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Home My WebLink About0072 WHEELER ROAD - Health 72 Wheeler.Aoad _ I� 103-106 Marstons Mills I� • - * TOWN 9F BARNSTABLE LOCATION �U SEWAGE # VILLAGE = ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. / SEPTIC TANK CAPACITY 1-600 y/j C -6 �1�/ Y VV[/ + LEACHING FACILITY: (type) (size) � NO. OF BEDROOMS BUILDER OR OWNE vr Z �M, PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: f Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility d 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 Lea •ng Facility(If.y y [lands exist rat within 300 fret le fa lity) _- Furnished b ` '� laa•\ \ � \ R` % rz 1 o d N. nu j --0�—� Fee------ BOARD OF HEALTH TOWN OF BARNSTABLE App[icat ion ArVeil Con5truction3oermit Application is hereby made for a permit to Construct ( pk Alter( ), or Repair ( )an individual Well at: ----------------- Location — Address Assessors Map and Parcel Owner Address -------k io p--A1Lc -g _ ---- -- Installer — Driller Address Type of Building �. Dwelling-- ---- -- — --- — Other - Type of Building— -- --------- No. of Persons---n—�------------------- -- Type of Well—- -- L--- Capacity----)�—��_ _ P1`�`---- ——— 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 C pliance has been issued by the Board of Health. 7 v OIL Signs ` ------------- — — date—` Application Approved By — —__—_—_________— date Application Disapproved for the following reasons:------------- - ——- -- ---- -------------- -- - --- ------------------------------- --------- date Permit No. — — Issued---— -- - - ------- -- — date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Comptiance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) ------------------ Installer at- -— -----—-------- - - -- --- ------ 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 Construction Permit No. --------------Dated---------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------- -- —— - --- Inspector-------------------------------------------- V a Fee---- f BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVell Congtruction30ermit Application is hereby made for a permit to Construct ( pk, Alter ( ), or Repair ( )an individual Well at: ------------------- --------- -- ---- Location — Address Assessors Map and Parcel Owner Address i -Sim-&•�-- r�� o -- - -- '-o _ _o mac_ 1-e--c- I - o Installer — Driller Address,' Type of Building f Dwelling ---- -- --—-- — Other - Type of Building------------- No. of Persons------------- ---- i Type of Well LA —�V L--- Capacity--A0 ____Ge_M___--- —-- Purpose of Well----TkJ*c-a-,aA_j_0_q:N------ IAgreement: 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 C pliance has been issued by the Board of Health. g - - 9 Z0 OtL s Sign --- — — — — dal Application Approved By --------—— date - I Application Disapproved for the following reasons: ----------------------—-- --— —-__—_ —_—_—date— r. Permit No. — -- -- Issued------ -—— -- -- ---------- date f I BOARD OF HEALTH TOWN OF BARNSTABLE E (Certificate Of (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by---- - -- Installer at 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 Construction Permit No. -------------------Dated--------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE ti .Inspector i BOARD OF HEALTH TOWN OF BARNSTABLE Well (Con5tructionpermit No. � --1—� G7'M Fee CPermission is hereby granted— 11 F to Construct (IVL), Alter ( ), or Repair ( ) an dividual Well at: No. -- 2':-�'— —t�—lwt 0-�0 r . r ! 1—�--------------------------------------------------- Street as shown on the application for a Well Construction Permit No. ---- -- Board of Health DATE—7-h-1a q— -- • 1. P?I✓A l I . 9 1 A R V. 1 :a V 1"• , 1, 4 . 4 n J / L o S 1 L. 1'1, 1e 3 ...IM1.e m • . R4.e d r � Ap,�•� � r ° $f DQN R � �'' G+4EUrIrJb P O , . �� gl • . LPL apt G TA OFP pit - loo 1 No.10951�O Q n vIT l I 1<IP�t IN V 'P�FF6157E�6�� lb �5.. p LEGEND !