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Home My WebLink About0543 WAKEBY ROAD - Health y,,10 543 Wakeby R® d --� Marstons Mills ---- — ---` - A= 028 062 TOWN OF BARNSTABLE Y LOCATION SYS k1lefR&C 12-0 SEWAGE # VILLAGE 014a5T6 DVS AIILl !3 ASSESSOR'S MAP & LOT LS 62 _ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /60b LEACHING FACILITY: (type) (-h 4,wAw-5 Q 1 oO/ (size) NO. OF BEDROOMS BUILDER OR OWNER e,%Lw- n C'[aur e.£ 4 PERMTTDATE: LII 11I b7� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet ti 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 Az 73 3` �Z c (01 ` r CL1 y s 1 . 8 { ~ '�`�.• .. . 1. _ TOWN OF BARNSTABLE LOCixTION -Sy-3 WAYLP, SEWAGE # V VIL`L1s:GE MACZ06 �+�-e3 ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY kLco G/kt LEACHING FACILITY:(type) �c�C� (J Z r (size) NO. OF BEDROOMS �'— RIVATE WELL R PUBLIC WATER?nuP(�t BUILDER OR OWNER - 1`6\andl� CCUV 't DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No Fc-)f"..�1 S1q j 6,y NDfnolol s� -110000 i Q e � I' K �L 26��-sib T 44A,"l 1�1 D rT1dM t �-p I 1 V� Ict ,fps U-V� ot Q I\ 1 p, �� ` s UL A 0/ 0' 20A IVOL Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 543WAKEBY ROAD Property Address BANK OF AMERICAN SEC HUD Owner Owner's Name information is required for every MARSTONS MILLS WIA 02648 04M 112013 page. Eiiji-Ton state Zip Gwe 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 A filling out forms A. Generale Information Tm on the computer, use only the tab 1. lnspecto;r key to move your cursor-do not DAVID J BLYRNIE use the return key, Name of inspector NEIGHBORHOOD WASTE WATER V�Q Company Name 350 MAIN ST Company Aduaire&s WEST YARMOUTH MA 02673 Cityrrown State Zip Code 508-775-2820 SI-386 Telephone Number License Number < B. Certification ;0 I certify that,I have personally inspected the sewage disposal system at this addres and that Ale information reported below is true, accurate and complete as of the time of the ins c t i o n. T hd i n 111;p iez i Lion n I i ,I was performed based on my training and experience in the proper function and ma tenance-of on 5j e systems. I am a DEP approved system inspect r pu uant to i ec ' sewage disposal 0- rs Title 5(310 CMR 15-000). The system: I A e*,S Passes F❑ DAVI D Conditionally Passes =0: B U RN 1 Ez ❑ Needs Further Evaluation by the Local Approving Authority = ST3 86 I 041115,120 1 N S V) Insp ignature i Date The system inspe or shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. if the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DER The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3/13 Tide 6 Offli��iai Sutcvfface Sewage Disposal System-Page I of 17 Commonwealth of Massachusetts 0.- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form a Not for Voluntary Assessment's 543 WAKE-BY ROAD Property Address BANK OF AMERICAN SEC HUD Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 1/2013 page. 16ty/717--14f;,,,-—-,— -�t�te Yip Code Date of Inspection B. Certification (ciont.) 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: INLET TO SEPTIC TANK UNDER DECK AND COULD NOT ACCESS 13) System Conditionally Passes: El 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 'CIO years old is available. 0 Y ❑ N 0 ND(Explain bellow): .......... ............ t5ins-3113 TWe 5 Offim!lj"Ispoctlion Form Subsurface Sewage Dispusai SWe.-n•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fol Subsurface Sewage Disposal System Forma Not for Voluntary Assessments 543_WAKEBY ROAD Property Address BANK OF AMERICAN SEC HUD Owner Owner's Name information is MARSTONS MILLS MA 02648 04/11/2013 required for every, page. City/Town -- --- State Zip Code Date of tnspect'se B. Certification (Cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Sar d of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain bebw): ❑ 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 pipes)are replaced ❑ Y 1-1N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required b the Board of Health:q y ❑ Conditions exist which require further evaluation by the Board of Health in order to;determine if the system is`ailing to protect public health, safety or the environment. 