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HomeMy WebLinkAbout0094 WATERS EDGE - Health (2) 62 Barnicle Drive Marstons Mills Z A = 062 045 TOWN OF BARNSTABLE CATION 2 sv / SEWAGE #A VJ— ,,11LLAGE y �ASSESSOR'S /MAP/& LOT 076 "'0'-/S INSTALLER'S NAME&PHONE NO. 1_� � �`� �1 �g SEPTIC TANK CAPACITY LEACHING FACILITY: (type)5V6 6 LAPVdrsf C7 (size) /Q ��41Q �42 NO.OF BEDROOMS BUILDER PERMITDATE: 9'41 -,OS- 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 b �/ ,, /w .��� gar ;3�s:ft .., �� b`� d�b�� � 3�' 6,. �$ � � O o ' S No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE., MASSACHUSETTS As 0[ppYication for Dizpogar *pMem CCollelruction Permit Application for a Permit to Construct( . )Repair( )Upgrade(✓)Abandon( ) ❑Complete System 2 idividual Components Location Address or Lot No. Owner's Name,Address and Tye N 12s 's�Ma /Pazce Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. PY Type of Building: tf Dwelling No.of Bedrooms Lot Size Z 17z sq.ft. Garbage Grinder( ® Other Type of Building S 'No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow Y gallons. Plan Date umber of sheets Revision Date Title .S cs1 l�'>? .�Z 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 issued b is az f Health. Sig f Date Application Approved b Date Application Disapproved for the following reasons Permit No.'—ate 43 1 Date Issued 5 �,I 5 No. � it`' i _. Fee THE COMMONWEALTH OF MASSACHUSET,IS Entered in computer: ,�...r. "fir Aeg!s!�' PUBLIC HEALTH,DIVI,SIQN`;,`TOWN OF BARNSTABLEs MASSACHUSETTS application for Di5po5ar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade(✓)Abandon( ) O Complete System LJ Individual Components 4. Location Address or Lot No. /L �i�ylC►1�4 �r� Owner's Name,Ad ress and Tel.N . Vey is ap cel CJ ����,/� f Installer's Name,Address,and Tel.No. �+ Designer's Name,Address and Tel.No. _ 7 ?/_ �Wi Type of Building:Dwelling No.of Bedrooms-- Lot Size ✓C j J72. sq.ft. Garbage Grinder( � Other Type of Building 44-t-5 P!�'ZC.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow / 0 gallons per day. Calculated daily flow ( � gallons. Plan Date Iyumber of sheets , Revision Date Title S tj/ `C' !0 fir( 12 6f 7 All^,-� ` C Size of Septic Tank IMe) . Type of S.A.S. `_5_0© 'P_0 C Description of Soil �� y� -rz 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 hi d •-f Health. / Sig -�'"' Date 7 k(�J— Application Approved b Date Application Disapproved for the following reasons Permit No. 5 Date Issued Q' 3 -----=--------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the n-site Sewage Di sal System Constructed Repaired Upgraded ., g Y ( ) P ( ) Pg ( ) � � e°Abando ed b / d f� ( ) Y at 12 Z /d0 li - e ri 1)12 / --- ////has been constrftjd in accordance with the provisions &ti e 5 and�}e for Disposal System Construction Permit N,- 7 dated _t 3 -5 Installer .�r-dec� ld Designer The issuance of this permit h not a construed as a guaranteeClate syste 1 n tion as desi ned. gDate 1 � In ��. � :, '7�( -------------—----------------- � No � Fee �— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS Mi!5poal *pgtem Couttruction permit Permission is hereby granted to Cons}ruct( )Rep 'r( )Up ade(&,<Abandon System located at �l �i0//' ��,�`��1✓e 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: Constructiond ate o myst be completed within three years of the f thi i it. Date:_ I J l Approved by FROM :down cape engineering inc FAX NO. :15083629880 Sep. 27 2005 10:32AM P1 Town of Barnstable •dFTME'a Regulatory Services Thomas F. Geiler,Director &ULMABM �• Public Health Division Thomas Mclean,Director 200 Main Street, Hyannis,NIA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: Sewage Permit# Zpo�Assessor's MapTarcele SewA g Designer* n ( ! :✓� Installer: �o / b��/ �^d4A, .Address: Address: P�0 • lk( �Q ��w�-•f' �� l"I��� mil,l��1� /o).6 7_i- 0c) �ll j�D j� ®/�fOl� (date) 1^ y63, was issued a permit to install a On (installer) septic system at�b L7a l/�i G 6 & ~ M - M►r based on a design drawn by (address) (�t�✓�. J dated (desi er) 1 certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes'such as lateral relocation of the distribution box and/or septic tank. 1 certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State.