°5 11 EXISTING SPOT ELEVATION ORO ' 2s CERTIFIES EXISTING CONTOUR p - �-- �. Cori 6;: t,✓Mt :FINISHED- SPOT ELEVATI.ON � 'r�r FINISHED CONTOUR ,0 R y ,6r a APPROVED BOARD OF HEALTH DATE AGENT OF ly SCALE L D EDGE E G�E ! G CO.IN G1►1� iT�'f T. f,: �'`��`Vti a i. kGISYERED `' iil~QISTENED v41j '�' .,G11 I `CERTIFY � "3e�1 � g flUILDING.: SH( CIVIL "LAN CON,FOR6N3 :'TI ENGINEER SURVEYOR �C?° RV�I1+Y ;' hl „ , i D ATE:,.2Z16LQ1 PROPERTY ADORE SS: •;,T ;]„�-,$pa,(3----,-,-- ' Marstons Mills ----___----------------- Mass 02648 ------------------------ on the abOYe data, I Inapeoted the septlo eylte'M at the above address. Thls ayvom conalali of the following: 1 . 1 -1500 gallon septic tank. 2. 1 -Distribution box. 3 . 2-1000 gallon precast leaching pits. 6 'X10 ' eased on my Inepectlon, I cortify the following oondltlonv 4 . This is a title five septic system. ( 78 Code ) 5. The septic system is in proper working order at the present time. Both the invert and the outlet invert of the septic tank are the same. 6. 1 -pit is dry. 1 -pit has waste water 36" below the invert pipe.Instal led 1 -speed S I Q NAT U R / leveler in the distribution box.This made both utl t inverts even. Name : !•--—————— Company; Jo� . ph_p _ N•comber—b Son , Inc , Addre3S :_ Box_ 66 __Centerrille � Nei- 026�2-0066 Phone $08- 775- 7338 .•.._ w-wwwww THIS CIATIFICATIOH OOES NOT CONSTITVTE A OVARANTY OR WARRANTY JOSEPH P, MACOMBER & SON,. INC, T+nks.Cv I'spool I.Lo ichfloldl Pvrn 4 Initsllod Town 3iwfr Connfotloni P,0• Box 66 CinlfrYlllf, MA 02637-0060 775.33J8 r15.6112 , RECEIVE® JUL 3 0 2001 TOWN OF BARNSTggLE HEALTH DEPT. .\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE QFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION i TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:72 Wheeler Road Mar tons Mill Owner's Name: Jim & Emma Cata 1 i n i Owner's Address: "i i Date of Inspection.7277 17 7 01 Name of Inspector: (please print) J.P. Maeombpr y Company Name:Joseph P. macomber & Son Inc Mailing Address: Box 66 'Centeryil1P Ma 02632 Telephone Number: 608_775_3y38 CERTIFICATION STATEMENT I certify that l 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: Passes , Conditionally Passes _ Needs Further Evaluation by the Local Approving Authority Fails g InsP ector's Signature- � �� Date: J The system inspector sha ubmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments "**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 Paee 2 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 72 Wheeler Road Marstons Mills Owner:Ji_m & Emma Catalini Date of lospectioa: j!/1 7/01 Inspection Summary: Cbeck A,B,C,D or E/ALWAY complete all of Sectlon D A. System Passes: MC . I have not found y information which indicates that any of the failure criteria described in 310 CMR /S.J03 or m 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system com onencs as described in the"Conditional repaired. The system, upon completion of the replacement or epair,as approved by the Board ofeHealth, w replaced�l pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements. !f"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 exftltration or tank failure is imminent. System will pass inspection if the existing taak 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: 0 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, sealed or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed _ distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): _ broken pipe(s)are replaced _ obstruction is removed ND explain: 2 Page 3 of I I OFFICIAL, INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:72 Wheeler Road Marst ons Mills Owocr: Date of Inspection: 1 7 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 envirorurent. I. System will pass unless Board of Health determines In accordance with 310 CMR I5.303(1)(b) that the system is not functioning In a manner wblch will protect public health,safety and the environment: i a Cesspool or privy is within 50 feet of a surface water Cesspool or privy is witbin 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, If any) determines that the system is functioning in a manner that protects the public bealth, safety and environment: 1A 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 I 