1. Systems will pass unless Board of Health determines in accordance with 3110+3MR 15.303(1)(b)that the system is not functioning in a mariner 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 Meet of a bordering vegetated wetland or a salt marsh t5^. 3»3 i i;la 55 0fwai i nspemon Fo,--.St oskmace Sewage Gisposai Sy-em Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 543 WAKEBY ROAD Property Address BANK OF AMERICAN SEC HUD Owner Owners Name information is required for every MARSTONS MILLS MA 02648 04111/2013 page- Gityrrown state Zip Code Date of Inspedion B. Certification (cont.) 2. System will fait unless the Board of Health (and Public Water Supplier, if anyj determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ T he system has a septic tank and sod absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water-supply. [I The system has a septic tank and SAS and the SAS is within a Zone -11 of a public water supply. [] The system has a septic tank and SAS and the SAS is within 50 feel of a private water supply well. El The system has a septic'Lank and SAS and the SAS is less than 100'let 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 !abora-tory, 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 ana!ysis must be attached to this form_ 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ED 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 Y2 day flow t5ins•3/13 Title 5 Offic6ai inspec"Gri Form.S16SUOZICe rage 01?OoSal SySte--r.*Page 4 of 97 Commonwealth of Massachusetts Title 5 OfficialIns ection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'h a:, 543 WAKEBY ROAD Property Address _ BANK OF AMERICAN SEC HIED Owner Owner's Name requir on is MARSTONS MILLS _..___..... MA 0�648 04111/2013 requiredd for every -- ----- — -- -..._ _.. _ ..._. page. Cdyrrown - State Zip Code Date of Inspection, B. Certification (coat.; - Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipets). Dumber of times pumped: ❑ z 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. Q Z Any portion;of a cesspool or privy is within a Zone 1 of a public vvell. ❑ ® 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 qualit, analysis. [This system passes if the well water analysis, performed at a D P certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. The system faits. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems- To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd_ For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions In Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (interim Wellhead Protection Area-iWPA)or a mapped Zone II of a public water supply well if you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system, considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5iw•ao.3 Title 51 M.ldat Inspect-ai Formn:Subsirvace Sewage DtWsai sys:oirti•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y � 543 WAKE',BY ROAD _ Property Address BANK OF AMERICAN SEC HUD Owner Owner's Name information is required for every MARSTONS MILLS MA 0264$ 04/11/2-013 ---.--_•-._...___.,�.._� page. City/Torrn State Zip .ode_-- Date of inspection C. Checklist Check if the following have been done. You must.indicate"yes"or"no"as to each of the following: Yes No 0 ❑ Pumping information was provided by the owner, occupant. or Board of health ❑ Vvere any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flaws in the previous two week period? ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ Z Were as built plans of the system obtained and examined?(If they were not available note as N/A) 2 ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? !� 7 Were all system components, excluding the SAS, located on site? ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ Existing information. For-example, a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable);31Ct CR 15.302(5)j D. System Information Residential Flow Conditions: Number of bedrooms(design): EST 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 110X3=330 t5ins•3113 Title 5 Official inspection Form:Subsurface Sewone Disposal System-Page 6 of 17 Commonwealth of Massachusetts -- �� " �� rn Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 543 WAKEBY ROAD Property Address BANK OF AMERICAN SEC HUD Owner Owner's Name _ information is MARSTONS MILLS MA 02643 04/11/2013 required for every - ...... ._ .._.._. _ Page. C;tylTown Mate Zip Cody: Date of tns coon D. System Information Description: Number of current residents: N/A Does residence have a garbage grinder" Yes No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ( Yes 4�( No Laundry system inspected? Yes [I No Seasonal use? El Yes F-1 No Water meter readings; if available(last 2 years usage(gpd)): Detail: RECORDS SHOW NO USEAGE IN LAST VVO YEARS. LAST RECORDS OF USEAGE ARE FROM 2010: 72,000 GALLONS TOTAL AND 2009: 92,000 GALLONS TOTAL Sump purnp? [ Yes No Last date of occupancy: Da _ te Commerciallindusb al Flow Conditions: Type of Establishment: -- --- --- — ........--- Design flow(based or�310 CMR 15.203): -- ----......_.....---- Gallons per day(gpd) Basis of design flow(seats/persons/sq.4., etc.): Grease trap present? E] Yes 0 No Industrial waste holding tank present? El Yes [] No Non-sanitary waste discharged to the Title 5 systems? Yes .No Water meter readings, if available: 15im-T'3 Title 5 OtfCia lespeCUM Fom:Subsuftee Sewage Disposai-System-Page 7 of i7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposai System Form Not for Voluntary Assessments 543 ANAKEBY ROAD Property Address BANK OF AMERICAN SEC HUD Owner Owner's Marne iion is requirenformatd for every MARSTONS MILLS ...... IVIA 02648 04/11/2013 page- Cityrrown State Zip Code Da,t e-,-—ofinspection D. System Information (cont.-I Last date of occupancyiuse-. oats Other-'describe below): General information Pumping Records: Source of information: LAST PUMPED 9/1/2004 Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: gallons How was quantity pumped determined? ---------- Reason for pumping: Type of System: z Septic tank, distribution box,soil absorption system El Single cesspool 0 Overflow cesspool ❑ Privy El Shared system (yes or no) (if yes, attach previous inspection records, if any) El 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. El Other(describe': L51111%-3113 Title 5 Offiaa;inspectan Form:Subsui—we Sew age Disposaf System-Page 8 of 17 Commonwealth of Massachusetts - Title 5 Officialr 1-1 Subsurface Sewage Disposal Systems Form -Not for Voluntary Assessr nen>s 543 WAKEBY ROAD Property Address T BANK OP AMERICAN SEC HUD Owner Owner's game information is MARSTONS MILLS MA 02643 04111/2013 required for every _ ___..._. page- Cftyrrown State Zip Code Date of Ins ction D. System Information (cant.) _- Approximate age of all components, date installed (if known)and source of i fforrmation: Were sewage odors detected when arriving at the site? Yes Nc Building Sewer(locate on site plan): Depth below grade: UNDER DECK. UNKNO VN feet Material of construction: cast iron 0 40 PVC other(explain): — -- --- --- Distance from private water supply well or suction line: feet - Comments(on condition of joints, venting, evidence of leakage, etc.): OK AS TO WHAT WE CAN SEE Septic Tank(locate on site plan): Depthbelow grade: - -----._.._.....OUTLET 6"-- - ..........------ feet Material of construction: concrete l metal fiber lass ' � � g � polyethylene �]other{expfaln, 1000 GALLON SEPTIC WANK. NORMAL LEVEL if tank is metal, list age: _.— years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate), Q Yes F1 No Dimensions: Sludge depth: tsins-_V13 Title 5 Ofrici2l inspection Form Subsurface°,.