& Local Regulations. Plan revision or certified as-built by designer to follow. 4H OF P44 q'�n ARNE H yGN OJALA 4( rnwistal6le Signature) CIVIL N No. 30792 ASS/ONAL ENG (Designer's Sid re) (Affix Desigmr s Stamp Here) J!LF.AS RET N T BA STABLE PUBLIC ALT DMSION. C TIFI ATE OF CQMPLI NCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM A AS-BUILT C RD ARE RECEIVED BY THE BARN JTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Hcalth/ScptidDesigner Certification Form 3-26-04.doc Lo 7 PERMIT NO. Oay LOCATION SEWAGE 111CL, al �r3 o--x r; 1IILLAGE UT �a 5 1a h i I N S T A llE 'S NAME !� ADD` Ge sUILDER OR OWNER �r DATE PERMIT ISSUED 1.2 1-3 — 14 10 DAT E COMPLIANCE ISSUED I �a T� �., � 7 T _VNo . T o-3 ............. THE COMMO' _rs' B0 A IFF 0 ­rv. r4 Ue... . ........ ....... .. ..... .._0............OF . a..,e... ... . ................. .................... Appliratiou for Uhipasal Morkii Tomitrurtiou rrrmit Application is hereby made for a Permit to Construct 06 or Repair an Individual Sewage Disposal Syst t .................................. ....... ............................ ........ ............................ aP1 r�.f.C.�:e......._I�.dV o o n-Address ey--- -----------------_--0.4 . .. ......... .....CC Qwner Address .................................a.&�............................................. .................................................................................................. Installer Address Type of Building Size Lot..'�Q_172.....Sq. feet U Dwelling— No. of Bedrooms............................................Expansion Attic Garbage Grinder (140 Other—Type of Building ---------------------------- No. of persons---------------------------- Showers Cafe P64 P�1) Other �fi�rs.. .. ......:::- -------------------------------------------------------------------------------------------------3 --------------------------------- Design Flow............ �:: gallons per person per day. Total daily flow............ .. ....................gallons. OddSeptic Tank—Liquid capacit.............gallons Length________________ Width__............._ Diameter__.__.__-__--._- Depth_.__.__..__..... Disposal Trench—No. ........ ..... Width....,.............. Total Length......... .7---- Total leaching area_.__ sq. ft. Seepage Pit No........J.......... Diameter/2-6........ Depth below inlet......6......... Total leaching area.._?,1"_9...,S_q. ft. Z Other Distribution box YJ Dosing t nk (I 0-4 Percolation Test Resu!? Performed by ....Cq:... Date....._ Test Pit No. 1.--. 2 minutes per inch Depth of Test Pit----//.......... Depth to ground wa' ter------- 1-4 Z2�----- �Tq Test Pit No. 2................minutes per inch Depth of Test Pit__._-1?........ Depth to groun ................................................................................................... ..... 0 Description of Soil..........1. win...... ........................................................ ...... U ............................................................................................................................................. ....... .... ................................................................................................................................................. ........ 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 TL I T=j 5of 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.:XMVAa.-� ............ Date Application Approved By--- ------ .. . .................................................. ...... 