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 f et but 50 feet or more from a private water supply well''. Method used to determine distance j1i.c QQ 'This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volar:ile 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 anached to this form. 3. Other: 3 Page 4 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 72 Wheeler Road `. Marstons Mills Owner: Jim & Emma Catalina Date of laspection:1/1 7/01 D. System Failure Criteria applicable to all systems: You must indicate yes"or"no"to each of the following for all inspections: Yes Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or / clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow _&Z'Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number 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. Any portion of a cesspool or privy is within a Zone I of a public well. _ Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this forma (Yes/No)The system fails. 1 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• You must indicate either yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply J the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA)or a mapped Zone 11 of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered eves" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:72 Wheeler Road Mars tons Mills Owner:Jim & Emma Catalini Date of Inspection: 6 1 7 01 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant, or Board of Health Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? jZHave large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) zoo,_ 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,aluding the SASjocated on site ? Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction,dimensions, depth of liquid, depth of sludge and depth of scum ? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes/no ✓/ Existing information. For example, a plan at the Board of Health. _ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)) 5 Page 6 of 1 1 OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:72 Wheeler Road Marstons Mills Owner: Jim & Emma Catalini Date of Inspection: 7 16 01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual):4 ( gn)�� DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):JLYJ Number of current residents: 2 Does residence have a garbage grinder(ytor no):no Is laundry on a separate sewage systenk�ys or no): no [if yes separate inspection required) Laundry system inspected(yes or no): jab 55� Seasonal use: (yes or no): no q ; y� oao - G 'P`� Water meter readings, if available(last 2 years usage(gpd)): _ �S (r 17.17 Sump pump(yes oran Last date of occupancy: COMM ERCIAL4"USTR JAL Type of establishment: Design flow(based on 310 CMR 15.203) gpd Basis of design flow(seats/persons sgft,etc): Grease trap present(yes or no):W Industrial waste holding tank present(yes or no):[A Non-sanitary waste discharged to the Title 5 system(yes or no)Wa- Water meter readings, if available: Last date of occupancy/use: j� OTHER(describe): ►J GENERAL INFORMATION Pumping Records Source of information: NA Was system pumped as part of the inspection(yes or no): If yes, volume pumped: gallons-- ow was quantity pumped determined? n/li Reason for pumping: / w,1 T i'194 /l TYPE OF SYSTEM ✓Septic tank.dwxil==boi,soil absaxprusa ssysrr,Aa. 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) lb Tight tank .0 Attach a copy of the DEP approval Other(describe): 1014 Approximate age of all coTponents, date.instal I7d(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): 6 1 Page 7 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:72 Wheeler Road Marstons Mills Owner:Jim & Emma Catalini Date of Inspection: 7 1 6 01 BUILDING SEWER(locate on site plan) Depth below grade: 613 y I ,q. Materials of construction: _cast iron _40 PVCAother(ex lain): /Vr Distance from private water supply well or suction line: / Comments(on condition of joints, venting, evidence of leakage, etc.): lnfnt c3 ho2G(' -��4hJ Vo eVtClen o o� tC Q&A A m t S V1 Q Je, v Zv)A SEPTIC TANK: ✓(locate on site plan) i$QpqJ p (fans Depth below