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Home My WebLink About0332 WHEELER ROAD - Health 3 I WHEELER R O CL - A= 082 021 }�q r -a'n 5" ►�1 L __ _ - _ - -- _ _ _ _ - - ----- __ i I Dal -dd-I - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments e 332 Wheeler Road Property Address Kevin &Maura Bresnahan Owner Owner's Name information is Marstons Mills Ma 02648 10/16/2020 required for every State Zip Code Date of Inspection page. City/Town 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. Inspector Information filling out forms on the computer, Sean M. Jones use only the tab key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Beldan Lane Q Company Address. Centerville — Ma 02632 Cityrrown State Zip Code 774-2484850 smjonesbtle5@gmail.com, SI4522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 10/16/2020 Inspectors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.71 W018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 332 Wheeler Road Property Address Kevin &Maura Bresnahan Owner Owner's Name information is Marstons Mills Ma 02648 10/16/2020 required for every CityRown State Zip Code Date of inspection page. C. Inspection Summary Inspection Summary: Complete 1, 2, 3,or 5 and all of 4 and 6. 1) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The property located at 332 Wheeler Rd Marstons Mills is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and 3 500 gallon leaching chambers. Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes" "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain_ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc• Title 5 official Inspecti on Form:Subsurface Sewage Disposal system•Page 2 of 18 rev,M2812018 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 332 Wheeler Road Property Address Kevin&Maura Bresnahan Owner Owner's Name Ma 02648 10/16/2020 information is Marstons Mills required for every CityRown State Zip Code Date of Inspection page. C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t51nsp.doc•rev.7128P2018 Title 5 official Inspection Fonn:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3 332 Wheeler Road Property Address Kevin&Maura Bresnahan Owner Ownees Name information is Marstons Mills Ma 02648 10/16/2020 required for every city/Town Zip Code Date of Inspection page. C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool tsfisp doc•rev.7/26/2018 Title s offidal Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 4 Commonwealth of Massachusetts Title 5 official Inspection Form WWISubsurface Sewage Disposal System Form-Not for Voluntary Assessments - 332 Wheeler Road Property Address Kevin&Maura Bresnahan Owner Owner's Name information is Marstons Mills Ma 02648 10/16/2020 required for every State Zip Code Date of Inspection page. Citylfown C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/Z day flow El ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. El ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 t5insp.doc•rev.7/26/2018 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 332 Wheeler Road Property Address Kevin&Maura Bresnahan Owner Owners Name information is Marstons Mills Ma 02648 10/16/2020 required for every State Zip Code Date of Inspection page Cityrrown C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered yes to any question in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El available as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ 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)1310 CMR 15.302(5)] .doe•rev.7@8f2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 15fnsp Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 332 Wheeler Road Property Address Kevin &Maura Bresnahan Owner Owner's Name information is Marstons Mills Ma 02648 10/16/2020 required for every State Zip Code Date of Inspection page Cityfrown D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd Description: 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No vacant Last date of occupancy: Date t5insp.doc•rev.7f28MI8 Title 5 official Inspection Form:Subsurface Sewage Disposal system•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 332 Wheeler Road Property Address Kevin &Maura Bresnahan Owner Owner's Name information is Marstons Mills Ma 02648 10/16/2020 required for every State Zip Code Date of Inspection page. City/Town D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding flank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records : Source of information: tank pumped for inspection Was system pumped as part of the inspection? ® Yes ❑ No 1500 If yes, volume pumped: gallons How was quantity pumped determined? size of tank routine maintenance Reason for pumping: t5insp doc-rev.MOM 8 Tate 5 official inspection Form:Subsurface Sewage MVosai