1.1 no Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date Permit No................... = ------------- IssuedL....................... Date `irP'�' '71r► rto.... .......? Fxs..... `.,&r........... THE COMMONWEALTH OF MASSACHUSETTS 1 BOAR®OF H AL.TH �C</. .►` ..............OF......V.0. .. � '• ..........---•- ... Appliration for Bhipoiial Work.6 Tomarnrtinn amit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage, Disposal System at: Address o ner� Address Installer Address ? Q Type of Building Size Lot............................Sq. feet U Ex Garbage Expansion Attic Grinder Dwelling—No. of Bedrooms----------------............................ p ( ) g ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria QOther fixtures .----•--------•--------•-------•-•-•-----•------••--••--•••-••••••---••--•--••..................••••- Design Flow.•..........°.6.......................gallons per person per day. Total daily flow............................................gallons. Cd Septic Tank—Liquid capacit/MQ.gallons Length................ Width................. Diameter---------------- Depth................ Disposal Trench—No. .................•.. Width..........._...._.... Total Length.........___•_.... Total leaching area...�. ._j....sq. ft. Seepage Pit No--------i........... DiameteR-.6.......... Depth below inlet.....t''.._..__.... Total leaching area.�-•--•9_....sq. tt. z Other Distribution box ) Dosinp k ~' Percolation Test Results. Performed by................5'!�' ' ._....� '.�' .._.Co._.... Date.....`....��--- ----.--•--.. a a Test Pit No. 1_"' _ '__-:.minutes per inch Depth of Test Pit---/f......'.. Depth to ground !'104(--__. (i, Test Pit iVo. 2 '� '___._minutes per inch Depth of Test Pit___1.2-_..._.._. Depth to gro �� 4 Description of Soil....... ------..Y49---11-- •...............=................................ ----- x lF Ili ---- ------ Wt ---------------------------- ......................------------------------------------------------------------------------------ - UNature of Repairs or Alterations—Answer when applicable................................... ... ........ 9� 6�;•=4�� 1`_._,;_... z s Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with f'171!"^ the provisions of :i:i 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..... _ ---------- Application Disapproved for the following re ons:-----•------••••-•-----•••-•••••--••--••-----•--------•---•-•••••--•---••••-•--------•-------•-•-•••-•......•••- Date ~ Permit No......................................................... Issued....................................................... Date S- t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH JJ ......... `'�..............OF.......1..,..�... .......- "L '/C ................................. At Qwrt firatr of Toutpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) f by••-•••-•..................•••-•-•-•••--•-•-•. ..............-•--•-----•-•----••-----v----.-------•••-•-•••--------•••-••--•-•----•--•••-•-•••-•--•-.............•---.:.....•••--..:.......... j j? Installer has been installed in accordance with the provisions of TI`i'•' j of The State Sanitary Code as described in the application for Disposal Works Construction Permit ; ...................... dated----------------------._.--..................... THE ISSUANC LL OF THIS CERTIFICATE SHA NOTE CONSTRII ® AS A GUARANTEE THAT THE SYSTEM W)ILL ,FVNC ION SATISFACTORY. DATE. ' .. .... ................................................ Inspector. ----•-------------------------------------------------..................••-- THE COMMONWEALTH OF MASSACHUSETTS v PU BOARDS# F HEALTH ......s..fits+ . ........OF........'� `' -p` le 2! gU..... Fu......�............. Permissio. is hereby granted............... ........ .........-------------•---------------------------------------------•-------------•---•--..........------. to Construct or or R-ejair ( ) .an Indiv-idual Sewage Disposal System atNo........ -•-•---• -••..... --•-------. Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ------------- Board of Health DATEIv1i•• ....