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HomeMy WebLinkAbout0512 WHISTLEBERRY DRIVE - Health 512 WHISTLEBERRY DR.,,MARSTON MILLS A = y 1 EXCERPT FROM THE BOARD OF HEALTH MEETING MINUTES 9/08/09: VI. Hearing — Septic: Francis and Barbara Ferguson, owners 5-1-2-Whistleberr-y D ivr e, .::D `rstons'Mills�b�edroom count. Mr. Ferguson and the Board discussed the situation. Upon a motion duly made by Mr. Sawayanagi, seconded by Ms. Rask, the Board voted to extend the deadline to 60 days, at which time, Mr. Ferguson will enlarge one of the bedroom doorways to 5 feet. (Unanimously, voted in favor.) Date: August 4, 2009 To: Board of Health From: Robin Anderson, Zoning Officer Re: 512 Whistleberry Drive, MM The subject property was inspected by the Barnstable Inspectional Services Team (BIRST) on the evening of June 25, 2009. We were admitted to the property by the owner, Francis Ferguson. He escorted us to the apartment on the second floor. A one-bedroom apartment with a living room and full kitchen was found off a short hallway at the top of the stairs on the second floor. It was obvious that the apartment was unased at this time. On Feb. 2, 2009, the owner had submitted the required annual affidavit declaring Angela Smith to be the occupant of the accessory unit. During the inspection on June 25, 2009, the owner stated that the unit had been vacant for 2 years. He was reminded and re-informed during this inspection that according to his agreement with the town under Chapter 240 Section 47.1 A(5),when the need for a family apartment ceases the unit must be removed. Typically, this is satisfied by the complete elimination of the food preparation area. It is also customary in properties with limited septic capacity, to allow the property owner to remove the privacy in another"bedroom" in order to accommodate a bedroom elsewhere in the dwelling. After our discussion recapping the family apartment requirements, Mr. Ferguson stated that his niece would be attending 4C's and would be moving in shortly. We did not inspect the entire house at this time as Mr. Ferguson was apparently upset and was declaring his intent to appear before the US Supreme Judicial Court. The team did not want to further incite or otherwise inflame the situation. We exited the property with the intent to research and assess the situation. Based on the information available in town records, the visual layout of the dwelling as observed inside and out, floor plans on file, and factoring in Mr. Ferguson's remark that`Bortolotti worked wonders"with the new septic system, one would not unreasonably conclude the following: • The dwelling currently contains more Title 5 defined bedrooms than approved, • The septic system was upgraded in some fashion but not necessarily in accordance to what was filed with the town. It should be noted that at the time of this inspection the property was listed for sale. Documentation was found regarding the rental of a studio apartment in May of 2000. This of course is a violation of the local ordinance under Chapter 240 Section 14. r _ Town of Barnstable Regulatory services 0 Q Public Health Div. 200 Main St. Hyannis,Ma.02601 Sirs; Francis Ferguson and Barbara Ferguson owners of property at 512 Whistleberry Dr. Mustons Mills,Ma. Request a hearing regarding the NOTICE TO ABATE VIOLATIONS,which was received on July 9, 2009. Francis Ferguson J�6°' u� C co ..,' b l Z� _- ����NS U.S. Po' MARSTONSAMOIL 7008 1830 0001 8926 9381 JUL013.' "VNITEDSTATES AMOUNT POSTAL SERVICE e IOOO 0260! 000482 RETURN RE EepY REQUESUD tt yt y 1if tt ``1i j iy {{ 11 14 C�2¢s��1''�,'a►UU"G CU2.1: �i�ttsetltit��telietstit�lt�itli'ttt�ittttA IM1tti�1({ttttyyltltl i 60 f y � 3Jti1 . � _ _ : - :..- ..->._- ! I,l■1 1 IIII N11 1II�l`ii-,;..��-'.�1 III - ... ._:_ ,--a. - -�---- - N, Certified Mail#7008 3230 0002 5177 8230 IKE Tp�'� Town of Barnstable Regulatory Services BAPNS-rasLE, MAS& g Thomas F. Geiler, Director Qj 1639• �� 1639. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 July 7, 2009 Office: 508-862-4644 Fax: 508-790-6304 Francis &Barbara Ferguson 512 Whistleberry Dr. Marstons Mills, MA. 02648 NOTICE TO ABATE VIOLATIONS OF 310 CMR 15.000, STATE ENVIRONMENTAL CODE TITLE 5. The property owned by you located at 512 Whistleberry Dr., was inspected on June 25, 2009 by Donald Desmarais RS, Health Inspector for the Town of Barnstable. The following violation of the State Sanitary Code was observed: 310 CMR 15.203: There were a total of four (4) bedrooms observed in this dwelling. However, the existing septic system engineered-plan was not designed for four (4) bedrooms. It was designed for three (3)bedrooms. You are ordered to correct the violation listed above within thirty (30) days of your receipt of this notice by pulling any required building permits (if applicable); You are ordered to remove one of the bedrooms from this home by. removing the entrance door and by opening the door-way entrance to the room to a minimum of a five feet wide opening. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding above violations, please contact the Town Health Division and ask to speak with inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable V Certified Mail#7008 3230 0002 5177 8230 Town of Barnstable Regulatory Services IBM LE, 9�p `363 Thomas F. Geiler,Director ArFbMA�A Public Health Division Thomas McKean, Director 200 Main Street,,Hyannis, MA 02601 July 7, 2009 Office: 508-862-4644 Fax: 508-790-6304 Francis &Barbara Ferguson 512 Whistleberry Dr. Marstons Mills, MA. 02648 NOTICE TO ABATE VIOLATIONS_ OF 310 CMR 15.000, STATE ENVIRONMENTAL CODE TITLE 5. The property owned by you located at 512 Whistleberry Dr., was inspected on June 25, 2009 by Donald Desmarais RS, Health Inspector for the Town of Barnstable. The_foll_owing viol_ation_of the State Sanitary Code was observed: 310 CMR 15.203: There were a total of four (4) bedrooms observed in this dwelling. However, the existing septic system. engineered plan was not designed for four (4) bedrooms. It was designed for three (3) bedrooms. You are ordered to correct the violation listed above within thirty (30) days of your receipt of this notice by pulling any required building permits (if applicable); You are ordered to remove one of the bedrooms from this home by removing the entrance door and by opening the door-way entrance to the room to a minimum of a five feet wide opening. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with,an order shall constitute a separate violation. Should you have any questions regarding above violations, please contact the Town Health Division and ask to speak with inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable -' `�z+; = � - �,� � �.j :.?5 i .�. �- �: .: s5�a � �_ a��'� W� �� ,.� ��� .,�, ,. ----- - R..- ��_ t� t K., �i��cl �� ', I � � � � / i �1� c. f�ilChen Bahl Laurxtry o. Area. ..:.: :: Room b a�P�n mod►.: Bedroonrl = 22.0' 50A' 1�a . . -._. Bedroor i TUO tn.. 04 p - 5:0 to tonaadits: 77 AREA.CALCULA710NS=SUMMABY LMNG ARE4 BREAKDOWN - 6'�►1....,:Fi;sC,Flaor .;;. 1a92 00:'; ]�32io0 ;Pisst ioor lilJlZ Ssean;4_ loo 1156 00`. is 1156.00 #l.0•x SO.O ss0-Bo PJP Aped koseh ;2Z o0 7 6 It _ 22.0 22.00 Dee![ tl6-00 r, 48 GO, ,Y5 O x_.'. s0'.0 7SO.00 A A.agp }84.00t �64 80 E� :a --22.0 110.00 �J _ 'SeaeOd:•Floor. J/_ 5.0 x 12.0 60_00 22.6 x 25.0 SSO 00 .♦ .-.. ...�-:.: :�_. ice..'. ...... 70fAi UVQBL (rountiec} > b$8 7Areas Tohai(rounded 2586 aaa 000aE00 'L . _ 50.0' m : Drnrng: Kitchen . [jath Laundry o Area:::_ ..:..._:.' Room a koQm- \\ Via' ` Bedroom .... 22 !^. . _ A . - sotr Bed K _ - :: . Conanentc_ i seams t:-ts AREA:CALCULATiOdS'SUMMARY =WfNG AREA_BRF�lKDOWN` �t3LA1. Fis±Ft E7oat: 14M 1432 00 P b Floor CMA2 g gTp� 1156 00 1156 00 II 0 x 50.0 S50 00 No Leh aetlf 112 60 14 z 22.0 22 00 c Deck �36.00 $t} 00 15 0 Z SG O ISO_00 3ncoA�Floor. f 12.0 5.0 25.0 ssa oo 2910 Wl 44 o0 '_oMI NABL (rounded _ 7 Areas Total(rounded) 2588 ;;- ors ti : t3 v x ! x 1 F,3g r.&��77,11.1 7s : k'S' I -D6p1� J sTiA)G- I-rcI4 J--Al � r �{q(, sp Y Goo L�� r OWN OF BARNSTABLE ON SEWAGE #el� VIL,AGE ASS �SO�'M&,PARCEL INSTALLERS-NAME&PHONE NO. Cr1. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) , (size)_ 'NO.OF BEDROOMS OWNER t° PERMIT DATE: ® 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 OP-S 3`1 5 \ No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zppgication for ate o ar �pgterrt Cott t ctiott permit Application fo-a Permit to Construct( ) Repair( Upgrade( ) Abandon( Complete System ❑Individual Components Location Address or Lot No. �/ 1�� t ) Owner's Name,Address,and Tel.No. �jaJGw �•/j9i f: Assessor's Map/Parcel / sw-V03.'0- 14,ms//S /L q C� /Yrsi Installer's Name,Address,and Tel.No.%, �"` `/ Designer's Name,Address and Tel.No.� -�� s yJ (-/S l4 W/-7 Type of Building: / f Dwelling No.of Bedrooms ✓ Lot Size J (O3 sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures r� Design Flow(min.required) -?- gpd Design flow provided -37G gpd Plan Date / ;7'vc y Number of sheets Revision Date -TUt 1700 Title r• ' � S— P� -r Size of.Septic Tank /FtV Co L —490 Type of S.A.S. L✓—-�'� (Aw la� 30t-0 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 BgA of Signed Date Application App-oved by Date Application Disapproved by: Date for the following reasons Permit No. °7-0 0 30 r> Date Issued 7— No. ~ Fee A70� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ppficatiou for �Di5po'5ar *pgtem Con0tr6uctiou permit Application for a Permit to Construct( ) Repair(Zpgrade( ) Abandon( ) L'J Complete System ❑Individual Components Location Address or Lot No. t✓� 1/�� 'YF /�� v1 Owner's Name,Address,and Tel.No. � G'l Assessor's Map/Parcel ` Installer's Name,Address,and Tel.No.� ' ' Designer's Name,Address and Tel.No. 1" ' C"S� /-/f- !j?GnJ 5 t f7 y / Y 11,)G /r��•� ` y Ajo-/ Type of Building: Dwelling No.of Bedrooms Lot Size ((0 7 sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 73el gpd Design flow provided % gpd Plan Date 7d7 /, ./aG Number of sheets Revision Date ]iiZ-, Title 61/G- o 5"/.� G✓/�A 4—,,, /)A. Size of.Septic Tank /f6o Co L 1—,907 Type of S.A.S., -/7ifio 3p,J p Description of Soil' /r111I ,Nature of Repairs or Alterations(Answer when applicable) ,'OG/r- �, �`�n7 �*�^ /J�047 Y Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in I ccordance 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. 4 �..._----- Signed Date � y Application Approved by Date Application Disapproved by: /l Date for the following reasons Permit No. a O O (J Date Issued ?' p THE COMMONWEALTH OF MASSACHUSETTS _ BARNSTABLE, MASSACHUSETTS a (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( by -}Lir 4/y/0 at S"/2 y I/r,)�iC ��.; ,, /�/�, 1 .///i��C has been constructed in accordance with the provisions/of/Title 5 and the for Disposal System Construction Permit No. 900A �O�J dated /— ? _p Installer /ter.�41.wl emw� iyt�.✓ Designer .I lw-� C,7/-r Cn5r #bedrooms _/ Approved design flow 31/10 gpd r= The issuance of this permit hall-not be construed as a guarantee that the system will functio�designed. Date �"�l O $ Inspectdr—� .- No. , 30 5 Fee le2o THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS aiopoal �§pgtem Co �trUCtion 3Permit Construct Repair Upgrade ) Abandon ( ) Permission is hereby granted to ( ) p ( ) pg / ( System located at /Z GJ k i /1 -•,,-, ��� /n•hyi�i► and as described in the above Application for Disposal SystegrConsfi action 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 thisrpxmitn nA Date —7— _0 Approved by (/r--(3[) �✓ d FROM :down cape engineering inc FAX NO. :15083629880 Aug. 06 2008 01:26FM P1 11>j Town of Barnstable Regulatory Services Thomas F. Geiler,Director n�►aw�raa�, @ MAB� Public Health Division Thomas McKean,Director 2W Main Street,Hyannis,MA 02601 Office: 503-862-4644 lax; 508-790-6304 Justallcr& Designer Certification Form Data;: �`�`�� Sewage Permit# c�Z o /3drAssessor's MaplParccl r'I Dcrigner: \- Ow'I Cape E! 'I e � Installer: 0✓TDIp �� - '/ A,ddrevs: 4J� y— i✓1 V L Address: O _+Q07 /a ._ — On �-6� �i������ evjkl� was issued a permit to install a (elate) (imstal.ler) II� , t ;septic system at °� G�n i f k be f 2g �r)V e based o»a design.drawn. by (address) 0 tnl11 �(��� dated 1� U (designer) _ I certify that the septic system referenced above was installed substantially according to the desiim, Arbieb may include minor approved changes such as lateral relocation of tli.e distribution box andlor septic tank. N O.A.t W-7,0 Se-PO9— -t' ra G l OT.,%.