=^rage Disposal;system-Page of 17 Commonwealth of Massachusetts Title 5 Official Inspection For am Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address BANK OF AMERICAN SEC HUE) inforrnation is page. cityrrown State Zip Code Date of in_�pecii_on _ D. System Informatior (cont.) Septic Tank(cont.) Distance from toP Of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottorn of scum to bottom of outlet tee or baffle 14" How were dimensions determined? i APE& EST 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 SHOULD BE SERVICED EVERY YEAR IF USED YEAR ROUND. EVERY TWO YEARS IF SEASONAL Grease Trap(locate oh site pkun): Depth below grace: -- -- — ----- hyet Matedal of construction: E! concnabe Flmetal fiberglass FlpolyethyleneFlother/axmlain): Oknanaionn Scum thickness ----------' - Distance from top uf scum bo top of outlet tee cnbaffle Distance from bottom, ofsCunntubotton) VfouUetbamo/bafDe - Date of last punn � Cate ------------- mmv'oo Title aonmla I in.°��oil m�.SU^=�r 0o�Vwo uaw0-nymys*m'Page m0',, - Commonwealth of Massachusetts _ Title Official Inspection o Subsurface Sewage Disposal Systems Form Not for Voluntary Assessments by 543 WAK_E_BY ROAD Property Address BANK OF AMERICAN SEC HUD Owner Owner's Name information is MARSTONS MILLS -- _ - MA 02648 04/11/2013 required for every _ page. Cdyfrown State Zip Code Date of Insp;c uon Da System Information (cgnt.) Comments(on pumping recommendations, inlet and outlet tee or bare condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time e of inspection) (locate on site plan): Depth below grade: -- Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polvethylene ❑ other(explain): Dimensions: - Capacity: _ gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: 0 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? Of Yes No .Sins°3;13 Titer 5 Offlaoi i nspaMon Form:Subsurface 1cwage Disposal Yystem Page 11 of 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 543 WAKEBY ROAD Property Address BANK OF AMERICAN SEC HUD Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 041111/20 13 page, Cityfrown State Zip co-de Date of Insped- ion D. System Information 1cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet inver, 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. NORMAL LEVEL Pump Chamber(locate on site plan): Pumps in working order: L1 Yes No* Alarms in working order: El Yes E] No* Comments'note condition of pump chamber, condition of pumps and appurtenances, etc.), If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: LOCATED AND FOUND CLEAN AND DRY y' Title 5 Qffioc;al Inspection Form Subsurface Sew.,ia Disposal' ste, page 12of Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 54,3 VVAKEBY ROAD Property Address BANK OF AMERICAN SEC HUD Owner Owners Name information is required for every MARSTONS MILLS MA .02648 04/11/2013 page. Cityrfown State Do Code Date of Inspectir-ri D. System Information (cont.) Type: ❑ leaching pits number: leaching chambers number: El leaching galleries number: El leaching trenches number, length: FJ leaching fields number, dimensions, 0 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.), NONE CLEAN & DRY Cesspools(cesspool must be pumped as part of inspection) (locate on sate plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensicns of cesspool Materials of construction Indication of groundwater inflow ❑ Yes F-1 No L5nn S-3j13 Tiltla 5 -1 6ns--n PC,mn:S iul5ullaag S&—,age Page 13 ai 17 Commonwealth of Massachusetts Title 5 O #'icy t lnspect:on Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 543 WAKEBY ROAD Property Add•ess BANK OF AMERICAN SEC HUD Owner Owner's Name information is required for every MARSTONS MILLS _ -- MA -- 02648 -- 04/1 /2 13 _ __.................... page. City[Town State Zip Corte Date of Inspection D. System Information (cart.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids -- - -- ---.__. Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): f5ins-W 3 Title 5 Official;nSpectAn FOs;r.Subztxla,tie S&wago Dispsal System°Page 14 of.17 Commonwealth of Massachusetts - - -44 Title 5 OfficialInspection aw - i=i Subsurface Sewage Disposal System Forma -Not for Voluntary Assessments 543 WAKEBY ROAD Property Address BANK OF AMERICAN SEC HUD Owner Owner's Name information is MARSTONS MILLS MA 02048 04/11/20 3 requiquireded for every _. --_....._... _...._ __. ._..._._ page- Cityrrown — - -- --- State Zip Corte Date of Inspection D. System Information (coat.