-••---••-•••••••---------------•••-••••--...... FORM )"95 HOBBS & WARREN, INC.. PUBLISHERS �/s I THE ram,O Town of Barnstable Regulatory Services * * * BARNSTABLE, * Thomas F. Geiler,Director MASS. g ab 1639. Public Health Division ArFD MA'S A Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Paul J. MacDonald Date: March 1, 2005 62 Barnicle Drive Marstons Mills,Ma. 02648 NON-COMPLIANNCE WITH STATE ENVIRONMENTAL CODE TITLE V. M rn The septic system owned by you located at 62 Barnicle Drive, 6errtepieiHe was inspected on, 1/22/2002 by Robert J. Bortolotti a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: SAS was in hydraulic failure: Our records show that the system has been in a failed state for more than two years. You are ordered to hire a professional engineer or registered sanitarian to prepare a.plan of proposed replacement septic system. component(s). This plan is to be submitted to the Town of Barnstable Public Health Division Office (Regulatory Services, 200 Main Street, Hyannis),within (90) days receipt of this letter. The plan will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title V. You are a lso o rdered t o u pgrade o r r eplace t he s eptic s ystem w ithin s ix months (180) days o f y our receipt of this letter. Any person aggrieved by any order issued by the local approval authority may appeal to any c ourt o f competent jurisdiction as provided for by the laws of the Commonwealth. You have the option of requesting an adjudicatory hearing pursuant to 310 CMR 15.422 Failure to comply with this order will automatically result in a public hearing scheduled before the Board of Health. PE RDE T BOARD OF HEALTH mas A. McKean,R.S., C. Agent of the Board of Health CC: Board of Health 1/failed-septic-letters r Barnstable Assessing Search Results Page 1 of 2 ;/ ,r(i; ��£? �y<�r y�� _. �YM*r i:✓T+��:�Fi",L� V d � Home: Departments:Assessors Division: Property Assessment Search Results 62 BARNICLE D-DIKII'VE I Owner: MACDONALD, PAUL J& property Sketch Legend Map/Parcel/Parcel Extension 076 /045/ Mailing Address MACDONALD, PAUL J& MACDONALD, CLAUDETTE&PATRICIA - � 62 BARNICLE DRIVE MARSTONS MILLS, MA.02648 2005 Assessed Values: Appraised Value. Assessed Value Building Value: $246,900 $246,900 Extra Features: $5,400 $5,400 Outbuildings: $0 $0 Land Value: $283,400 $283,400 Interactive Property Map: 'Ma requires Plug in: Totals:$535,700 $535,700 1 have visited the maps before Show Me The Map : April 2001 photos available . Sales History: Owner: Sale Date Book/Page: Sale Price: MACDONALD, PAUL J&CLAUDETTE A 9/26/2001 14267/340 $ 100 MACDONALD, PAUL J& 8/25/2003 17526/125 $ 100 MACDONALD,CLAUDETTE A 9/15/1990 7289/275 $ 1 MACDONALD, PAUL J 4/15/1984 4060/327 $ 149,000 SPRINGER, RICHARD UMAURE 8/15/1983 3838/311 $25,000 2005 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation) Land Bank Tax $97.23 Town Fire District Rates Other I $6.05 Barnstable-Residential $2.12 Land B. Barnstable-Commercial $2.80 C.O.M.M. FD Tax(Residential) $541.06 C.O.M.M.-All Classes $1.01 Cotuit FD-All Classes $1.28 Town Tax(Residential) $3,240.99 Hyannis-Residential $1.52 Hyannis-Commercial $2.39 http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 2/2/2005 Barnstable Assessing Search Results Page 2 of 2 W Barnstable-Residential $1.44 W Barnstable-Commercial $2.10 Total: $3,879.28 Due to rounding differences these values may vary Land and Building Information Land Building Lot Size(Acres) 1.2 Year Built 1984 Appraised Value $283,400 Living Area 2201 Assessed Value $283,400 Replacement Cost$274,378 Depreciation 10 Building Value 246,900 Construction Details Style Cape Cod Interior Floors CarpetHardwood Model Residential Interior Walls Drywall Grade Custom Heat Fuel Oil Stories 1 1/2 Stories Heat Type Hot Water Exterior Wall's ClapboardWood Shingle AC Type None Roof Structure Gable/Hip Bedrooms 3 