�� t-4 atr 4,S Y 1 certify tbat the septic system referenced above was installed with major ebanges (i.e, greater than 10' lateral relocation of the SAS or any vertical relocation of any component ' of tb.e septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer, to follow. 101 of+u�ssc 9 Qs ARNE H. _ gnature) a OJALA ntitaller's Si CiV,L No. 3a792 4 _ r s"�pN.4l EN� - :signer's gnature) (Affix Designer s Stamp Here) PLEASE RETURN TO BARN%TABLE PUBLIC: I RALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT HE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD .A,RR RECEIVED BY'I'HL BARNWARLE PUBLIC: HEALTH DIVISION. THANK YOU. Q;Hraltb/Srptic:/l)rs;Kr r CertiYicationborm 3-26-04,4cic SENDE CPMPLETE THIS SECTION e Complete items 1;2,and 3.Also complete A. nature Item 4 if RestrictedSignature Delivery is desired. ❑Agent ® Print your name and address on the.reverse ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. D e of el've ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No J I h,( , f�l M 3. Service Type ��w �I ❑Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise 6 0`u`t ` ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number1 tits (rransfer from service label) i t[i i O G0 6 215 0 i 10 0 0 2 'f 1 4:1 9 7 4 7 PS Form 3811,February 2004 Domestic Return Receipt 102595.02 W 540 UNITED STATES POSTAL SERVICE "'c� ;r �':>.-1" y.;s q wro ;:y r.» V. y a�a .,�?ri. R yw.w.wJ� PS-- • Sen,jer. PAase pri it your name, address, and Zl 1n this box • "�� I �I d T of Barnstable I P Health Division Fa,oM;. 2 (Main Street U- H ®nis,MA 02601 II Gr.}: 11tt3?iliitllP!'II?It�3�tJ?1?:Ifl?tt( dttJ?i:/ilff?l.lTlfdl?ii! U.S. Postal Service . CERTIFIED M41LTM REC-EIPlg0mnhid' MairOnly;No Insurance(overag Provided) �F&,delivery,information,visit our,website aat vww.usps.com® s.. w � � w , � w is Form 3800,August 2006 See Reverse for�lnstructions Certified Mail Provides: , e A mailing receipt o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: e Certified Mail may ONLY be combined with First-Class Mails or Priority Mails. o Certified Mail is not available for any class of international mail. n NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ® For an additional fee,a Return,Receipt may be requested to provide proof of delivery.,To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for, a duplicate return receipt,a LISPS®postmark on your Certified Mail receipt is required. o For an additiorial�fee delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". " n If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 Town of Barnstable Barnstable I-America C A " j Regulatory Services Department A BARNSTABLE. 9 M 39. ,� Public Health Division �PrfD µa+A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO June 4, 2008 Francis Ferguson 5 12 Whistleberry Drive Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 512 Whistleberry Drive, Marstons Mills, MA was last inspected on May 21, 2008,by Patrick M. O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Observed liquid level at the top of structure, leaching pit is in hydraulic failure. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF T E BOARD OF HEALTH 1 omas McKean, R.S., CHO Agent of the Board of Health CERTIFIED MAIL#7006 2150 0002 1041 9747 Q:\SEPTIC\Letters Septic Inspection Failures\512 Whistleberry Drive.doc I , Al Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments (` 512 Whistleberry Drive �J " y Property Address Francis Ferguson � I -® a,3 Owner Owner's Name information is y Marstons Mills MA 02648 May 21 2008 required for , every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. ILA Company Name 189 Cammett Road Company Address Marstons Mills MA 02648 Cityrrown State Zip Code 508-428-1779 SI 12855 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this addressl and that�he 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 maihtenanc6:df on site sewage disposal systems. I am a DEP approved system inspector pursuant to-Section 19.340 Q$ Title 5(310 CMR 16.000). The system: U ;a O -v ❑ Passes ❑ Conditionally Passes ® Filk ❑ Needs Further Evaluation by the Local Approving Authority May 21, 2008 Inspector's 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 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. ****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. 08-122 Ferguson.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °( 512 Whistleberry Drive Property Address Francis Ferguson Owner Owner's Name information is y Marstons Mills MA 02648 May 21 2008 required for , every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any 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: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 08-122 Ferguson.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 I�— Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 512 Whistleberry Drive Property Address Francis Ferguson Owner Owner's Name information is Marstons Mills MA 02648 May 21 2008 required for Y every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 08-122 Ferguson.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 4 Commonwealth of Massachusetts Title 5 Official Inspection Form j Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 512 Whistleberry Drive NI�t Property Address Francis Ferguson Owner Owner's Name information is Marstons Mills MA 02648 May 21,2008 .required far Y every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria 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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® 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 ❑ ® 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. 08-122 Ferguson.doc-OWS Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts ur Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 512 Whistleberry Drive Property Address Francis Ferguson Owner Owner's Name information is y Marstons Mills MA 02648 May 21 2008 required for , every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrog en gen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. I 08-122 Ferguson.doc-M06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 512 Whistleberry Drive Property Address Francis Ferguson Owner Owner's Name information is Y required for Marstons Mills MA 02648 May 21, 2008 every page. City/town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as.to each of the following: Yes No ® ❑ 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? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(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) [310 CMR 15.302(5)] 08-122 Ferguson.doc-08W Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 L Commonwealth of Massachusetts U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 512 Whistleberry Drive Property Address Francis Ferguson Owner Owner's Name information is Marstons Mills MA 02648 May 21 2008 required for Y every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? El Yes Z No Water meter readings, if available(last 2 years usage (gpd)): 354,000 gal. _ 484 gpd. Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day Y(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank 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): 08-122 Ferguson.doc-Oal06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 I` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °( 512 Whistleberry Drive Property Address Francis Ferguson Owner Owner's Name information is y Marstons Mills MA 02648 May 21 2008 required far , every page. Cityfrown State Zip Code Date'of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Tank pumped in 1999 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1986 Were sewage odors detected when arriving at the site? ❑ Yes ® No 08.122 Ferguson.dac•0&06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 I_ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "t 512 Whistleberry Drive Property Address Francis Ferguson Owner Owner's Name information:'s Marstons Mills MA 02648 May 21 2008 required for Y every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 8' 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.): Septic Tank(locate on site plan): Depth below grade: 8'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 -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1250 gal. Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness' Distance from top of scum to top of outlet tee or baffle , Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? 08.122 Ferguson.doc•08M Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 512 Whistleberry Drive Property Address Francis Ferguson Owner Owner's Name information is Marstons Mills MA ' 02648 May 21 2008 required for y every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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 had solids to top of structure, structural integrity could.not be determined. 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.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: P Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): 08.122 Ferguson.doc•W06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts rA Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 512 Whistleberry Drive Property Address Francis Ferguson Owner Owner's Name information is Marstons Mills MA 02648 May 21 2008 required for Y every page. Cftyrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day 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 Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 08-122 Ferguson.doc-W06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts ugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 512 Whistleberry Drive Property Address Francis Ferguson Owner Owner's Name information is y Marstons Mills MA 02648 May 21 required for , 2008 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® lea-.hing pits number: One 6x6 pit ❑ leashing chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Observed liquid level at top of structure, leaching pit is in hydraulic failure. 08-122 Ferguson.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 't 512 Whistleberry Drive Property Address Francis Ferguson Owner Owner's Name information is y Marstons Mills MA 02648 May 21 2008 required for , every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No 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.): t x 08-122 Ferguson.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ° 512 Whistleberry Drive Property Address Francis Ferguson Owner owner's Name information is Marstons Mills MA 02648 May 21,2008 required for y every page. City/rown State Zip Code Date of Inspection D. System Information (cont.) 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. Whistleberry Drive Water Service % / / JJJJ / / J / JJJJ / / /%/ /%/% JJ%/%J / JJ%J% / , / / %/%/%/%/%,% / / / / /%%/ I / /% %/ / I 9%/% / / / I%/ / / /%/ % / J / / / / J J / / / %/%I /%/%/%/ 34 22 44 37 } Commonwealth of Massachusetts _ Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 512 Whistleberry Drive Property Address Francis Ferguson Owner Owner's Name information is Marstons Mills MA 02648 May 21, 2008 required for y every page. Cityrrown State Zip Code Date of Inspection eP D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to ground water: N/A 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: Date ❑ 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: 08-122 Ferguson.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 �o�.�Hs roil Town, of Barnstable Regulatory ,Services MRNSMBLE, : Thomas F. Geiler, Director 9Q 6� ,fig ArFo �a Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving tl-is report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. QASEPTIC\Disclairner Private Septic Inspections.DDC - — % s� COMA IONWEALTH OF I)rLNSSACHL%SETTS , EXECUTIVE OFFICE OF EN-VIRONb4ENTAI' DEPARTMENT OF ENVIRONMENTAL PROTE QIG ONE "INTER STREET. BOSTO\ \L4 1 ,9 02108 (617i 29'1•S:iu i 19 1999 I%- TRlibV CIOXE �Secretar� ARGEO PAUL CELLUCCI � ��D''B. STRUHS Governor Conunissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM vko PART A CERTIFICATION Property Address: ( 1XL Name of Owner M Iddress of Owner: yy�,Q MCI. IW Date of Inspection:`r�ul / 5 Name of Inspector:(Please P'nt) C ha kal I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: d&ce y A? 6k t^,''Ane- a &*A C a+CA / Mailing Address:?