System•Page 8 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal,System Form-Not for Voluntary Assessments 332 Wheeler Road Property Address Kevin &Maura Bresnahan Owner Owner's(dame information is Marstons Mills Ma 02648 10/16/2020 required for every Cityfrown State Zip Code Date of Inspection page. D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: item repaired 6/312008 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No 5, Building Sewer(locate on site plan): 2 Depth below grade: feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints in good condition, no leakage,vented through roof. t5insp doc•rev.7rAW018 Title 6 Official Inspection forth:Subsurface Sewage Disposal system•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 332 Wheeler Road Property Address Kevin &Maura Bresnahan Owner Owner's Name information is Ma 02648 10/16/2020 Marstons Mills required for every State Zip Code Date of inspection page- City/Town D. System Information (cont.) 6. Septic Tank(locate on site plan): 1.5 Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 1500 gallons Dimensions: 5" Sludge depth: 3' Distance from top of sludge to bottom of outlet tee or baffle 21' Scum thickness 7" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 10" Opened covers and took How were dimensions determined? measurements 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 was pumped for inspection and should be done again every 2-3 years for proper maintenance. Tank was structurally sound. Inlet cover is on a riser. t5insp.dac•rev.MAW 8 TRIe 5 Official inspection Forth:Subsurface Sawap Disposal System•Page 10 of IS I Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 332 Wheeler Road Property Address Kevin&Maura Bresnahan Owner Owner's Name information is Marstons Mills Ma 02648 10/16/2020 required for every City/Town State Zip Code Date of Inspection page. D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7128f2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 332 Wheeler Road Property Address Kevin&Maura Bresnahan Owner Owner's Name information is Marstons Mills Ma 02648 10/16/2020 _ required for every Cityrrown State Zip Code Date of Inspection page. D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): 0° 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.): DistribUition box was level and in good condition with no rot. Water level was even with outlet inverts with no:signs of past backup.Access cover is on a riser Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 fjmsp.doc•rev.7R82o18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 332 Wheeler Road Property Address Kevin &Maura Bresnahan Owner Owner's Name information is Marstons Mills Ma 02648 10/16/2020 required for every CityRown State Zip Code Date of inspection page. D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: 3 ® leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: t5'msp.doc-rev-7/j&P2D7 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pie 13 of 18 ; Z Commonwealth of Massachusetts . Title.5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 332.Wheeler Road. Property Address Kevin&Maus Bresnahan Owner Owner's Name information is Marstons Mills Ma 02648 10/16/2020 required for every ` Cityrrown State Tip Code Date of irmpection page: . D. System Information (cont.) r }` 11. Soil Absorption System (SAS) (cont) Comrrients(note condition of soil,signs of hydraulic failure, level of ponding, damp soil,,conddion,,of vegetation,etc.): { s:as. consists of 3,precast eaching chambers in a 33.5xiUT trench. Leaching facility was dry writh no signs of past overloading. Access cover is on a riser. 12. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): a _Number and configuration Depth—top of liquid to inlet invert Depth.of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of,vegetation;, -4; as We 5 official Inspection Forth:Subsurface Sewage 0000351 System'Page 14 of 18 t5in .doc•rev.7P18I2018 -ra " Commonwealth of Massachusetts Title 5 .Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r r, 332`Wheeler Road w PmperhlWftess c� 4 Kevin 8 Maura'Bresnahan ;Owner owners Name '. information is ns'Mills Ma 02648 10/16/2020 w Marsto - re ufred for eve pate of Inspection ' 9 every City/Town State. Zip Code Pe _page D. System Information (cont.) 1`3. 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, a: rR. etc.): ; 6 ' i r a 15insp.doc•rev:7/26J2016 Title 5 Official tnspeclion Forth:Subsurface Sewage OlsposafSYStem•Page Is of 18, 1 Commonweat fi of Massachusetts - z- 10 Title '5 Official Inspection Form Subsurface.Sewage Disposal.System form-Not for Voluntary Assessments 332 Wheeler Road ,. Property Andress Kevin,&Maura Bresnahan ..Owner Owners Name Information is Marstons Mills Ma 02648 10/16/2020 . . 