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 21/2 Bathrms Total Rooms 8 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value ; FPL2 Fireplace 2 $5,400 $5,400 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area (Unfinished) FTS Third Story Living Area (Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area (Finished) UST Utility Area(Unfinished) FAT Attic Area (Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 2/2/2005 Septic Inspection Information y „D?tant Y e1 2/12/2002 Septic InspeeNo 273 vAssessors 076Parcel 045 mtg 47�Busmess Number 62 Acldss Barnicle Drive ;;vim Marstons Mills t sp tor; Robert J. Bortolotti �n P? f date 1/22/2002 System Stats IF Comment Backup of sewage into facility or system component due to overload or clogged SAS or cesspool �Fermit:#�: e D te: Notrfrcatirori,Da"te• En l�Installer RepaDeadline Date a 73 COMMONWEALTH OF MASSACHUSETTS ENECUTIVE OFFICE.OF ENVIRONMENTAL AFFAIRS . DEPARTMENT OF ENVIRONMENTAL PROTECTION AAAP . PAM FAILED INSPECTION TITLE.- OFFICIAL INSPECT.ION FORM-NOT-FOR VOLUNTARY:ASSESSMENTS SUBSURFACE SEW AGE.DISPOSAL SYSTEM FORM` PART A CERTIFICATION .�� Property Address: Owner's Name: " Owner's Address. 9 .III-. Cho Date of Inspection. / R CEIVED Name of Inspect r:. leas print) . Company.Name. FEB 1 1 2002 Mailing Address: a TOWN OF RP w��^R': I T Telephone Number- 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 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 15.00.0). The system: .Passes Conditionally Passes Needs:Further.Evaluation by the Local Approving.Authority F s Inspector's Signature.: Date: lid,ba` The system inspector shall mit a copy of this inspection report to the:Approving Authority(Board of Health or.-„_ DEP)within 30 days of completing.this inspection.If the.system is a s}ared.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 5 Inspection Form 6/15/2000 page I Page 2 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS: . SUBSUPWACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 3 OR A4 Property Addressc .Owner.: Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of,Section`D A. System Passes: 'I have not found any information which indicates that any ofthe-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 ofthe 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 exfiltrafion or tank failure is imminent.System will pass inspection if the existing tank is replaced with a.complying septic tank ts'approved by the Board of Health. *A metal septic:tank'will pass inspection.ifit is structurally sound,not leaking and if a Certificate of Compliance =5- ~ 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 disfibution box due to broken or; obstructed pipe(s)or due to abroken settled or uneven distribution box. System wili'pass inspection if(with approval ofBoard,ofHealth): _.. broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: . The ystem 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 "obsiruction'is removed ND explain: Page 3 of 1'1 OFFICIAL INSPECTION FORM.. NOT FOR VOLUNTARY:ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A` .. CERTIFICATION:(continued) Property Address: z1�L� .oJZZL& 4 . Owner: Date of Inspection. 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 C..MR,1:5.303(1)(b)that the system is no.t functioning in a manner which will protect pubhc 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 1,00 feet of a surface water supply or tributaryao a surface water supply: The system has a septic tank and SAS and the:SAS is.within a.Zone ] 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 arid.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 l l OFFICIAL.INSPECTION;FORM'-NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM_ PART.A . CERTIFICATION'(coniinued) Property Address: Owner: Date of Inspection; f � Q.. D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"totach_of.the followmg for alf.inspections: Ye No !