-,a Z.7?.gtL• Ne1g5 New_ troo ,2- 4,-cl Telephone Number: �SQ _y�(� 7-; . CERTIFICATION STATEMENT 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: Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails q C Inspector's Signature: Date: G 1 The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)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 iregional 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. NOTES AND COMMENTS r- revised 9/2/98 4 Page iorII , �� Printed on Recyckd Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 'MI3 ty,Address: Jwner: , Date of Inspection 04 INSPECTION SUMMARY: Check A, 8, C, o/ D: A. rSYSTEM PASSES: 1 have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated.are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES`. One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined(Y, N, or ND).' Describe basis of determination in ail instances. If "not determined", explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a-copy of a Certificate of Compliance (attached)indicating that the tank was installed within twenty(20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing,septic tank is replaced with a complying septic tank as approved by the Board of Health. _ 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 mote 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 I revised 9/2/98 Page 2.of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to det rmine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANC WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEAL AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland r a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PU IC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC H LTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption s stem(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 soil absorptio system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorpti system and the SAS is within 50 feet of a private water supply well.. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well wat analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility nd the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximatiori not valid). 3) OTHER revised 9/2/98 Page 3ofIt SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) ' Property Address: Owner: Date of Inspection: D. SYSTEM FAILS: You must indicate either "Yes" or -No" to each of the following: 1 have determined that one or more of the following failure conditions exist as described n 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determi a what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to en overload e or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surfa waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to n overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or availabl volume is less than 1/2 day flow. _ Required pumping more than 4 times in the last year NOT d to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or ivy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet o 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 within150 fe of a private water supply well. Any portion of a cesspool.or privy Is less-than 0 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well as been analyzed to be acceptable, attach copy of well water analysis for •coliform bacteria, volatile organic compounds ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the folio ing: The following criteria apply to large systems in ad ition to the criteria above: The system serves a facility with a design flow 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because ne or more of the following conditions exist: Yes No the system is within 400 feet of a urface drinking water supply the system is within 200 feet of tributary to a surface drinking water supply the system is located in a nitrog n 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 grade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Pare 4oril i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1Sk1ZW\1\ Owner: a-�,� Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No _ Pumping information was provided by the owner, occupant, or Board of Health. x _ None of the system'cbmponents 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. As built plans have been obtained and examined. Note if they are not available with NIA. 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. For example, Plan at B.O.H. _ Determined In the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 115.302(3)(b)) ' The facility owner(and occupants,if different from owner) were provided with information on the proper inaintenaaco.of SubSurface Disposal Systems. I revised 9/2/98 Page sor11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION 'roperty Address: S Owner: . Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:. � g.p.d./bedroom. Number of bedroom s''(design): 0-�, Number of bedrooms (actual): Total DESIGN flow ��6 Number of current residents: Garbage grinder(yes or no):� Laundry(separate system) LUs or no): If yes, separate inspection required Laundry system inspecte (ye r noP Seasonal use (yes or nol: Water meter readings, if available (last two year's usage (gpd): 6 Sump Pump(yes or no):(.. Last date of occupancy:-VA eV`T COMMERCIALANDUSTRIAL: Type of establishment: Design flow: gpd ( Based on 15.203) Basis of design flow 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 inform tion: Wvy"N AIM System pumped as part of inspection: (yes br no) If yes, volume pumped: gallons , Reason for pumping: F 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) IIA Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval, Other 1 APPROXIMATE AGE of all components, date installed lif known)and source of information: YL C -OlN wt, Sewage odors detected when arriving at the.site: (yes or no) revised 9/2/98 Page 6orll _ 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'roperty Address: Owner: rT Date of Inspection: V BUILDING SEWER: 'w � (Locate on site iplan) Yw Depth below grade:_ Material of construction:_cast iron_40 PVC—other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage,—etc.) SEPTIC TANK: . (locate on site pl n) Depth below grade: VO Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal, list age4 Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: Sludge depth: a t') Distance from top of sludge to bottom of outlet tee or baffle:_ Scum thickness:_ '6h Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: \!