'w required for Beery cityrrown state Zip code Date of Inspection Ps9e `.. D. System information (cont.) 4 14. Sketch Of Sewage Disposal System: m Provide a view of the Sewage disposal system; including ties to at least two permanent reference` landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the budding. Check one of the boxes below: , _ 0 hand-Sketch in the"area below drawing;attached separately i. a 1 . d AI � 4 33 : 3 3 C33 Title 5 of iciat inspection Fwm:subsurface Sewage Disposal System'Page 16 of 18 t5insp.doe•rev:-7186M8 _ f, x Commonwealth of Massachusetts r'� _ t Inspection ct ion For m UTale 5 Official p Subsurface Sewage Disposal System Form-Not:for Voluntary Assessments 332 Wheeler Road # i Pioperty Addrsss Kevin&Maura Bresnahan Owner Owners"Marne x information is Ma 02648 10/16/2020 regwrr I for every, Marstons Mills CltyrTown. State Zip Code Date of Inspedion. Page. .. D. System Information (cont.) 15. Site Exam: , Check Slope Surface water 0 Check cellar 17 Shallow wells 12'+ Estimated depth to high ground water. feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked, date of design plan reviewed: Data Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: [] Checked with local excavators, installers-(attach documentation) [] Accessed USGS database-explain: You must,describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. r Before filing.this Inspection Report,please see Report Completeness Checklist on next page.. We 6 Official Inspection Fonn:Suiarraee Sewage Disposal System•Page.17 of 18- Commonwealth of Massachusetts J Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3321 heeler Road Property Address Kevin&Maura Bresnahan .6—Owner, Owner's Name —irdbrrnafion-tsMarstons Mills Ma 02648 10/16/2020 required for every pe9e. Citylrown State Zip Code Date of Ir�pedion .. E. Report Completeness Checklist ' Complete all applicable sections of this form inclusive of: } A. Inspector Information Complete all fields in this section. B.Certification:;Signed & Dated and 1, 2, 3, or 4 checked ' a i ® C. Inspection Summary: 1,2, 3, or 5 completed as appropriate 4.(Failure Criteria)and 6(Checklist)completed ® D. System Information: For'8:Tight/Holding Tank—Pumping contract attached For 14:Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included amp-doe•rev.U28=8 Title 5 Official InspeCOon Form:Subsurface Sewage t)isposal system Page.18 of 18 r , TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE t-k_ *A ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. ic SEPTIC TANK CAPACITY LEACHING FACILITY:(type) k3 a (size) X2-,C ZS:X, NO.OF BEDROOMS WNER 1n��•a•� PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility i Z 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 F ility(If any wetlands exist within 300 feet of leachi fa ili ) Feet FURNISHED BY �,. i � �I � y II �� ` r�`,• �--�• `, � �� No. a� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zppgicatiou for 3h6pogal *p5tem Cottgtruction Permit Application for a Permit to Construct( ) Repair( KUpgrade( Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. e+— Owneramr�ddresan el.No. Vv` lli� 4 Assessor's Map/Parcel wk Installer's Name,Address and T I.No. Designer's Name,Address and Tel.No. 9Zs,g.— 6Z— S-V Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder (0 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.req fired) gpd Design flow provided gpd Plan Date Number of sheets r Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Y Signed �` Date j rdZ.. a Application Approved by Date 2- Application Disapproved by: Date for the following reasons pp' Permit No. a`b p ��"' Date Issued ell No.g 0o0 — Fee / r THE COMMONWEA TH.,OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpplication for Migonl 4p!5tem Cou.5truction permit Application for a Permit to Construct( ) Repair( 4 Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components } Location Address or Lot No. 3,� W��(�` ! Owner's„Namee�A s�,and Tel.No. _ by Assessor's Map/Parcel S`4 Ike a Installer's Name,Address,and Tel.No. * Designer's Name,Address and Tel.No. Si78-6Y 8=g9a�. �o�� C 36Z- Ys\1 Type of Building: Dwelling No.of Bedrooms Lot Size �� 4 y, sq. ft. Garbage Grinder (UP Other Type of Building No.ofrrersons Showers( ) Cafeteria( ) Otlier Fixtures Jf Design Flow(min.req•ired) 4 �gp CD sign flow provided / gpd Plan Date k 'x(6Sr Numb _'Wheets Revision Date /��fir' Title r Size of Septic Tank 1t � Type ofS.A.S. Description of Soil r 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 Certificate of Compliance has been issued by this Board of Health. Signed ,Q Date 'Z8 Application Approved by Date s Application Disapproved by: Date for the following reasons Permit No. ;..6 0 �^ I Date Issued S -------------------- THE COMMONWEALTH OF MASSACHUSETTS - --------------- __ _ Y ^r BARNSTABLE, MASSACHUSETTS �Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired Graded ( ) Abandoned( )by r e 44 A g r.