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0140 WHITE MOSS DRIVE - Health
4;- P TOWN OF BARNSTABLE LOCATION (qO U_*,'�G fv)OSS DQ SEWAGE# Z019 - 19$ VULAGE in, rn' l l 5 ASSESSOR'S MAP&PARCEL,'?I- ®y-OS INSTALLER'S NAME&PHONE NO. (3 . Q E y ccL ValJ;OJT 419- 0 LS3 SEPTIC TANK CAPACITY .1000 LEACHING FACILITY: (type) (size) 13 x 2 x Z NO.OF BEDROOMS 3 OWNER SAcVc- E W►,r,c] PERMIT DATE: G-3.19 COMPLIANCE DATE: Z.-y• 19 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 f Al - 33 _ Az. 35'y " QZ. Zo I L F-roni A3' 43►911 133- 3L'$" M.- q r s5 � 32'5 ,�� Wti�ik' �nbSs 0 3 CO .< ` , "'13 Certified Mail FeeEr $ Extra Services&Fees(check box,add fee as p ate) U ❑Return Receipt(hardcopy) $. Q r3 ❑Return Receipt(electronic) $ c ostm rk p ❑Certified Mail Restricted Delivery $ Here O ❑Adult Signature Required $ �- []Adult Signature Restricfed.Delivery$ N Postage _ +V N $ 7 r-j Total Postage and.Fe $ EWING, SEPHEN D . � Sent To 140 WHITE'MOSS I '' 7' o `'w �rioiifi -Ajy No.;of MARSTONS MILLS, MA02648 - Ciry-3Yafe,ZIP+4®'� _ Certified(Wail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this T. delivery. I USPS®-postmarked Certified Mail receipt to the; ■A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service- Restricted delivery service,which provides � for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent. Important Reminders;?ji'rcpt4; Adult signatureservirp „�uiresthe ur ■You may pu�chase'Ceitified Mail service'with signee to be at lea5�2d y arU df agb(noF; First-Class Mail®,First-Class Package Service®, available at retiil)fq y or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is potavailable for requires the signee to be at least 21 years of age, international mail, t11 and provides delivery to the addressee specified] •Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent") with Certified Mail service!However,the purchase W (not available,at retail). Ct of Certified Mail service does not change the u To ensure:ifi t our Certified Mail receipt is Insurance coverage automatically included with accepted as�e al.proof of mailing,it should bear a� certain Priority Mail items. USPS`p0stfnaffc lfyou would like a postmark on n For an additional fee,endwfth a proper this Ce,ified Mail receipt,please present your endorsement on the mailpiece,you may request Ceri fjed,Mail item at a Post Office-for F the following services: t,. post{narking.If.you don't need a postmark on this -Return receipt service„which provides a record;" Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). :_Of,this label,affix it to the mailpiece,apply F-, You can request a hardeopy ielum`receipt or an,o.vS pproptiate postage,and deposit the mailpiece. C'= electronic version.For a hardcopyreturn receipt;' '.A.', , _Z complete PS Form 3811,Domestic Return Receipt,attach PS Form 3811 to your mailpiece; IMPORTANT:Savo this receipt for your records. PS Form 3800,April 2015,(Reverse)PSN 7530.02-000�9647 COMPLETE THIS SECTION'CIN DELIVERY, le Complete items 1,2,and 3. A. Signature � ❑Agent ■ Print your name and address on the reverse _ so that we can return the card to you. ❑Addressee E Attach this card to the back of the mailpiece, B. Re ivied by(Printed Name) C. Dale of)Delivery or on the front if space permits. HrAi b ,ce-j:,4j67 4 r+rticle Addressed.tn,r-—= -- - D. Is delivery address different from item 1? ❑Yes I If YES,enter delivery address below: ❑No STEPHEN D Et�tG, ! 140IITE MOSS DRIVE MARSibNS MILLS, MA 02648 I li —— — 3. Service Type ❑Priority Mail Express® (I 111III1I IIII III I II II1I III I I III'II I II it I II I III ❑Adult SSignature 0 Registered MaiITM ignature Restricted Delivery ❑Registered Mail Restricted Certifid Mail® elivery 9590 9402 4798 8344 8568 37 ❑Certified Mail Restricted Delivery nReceipt for ❑Collect on Delivery eKet erchandise ❑gollect on Delivery Restricted Delivery ignature Confirmations" Mail ❑Signature Confirmation 7 015 17 3 0 0 0 01 4. 8;; `[ail Restricted Delivery Restricted Delivery I . !. PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt USPS TRACKWG# III ,' First-Class Mail Postage&Fees Paid USP PermitNo.G-10 III fill,.I ram:� s ;� 9590 9402 : 8344 8568 37 I I United States •Sender:Please print your name,address,and ZIP+4®in this box* I Postal Service _1 "Town of Barnstable A Health Division wU� 200 Main Street. I Hyannis,MA 02601 I I 44 I Jt'itJJ��lltil!?,�,J�Ilillfl'iI3I�llizi''�al+itriij;r}t��i��:>>:�� No. O jq� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Disposal *pstrm (Construction VPrmit Application for a Permit to Construct( ) Repair(,,�Upgrade( ) Ab ' on( ) ❑Complete System ❑Individual Components Location Address or Lot No. 140 06'-ic rn 055 'D n 's Name,Address,and Tel.No. ,DR• rn• m;lls Assessor's Map/Parcel — 00 ��U� lyo Q ki4r. rn055 Installer's Name,Address,and Tel.No.ja�i.Q E XC 410 A Designer's Name,Address,and Tel.No. (auk r la),-=r-I y 6�I?'ca =rry t,rV F"oresido�ic 01.0453 �0 530� 