� Backup of sewage into facility or system component due to overloaded or cloaaed SAS or cesspool —� as P. _ Discharge or.pon.ding of effluentao the surface of the ground or surface waters due town overloaded or / clogged SAS or cesspool i� 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 Yz day flow Required.pumping more than 4 times.in the last year NOT due to clogged or obstructed pipe(s).Number of times " pumped An portion _ on of the o x p SAS,cesspool or privy is below high around water elevation. Anyportion 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 I of a public well. _ .Any portion of a cesspool or privy i within SO.feet of a private water supply well. ,P. vy . P i PP Y An portion,of a ce sspool ool or. ri is less than 10 feet— — Y r r r vY � , tiut: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 31 O CIv1R 15.303,therefore the system fails.The system owner should contact the Board of Health to deterriiine 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 You must indicate either"yes"or"no"to each of the following; . (The following criteria applyxo 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 Il of a public water supply well If you have answered"yes"to any questibn 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 thesystem in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional'office of the Department. .'4 Page.5 of 1.1 OFFICIAL.INSPECTION FORM-NOYFOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAI�SYSTEM INSPECTION FORM RT B PA CHECKLIST Property Address: A �` 114 Owner: Date of Inspection:L �c 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 LI-11Were.any of the.system components pumped out in the previous two weeks Has the system received normal flows in the previous two week period Il' 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?(Ifthey were iiot 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 theseP tic 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 15302(3)(b)]: 5 Page6 of 11 OFFICIALL INSPECTION ]FORM--NOT FOR VOLUNTARY ASSESSIVi]ENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION:FORM PART C SYSTEM INFORl1'IATION ..Pro erty Address: .. _. . o Owner:, .. Date of Inspectio FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design) Number'of bedrooms(actual). DESIGN flow based on'310 CMR 15.M3 (for examp1e:.110 gpd x#of bedrooms): Number of current residents: ea Does residence haye.a garbage grinder(yes-or n� Is laundry on a separate sewage system (yes or no if yes separate inspection required) Laundry system'inspected(yes or no)y,_ Seasonal use:(yes or now Water-meter readings, if available(last 2.years usage(gpd)) Sump`pump(yesor no Last date of occupancy,-,,. COMMERCIA L/INDUSTRIAI� Type of establishment Design flow(based on 310 CMR,15.203): . . .. gpd Basis of design:flow.(§eats/persons/sgft;eic): . Grease trap present.(yes or no):—. Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the.Title5 system(yes or no) Water.meter readings,, if available: Last date of occupancy/use:.,: OTHER(describe): GENERAL:INFORMATION ` Pumping Records : pa, Source of information Was system pumped as part of the inspection.(yes.or n If yes,volume pumped gallons=_How..was quantity determined?.. Reason'for.pumping: . ; TYP?OF SYSTEM _Septic Tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system.