► t'�,'r✓r t7tA) `I at �..��+ 141�. �w�.r� R J_ Af_*`l�thas been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. oleo 0 2,;, 1 dated Q Installer Designer _ r 1.s (S-A-a.,,,,,.,. #bedrooms Approved design flow 4� gpd The issuance of this permit shall of be_construed as a guarantee that the systeimwill functio as)dsigned. Date P Ins ector< _ --_-�--- ---- ----- ----- - ------------———— ---------------------------------- a�009 — �7"i Fee --'-`------6 No. i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION —BARNSTABLE, MASSACHUSETTS Migoal �&p!gtem Cott xUctiou permit Permission is hereby granted to Construct ( ) Repair ( Upgrade ( ) Abandon ( ) System located at _Z Z,Z.- W`,.,,-.ek and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this per!mit. SL,__ Date S- -� Approved by No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Z[pptication for Th6pogar 4p!5tem Cott.5truction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min,required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of.Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued ---------------------- ---------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Mhgonl �&p5tem Cow6tructiou Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at and as described in the above Application f'or Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date Approved by No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Th5pogar *pgttm Con.5trUCtion permit Application for a Permit to Construct( ) Repair( 4 Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components wJoIr.- 1 r ,. Location Address or Lot No. �F{. C Owner's,Name,Address,and Tel.No. Assessor's Map/Parcel ' M • v Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size 44, 4 sq. ft. Garbage Grinder (vo Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required)r gpd -Design flow provided gpd Plan Date t tk It Number of sheets Revision Date t t Title t �. 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 Certificate of Compliance has been issued by this Board of Health. Signed ,_.,a c?: Date 5l'1 Application Approved by Date " Application Disapproved by: Date for the following reasons r.� Permit No. ` ' Date Issued ' -------------------------- THE COMMONWEALTH OF MASSACHUSETTS------_--'---------------------- { =BARNSTABLE, MASSACHUSETTS ° Certificate Of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( uo Upgraded ( ) Abandoned( )by /t Fa: a►ad at �L t. ,+e fY°• /IS/, -has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ;a0 `` 1 dated ~ Installer �`�, �, t��.� ti Designer -- #bedrooms Approved-,design flow 'A gpd "00The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector ' w — —————————————————————— ---------------- _- No. - Fee ✓ t- 1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS lwigpoof *pgtem CongtrUction Permit Permission is hereby granted to Construct ( ) Repair ( (�) Upgrade ( ) Abandon ( ) System located at K-L t •e It"r, " and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date " Approved by M ---�--- ` A' r 1=ROVI :do;�.,n cape engineering inc FAX NO. :15083629880 Jun. 10 2008 12:26PM P1 Town of Barnstable Regulatory Services Thomas F. Geiler,Director �rA AM& Public 'Health Division 105 Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 G 509-9624644 Fax: 508-790-63(.14 Installed-& Designer Certification Foam 1T1I24V. Sewage Permit# Assc%sor's Map\Parcel e° wj 5"\c, t)ee:✓1 v,\c- Insta➢lcr: 7 C 1�(c �,•.. rv�'wl U mot. . ..... was issued a pen-nit to install a (date) (installer) Se 4yslem at 3� wC P'l �' based on a design drawn by (address) r ---( 0�- ................. dated I certify that the septic system referenced above was insta.iled substantially according to the design, which niay include minor approved changes such as lateral. relocation of the distribution box and/or septic tank. I certify that the septic system referenced above wits installed with major obanges (Le. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of`&Ic septic system.) but in accordance with. State & Local Regulations. Plan revision or certified as-built by designer to follow. OF Mqs`t•9Cy o ARNE H c, OJA - --(Installer's Signature) CIVIL No. 30792 S T naturc)_ - (Al'lixDe ag ner'sSamp ITere)--- q4TU _x.Q �ra�r�r, HYT PURTAC ria?mTs r rr 1111bIS9O�l. c:r l�T�E �ATa;� �>F, (ILL NOT HE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CAD ARE4 13Y THE BARNSTABLE PUBLIC ALTI T.D MSION. •r.