331-f�arcJ►cb. Typed Building: Dwelling No.of Bedrooms !3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 O gpd Design flow provided N6 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank /000 Type of S.A.S. Spp p2) C.LC K 2,*) Description of Soil Nature of Repairs or Alterations(Answer when applicable) f 4 20_D BOX - *2 -1/ZO SaO!j,I Ll C- 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 L -3-)9 Application Approved by �^ Date — Application Disapproved by Date for the following reasons Permit No. 9©M ,l Date Issued �j 3 414 h*F+ o No. 00 _ f 1 y , Fee THE COMMONWEALTH OF MASSACHUSETTS Bateredincomputer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS, ; Ye application for Misposar;,Opstrm Construction Vermit Application for a Permit to Construct( ) Repair(r.o)"Upgrade( ) Ab don( ) ❑Complete System ❑Individual Components Location Address or Lot No. 40,Jh;-lc rM oS5 {�. P eI's Name Address,and Tel.No. ._ � Assessor's Map/Parcel o 0 it, ��� 1440 01„ �� m ASS ,DA• yrl. M; I IS L Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. IyTraSerrq Lko F-ores1a4,:0c y�'7'oG53 P n• 3°'` Type of Building: Dwelling No.of Bedrooms h Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria Other Fixtures Design Flow(min.required) 33 n gpd Design flow provided Z.fj� gpd Plan Date Number of sheets Revision Date < Title 4 Size of Septic Tank p oo Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ��� 8 ,��7�Q goo 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 •y W Date ,1 ` t Application Approved by "`% Date _ Application Disapproved by v / Date }4 { I for the following reasons Permit No. r�D1 I — 1 Date Issued ------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(,,o� Upgraded( ) Abandoned( )by F'x c-,z 4' at , ,p has been constructed in accordancejg 22 C with the provisions of Title 5 and the for Disposal System Construction Permit No. Q —�C dated J —/ 5 Installer � 4 Designer 0C #bedrooms Z Approved design flow J - gpd The issuance of this permit shall not be construed as a guarantee that the system will fi �ction r esigned. Date' ( ��( Inspector ------- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Bisposal 6pstem Construction :Prmit A Permission is hereby granted to Construct( ) Repair(,/� Upgrade( ) Abandon( ) w. System located at I W,, and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 perm--11' Date ( f' / Approved by I �. »a :"wv's ire %�7" d ♦ y` 4� tit 7 - .r^`_•f •..- {;fir � =,�,.: J Town of Barnstable Py0*1HE Tp Regulatory Services Thomas F. Geiler, Director BA"SIABLL Public Health Division Thomas McKean, Director f0 MAy -200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 6%6- 113 Sewage Permit# 2019 19$ Assessor's Map/Parcel al-Oq-C6 Installer & Designer Certification Form Designer: _Dayc Installer: (fi r EXC.0.Va-A I ors Address: p S3ox 331 Address: ,q 'i'cc.Scrrg_ LtJ F-ores-lc�a l c— On 1,-3.19 EXca.uvsAio✓\ was issued apermit to install a (date) (installer) septic system at l(}o t.3w,AC.. mo5S ,DIQ based on a design drawn by (address) �c �'loln�r�lu dated Z. . Z- �4 (designer) _ I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank Stnpout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) was inspected and the soils were found satisfactory. DAVID D. /Installer's Signa e HERTY, JR? to. 12il (Designer' Signat, ) (Affix Desig p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. q:office forms\designercertification form.doc t �pFrtfiE 7p�� Town of Barnstable Barnstable 4 Inspectional Services W-MmicaC"j c BAi2NS'T'ABLF, ' MAS&t639. Public Health Division �� m Arfio► �° 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 7688 May 7, 2019 EWING, STEPHEN D 140 WHITE MOSS DRIVE MARSTONS MILLS, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 140 White Moss Drive, Marstons Mills, MA was inspected on 04/30/2019 by Brett Hickey, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2) years 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 THE BOARD OF HEALTH c ean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\140 White Moss Drive Marstons Mills.doc �TKXE s Town of Barnstable BA.RNSTAHM 6 9. ,��a Regulatory Services Department Arfa�,� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑i Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) 4IIIII(eaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc 031— ODD- b D�[ Commonwealth of Massachusetts �e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 White Moss Drive i Property Address Ev Steve Ewing Owner Owner's Name information is required for every Marstons Mills ✓ Ma 02648 4-30-19 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. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, use only the tab Brett Hickey key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 4:1 Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113747 Telephone Number 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 pe'�bcgrea M&en niaq Brett Hickey �:�_�,��.o.W•m,^ �,�,.