grade: 14 ll _ Material of construction:Zoncrete i)metal /VOfiberglass NOpolyethylene Alother(explain) A/it If tan}: is metal list age:ALO Is age confirmed by a Certificate of Compliance (yes or no):_(attach a copy of certificate) Dimensions: rp'(Dl�lt��J[, S//DID .5L7��hC�h Sludge depth: 0 Distance from top f sludge to bottom of outlet tee or baffle: Scum thickness: O Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels related to outlet invert, evidence of leakage,etc.): cam Q- GREASE TRAP: rocicate on site plan) Depth below grade: Material of construction:,keoncrete,kmetal Wiberglassj6# polyethylene/&other (explain): )VA Dimensions: AIA Scum thickness: V4 Distance from top of scum to top of outlet tee or baffle:k- Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: M — Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): r-Yeas- trap not—Present 7 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:72 Wheeler Road MarstnnG Mil lc Owner: ,Jim & Enma Cata1_i ni Date of Inspection: 7/1 6/01 TIGHT or HOLDING TANK:(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete Ametal M fiberglass polyethylene Z#other(explain): Dimensions: 41A Capacity: Ak gallons Design Flow: gallons/day Alarm present (yes or r.o): Alarm level: -& Alarm in working order(yes or no): l� Date of last pumping: -A& Comments (condition of alarm and float switches, etc.): Tight or holding tank not present DISTRIBUTION BOX: i�(ifpresent must be opened)(locate on site plan) Depth of liquid level above outlet invert:�Q Comments (note if box .s level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): 7 PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Am. Alarms in working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): ppiim=chamber not present 8 Page 9 of 1 1 OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 72 Wheeler Road Marstons Mills Owner:Jim & Emma Catalini Date of Inspection: 7 1 6 01 100o1aIJo� SOIL ABSORPTION SYSTEM (SAS):o2" (lo to on site plan,excavation not required) If SAS not located explain why: Types �4 leaching pits, number:2_ .t,ID leaching chambers, number: Alb leaching galleries,number: leaching trenches,number, length: D leaching fields,number,dimen ions: a AV overflow cesspool, number: �V _ innovative/altemative system Type/name of technology: Ube—:Z- 7$Codc Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): L s CESSPOOLS: "(cesspool must be pumped as part of inspect ion)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: N//} Depth of solids layer: AVA Depth of scum laver: p/Iq Dimensions of cesspool: 111 Materials of construction: a Indication of groundwater inflow(yes or no): 1C� Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Cesspools are not present PRIVY:kbLflocate on site plan) Materials of construction: Dimensions: All Depth of solids: J/tA- Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy is not resent 9 } Page 10 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:72 Wheeler Road Marstons Mills Owner:Jim & Emma Catalini Date of Inspection: 7 1 6 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. r ' � ti\ n C:3 7z V& eeP1e-< A a 10 V Page 1 I of 1 1 OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 72 Wheeler Road Marstons Mills Owner:Jim & Emma Catalini Date of Inspection: 7 1 6 11 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water W"feet Please indicate(check)all methods used to determine the high ground water elevation: OBed n record-If checked,date of design plan reviewed: .r1� site(abutting pro erty/observahole within 150 feet of SAS) Cwith loca oard of Hea -explain: ,UI� 4-'Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: a mA Q Q � > 4 �3 I a 11 `i•1T.f1T r•t1TIfTt� '/f�lllf'ITRTTIfi7R.J'R111-.T'�T'Ifll.R'RRT TfR\�i1�f'R7�IRn TR'T'.T 1lr'1T-..�• r...' TOWN OF BARNSTABLE BOARD OF HEALTH SOBSURFACF SFWAGF DISPOSAL SYSTEM INSPECTION FORM - PART D .- CERTIFICATION I -•r^1�T••.