�rANK YOXJ. ncrCrai'I'icatioll Form:i-26-04.doc t TOWN OF BARNSTA.BLE LOCATION W lk Ion rU SEWAGE # c G� - VILLAGE ✓V m a I r ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS - � BUILDER OR OWNER PERMITDATE:- 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_ e v � •0 c e `e Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection Wllllam F. Weld Governor Trudy Coxe Argeo Paul Cellucci secretary tr.Gwamor David B. Struhs Commissioner C) D�( SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM I II PART A (20"dC%' r CvJy"' taus,_' CERTIFICATION Property Address: l.tJ�'��`l�� K�� I"'t,x t�C�%S �-1�t�S Address of Owner- Date of Inspection: /LtQ�ri►J ��ry�G 141 S (< Name of Inspector. r. Y� (If different) � Company Name, lAddress and Telephone'Number. C `n1Qi oS 1Wc- 0 ZE3C 3 C Z r 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: XPasses Conditionally Passes Needs Further Evaluation By the Local Approving Authority • Fails Inspector's Signature: "P �. Date: 1-(AY lC1�6 The System Inspector shall submit a co this inspection report to the Approving Authority within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. 6 INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system. upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of detertaination in all instances. If"not determined", explain why not) The septic tank is metal. cracked. structurally unsound, shows substantial infiltration or exfrltration, or task failure is imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board of Health. ;revised 11/03/95) 1 One Winter Street a Boston, Massachusetts 02108 a FAX(617) 556-1049 a Telephone(617)292-SW 10.0 PnMed on Recvued Paoer SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:332- U.i j ln�<R 12� r L'S�L—S . r`,I j.S Owner. G c,-,16ti T Ca.,o�,n ILi e.Yscti Date of Inspection: BI SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced _ obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 r CI 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 F UNLESS THE BOARD OF AIL U HEALTH (AND PUBLIC WATER SUPPLIER. IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a.public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a privatd water suppiy well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. 3) OTHER (revised 11/03/95) 2 i f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION l. (continued) Property Address: .z�� J, 12A P ez,- t O�J c M�1\.s Owner. 6C A' C.. Date of Inspection: D) SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an 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. r Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems �n addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: S c'_ w� �-ti= MIN, Owner: _�g C C:•ticll r' (f V^C.I�NJ Date of Inspection: S /l- aj �! Check if the following have been done: L Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. r X As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner land occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11./03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 1 (� SYSTEM INFORMATION Property Address: J 5 � �l+'� ke. +GAi S. 1 n Owner. Gprc Ga+ � CG1E:�vJ N��GN � Date of Inspection: FLOW CONDITIONS RESIDENTIAL- Design flow: �3�sallona Number of bedrooms: : Number of current residents:_ Garbage grinder(yes or no): Laundry connected to system (yes or no): 'S Seasonal use(yea or no):-AID V C T Water meter readings, if available: Last date of occupancy: Cu I e. A�y V� r COMMERCIAL/INDUSTRIAL:- Type of establishment: .' Design flow:_gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: G►w'uC�.�c\�.f' 1'rtcx,•c1S S�`Aw`' SysterA pumped as part of inspection: (yes or no) G If yes,volume pumped: ___gallons Reason for pumping: TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed(if known)and source of information: J SCt•rcc . L rD� cw� iS' Sewage odors detected when arriving at the site: (yes or no)�t7 (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C (�SY�STEM INFORMATION} �(c1ontinued) Property Address .��2 ��,�,�e,�-e� Rat Owner. 6C'."C1C v r Date of Inspection: M0-7 SEPTIC TANK_ (locate on site plan) Depth below grade: _ Material of construction: concrete_metal_FRP_other(explain) Dimensions: 7 'll X 3'I 0 x S'y Sludge depth: ti " �3 d I ffl Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: ly 11 Distance from top of scum to top of outlet tee or baffle: S Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping condition of inlet and outlet tees or baffles, de?th of liquid level in relation to outlet ' vert structural}{�tegrity, evidence of leakage, etc.) GREASE TRAP: d)/A (locate on site plan) Depth below grade: Material of construction: _concrete_metal_FRP —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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C { SYSTEM INFORMATION (continued) Property Address: 3 z w I L��I e_v� pPpd r'" ais TL,J S /`'l, 1 S Owner. Date of Inspection: l S F TIGHT OR HOLDING TANK (locate on site plan) Depth below grade: Material of construction: _concrete_metal_FRP_other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: +` Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is ual, evidence of solids carryover evidence of leakage into or out of box, etc.) s ,r.