(yes'or no)(if yes, attach.previous inspection records;if any) Innovative/Alternative technology,Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach a copy.of the DEP,approval Other(describe): roximate age o,_ 11 eom one ,date install if known)and source of information: Were sewage odors;detected when arriving.at the site(yes or no f Page 7ofII OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS- SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION. FORM PART C SYSTEM INFORMATION(continued). Property Address: � G} Owner: AA( L Dr)ra 7W. Date oflnspection: 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: "ate on site plan) Depth below grade: Do Material of construction: vconcrete 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: , s% (o ' Sludge depth:(n Distance from top of sludge to bottom of outlet.tee.or baffler.; 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.bafh How were dimensions determined: ,f a �/e/�. Comments(on pumping recommen tions, let and outlet tee or baffle condition,structural integrity, liquid levels s related to outlet invert, e idence of leakage,etc.): m= - /000 �. GREASE TRA`l 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 I OFFICIAL INSPECTION FORM=.NOTFOR VOLUNTARY-ASSESSMENTS SUBSURFACE"SEWAGE DISPOSAL SYSTEM INSPECTION FORM ,PART C SYSTEM INFORMATION(continued) Property Address: 3 � ' Owner•- " Date of Inspection. 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/day Alarm present(yes orno): Alarm level: Alarm in working order(yes or no): Date of lastpumping: 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 % 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) z p PUMP'CHAMI1 .' locate on'srte 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.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT.FOR VOLUNTARY.ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION(continued) Property Address: . o Owner:L11 ZOO 0 AD-Aw�_i&w Date of Inspection: c� SOIL ABSORPTION SYSTEM (SAS): ✓(locate on.site plan,excavation not required): If SAS not located explain why: Type eaching-pits,number:.1 - leaching chambers,number: leaching galleries,-.number: leaching trenches,number,,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name.of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil;condition of vegetation, .,_t; _ Cs�, O (21 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 or no): Comments(note condition of soil,.signs of hydraulic.failure,level of ponding, condition of vegetation,etc.): PRIVY:A/ - pcate 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 Page 10 of 11. OFFICIALINSPECTION FORM`. NOT FOR VOLUNTARY,ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART:C SYSTEM I'NFOPMATION'(continued) Ptoperty Address:. Owner: Q0W Date of Inspection. _ . SKETCH OF SEVVAGE'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. .. ,. .•. � , rho. . ►a o . P 10 i Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 9 litl�C Owner Date of Inspection: SITE EXAM; Slope Surface water Check.cellar. Shallow wells 7 Estimated depth to groundwater 7, feet Please indicate(check)all methods used to determine the high groundwater 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: Checked with local excavators,installers-(attach documentation) Accessed USGS database=explain; AV You must describe how you established the high ground water-elevation: _. .� I1 Completed by: 6 �`L 3 HIGH GROUND-WATER LEVEL COMPUTATION Site Location:�h �j��df���� Lot No. Owner: 017a /v!Q Address: Contractor: � ®�/ �®1r�5� Address: Notes• STEP 1 Measure depth to water table to nearest 1/10 1. Date .............................. . month/day/year STEP 2 Using Water-Level Range Zone and Index Well.Map locate site and determine: O Appropriate index well............................................... V4as3 O.Water-level range.zone........................................................ I I STEP 3 Using monthly report "Current Water Resources Conditions." determine current depth to fLJ®/ -� water level for index well ....................._.... G nontn/year STEP 4 Using Table of Water-level Adjustments for.index well (STEP 2A),.current depth. to water level for index well (STEP 3), and water-level zone (STEP 20) p y determine water=level adjustment ........................................................................................... 