••. t-T.1►-�rnmmn•rtnnr��e.rrn�rerrr-t�rivewr�www-TwRAw7w�w�1R� twn vnrT•r--�. •-..A -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 72 Wheeler Road Marstons Mills Ma ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Jim & Emma• Catalini PART D - CERTIFICATION NAME OF INSPECTOR _Joseph P. Macomber Jr.. COMPANY NAME Joseph P. Macomber &'"Son Inc i COMPANY ADDRESS Box 66 Centerville Ma 02632 Strw t Town or City Stat• LIP COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 1 790 - 1578 s i CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete as of the time of.inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : 6_ System: PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 151303 ► Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , System FAILED* The inspection which I have con cted has found that the system fails to Protect the jiublic health and the environment in accordance with Title 6 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date ;?;�211 copy of this c ti f ication must be provided to the OWNER, the BUYER Dne where applicableY and the 130ARD OF HEALTII, * If the inspection FAILED, the owner or operator shall upgrade ' the ayetem within one year of the date of the inspection , unless allowed or required otherwise as provided in 3.10 CMR 16 , 306 , , partd .doc ILI _ . ell L _�; 'T' VH S E W k G E PERMIT N0, -ee'lV ; L L A,,r M S Nlmsk A ILLER'5 NAM � ADDRESS ► _ er r ,�e i— 3 Y/G-.rtn?O L b r,R UI ER CR WMEN / I� ' D &TE PEA MIS ISSUEO ! - OATE COMPLIAWCE I S 5 U E 0 l ft � 73 No------' - F�s.....?W.,2-11.......... THE-_CU;MMONWEALTH OF MASSACHUSETTS BOARD OF, HEALTH ------.... .........................O F.......................................................................................... Appliratioat for Uiopoiital Works Tomitrurtioat Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at G;�h�,�1�2 /1�. .. --............................................................. ....--- - ----- - t ----_.... Qca/ji/on•Address or Lot No. -----------------------------••----•----- • Zn. .._._....---••--•...............Address a Installer Address Type of Building 1� Size Lot............................Sq. feet Dwelling—No. of Bedrooms____._____T_.............................Expansion Attic ( ) Garbage Grinder ) '� Other—T e of Building No. of ersons____________________________ Showers — Cafeteria G" Other fixtures -----•-------------------------- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity/,J D�tgallons Length................ Width................ Diameter________________ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No...Ze-A------- Diameter._?.___________ Depth below inlet...... ....... Total leaching area__,rX,?......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water_______________________. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' ------------------------------------------------•-•--------••--•......._....._.._•------•-••---•----......................................................... 0 Description of Soil........................................................................................................................................................................ x U ---•---•-------------------------------•--•----•---------------•------------------------------------•---••--------- ---•------------------------------------------------•----•----•--.._.._------•...__. W --------------- ----------------------------------------------------------------------------- ---------------------------------------------------------•----------------------------------..__...._ UNature 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 TIT11 5 of the State Sanitary Code—The undersigned further agrees not to place the system in o rati n until a4, B Compliance has been issued y the board of/health. G` Signed-------------- ------- --._....- ----------------•--•---••---•--------- -------a--•---••-•---•----•-- DApplication p e Date Application Disapproved for the following reasons:----•-------------------------------•-----------•-----••--•-...---------•---•--••------•--------------•....._... ........................................................................................................................................................................................................ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................................I..,.....OF.................................................................................... (Irdifiratr of ToaZ ph aata THIS IS TO CERT Y, Th the Pdivl al Sewage Disposal System constructed ( ) or Repaired ( ) by................. ..................... - ....... .........__....... ......................................... 70 ns 1 at.. ... tG7L ��........ U �—�I-� . ' ------------------------••---•---•----------------------------._..__..__..........-•------------- has been installed in accordance with the provisions of TIT R 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__ - 3'2V.............. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... No....-- Fms.._...9A ......... j THE—COMMONWEALTH OF MASSACHUSETTS V, BOARD OF• . HEALTH .................. .. - ..--....-.....OF.............-...-.........-.....-.... Appiiratiuit for Diipuuai Workg Tonstrurtion rami# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �f Loca on-Address or Lot No. -----•---•-•----- ----.......... -• ......... .--------------- ................ .... . .......... ------- ------- ------------ Address a .................................... ......~ --•--�•-•--- .. •.............................. Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.__._..._._............................Expansion Attic ( ) Garbage Grinder ( ) YA aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -------•-----------------------•-----------•--................................. " :; WDesign Flow......................................______gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity_/744 gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No_ ____________________ Width___ -------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit. No....Ze.4_.____ Diameter.... r!_.._.__.___ Depth below inlet....... ...... Total leaching area... 57�.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -•-•----•••-•-••-•--••-•---••-•------•---•----•-•••-•••----•-•••-----•--------------•-------•_-••---......................................................... 0 Description of Soil___________________________________________ W U ---•---•-•-------------•-----------------...--------•-•--------....._..--------------•---•-------•------••--•-----------.-.----•-------------------------------------------.....-••-•---••••-------•-••- W --•----------------------------------------------•------------------------------------._...---------------------------------...--------------------••---•----------------------•••---•••••••••----•-•- 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in op atio until a Certifica e - Compliance has been issued y the board of health Signed ------ �.... .,. --•---------------•--_ Da Application Approved rBy-- ................... . Date Application Disapproved for the following reasons:----•-------•---••------------------------------•------•---•--------------------•••-•---•-•-•••---._...•------- •--•--•-....._..-•••--••---•-••-•--•-••-•••••--•...-•••---•--••-•-•------.....••---...---•-•---••------•-•-------•---•••-••••••-••••--------•------•-----•••---•-------•••--••------•-••-••---•••-•----- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Currfif iratr of Tompiiattrr THIS IS TO CERT Tha the Iivid 1 Sewage isposal System constructed ( ) or Repaired ( ) by--••••---•------•-•-••-•-•••.__-_ .... `----.s I St ...........................---•-•.............:.....................................•----- at............. ---•--•• . . f has been installed in accordance with the provisions of TIT - 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No________________" �_.._ Z__________ da.ted................................................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..............•-----.....--•---•------•--•------•----...---•---•-----........... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH L '�' '.....OF._...:...-. .................................... -` No. .... --•t- / FEE........................ Dispogs Tongtriwinit Virrutit Permission is hereby granted........... e,. 4'�.._ ' ..� to Construct ) or Repair ( an Individual Sewage DispSal System at No...-••••••••44_ ... Ap'��• v1, `!'"',` ...s '==^. -•• •••-••---•---•-••-•••-...••-•-••-•-------••••----•••••-•••--•............. Street �� a as shown on the application for Disposal Works Construction Permit No._._____.__'_____.__(Dated.......____ _-C3........... ----------------------------------------- :�1—�7 B ofH DATE................................................................................ ._ __.FORM 1255 HOBBS & WARREN. INC., PUBLISHERS NOTE = /F E/7H. THE SEPT/C TANK OR M/N. 10 !EAC.y/wG ?/T ArtE MORE TNA.V /2"BEL0$V /a F7: Miry. •- - • 1RAOF� A 24'O/AMETEK C'CNCr�ETE GOYER S."A L L &,& BROUGHT 7'0 G RA D E.6-;Iy EX7-,?.A — CONCRrTE 4�PYC P/PE HEAVY CA ST /RON CO j/Ef? Sf/ALL 3E USE1� EL= 9 8•� COYE/GS /IV OR/VEI�VA Y •. PER FT. ;:'• 2 y MiN.� CONCRETE A .a G AOE CC3 V'ER C.L EA/V .SAN.O rr— 5 Z'LAYER •��- /RON P/PE 0 0 0 MIN.P/TG/f/ (500 G/4L. D/ST. • e 1 • • • • • • • • n •• WASHED S71ONE �4"PEit/T. SEPTIC TANK ' O s 1 •" .• • - • • • • � a ea • n • • Bi • • • • r .•d • tF3[ : E2TP- • • • r • • 34 cart ci�c rc D f r s--- • r DEPTtd o v WA5,YED STaNE O r • • • • • • • r p o • peg X2.5 = 470 _L-7lD A 4 �v ' PREGgSTSEEPAGE 78 x I.o = 76 G%D iJoe� • • • • • • • a •o P/7 OR EgL/IV. INYPIC'T LLEi/.�lT/DNS . a _ ��TcAGAc�•r/: S¢8 b/D} r EL = a3.S 'i INVERT AT QU/L_O/NG -9<2•5 FT. = T�rAL cAPAc°�:: 548 Lz/D f`- /MLET SEPT/C TANK 170.3 FT FT. 01AAf- D-4 C(.SEE TABS T OAV> FT GARF3. l.09Co /D_ 13 ( .6/D NOTE : � OUTLET SEPTIC TANK 90 pisp 50 7o To axcAvA-lC //VL.ET D/STR/8l/T/ON BOX 18".9 A GROuNO Nr�iTEfr TALfLE FE=-T L� \" BnreN,,n oa7LETD/3TR/Birr,ON mx e)9.-7 FT. SECT/ON OF SELVAGE 011S,4005A 4 SYSTEM =L- ��+•s� T� '"'S"e� /NtET LEAGN/A/G f�/T 8 . '� fT. -"��No vRcua.,D LEACf1/NG P/7' TABIlLATIO w�Tea Oe—leur SCALE %�~ _ /`-D` DIMENSION A 8 F•7F BEFORE INSTALLIH6 DOS/G/V CRITERIA . D/tfElvs/o/v $ NUMBER OF 9EDROOMS Fou(Z DIMENSION C ¢ FT. GAReAGED/SPD.SAL UNIT `�E� SOIL LOG SD/L TEST TOTAL E.?T/MATED PLOry 44o G.�L.IDAY SO/L TEST At/ SO/L 7FS7 402 fr 91 NUMBER OF LEACVf VG P/TS 2 f`EtEK Q 9 7 ELFY, 90, 1 oATE OF SOI L TEST Zr S/OE LrACH/NG PER PIT U 88 SCa PT. RESULTS iV/TNF_SSED dY`/2 `/A GD f3/ BOTTOML.ZgCN/NG PER P/T 18 54• /tT. - Ld,+•� u PERCOt�►T/ON RATE,{t/ LC='sS lylNr/INCN p2v.� TO71,94 LEACHING AREA 532 So. FT, -7'v AE)ICOLr1T/ONRA7^E1k2 T M MIN.IINCH r Goi'7�gc-TcF� � ra RESERiiEGEACNlN6AREA 532 SQ. FT. 2 z Nl� 3 , n /}2 � .,3.e o�-�w K F- . '�-�i t_ i :�T Y6 (�03 91 H'N r1 .✓i?� /�Ems. OF '44� P�(N OF MASS 1r,2 e,v£L L 07 (' A -'F A- �'-r'o AI.S f'" L L� MORSE w Ste'^/� 4�C p No:10951�O ELORE®GE ENG/NCR/IVG CO,/NG' �} O/fig oQ ,o9oFFG1STEP,�\��c , �L e �''y / EI�Y -78. / 7/Z MAIN ST. , HYANN/S. INAS.T. O,SURV y FSSIONA\-� NO GROIJNv YNi4TL'R CLIENT: • J08 ND; S3 0 / SHEET�OF a-- +..yKKK 'F � � . k.♦ ; a' f fk� heft PSFkA, 1 1 A„ '3 4. ..Ll �x 1P oll It � x3 1 �, 11 q = -. O �A� q ' t�,�, �T_F 1 4 F'l�f /'1' 1 • _ - ,*. _Y• r+a-S'Cp td i.. L' y: Y .�* � •`r 1111-- '� ens, 57� P. -ram € e)(C&ATE Rao Fer EEld ! (3c57Te=%tn of L%Rcrl ifJ6 ?':f PA eAF- o PIT (I.E. EL= -/9.5 llil 14 ��5 � .FND P>!=. ..22.E \ 57ALLT ....• :r O (yNEU.�tiI — �1L P � , Iv 15o FPnwiAGE A F NbA r p7µ f} OF A. Leff Q F�. B ,A E `'� RSE to v No.10951O�� y. s I A�YN ,T � . ( V F�SIONAL�� j LEGEND- . ,EXISTING SPOT ELEVATION OxO t z' FY v39 �ZS CERTIFIED PLOT PLAN `EXISTING. CONTOUR FINISHED. SPOT ELEVATFION.. F I N I S N E D ' C 0 N TO U R 0 -�---� , t }_ 4 F ' f M� � g� 7-0N z g APPROVED 60ARD� OF HEALTH , 2G? _ ",'� IN �At 1 L t 1/4�k'.!��/ j1- 4 A,it�`l SO to�� -W� '�` ASS*` `\]TS(Jj 9rt41,S1 ' *` { 1 Y DATE' AGENT` r � 1\cl -1,i '' o� SC'ALEs Via=40 DATEor t :S� L D EDGE ENGl E ! G C •II! r r'� 1 4 a ".��" 4i yi T 'i►W �� s r �.. I CERTIFY THAT THE 'PROPOSED f Et31$TERED Rt018TEkw f ° •�¢ —� rn� T J0�•M0. AP . CIVIL ti BLAND;$: �� JoIll, *•� s BUILDING SHOWN ON THIS PLAN r { _ a a 'CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR " DfiBY�+ ®�se�y� O;F DARNSTA IL E ;x .r r CN.=®�� i MAI N STREETS p H:YANRIS r MA5s�; f Mr L N