�� ec.. r �S i PUMP CHAMBER/✓ Ilr (locate on site plan) Pumps in working order-(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner. Q'_C`oL.%_ Date of Inspection: 15- May SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: �y leaching pits, number:�L leaching chambers, number._ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: C Comments: (note condition of soil, signs of hydraulic failure, level Hof)ponding, condition of ve tation etc.) C>�JS�ti k IG C�7� Stec Nr� S C JL^a,� \ IS CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liq•.:°d to inlet invert: Depth of solids layer: Depth of scum layer- Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) 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.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 11 11 SYSTEM INFO1RMATIONn (oontinued) Property Address 33 w l-v'^— t n/V�CvS TDti s Owner. Date of Inspection: 7 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' f Q� G 1 i 0 .`�0 IEPTH TO GROUNDWATER )epth to groundwater. t n _ nethod of rmination or approximation: &5eci �1 co)u &--,t Scx� o ,S'e . L 5 � �ec r LCLCcn E�u4i� t C`G 7,'CeC Ci f g iL f C Sc c c PCIA 36.6 revised 11/03/95) 9 Sewer Permit No. 3 "�a Name Location -- �bUUZ)Htl.L) M p RY SERVICE Installer's'Name and Address 4 � e -Builder's-Name and Address - - Date Permit Issued: 9>3 Data compliance Lsued: I OP / f OO Oil,1 No..Dt.. r�/® FEs.......'../d............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................OF.....EA�/.N...S�� C',�.................................... Appliration for Biopoottl ]VOrki Tonotrnrtion ranfit Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal System at: m ? ... ..... -ea ..... :...�1. .....(............ --•-•-------....-•-•--•---•--••---•--•..................•-•-------- .... oc tion_.A ess or Lot No. Owner �� Address --...... Installer Address UType of Building Size Lot_'yf .........Sq. feet . Dwelling—No. of Bedrooms.........____-___............................Expansion Attic (Jyj) Garbage GrinderQ) �4 Other—Type e of Buildin py yp RAM_K._._. No. of persons._.____................ Showers (2-) — Cafeteria ( ) QOther fixtures -___..S_%1aX _ W Design Flow........... ._ --------gallons per person per day. Total daily�flow..___..._.� ®_____________......OlonWSeptic Tank—Liquid capacity/4�VV__gallons Length__V� ._ Pt-_-___. Width _.. Diameter________________ De th_ 6...... x Disposal Trench—No. _.O-............. Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..._._.I...._....__ Diameter__._.��....._.... Depth below inlet_�a_.___._.....__ Total leaching area�9'�......sq. ft. Z Other Distribution box (�) Dosing nk d) aPercolation Test Res -1 Performed by. _.._ __.?�-.. ._r Date__. . _.__. Test Pit No. 1.... .._....minutes per inch Depth of Test Pit...... .2........ Depth to ground water._�-.._..__, 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ................................................. ............. 0 Description of Soil__..._r �.�_.......� ._ .. .. W --- ...................................3-�12-------------------J .. '....................................................................................... VNature 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 LITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beeossued by the board of health. lollowing gned_ _ .......................•----._..._._....-------••••------.........---------•_- 00� J Application Approved By ...... 4/ Date Application Disapproved reasons:...................................................... ----------•------------------•----•------•--•------•---------------------....----•-------._._..........-•-----•------._....._.__....----------------------------...------------•--------------....._.... Date PermitNo......................................................... Issued--•------..__...-------•---•-•...__•--••••••-•......... Date r No.. ... :r)./o Fmc................................THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Diu . ....................oF....,P1 ' .1 ;/}&L:-.................................... Appliratiun for Diiijiuiittl Works Toniitrurtiun Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...... . ...... --•-----------------------•---•-----------.... Loc lion Add�rtess -- •• -•.--•-•---or Lot No. Owner Address Installer Address UType of Building Size Lot.ft.—op.__._._._Sq. feet . Dwelling—No. of Bedrooms_____________________________________________Expansion Attic (j��) Garbage Grinder A) a'4 Other—T e yp of Buildin �j�A�'I_�•._.