7i STEP 5 Estimate depth to high water by subtracting the water level adjustment. (STEP 4) from measured depth to water level at site (STEP 1) .......:..... � /r 33 Figure 1.3,Reproduclb)a computation form. -T, C - � leor li TOP FNDN. AT EL. 62.1' SYSTEM PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN / ACCESS COVER (WATERTIGHT) TO 6" OF FINISH GRADE ENGINEER: LISA LYONS, RS / MINIMUM .75' OF COVER OVER PRECAST /� WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 53.0' WITNESS: D. DESMARAIS, RS 2" DOUBLE WASHED PEASTONE 8/15/05 �- ELEV. 56.8' RUN PIPE LEVEL DATE: Ll FOR FIRST 2' < 2 MIN INCH dr DORY EXISTING 1000 3' MAX. PERC. RATE _ ti GALLON SEPTIC =* 50.0' 1 11049 0� 55.4 t TEE" Fir 'dA CLASS SOILS P# 6 LOCUS TANK (H- 10 ) GAS �49.30' � � p � � pF] p ga �o RE-USE BAFFLE 49.47' �� 49.17' = O 0 O = 0 O C7 0 % 6" CRUSHED STONE OR MECHANICAL = Cl 0 = = � � � 0 N 80 COMPACTION. (15.221 [2]) `� 2' 0 0 0 Cl c 47.17' 4 ELEV. 4 DEPTH OF FLOW = 4' ( % SLOPE) ( 1 % SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE ��� 53.5' 0"12 53.8' u NEay'*X'f TEE SIZES: A A INLET DEPTH = 10" // LS UNSUIT. ILS UNSUIT. OUTLET DEPTH 14" 5" 10YR 4/3 3" 1OYR 4/3 LOCATION MAP NTS B B FOUNDATION D' BOX 14' LEACHING �SL UNSUIT. EXIST. SEPTIC TANK 50' FACILITY 4 37' "� /S; uNsulr. ASSESSORS MAP 76 PARCEL 45 'THE INSTALLER SHALL VERIFY THE LOCATIONS OF 28 10YR 5/4 30" 10YR 5/4 ALL UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS PRIOR TO INSTALLING ANY PORTION Cl Cl OF SEPTIC SYSTEM THE INSTALLER SHALL CONFIRM MIN. SEPTIC TANK SL SIZE AT 1000 GALLONS AND ITS SUITABILITY FOR 35 t // UNSUIT. �� UNSUIT. RE-USE 42.8' » 1OYR 6/2 1OYR 6/2 55 48.9 60 48 8' -I- WATER EXPECTED AT ELEV. PERC C2 PERC C2 12 f PER TOWN x x GROUNDWATER MAP MS MS 2.5Y 6/4 2.5Y 6/4 5' REMOVAL OF UNSUITABLE SOIL 128" REQUIRED AROUND PERIMETER OF 42.8' 130" 1 42.9' L=11 8.16 LEACHING FACILITY, DOWN TO NOTES: SUITABLE SOIL LAYER. REPLACE NO GROUNDWATER ENCOUNTERED R=1 30.00 WITH CLEAN MED. SAND. i� SEPTIC DESIGN: (GARBAGE DISPOSER IS 1. DATUM IS APF�ROX. NGVD NOT ALLOWED � DESIGN FLOW: 4_ BEDROOMS (110 GPD) = 440 GPD , 2. MUNICIPAL WATER IS EXISTING DQR� USE A 440 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 / s1.25 C/R SEPTIC TANK: 440 GPD (2) = 880 5. PIPE JOINTS TO BE MADE WATERTIGHT. \ 1000 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. h o 1 110" �� �F USE A ____ GALLON SEPTIC TANK (RE-USE EXIST.) ys WALK T o K 7" OAK ENVIRONMENTAL CODE TITLE V. `b G LEACHING: 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT Of 3 2' 1 8 5 5 �� \ �� SIDES: 2(40 + 10) 2 (.74) = 148 TO 3E USED FOR ANY OTHER PURPOSE. 1 � EXIST. �55. � 10` OAK R�68 Ss' \ BOTTOM; 40 x 10 (.74) = 296 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 9'87 DWELL. .39 .\ -6, 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT TOP FNDN 1 PIN 110 OAK TOTAL: 600 S.F. 444 GPD INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED - 62.1' w USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH. c 5751 153.09 EQUAL) WITH 2.6' STONE AT SIDES, 4' AT ENDS AND 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) FAILED LEACH PIT \\ 24 DECK 6 ST IT' DOUBLE 12" 3.25' BETWEEN UNITS MAPLE \ � 54.95 LEGEND \\ ' 61 00 5 59 �� FAILED 52 �2 sF TITLE 5 SITE PLAN \\ / ASS 0 LEACH PIT ' 100.0 `� PROPOSED SPOT ELEVATION OF ca �\ ?� 61�� 61.3 O 9 a 100x0 EXISTING SPOT ELEVATION 62 B A R N I C L E DRIVE 1.3 �o0 6 .30 5 IN THE TOWN OF: �\ 3� �/ ,moo /. 5 1°0 PROPOSED CONTOUR 6 .28 ( MARSTONS MILLS) B A R N S TA B LE 60.01 2 \ Q 100 EXISTING CONTOUR 3 022 PREPARED FOR: BORTOLOTTI co � 61.46 .3 BENCHMARK: BENCHMARK USE DECK CONSTRUCTION MacDONALD, O \ � �� CORNER AT ELEV. 62.4' 30 0 30 60 90 � BOARD OF HEALTH V APPROVED DATE MA SCALE: 1" = 30' DATE: AUGUST 16, 2005 OQ �S N Off' off 508-362-4541 fax 508 362-9880 * � 9�N OF k4o down cape engineering, Inc. A3?11E y cya o` ARNE 9c�c CIVIL ENGINEERS �wI�A H. OJALAul ,� N g' LAND SURVEYORS No. 307 2 \o /6165'__ 939 main st. yarmouth, ma 02675 �� 05- > 79 oJA P.L.S. DATE