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. 'Locate all weais 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 r I� } i i i i I (,.jln,•Y13 Page i.+of 17 Commonwealth of Massachusetts 7. - Title 5 Official Inspection Form a' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 543 WAKEBY ROAD Property Address - _--- BANK OF A_MERICAN SEC HUD Owner Owner's Name information is MARSTONS MILLS required for every MARS TONS _-.- _-. _ MA 02848 04f 11/2r313 _ page_ City/Town State Zip Code Date of inspection D. System Information (con}) Site Exact: ® Check Slope Z Surface water Check cellar Shallow wells Estimated depth to high ground water: fee? — Please indicate all methods used to determine the high ground seater elevation: �] Obtained from, system design plans on record If checked, date of design plan reviewed: _-- Date El 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) Z Accessed USGS database--explain: You must describe how you established the high ground water elevation: USGS MAP COTUIT 1974 SHOWS ELEVATION AT INTERSECTION OF WAKEBY RD AND NEWTON ROAD AT ELEVATION 84'. LONG POND HAS AN ELEVATION OF 5V ALLOWING FOR AN ESTIMATED SEPERATION OF 33'. THE BOTTOM OF THE LEACHING IS AT 5' BELOW GRADE STILL ALLOWING FOR AN ESTIMATED SEPERA T ION OF 27' Before fling this Inspection Report, please see Report Completeness Checklist on next page, t5ins•3113 vna 5 offic w'lnspL- inr Farm s:bs.;ace gage 7S sat sy. om-:-age t6&17 Commonwealth of Massachusetts Title 5 Offir W In-Qnar-finn rewevwa x waging face Seviage . Subsur D'sPosal System Form-Not for Voluntary Assessments 4':z 5 WAKEBY ROAD � 51�01 ty,A�dd-na BANK OF:AMERICAN SEC HUD Owner Owner's information is required for every MARSTONS MILLS MA 02648 04111/2013 page. City/7own -Z—i-p- Cad-- Date of finspect-,on E. Report Completeness Checklist Z Inspection Sumn ary:A, 137 C, D, or E checked Z Inspection Summary D(System Failure Criteria Applicable to All Systems) completed System Information—Estimated depth to high groundwater Sketch of Sewage Disposai System either drawn on page 15 or attached in separate file 15ins-3113 Tal 50fF..,601 inspedion Fom Subsu^ace—,�wage 1�jspos@i.1ystern Page!7 0f17 _ _ r 1 Viz.• r .y A3vl7d�z n . ( 1 ...... . { i i No. f` Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: , f; Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for izpogar *pztem Construction Permit Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) Complete System Individual Components Location Address or Lot No. SlJ e,J�} �� 1Q'D. Owner's Name,Address and Tel.No. rM►��s`o►�ys Vtiu_�..5 '.2v�ai�.\ cO �iv� Assessor's Map/Parcel .8 6� -27y -2.3 u•-6010 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. e9 ) 30.ink `l1 jl►rl�l�g�o►5s ��ws �:n b� 7 -9oS 08 3 -z Type of Building: ti Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons v? Showers( ) Cafeteria( ) Other Fixtures J Design Flow 33 O gallons per day. Calculated daily flow 3S3 gallons. Plan Date Number of sheets 3 Revision Date Maki— Title Size of Septic Tank 11660 a , Type of S.A.S. L, r Z Description of Soil Nature of Re air or Alterations(Answer when applicable) U ® r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss Board realth. Sig Date �� 5 Application Approved by -- Date r� / Application Disapproved for the-following reasons Permit No. �--� J Date Issued l x No. O� j ' RF ,t1may �� _..w:.r- Fee �/ Y � 4 THE Q-MMONWEALTH OF MASSACHUSETTS Entered in computer: - . PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS Yes ..x Z(Ppricatiou for ioogal,,6psacm Con!5truction Vermit Application for a Permit to Construct( Repair( )Upgrade( )Abandon'( ) O Complete System ❑Individual Components 4% Location Address or Lot No. A tE 6� 9 Z, #Owner's`Name,Address and Tel.No. Assessor's Map/Parcel: {m1QR S�OtJS hM1 ll„t.,5 1�4i din a C��" %z8 10, 23 Goo Installer's Name,Address,and Tel.No. Designe'r's Name,Address and Tel.