__ No. of persons__..___................ Showers (.Z) — Cafeteria ( ) d Other fixtures ..ZZ W.M.t_--• -w 7, �C 4aP f.__.GlJ1�Si/__/�/'�i C/ � /_F%/ 1SES -.__.... W Design Flow ,.., _gallons per person per day. Total daily flow.......... -------------------g'Allorpi. WSeptic Tank _--Liquid capacity 0$ ---gallons Length_.%ft.--. Width_f.�D!____ Diameter................ Depth_ ___ ..__. x Disposal ,Trench—No. Q____.___.............. Width.................... Total Length.................... Total leaching area....................sq. ft. � Seepage Pit No______ _ ________ Diameter._.__ .._.__.... Depth below inlet_4 .______..___ Total leaching area Q __....sq. ft. ` Z Other Distribution box ( )° Dosing 1nkkfill •�^Percolation Test Resul Performed by . ... - -e--r-1"�I4_..._._.__ Date.__. .?fl� .. Test Pit No. 1___ _..._._minutes per inch Depth of Test Pit___ `!.z_.______ Depth'to ground water_.N .�1�71K G14 Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................ - - ... ---------------------•---•-•------•-•----_-_-•-•-•••....................... O Description of Soil...:__""'..'- 40!�!tt�_. .� --� --- ----------------------------- ____----- - V ---•----••-•-------- a� •-............... w - 4 ----------------- ----------------- - ----- In' x ---=/�--•------.._.. rr .............................................. U Nature of Repairs or Alterations—Answer when applicable. :.. :._..r_....... ---- Agreement: t r, The undersigned agrees to install the: foredVkribed Individual Sewage Disposal System in accordance with the provisions of l I.L L 5 of the 8t to Sant any Code=The undersigned further agrees riot to plac the system in operation until a Certificatee• a e ssued by the board of Health. Application roved B _._._ .............. w ____.___ __Y _ ._ PP PP y----- ` ' Date Application Disapproved f the llowing reasons_____________•______________..._____•_____.._..__••____•___________-_-__________...._....._...___.....__.._...... y Date PermitNo......................................................... �' Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Pr` ..........................................O F..................................................................................... Trrtifiratr of Tompliatta S IS TO EIZT,I , That the Individual Se age Disposal System constructed ( . or Repaired ( ) by.. f.. ..= ... • -----------•...................................................•-------...•----•---•--...._....-•-- -- Installer has een installed in accordance with the provisions of T IF 5 of The State Sanitary Cod ribed in the application for Disposal Works Construction Permit No.K3 ................ dated__ ._a THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A GUARANTEE THAT THE SYSTEM 1 llI F NCTION SATISFACTORY. DATE. J Inspector. --•-•----------•----•--------------------•-----_-----•••••-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - .___- ..r, ..........................................OF..................................................................................... �/ No _- ---•-------• _. FEE.....v............... Diu ou41V_ utrnrt' n Permit Permiion is by gra d--•---- .......................................................................or R n In !Dispos l ys. toYConstruct { tat No ----- _._._. ................... ...---...----- �..-•------ •••-••----•--••-- --_._...._... --•---•--•------ n. Street r� as�show"'. the lication for Disposal Works Construction Permit No:_ ___.__: _ Dated__ _ ! ..:��................. 6 e a" �/pp _.._...---•.......---•........... .... ... ......................................................... L 2 Board of Health DATE- -- ---�... .1.__.._._._... --- ....... ` FORM 1255 A.,-M, SULKIN, INC., BOSTON zc z 77 ' v r S /'g:Z�aa e,4 4.. GA L. � T� 7 L4i�Al I�w �I • � Vr+.rFN.I�r. _ �.4 Y�� r —4 7e. /46-,'7-1.CY 7'i�,Al *"7"� ,P 1�5 /�S J r '.�`i' i��r'. A 11,L6 IV,4 6-1; trt /7 440 ,i/ar-4.-!'4-77F1-;� f f �� THY/ .,� i .' .V40 T f3104S,rr o ,4.cf #;k: V ALAN / CJ�- Sim CN 41 " i TE LL SYSTEM PROFILE MALL ARK DS WITHCMAGNETICTTAPEAOR BE NOTES LEGEND COMPARABLE MEANS FOR F TURE LOCATION. (NOT To SCALE) 1. DATUM IS APPROXIMATE NGVD 99- EXISTING CONTOUR SYSTEM DESIGN. ACCESS COVERS TO WITHIN 6'" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3' GRADE (SEA VENT NOTE ON PLAN) 2. MUNICIPAL WATER IS NOT AVAILABLE X 99.1 EXIST. SPOT ELEV. GARBAGE DISPOSER IS NOT ALLOWED \ TOP FOUND. EL 84.8 FILTER FABRIC OVER STONE 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. $5.0' MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 99 PROPOSED CONTOUR DESIGN FLOW: 4 BEDROOMS ® 110 GPD = 440 GPD 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS QOCI-BLOCKS tie PRECAST H-10 PRECASTORISERS TO BE AASHO H-2Q "P 198.41 PROPOSED SPOT EL. USE A 440 GPD DESIGN FLOW RISERS (TYP.) " TOP S S. EL. 81.6 5. PIPE JOINTS TO BE MADE WATERTIGHT. O 2'0 41aSCH40 PVC MORTAR ALL d TH1 �; PIPES LEVEL 1ST 2' 4' COMPONENTS NTS IN 'S 0.6 4' a\e� SEPTIC TANK: 440 GPD 2) = 880 •••• ( ,.: � �ENDS SIDES RDANCE WITH ire TEST HOLE ,,,,••••• 6 CONSTRUCTION DETAILS TO BE IN ACCO ' **RE-USE EXISTING 1000 GAL. SEPTIC TANK '.