�6h How dimensions were determined: tlSySsa^t 'omments: (recommendation for pumping, condition of in ,and outlet tees or baffles, depth�f liquid level in relation to outlet inrert structural integrity, evidence of leakage,etc.) -z c- 40 1, GREASE TRAP_J � (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensions: Scum thickness. Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (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 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 'roperty Address: S,Z �Stu Owner: Date of Inspection: TIGHT OR HOLDING TANK: JJD(Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:____ Material of construction: _concrete_Metal,_Fiberglass_Polyethylene —other(explain) Dimensions: Capacity:—gallons Design flow: gallons/day Alarm present Alarm level:—Alarm in working order:Yes _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX�S (loca te on site plan) I Depth of liquid level above outlet invert:� ,L_ a e into or out of box, etc.( Comments: evidence of solids carryover, evid a of leakage(note if level end distribu 'o is a ual, evi�e , PUMP CHAMBER: (locate on site plan) Pumps in working order:(Yes or No) , Alarms In working order(Yes or No) Comments: s and appurtenances,etc,( (note condition of pump chamber,-condition of pump S page fi of I revised 9/2/98 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) `roperty Address: Owner: v Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): v (locate on site plan, if possible; excav tion not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:40)kA leaching chambers, number:_ leaching galleries, number:_ leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of onding, damp soil, c ndition veg tion, etc.) ai CESSPOOLS: {) (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: 9epth of solids layer: )epth 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.) u revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 'roperty Address: V3\n\ST l.e\4�VL� )wnef: Date of Inspection: s. r SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) S�Z v I , JQ J 30 14� 37 revised 9/2/98 Plgcloof11 n SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) ropertyAddress: Owner: Date of Inspection: NRCS Report name ✓�`� _ Soil Type_ — — -- -- -- Typical depth to groundwater____ USGS Date website visited vv`�- Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope �j1,�►.T- Surface water tJU- Check Cellar Shallow wells Nu Estimated Depth to Groundwater '�'2,oFeet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property, observation hole, basement sump etc.) it Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) i revised 9/2/98 Page 11of11 /� THE COMMONWEALTH OF MASSACHUSETTS I /0� BOAR® OF HEALTH V� ---.... ........ ............ OF..............................-........................................................... W"NVpfiration for DiiiVntitt1 Works Tonstrurtion 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ....:.....�t� I.S.t .�J£' ... ........... /-•! /i1....M. 1 - .. t. ............................................. .• Locatio Address or Lot No. .....---- .. �4..5.....�� � -•----------------- . ......�U.=----.6UX....sa2Zf._1�•f��ll1/ulaS. ........... Owner Addre ........ S 1J.................... .. ................................................. �ll.J Installer Address d ............................ �/ 63 q Type of Building Size Lot........... ...............S . feet U Dwelling—No. of Bedrooms.................—1.....................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Pa Other fixtures -----------------•-•-•--•-------•---•---••-•-- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter......._-------- Depth................ x Disposal Trench—No. .................... Width.............._..... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by......................................................................... Date........................................ Test ?it No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ ----•--••-----------------------------•------------................-•---------......------------.........---.....------....---...--•......._......•--••.--•- 0 Description of Soil....................................................................................................................................................................... x 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—.T undersigned further agr not to place the system in i until a Certificate of Compliance h en issued e rd of health. operation t Ce t p Si g n e : ._ .......... --•-•--•-•••... ......._.--- Application Approved BY ..:. ........................ /Of.... 11 e..- ........... Date Application. Disapproved for the following reasons:--•----•-----•••••••-•••••-••-•••--•--••••-................................................................... . ......................................................................................................................................................................................................... Date Permit No.... rJ---..... �. �------------------------------•--. Issued-....................................................... Date NO.. THE COMMONWEALTH OF MASSACHUSETTS F BOARD OF HEALTH ` ............ ..:... ..:.................OF......................................._.......-----.._._....._........._._..........._.-- Appliration for Disposal Works Tonstrurtion rrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ....:...........__....__......;................................................................ ----•------.....••--•--••---........................_.........................-------.........- Location_Address or Lot No. ................_--..__......._............................................................... . ........................................................................................._........ Owner Address W Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building No, of ersons____________________________ Showers 0.1 YP g ----•----------------------• P ( ) — Cafeteria ( ) a' Other fixtures -----•--•----------------------------------------- -... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................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...___.____.......____... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ QG •-----•••••-•-•-•-•----••-•-•-•---•-----•---•••-•-•---__.-••-•..................................•-••.........................................................O Description of Soil........................................................................................................................................................................ V W UNature of Repairs,or Alterations—Answer when applicable............................................................e. .................:................ .. . -----••----------------•---•-•--•...........---•-----•-----................. Agreement: The undersigned agrees. to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.i 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed.............................................. Application Approved By..•--• 'r. .... ................................................... 1 Date Application Disapproved for the following reasons:........................................................................................................___ .. .---••...•-•••-•--•-••........•-•-•---------------•••••-•--••-••-•---•----•--•-......_.......-•--._......•-•---••---•...._•--•••----•....--••----....._ ,. Date i PermitNo...... ........................... Issued-....................................................._ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..........................._......................................................... &r#if irab of Tompliatta THIS U TO CERTIFX, That t e Individual Sewage Disposal System constructed ( ) or Repaired ( ) by........... .......�.__-----_-�_�_`__---.!.=�.���........ - - - - ._..._:................ - ........ ---..... ----- -.. ._ •-• ...._ _.... } , Installer at.............L`-. ._.._ .r....... 4? tar:f:--_....... � �!..c - - - ......._..... has been installed in accordance with the provisions of TIT 5 of The State Sanitary Code as d scribed in the application for Disposal Works Construction Permit No-___ "': '°7, ...... dated-.-. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ......: �go...................................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i^ ....OF....................................:.......... ............._•_-•• No........�.. Disposal IVo ko Tots#trWion Wrmi# Permission is hereby granted.... .................. •-•-.......................................................... to Construct ( or Repair ) an Indiv'du Sewage Disposal System .4, r .Lil ..... Y. e y arc M.. --.� - - .......... ..................................................... at No........_ Street _ as shown on the application for Disposal Works Construction Permit No..�� .: Dated.._._ ` .......... Board of Health .... DATE..... 1 jT�r FORM 1255 A. M. SULKIN, INC.. BOSTON 57/° Z/O. OU /0 -r t' �° ,.q � 1 AG21 CUL.TG/Iz�4 L- itJ CUES-% `a AlG 7- p )30¢ v 1 f J iz 99 LTI o z - o ry ,� �h— I o r ry i 1.0 Tw �uunrp ` Ar d. ZZ )ro�, >z,/ 3 �ZN[IF.AMASs ALBERT '? G7-cv MORSE Z/ t No.10951 O c LEGEND EXISTING SPOT ELEVATION OxO OF CERTIFIED PLOT PLAN R�q EXISTING -CONTOUR --- 0 __ �,� ss�c FINISHED --SPOT -ELEVATION Q. ROBBERY �� �,,�,� �ST���✓v � 1,', �_� FINISHED CONTOUR 0 _ ELDREDGE "' IN i! APPROVED BOARD OF'.-HEALTH - _ No. 19367 �ILSit LAM�S�Q� � fV di J`+ � �•�+1.� r�,,� I'�1��• DATE AGENT SCALE_ / = 4 0 / DATE LDREDGE ENGINEERING .CO. IN DR'Sc_'L 4- CL% IENT I CERTIFY THAT THE PROPOSED EGISTERE REOlSTERED. '' JOB� NO. 8S0 97 BUILDING SHOWN ON THIS PLAN CIVIL LAND' ;r': CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR S, DR.BY OF BARNSTAB E , MASSn�._� 712 MAIN STREET _ CH. BY1 �E' HYANNIS, MASS. �2 9585 _ -_ SHEET 0F A E' 'LAND_ SURVEYOR �l oUS� Sl : 71 451'53 LO.CAT10-N SEWACE� PERMIT NO. nl+ �/ Iry�➢ SQL Y� 2'�- Q`7� VVLLAGE INSTAL R'S NA i ADDRESS r h � BUILDER OR OWN rt DATE PERMIT ISSUED f0 7 DAT E COMPLIANCE ISSUED j,' `' _, ,,., a ��_� �' .�� t r `� �:� � �a � � • o y ,� ,� �, .� . � ,_ , /� �" ��r `� I I .;��a. "'� :xi t F y. a �� _... TOWN OF BA_RtiSTABLE L(Y A'I�Oi'�f `2. •W\rva SEWAGE # VT. j-kGE t ms bw-," ���ASSESSOR'S MAP & LOT z, INSTALLER'S NANE&PHONE NO. SEPTIC TANK CAPACITY Q q tt 1 LEACHING FACILITY: (type) t (size) {ol( NO.OF BEDROO,%v:S BUILDER OR OWNER CC&0'c%V—b PERMITDATE: COMPLL4NCE DATE- Separation Distance Between the: Maximum Adjusted Groundwater Table li Frc'. Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Fe:, Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) NIA F`= Furnished by__ �2. _ -1 CZD SNL 1F L ' ?O FT. M/N. N07.� /f EITNGR TNLr SEPTIC TAiVA< OR LEitC.vlwG PIT .4RE t10" rAtAlI /Z"QFLO.K /O /rT, M/N. /� 1R^OE•A 24'O/.�1�y E7 CONCRETE COVE, 49,g0V4S r TO 47RAoE.64 tc,,�TR�1 EE 4 PVC P/PL /y`r,4Wy CA S TR ION COI/E/? .Sh'.4I L B,E GJSEO ,►� � CCOYERSE MiN. P/TCN ( A M iw. C'DNCRL� TE CO VER CL E,4,ti' -a• f t c . BAC.+CFl L L .D t- SCHEOvli40 ?'ALAr-Fq 1[e: P/PE - •2rr rf /•!!N.0/TC/I I D U U C!/1 L. • •. o X a- I GK i'8 -!t prK IT. ` SEPTIC TANK D1577 WA SArFO STC•'rE DOX • • It; 6 • • • • • e ►• �. 14 ,,'' _. • • its GEPT/+N • to e • • • WASHED STdXE . i s. • 1 • • • • . . 1a P.4ECAST SE�fiCC,L' IAIVZA"r ELEVA'r1 Ns /"/T C.A P^ c '=v 490 6A411o,"5Y . , . of • . . . . e e . '. Piz OR Epu/v- WJOZtT AT Q/J/L,D/NG /07•O FT. INLET SEPTK' r,4/VK I°L S fT I Z- FT. Cb4M. C(SEE n+BLLA-riow, OU74ET SEPTIC TANK a G L FT, /JVLET D/STR/�VTION BOX FT. SECT/ON OF GROUND 14pATER TitQLE �VTlETD/STD/B1JT/ON BQX I,V4,C - LEA CRMa PIT ol.o FT. SE;VAGE DISPOSAL SYSTEM LEACH//VG P/T 7A- 4WL.AT/ON DES/Gh/ CRI UEMIA JCALE DIMENSION A A7. 0,.