�. ..• s 4-30-19 Gale:ID19 05.010):JJ:Sa-01LP 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 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. l5insp.doc•rev.7r.612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 r r. c Commonwealth of Massachusetts i p Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 White Moss Drive v� Property Address Steve Ewing Owner Owner's Name information is Marstons Mills Ma 02648 ,4-30-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: 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): l5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 r r c Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 White Moss Drive v� Property Address Steve Ewing Owner Owner's Name information is Marstons Mills Ma 02648 4-30-19 required for every page. City/Town State Zip Code Date of Inspection 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): I ❑ 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: t5insp.doc•rev.7P'612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form col Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 140 White Moss Drive Property Address Steve Ewing Owner Owner's Name information is Marstons Mills Ma 02648 4-30-19 required for every page. City/Town State Zip Code Date of Inspection 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 O ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ O Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 c � Commonwealth of Massachusetts +n Title 5 Official Inspection Form gal Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 White Moss Drive Property Address Steve Ewing Owner Owner's Name information is Marstons Mills Ma 02648 4-30-19 required for every page. City/Town State Zip Code Date of Inspection 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 ❑ 0 Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow ❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ El Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ a Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ O Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ Fx-1 Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ El 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.] ❑ 0 The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. El ❑ 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 II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 White Moss Drive Property Address Steve Ewing Owner Owner's Name information is Marstons Mills Ma 02648 4-30-19 required for every page. City/Town State Zip Code Date of Inspection 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 ❑ El Pumping information was provided by the owner, occupant, or Board of Health ❑ El Were any of the system components pumped out in the previous two weeks? El ❑ Has the system received normal flows in the previous two week period? ❑ 0 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 X y ❑ ❑ i available note as N/A) ❑ El Was the facility or dwelling inspected for signs of sewage back up? 0 ❑ Was the site inspected for signs of break out? El ❑ Were all system components, excluding the SAS, located on site? El ❑ 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? ❑ Q 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: 0 ❑ Existing information. For example, a plan at the Board of Health. ❑ 0 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 I , Commonwealth of Massachusetts �a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 White Moss Drive Property Address Steve Ewing Owner Owner's Name information is required for every Marstons Mills Ma 02648 4-30-19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 3 3 Number of bedrooms(design): Number of bedrooms(actual): 330/GPD DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Description: 1 j Number of current residents: Does residence have a garbage grinder? ❑ Yes E] No Does residence have a water treatment unit? ❑ Yes 0 No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes RI No information in this report.) Laundry system inspected? ❑ Yes 0 No Seasonal use? ❑ Yes [g No See below Water meter readings, if available (last 2 years usage (gpd)): Detail 2017- 95,000gallons 2018- 104,000gallons Sump pump? ❑ Yes ❑■ No current Last date of occupancy: Date t5insp.doc•rev.72612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 � _ arm-•� t cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 White Moss Drive Property Address Steve Ewing Owner Owner's Name information is Marstons Mills Ma 02648 4-30-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA 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 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 below): 3. Pumping Records: Source of information: Owner- date of last pump is unknown Was system pumped as part of the inspection? ❑ Yes ❑■ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 I c Commonwealth of Massachusetts �d Title 5 