example, a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] i S t Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 184 WAKEBY RD MARSTONS MILLS,MA 02648 Owner: TIM SHEEHAN Date of Inspection: 4/20/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a R I - Page 10 of 1 I I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 184 WAKEBY RD MARSTONS MILLS, MA 02648 Owner: TIM SHEEHAN Date of Inspection: 4/20/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two pennanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. i Betcll g 0A SIB Oo o � AA S-LI Ac G3 AD wl� � �-LI P z`�c�;� • t A 0.11 ll`--5 .I �' DY^eel j,V1t A r� Or Vol) Pre- " Sikt J r WOOD DECK - I 2•cr,12• l g�I via 0 .0 I I ' I ' KITCHEN O i DINING HATH IGARAGE I DE^ D�TDA•M, I VING I —up _ J vrwtM4ct s c CA bedfvvm- FIRST FLOOR PLAN �ivM f'414^ {rmcr oedream- I I BATH i _ BEDROOM r I JJ MASTER BEDROOM I f f 1 � • L J i I S T O R A G E S T O R A G E t Ir - - — — — — — — — — —— —� L I — — — — — — — — — — — J SECOND FLOOR PLAN oft►,E T�,�, Town of Barnstable a Regulatory Services • anarvSrABLE, '* y Mass. g Thomas F.Geiler,Director Public Health Division Thomas McKean,Director 367 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 DATE. 7zye VI .Qd 1C Z J/ er, *-?At '4ZPL 0zr3 6 RE: ' c(/R Cf The Barnstable Health Division has reviewed the Title 5 septic inspection form for the. above referenced property. The following comments listed below are deficiencies according to 310 CMR 15.300 and the Town of Barnstable Health regulations. Please re- inspect the system, if necessary, complete a new report form or revise the pages pertinent to the deficiencies listed and resubmit the report to this office within fourteen (14) days: CCI cl is /� A—�v t�.of l -41 S- d,4- /'@.9611 re CP, GLt 1 Df a-I sepdef.doc i r.n _ on U z o w >- o rt� fir► - - ---- - � w - o a . _ O _ 1 5 N `a "rn Ni � 1. � J *72� , DESIGN CRI TER IA : INVERT ELEVATIONS : GENERAL NOTES : DESIGN FLOW: INVERT AT BUILDING: Jv7•ss 3 BEDROOMS AT Ile G. P. D. PER INVERT' 1N SEPTIC TANK: /v7. 25 t , 1 . THIS PLAN IS FOR THE DESIGN AND ///,o -ACCESS COVERS MUST BE WITHIN BEDROOM EQUALS 'oG. P, D. INVERT OUT SEPTIC TANK: /o7•a CONSTRUCTION OF THE SEWAGE DISPOSAL FIRST 2 TO 12' OF FINISH GRADE BE LEVEL INVERT IN DIST. BOX: /off SYSTEM ONL Y. !-2-L GARBAGE GRINDER ` INVERT OUT 01 ST. BOX• /off•7 PVC MIN. 2" OF . 2. ALL CONSTRUCTION METHODS AND \LSCHEDUIE PEASTONE SEP /NVERT /N LEACH PI T:�a7� TlC TANK REQUIREDMATERIALS FOR THE SEPTIC SYSTEM 7•SS -- op.7 : ' - BOTTOM OF LEACH P/ T: /oo• S �l �5_ o6 aL.S G1 _ -330G. P. D. X /SOx - 41SS GAL 3/4' 1112' D/A. SHALL CONFORM TO MASS, D. E. P. ADJUSTED GROUND WATER: WASHED STONE SEPTIC TANK PROVIDED: / �� GAL :. : . T a� � OUTLET oo. < � OBSERVED GROUND WATER r l TL E 5 AND LOCAL BOARD OF HEAL TH 10' MIN. .L—GAL D-BOX , LEACH PIT REGULATIONS. SEPTIC TANK SIZE OF LEACHING FACILITY REQUIRED: 330 G.P. D. PROF I L E : NOT TO SCALE 3. ALL SEPTIC SYSTEM COMPONENTS LOCATED DESIGN PERC RATE - �- Z MIN/INCH REVISIONS : UNDER AREAS SUBJECT TO VEHICULAR TRAFFIC - �- _ NO. DATE REVISION OR GREA TER THAN 3 • 1 N DEPTH SHALL BE PROVIDED:_ 'PIT(S) W/ Z 'STN. CAPABLE OF WITHSTANDING H-20 WHEEL LOADS. SI DEWALL : S. F,X t - GPD ` o \ - `` BOTTOM: 72 S. F.X , 0 79 GPD 4. ALL SEWER PIPE SHALL BE SCHEDULE 40 . o a" o�` o° o�'.�o J TOTAL : ?G 7 S.F. SSA' GPD J q I 1.45I'p `Eo 210.87' OR APPROVED EQUAL . I N 83 SOIL TEST PIT DA TA 5, BEFORE CONSTRUCTION CALL 'D l G-SAFE 1 1 I 1 -800-322-4844 FOR LOCATION OF „ I I I 1 f ! `.�'. I ixDICATEs y INDIcaTEs I i RESERVE ZONE : RF PERCOLATION — , a I I EST GROOBSERVED NDWATER i UNDERGROUND UTILITIES. 1 ! l PIT 1 TONE SETBACKS: FRONT 30'' ! ! I I I l 000 GAL D-BOX W12' S SIDE /5 ' TP• / TP• Z 6. VERTICAL DATUM IS: ASSUMED I I I i sEPTIC TANK GRND EL. ��+ �' GRND EL. i aa; f I ` \ h a REAR /5 ' t I ( \ o B M,' RR SPIKE IN 12' P/NE 7. FOR BENCH MARKS SET. SEE S/ TE PLAN. ' ' 1 .� �, EL - 111 .5504 G,W.EL, G. W.EL. ILµ•I I p�F p9 F`p w TvPf.o) j.. .w O t F 51 •• I T •I 1 1 - , IL 23 Ln z I 1 .1 co as o �1P , .. � .. •9 .� � / I ,. \ I - I 1C tri I't i GZ� � Litt/i /�� - /z 45 ,4zo.✓ Z'� /ESL 34• .W DATE •p8 44 •h. / I S 78 1 ► B y ff a ,,,:,. , M • T #2� 80 31 i _, TEST : . ac e 'W T ESSE BYE I f,, . 2 a I N D,, , t s R A, e 1 1 1 PERC RATE Z- M/N/INCH I . _f J S. YS TEM v I - r ; T L L 0 T 30 ' ► • R S � �. O /VS M L S� I °'•t. 69. 585t S.F. +a, �. p.,.,, ;, _ DVS,�`"'a'r �•.�r.".`MI # '•`'Y •... . _ '. ,... • 1'-, _ ld, "� .- I � , of ,fr, ;r,' PREPARED FOR . ,. , . A P i M K, Irl O O P P . , C O FR C.4 L E : / -4 O MA R Cl� a 3 3 I NG . I N C CORNER CB/DH \ M L 5, 0 J ® .S'Bd � OczrC,� ; Lang EL . - l 00, 00 ---� 5 0 ' , t /o" R 2 h'y crn n t s Af �bt — p R QA ; , ,. WA KEEB s ✓OB NO: 9? O ?O �O 80 =330 FIELD:CFW/SAN CALC: CFW CHECK: CFW DRN: SAH Ili