&few510.V AR NlltlCE,4 OF DEA+�000/yS 3 Dl.,4&Ns/ON G �ARdt,tGED/SPO.S.4L [/s�/T IVO SO/L. LOG rO7i14 E.3rT//"L4TED FLOH/ 3 G.44./oAY SOIL TEST ,P/ So/t TEST-,* SD/L TEST VCIAfAER' GF LOAC.VINZ P/T'.S / —Lev `( S/D,'LrACHING PER P!T /S�/ ,r� F7 - �EL FklA .,OATE OF JO/L TEST / 8S Lo - / = RESULTS JW/rAlZ5SFv Jr k F :f Ct?N L 0/l JOTTpM L64:N/NG PER P/T w, A%ff'AC0LA7'/0JV AA7 LESS MIAVINCH 'OTiR� 1 EA:N.'NG ARE.t 2�Y ,S'� FT ,--�:f•::-:- '.� P��TCOL�T/ON iltTE ��'� ,./ 2 M!N�/1VGN ?sESECYL�LE-�CN1NS Ao?E/� ��u SG. f T. j 2_ ,U ALBERT. - R S E o,�_�o�' EL ORLEDGE E�IAIAMWJ� CL IIy`G- ' "a�:../i:5ti • ~�\� �Z.a 7t2 MAIN ST. /-S MASS . r;• a.• ;.. �;-1' ® NO 6 J�O fJNO yY r&m ENCOCINTEREO t l/.IwKT: �Rl s C'J�_ L_ LCT!�8`J �a G/COUJYO H//iTER AT ELLY_" I _/:` 'i( . .=-:• 1'c.�6�;;,;rh`c / �:,- :'= - - - :;: "- ;. - 104 AO. Bsn Q �It'Lr7r OVr I'1`{p� -•r-T..'r�,.�..H..�-,,._,�'••—. .<vY-i--<<-rr J._-_.•-r-_ .. . �£. -•y1.•-�_ '" -��i:. ,•,. tit.: ,�'�- •` - _ ... -• .':L"c ,*Z3, L' - .T�� .:.-�T".�.d.�...- �'�.,:�►�;%`....��. v+ �•..-..���--tea.__.�._ __.. �'.- .�. s. .� t_:I'•:�u'Z.. SYSTEM STEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES E C I D MARKED WITH MAGNETIC TAPE' OR L_L_ C N NOT TO SCALE COMPARABLE MEANS FOR FUTURE LOCATION. APPROXIMATE NGVD ce Lane SYSTEM DESIGN: ,. DATUM ;J _ 99- EXISTING CONTOUR ACCESS COVERS TO WITHIN 6" OF FIN. GRADE (SEE VENT NOTE ON PLAN) 2. MUNICIPAL WATER IS EXISTING PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE X 99.1 EXIST. SPOT ELEV. \ TOP FOUND. EL. 63.5': a �9� GARBAGE DISPOSER IS NOT ALLOWED 62 0� MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 58.6 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 99 PROPOSED CONTOUR 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS �98•4] PROPOSED SPOT EL DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD TO BE AASHO H-29 USE A 330 GPD DESIGN FLOW 4"SCH40 PVC 4 OSCH40 PVC �' TH1 2' DOUBLE WASHED PEASTONE 5. PIPE JOINTS TO BE MADE WATERTIGHT. r; PIPE:S LEVEL 1ST 2' I I } TEST HOLE OR GEOTEXTI E FABRIC Y SEPTIC TANK: 330 GPD (2) = 660 *EXISTING __ 53.61 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH 2� SLOPE OF GROUND "• 10" PROPOSED t50o GAL 14" TANK TO BE REPLACED WITH V,�,� 53.95 TEE SEPTIC TANK (H-20) TEE 53.7'f 310 CMR 15.000 (TITLE V.) EXISTING 1000 GAL. SEPTIC 00o0o0o0o0o0 0 53.11' r,=> 2T SIDES 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TOMiddle Pond UTILITY POLE A 1500 GAL. H-20 SEPTIC TANKGAS BAFFLE;; °°°°°°°°°°°° ° BE USED FOR LOT LINE STAKING OR ANY OTHER FIRE HYDRANT . .: : (ACME OR EQUAL) 53.31' 5314' 80 0 2' ENDS o PURPOSE. Y `• ' : . oo§o 000 51.11 Locus NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING °O ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° 8`� 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. a °°O°O°O°O°O°O°°°°°O°O°O°O°O°O°O°O°O°O°O°O°O°O LEACHING: 4' ^o°�° °°°°°°°° _^ °°°°• DEPTH OF FLOW = 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED F TEE E SI ZES: 6" CRUSHED STONE OR MECHANICAL 3/4" TO 1 1/2" DOUBLE WASHED STONE WITHOUT INSPECTION BY BOARD OF HEALTH AND - SIDES: 2 (30 + 10) 2 (.74 118 GPD COMPACTION. (115.221 [2]) - INLET DEPTH = 10„ - PERMISSION OBTAINED FROM BOARD OF HEALTH. p *THE INSTALLER SHALL VERIFY THE BOTTOM 30 x 10 (.74) = NOTE: PROP. TANK 222 GPD OUTLET DEPTH = 14" ELEVATIONS BASED ON Ui 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING LOCATIONS OF ALL UTILITIES AND ALL DIGSAFE (1-888-344-7233) AND VERIFYING THE BUILDING SEWER OUTLETS AND TOTAL: 460 S.F. 340 GPD EXISTING TANK ELEVATIONS LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES LOCUS MAP ELEVATIONS PRIOR TO INSTALLING ANY 1 PRIOR TO COMMENCEMENT OF WORK. PORTION OF SEPTIC SYSTEM USE (4). H-20 3050 INFILTRATORS ( SLOPE) ( 1 x SLOPE) 46.0' BOTTOM TH-i SCALE 1 =2000 t WITH 0.8' STONE 05 ENDS AND OR2.8' AT SIDES NO GROUNDWATER FOUND RE ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE „ LEACHING REMOVED 5' BENEATH AND AROUND THE PROPOSED FOUNDATION 10' SEPTIC TANK 39' D' BOX 5' FACILITY LEACHING FACILITY. ASSESSORS MAP 61 PARCEL 53 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. LOCUS IS WITHIN GP OVERLAY DISTRICT 13. NO KNOWN POTABLE WELLS WITHIN 150' OF PROPOSED MA LEACHING FACILITY. APPROVED DATE BOARD OF HEALTH 210 00> VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE 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 ENGINEER: DAVID FLAHERTY, R.S., SE2755 3) FAILED SYSTEMS ONLY - SOIL ABSORPTION SYSTEM WITNESS: DONNA MIORANDI, R.S. INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW JUNE 27, 2008 GRADE WITH PROPER VENTING (PIPED 1f0 THE ATMOSPHERE) DATE: AND WITH: H-20 LOADING, BUT IN NO (CASE SHALL THE SAS PERC.,;RATE _ < 2 MIN/INCH BE LOCATED MORE THAN FIVE FEET BELOW GRADE. CLASS I SOILS P#12263 II o ELEV. ELEV. opt. 61.0' 0» 4 61 .0' N N ALL FILL B B LS LS I 12" 10YR 5/6 60.0' 10YR 5/6 16" 59.7' I WF 1 I ` "�.. WF#2 PERC I '••\FQc� MCS MCS O,1- I \Bc)O N 2.5Y 7/4 2.5Y 7/4 �, "-AWF#3 cV Q LOT 61 I 56,663f SF 168" 47.0' 180" 1 46.0' I 1.3t AC i `QWF#4 NO GROUNDWATER ENCOUNTERED I •.\ GROUNDWATER EXPECTED AT EL. 42.0'f po' A WF#6 (SHOT ON WATER EL. 42.0') NOTE: FRONT YARD UNDERGROUND 2 WF#5 UTILITIES ARE APPROX. ONLY s� S I 6 TITLE 5 SITE PLAN I o \ s S S 5,3 OF PAVED 6 N \ DRIVE iw�W W W W\ 5 512 WHISTLEBERRY DR. DECK 4 I oo (MARSTONS MILLS) BARNSTABLE, MA 0 O, ••. SS ` � PREPARED FOR II / EXISTING 3 '•:,. I BR DWELLING "�• "'�`> �6 BORTOLOTTI CONSTJ T T T�� TOP OF FNDN „ DECK s� I EL. 63.5' FRANCIS FERGUSON DECK TO BE RELOCATED \ .H DATE: JULY 1, 2008 TH_2 REV. DATE: JULY 11, 2008 (NEW TANK EL.) LP 67 I Scale: 1"= 20' N rl I PROVIDE VENT WITH CHARCOAL FILTER 6 _ AND BUGSCREEN (FINAL PLACEMENT WITH 0 10 20 30 40 50 FEET o FREE AN�Nj G WALL HOMEOWNER CONSULTATION) o 00•00' BENCH MARK - CORNER OF LSHOFAf off _ _ 4541 o�'y�� Assgcy � oF�ss9c fax 508-362-9880 I 2 DECK ELEVATION = 62.3 0 Do AIA c� !. ° DAAIEL y�� ( downcape.com CIVIL ` OJALA N NOW4 cope el)1#7eering inc. XISTING S.T. TO BE No.465020 ��,, q No.40980 j REMOVED & REPLACED °� ' I e �`� °P SS v civil engineers WITH 1500 G.S.T. (H-20) G y -•� S�ONAL EN ' � AND UR EV � land surveyors 939 Main Street ( R to 6A) DATE DANIEL A. OJALA, P.E., P.-L.S. YARMOUTHPORT MA 02675 DCE #68- 135 08-135 BORTO_FERGUSON.DWG (DDF) ---- -. --- _ _,_ -, ... - -- _ ---- --- ------ ------ - _ _ L