Official Inspection Form �I e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 White Moss Drive L Property Address Steve Ewing Owner Owner's Name information is Marstons Mills Ma 02648 4-30-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: El 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)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: 1987 per plans I Were sewage odors detected when arriving at the site? ❑ Yes ❑E No 5. Building Sewer(locate on site plan): 21611 Depth below grade: feet Material of construction: ❑ cast iron ❑■ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town waterfeet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form + la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 p Y ry 140 White Moss Drive L Property Address Steve Ewing Owner Owner's Name information is Marstons Mills Ma 02648 4-30-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 11611 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 1 Dimensions: 000gallons � n 7 Sludge depth: 2991 Distance from top of sludge to bottom of outlet tee or baffle 311 Scum thickness Err Distance from top of scum to top of outlet tee or baffle 1311 Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is in need of pumping at this time and should be pumped every two years for maintenance. l5insp.doc•rev.726/2018. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts 1= � Title 5 Official Inspection Form l°I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 White Moss Drive u Property Address Steve Ewing Owner Owner's Name information is Marstons Mills Ma 02648 4-30-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA 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.): I 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): NA Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 140 White Moss Drive Property Address Steve Ewing Owner Owner's Name information is Marstons Mills Ma 02648 4-30-19 required for every — page. City/Town State Zip Code Date of Inspection 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): Orr 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.): The d-box was in poor condition at the time of inspection. P p t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'u 140 White Moss Drive Property Address Steve Ewing Owner Owner's Name information is Marstons Mills Ma 02648 4-30-19 required for every page. City/Town State Zip Code Date of Inspection 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.): NA * 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: ) 6' ' pit El leaching pits number: (1 x4 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7Q6/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 15 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ` 140 White Moss Drive Property Address Steve Ewing Owner Owner's Name information is Marstons Mills Ma 02648 4-30-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS was in hydraulic failure at the time of inspection. The pit is piped into through the riser. Liquid level in the pit is 7" below the top of the pit, and is over the effective leaching. Pit is also H-10 and under the driveway. 12. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA 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.): t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 White Moss Drive Property Address Steve Ewing Owner Owner's Name information is Marstons Mills Ma 02648 4-30-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): NA Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments —u 140 White Moss Drive Property Address Steve Ewing Owner Owner's Name information is Marstons Mills Ma 02648 4-30-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑■ hand-sketch in the area below ❑ drawing attached separately TC)ZV2�i0T`.HAl2,+iS"['�1 I.i LOC;AI'ION ri.�t�_ Ca 7`v _����__.'S_�?:T VII.LAG (Irl�.ig r 3 �+ � � 1" i t ry- ASSF:S`iOR•S MAP&:FAe( E. . INS"['A:l,[., ;RS;`dA.Pu£:k%8iPI•It::n2�S 1VC) ': "'�'. ..�...,y.t.__s_:a «at 1' ...:� ....._.._: .�..L__._..�.. SEPTIC TANK:G:.APAC:I'I'V ------------ - - LEAC:rIIIYG f.A+CILITYi(Wro,i l ..__s_._._.__�xec�__5.�b..�. OWNER :.._. _............. :_..._. PLldif CIAI _ _., c Q]N4'LIANCI-DATE:. +:bLparatntn I')��t�ae±e f3ehveen the. n uke aYad.S�ted�C9 undwater:Tahlc rcrthe:nott�ont'o Leaclnir,g FacilityMaX ,., P )ap �1!and L aching Facility(Sfxny v�Ils xi5t can sii't+rrrwtrh!srs�t)i)feast of leel�,hing fa�'iiicyj, _ tclp�of VvPttianct ano L&aching FaciliCy(if any watlonds exist wxthi -3p0'facerof"tiah'btingfaslay) E'cer FLMLNi.tMra s r } •= 3 W, 3 I, t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 White Moss Drive u— Property Address Steve Ewing Owner Owner's Name information is Marstons Mills Ma 02648 4-30-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑■ Check Slope ❑■ Surface water ■❑ Check cellar ❑Q Shallow wells Estimated depth to high ground water: NoGW@13' feet Please indicate all methods used to