�: *EXISTING 10" 14" � o�o �o` .. . .,. .. .,, .. °°°°°°°° 2� SLOPE OF GROUND '' ' EXISTING TEE TEE *81 .2'f > o 0 0 ° ®®®® ®®®® ®®®® !nmm ®® o0 0 0 71 THIS PLAN OIS FOR POPOSED WORK ONLY AND NOT TO1000 GAL (EXISTING) o'° ° o`o 0 0 0 0 ®®®®®®®®®m® ®®®®®® ® ®® ; 0000'000000°o°o°o O �o°o°o°o° �®®® ®®®®®® ® ® °o°O°O°OUTILITY POLE LEACHING: SEPTIC TANK BAGAS E °�o�o°o o°� N > 000000 ®®®®®®®®®®® ®®®®®® ® ® ,00000000 BE USED FOR LOT LINE STAKING OR ANY OTHER Locus SIDES: 2 (33.5 + 12.83) 2 (.74) = 137 GPD ": 4� u4. LEVEL PURPOSE. FIRE HYDRANT BOTTOM 33.5 x 12.83 (.74) = 318 GPD •`''' '�' 78 6 s.'PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 00 NOTE NOT ALL SYMBOLS MAY APPEAR IN DRAWING 3 4 -1-1 2 DOUBLE WASHED STONE 4 MIN. H-20 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. 4' / " / " ' 615 S.F. 455 GPD DEPTH OF FLOW = (3) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED Middle Pond P TOTAL: ALL AROUND PRECAST STRUCTURES WITHOUT INSPECTION BY BOARD OF HEALTH AND TEE SIZES: 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 33.5' X 12.83' PERMISSION OBTAINED FROM BOARD OF HEALTH. USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) INLET DEPTH = �� COMPACTION. (15.221 [2]) *THE INSTALLER SHALL VERIFY THE �' 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING WITH 4' STONE ALL AROUND OUTLET DEPTH = 14" DIGSAFE (1-�888-344-7233) AND VERIFYING THE LOCATIONS OF ALL UTILITIES AND ALL LOCUS MAP LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES BUILDING SEWER OUTLETS AND PRIOR TO COMMENCEMENT OF WORK. ELEVATIONS PRIOR TO INSTALLING ANY ( 1 % SLOPE) ( 1 % SLOPE) NO BOTTOM TH-2 SCALE 1"=2000't PORTION OF SEPTIC SYSTEM No GROUNDWATER FOUND � 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE MA LEACHING REMOVED 5' BENEATH AND AROUND THE PROPOSED ASSESSORS MAP 82 PARCEL 21 APPROVED DATE BOARD OF HEALTH FOUNDATION EXISTING SEPTIC TANK 30' D' BOX 13, FACILITY LEACHING FACILITY. j LOCUS IS WITHIN GP OVERLAY DISTRICT 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND ** R SHALL CONFIRM MIN. REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. THE I N STALLE i SEPTIC TANK SIZE AT 1000 GALLONS AND I ITS SUITABILITY FOR RE-USE VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE i IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR BY HEALTH INSPECTOR PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED TEST HOLE LOGS BY THE BOARD OF HEALTH REVISED DURING A PUBLIC �� HEARING HELD ON NOVEMBER 15, 2005 O ENGINEER: DAVID FLAHERTY, R.S., SE2755 1) FAILED SYSTEMS ONLY - SAS TO PRIVATE ONSITE WELL SEPARATION DISTANCE VARIANCES, IF LOCATED IN THE SAME WITNESS: DONNA MIORANDI, R.S. �� O GENERAL LOCATION AS THE OLD SAS AND MORE THAN 100 DATE: APRIL 14, 2008 10 N 0 3) FAILEDFEET ASYSTOEMSSON PROPOSED.SOIL ABSORPTION SYSTEM PERC. RATE < 2 MIN/INCH V� _ INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW CLASS I SOILS p# 12173 LOT 2 GRADE WITH PROPER VENTING (PIPED TO THE ATMOSPHERE) 44,450 SFf AND WITH H-20 LOADING, BUT IN NO CASE SHALL THE SAS BE LOCATED MORE THAN FIVE FEET BELOW GRADE. ELEV. ELEV. / $1� 011 4 86.0' 0" 86.0' A A �LS /LS 1OYR 4/2 1OYR 4/2 2 3 121p 12 3 \ \ $ EXISTING GROUNDWATER B B FLOW PER TOWN OF yE �� \\ 8� CONTOURBLELEV ON MAPER �i iS 27" 10YR 5/6 83.7', 28" 10YR 5/6 83.7' S �p�, C 1 C 1 -. 84 - cye , 10YR 5/6 10YR 5/6 oyE ELEC. 56" 81.3 59" 81.1' 85 \� METER C2 C2 EXISTING PERC PA V D GARAGE / D E MS MS UG PROPANE lbh TANK 120" 10YR 7/4 76.0' 150" 10YR 7/4 73.5' b WALK / NO GROUNDWATER ENCOUNTERED 197't ABUTTER'S WELL O r'.�. , \_ ----------- --TOPELLEVS=TANK 82.6' -� = UNSUITABLE MATERIAL �O- '. .,• Ht.r�i m° SST / *14 BENCH MARK: / TOP CORNER PORCH EL. 85.6' 41 TIT �� E P L A N EXISTING / / f{ S OF DWELLING PROVIDE VENT WITH CHARCOAL FILTER "'l TOP FNDN = 84.8' AND BUGSCREEN (FINAL PLACEMENT WITH f{ J.i A-HOMEOWNER CONSULTATION) + a4� 332 WHEELER RD. I � / (MARSTONS MILLS) BARNSTABLE, MA 9,p�<°� lbh I N PREPARED FOR o?11�° o y� HICKEY CONSTRUCTION/ MAURA BRESNAHAN DATE: APRIL 14, 2008 .0. / Scale: 1"= 20' / 0 10 20 30 40 50 FEET MIDDLE POND / _ off 508-362-4541 NOFMgSS I fax 508-362-9880 �\�NOFM DANIE;LA. downcape.com �� gs�� / OJALA �, �o DANIEL yc down cope engineefing, Al � th CIVIL � A• o� 2 ALA ll N�09 0 Civil engineers �p Ion d surveyors r V -11ii�9 a - 939 Main Street ( Rte 6A) DATE DANIEL A. 0JALA, ."01 rS YARMOUTHPORT MA 02675 BICE #08-080 08-080 HICKEY_BRESNAHAN.DWG -_T _ _ -- r T