-No. '- s eQ� Erb), -CI m et ovJs mms pc). k007aG-9U5V 0 8 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons i3 Showers( Cafeteria'( )M Other Fixtures /r • Design Flow 230 gallons per day. Calculated daily flow . g P Y Y �S3 gallons. Plan Date S 16,4Z, Number of sheets Revision Date tj0TJL, Title Size of Septic Tank ,e)60 !al Type of S.A.S. Lear CL 'r SOAv3 Description of Soil: Nature of Re air or Alterations Answer when a r' ( p' .1 ( applicable) Ut ctyr.)" \_61 Ca #ter Date last;inspected Agment: 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 issu,W--by this Board o ealth. ` Sig d—"--: Date %124 !OS Application Approved by -- Date Application Disapproved for the following reasons Permit No. c�— `� Jr`o Date Issued f 11-5 ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS k BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS JI TO CERTIFY, that tthheJ On-site Sewage Disposal System Constructed(�C.�Repaired ( )Upgraded( ) Abandoned( by ' v- at Jr V-Q yY1 I S d has been constructed in ccordance with the provisions of Title 5 and the or Disposal System Construction Permit No. 602 5`35 6 dated Installer @.� "5 Designer VAINVIN,4 r The issuance of this permit . �,,I o�e construed as a guarantee that the system will Inc on as designed. Date Inspector � ————————————————— — No. � �..,' �,. � Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS Digool *p.5tPm Cou5truction Permit Permission is hereby granted to Co ( Re air ("�Upgr' e^( ) bandon( ) System,located at T cs� Y!) 1 ' and as described in the above A`licationlfor Dis osal S stem Construction PP- P Yertrut The�,applicant recognizes'hisi'-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 perm 1 . Date: _ _._ Approved.by f L 1 � 9/16/03 Notice: This Form Is To Be Used For the Repair.Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, A4 W 14- MA hereby certify that the engineered plan signed by me dated g l l los- concerning the property located at S VUA-V meets.. all of the. following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: Q A) Top of Ground Surface Elevation(using GIS information) 6�� •O B) G.W.Elevation +adjustment for high G.W. _ t4 )40 (1 IA) r DIFY.BETVEENAandB r �I 2O SIGNED : DATE: NOTICE Based upon the above information;a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. qAS-eptic\percexemp.doc Town of Barnstable Regulatory Services Thomas F.Geiler,Director BAIWSFABEE, x a Public Health Division aTFp �' Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: - U( Designer: / ��k jt ( v"l r Installer: ep l C Address: . P.Lq 86K gal Address: Qb_ �x -7 1 On was issued a permit to install a (date) (installer) C septic system at based on a design drawn bye ' GBY (address) `� `� I CD _� ' dated Fr (designer) ' N) p a rq certify that the septic system. referenced above was installed substant'ally according � to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i'e. greater than 10' lateral relocation of the SAS or any vertical on of any component of the.septic system)but in accordance with State &Lo s Plan revision or certified as-built by designer to follow. DARRE �yGN o M. EY N 11 0 a er's ' ture) /srEa�`® s�NtrAM (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNS RYN PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS BUILT CARD ARE RECEIVED BY THE R;LNSTABLE PUBLIC BEALTI3 DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form r. CFO No.-------------------- Fee--- --------- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVell Congtructionpernat Application is hereby made for a permit to Constr/uct ( ), Alter ( ), or Repair (-- )an individual Well at: tj o/S�_1+S M t G Location — Address Assessors Map and Parcel ` �o u ti L �u/ z If/J�.�___ — n-t 6/S ------------------------------------------------------ ------- ---- Owner //✓� /� Address Installer — Driller Ad ress Type of Building > Dwelling---h t- --------------------------------------------------- Other - Type of Building----------_-------------------- No. of Persons-------------------------____--________ Type of Well `1 - —i —----------- Purpose of Well--- fin"--------- 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 a Certificate f Compliance has been issued by the Board of Health. Signed - Application Approved By— -- -------------------------------_-_-____-- --____-- date Application Disapproved for the following reasons:----------------___________________________----------__ -----------—-- -- ---- - — ----— - ---- —---------------- r� 0 L/ date PermitNo. "2-- ------------------ Issued----------------------------------------- — -------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ') ---------------------------------------------------------------- Installer at- �y3 wc� /�� AJ - - Xt6rb N,ti ,. !t/( - -------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection �� al Regulation as described in the application for Well Construction Permit No. ------------------ ____Dated---��- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- --�Z S �f ---�------------ ----- Inspector----------------------------------- ----- . .u. .r.'�.......��r�"_.-u..-p.`.r''"''_`�[r'y`,�i;4{.��+.,:. `LYE`;-rj _�r�''�i`�,�71r`."�tyYh'M.:.�l'�6`•^.rs.�.trrrtYvR7r�wr4;^-�-N/��i-�.^r,`. !G{�k+ft�"ft No ------__ - BOARD OF HEALTH TOWN OF BARNSTABLE - ��Cication,�or�e1[ �on�trutton�ermit � / Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ("/)an individual Well at: -03 ' -` 'Q K ��--------- ---- ---- ---------- ! + Location — Address Assessors Map and Parcel --J?o_IC,.�1 -(,01A I,,')) e t 4 3 t..�u l(/�a .�. /�+ i S ]�J.. s a Z. -- - - --- ---- --- -------- -- -- - -- _ --_ - COwner Address --:J —u—N /wf_.S�i a --— a ----—-------------- -----=--- ----------------- - - -- Installer — Driller j I ( Address Type of Building Dwelling---/u ------------------------------------------------- Other - Type of Building----------------------------A No. of Persons------------------------------— --- t Type of Well --�`�� -- -- - --- - -- - Capacity-------------------- ---------------------------- Purpose of Well--- 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 a Certificate .of Compliance has been issued by the'Board of Health. Signed ws/; Application Approved By'- ----- -—-- ---- —--—— -- ---- { _ date Application Disapproved for the following reasons:--- ---------------------------------------------------------------- ----------------------- - -------------------------------------- ------------------ ------------ — date Permit No. `� _�__ ---- Issued---=---------------------- - —- ---------- date s BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual We1T`Constii cted�{ ); Altered ( -); or Repaired J..,. ., d D A Sou N,� /I w i d�it + Installer' / r at-- y3___ l ±�< y—✓�`�W--M rs toS �+ r_C-- - --------------- --- ------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well'\Constructiori Permit No.W- 9-6---01---Dated--- -J�------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. -2 sly ; DATE------------- --- ------- Inspector---------=-------------------------=---------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE IV-ell eon5trur on permit CO _ � No. -------------- � Fee--------------- Permission is hereby granted-�—., e CA rj A-Le �/ �'{ `'! _------—___ to Construct ( ), Alter ( ), or Repair an Individual Well at: street N shown on th�Oplicattioon for a Well Construction Permit No. ----- -- -- -�v—��--�—----- — - Dated-_ /- ----- ---------------------------------------------- ------------------- -------------------------------- Board of Health DATE---- - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL NVUltKS CONSTIlUCTION I'EltRil*l' (WI'1'IIUU'I' DESIGNED PLANS) ] , hereby certify that the application for disposal works construction permit signed by me dated , concerning the property located at meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system Thcre arc no private wells within 150 feet of the proposed septic system The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED : DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system. Also if the licensed Installer posesses a certified plot plan, this plan should be submitted]. 4 r �duse I P? t, w ( �otip w 'k �r �� G A ENVIRO'ITECH LABORATORIES, INC. MA Cert. No.: M-MA 063 449 Rte. 130 • Sandwich, MA 02563 (508)888-6460 • 1-800-339-6460 FAX(508)888-6446 CLIENT: Roland Couture LOCATION: 543 Wakeby Rd. ADDRESS: Marstons Mills, MA SAMPLE DATE: 1-15-96 COLLECTED BY: DA Scannell DATE RECEIVED: 1-15-96 TIME: 12:30PM LAB I.D. #: E1117 JOB TYPE: New Well SAMPLE I.D. #: E1117 WELL SPECS. : 62' RESULTS OF ANALYSIS: Parameters Units Recommended Limit Result Coliform bacteria/100ml (MF Method) 0 0 pH pH units 6.0-8.5 5.53 Conductance umhos/cm 500 101 Sodium mg/L 28.0 10.4 Nitrate-N mg/L 10.0 0.40 Iron mg/L 0.3 0.06 Manganese mg/L 0.05 0.005 COMMENTS: Low pH indicates high corrosive characteristics. Yes WATER IS SUITABLE FOR DRINKING POSES F R PARAMETERS TESTED. XXX Date l onald J. ari Laboratory Director LT = Less Than Y - E i PO ss� �. f , 77 ?� y - fSk pp • 04 3. 777 a > kk F� �a) 7Ga�� 3 F � B CU?tL'''t F LL- / �a o ` 1 _ -Ficror �y _ e t. .............. : I T �. f, ; . s 1 i U l > Ir ovJ^ 71Z Al \ n _ _ C i 1 ' F2' e 4 a.- _ s 4 � - r ---- -------- J � 4 s Long " R and ASSESSORS MAP : TEST HOLE ' LOGS NOTES: C PARCEL: 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH o N\c 'D' 1995 MASSACHUSETTS TITLE V & TOWN OF 9 o FLOOD ZONE : I ob ) SOIL EVALUATOR : L- 4er KS e5E HIS PLAN, —T� BOARD OF HEALTH REGULATIONS. o S oo - WITNESS : T o REFERENCE: DATE: U 2) THE INSTALLER SHALL VERIFY THE LOCATIO�1 OF UTILITIES, p PERCOLAT i N RATE: L Z M I� (n►C1�- SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO � s 1 'Poo — Q f a/f.,�/ INSTALLATION. iMM ooa y ��+ [.� ��-+✓1_�V_ G___ . ---------� ��S .L �01 l,S LT�YL-=0,'1� U �"t °° �'� TH- I �_ �8.4� O�► TH-2 1 1,_ 4 .30 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION .1� /►"s E� ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE C. n kph inn 3 DETERMINATION. LA .AA 5 -- 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS fii, /g r�� u� �g SPECIFIED OTHERWISE) T . l �i J 1 5 THE LOCATION MAP�N S> a �tj,30 ) DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A 7j� V P C 39 GARBAGE DISPOSAL. µ n1 E IVIEDvM R 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) 3�i MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON Z•17Y A BASE OF 6"OF CRUSHED STONE. 1�2 If2'�b�4 7. 177 Iviq cE4c4 pt r 70 P,,t PLC C'eUS/tl Fl can E�-_ La V.o �w o�b��lr� b �,jo G w � -. yp ' _ _ --t��-__w�L►�1_s� �� Pam. - SEPTIC SYSTEM DES I GN nslS> � LOW ESTIMATE to) All VAZ)4nill 7?7LF-- V me- 7_7�&VA� Or- 116 BEDROOMS AT GAL/DAY/BEDROOM - �� GAL/DAY 8It'IZNS T"c-E 5D #-6-/1'(,7* 91,s SEPTIC 'TANK I () 40 Sul- tjm6a egvi g,6o._Fq4 EAlil r✓rg7 GAL'/DAY x 2 DAYS - (40 GAL 139.00 f t USE 160 GALLON SEPT I C TANK - 6 ISi l A 12CW L tce W/ /�Sdb 6A-L"ri SOIL AB.ORPT I ON SYSTEM UNrx-t-51?l -Ni - Scx� &;er4- --J Poll" �t-c tt (H4M P, k-S BENCH MARK 13' _ O � �� • 13' GR/7 rN� '''./�. � �..._ �:!�e a � C , r'C,�17 V 1� i I '7 1f\} TOP OF C.I. COVER i=�`---�+.- 1 _ : •' `.;.. _rt-� ELEVATION - 89.35 LE* SI)E AREA:( Z5)Z+-((j)-,— 2, x 0-7`( Z-�O USGS DATUM ASSUMED PIT BOTTOM AREA: 7> _ Zyx 13 x 0.7y 240.SO 3 t ' 3s x0l w �2 {t �33oGPpre SEPTIC' SYSTEM SECTIONCIO �z I I y ^'(r Covf�S p 1 I I 88 1a.W�/,J (p e 'ihrsh �adQ ° ►411 �� `� _� Cif 6� 3 t' Jr /3 '"`x a- 8�75' I + o z I ! \ Gas aa � 7 4� I ► Z i! 8�7.7y o I � � ,I;I f�� _ ' S ED - 4l GAL _. \ � ' GAS LINE i I I� ' � v p�•--t'-- I o SEPT I C TANK �r�eUe% 1 ► fop. NE+v N2o SFrtvtcE 20 ft - --EX/Sn�/G - , 3�4 - IL 1Dot) �r PAVED DRIVEWAY 7 w►� 5� ✓ S75- I De-3 � , 25'� x13'W STONE / I �1H OF Mgsrra►/►'I el 7�5 T. o L F1. 77.36 � 1 DRIVEWAY. HO � �y 87 DA E � SITE AND SEWAGE PLAN ME co Lu 1140 LOCAT I ON : S4J 87 147.87 ft PREPARED FOR : 89 IE >,r DARREN M. MEYER, R.S. SCALE: - DATE: P.O. BOX 981 U EAST SANDWICH, MA 02537 Z W DATE HEALTH AGENT Ph: (508) 362-2922 3 W Z