determine the high ground water elevation: El Obtained from system design plans on record 4-13-87 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: A plan on file at the local Board of Health was used to determine high groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.712U2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 .. r c� Commonwealth of Massachusetts Title 5 Official Inspection Form -" h4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 White Moss Drive V Property Address Steve Ewing Owner Owner's Name information is Marstons Mills Ma 02648 4-30-19 required for every page. City/Town State Zip Code Date of Inspection 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 ❑■ 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 t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS c DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 140 White Moss Drive Marstons Mills Owner's Name: John&Terri McDonald Owner's Address: 11 Cranberry Ridge Road Mashpee,MA Date of Inspection: 7/31/2006 Name of Inspector: (please print) Patrick T. Sullivan Company Name: Ready Rooter Mailing Address: P.O. Box 371 Sandwich,MA 02563 Telephone Number: (508) 888-6055 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System: Passes Conditionally Passes Needs Further Evaluation by the Local Authority,_., Fails f , f 1 d Inspector's Signature: i � _� a ,,��, Date:ifD . The system inspector shall submit a copy of this inspection report to the Approving Authority(Boar.�d of Health or o DEP)within 30 days of completing this inspection. If the system is a shared system or has a design-Pow of 10-000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the c DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,anld the approving'-- authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 140 White Moss Drive Marstons Mills Owner: John&Terri McDonald Date of Inspection: 7/31/2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: 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"Condition Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,a approved by the Board of Health,will pass. Answer yes,no or not determined (Y,N,ND)in the for the ollowing statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the,�eptic 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 distribution box is leveled or replaced ND explain: f t 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 off the Board of Health): / broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 140 White Moss Drive Marstons Mills Owner: John&Terri McDonald Date of Inspection: 7/31/2006 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further e/en the B rd of Health in order to determine if the system is failing to protect public health, safety or the t. 1. System will pass unless Board of Heai es in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a mannerI protect public health,safety and the environment: _Cesspool or privy is within 50 feet waterCesspool or privy is within 50 feet ng 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 S 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 use4 to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds iddicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy ofthe analysis must be attached to this form. f i %J 3. Other: ; Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 140 White Moss Drive Marstons Mills Owner: John&Terri McDonald Date of Inspection: 7/31/2006 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 and overloaded or clogged SAS or cesspool _ j Liquid depth in cesspool is less than 6"below invert or available volume is less than''/z day flow _ j/ 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. J Any portion of a cesspool or privy is within a Zone 1 of a public well. _ V Any portion of a cesspool or privy is 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] 9C�D(Yes/No)The system fails. I have determined that one or more of the above 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 facir with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the follow] g: (The following criteria apply to large systems in addition;ef the criteria above) yes no _the system is within 400 feet of a surface di inking water supply _the system is within 200 feet of a tribu /tm Y to a surface drinking water supply _the system is located in a nitrogen s6nsitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply ell If you have answered"yes"to any quelion 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�ontact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 140 White Moss Drive_ Marstons Mills Owner: John&Terri McDonald Date of Inspection: 7/31/2006 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? _ Z 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? ,L _ 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 than owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No _ Existing information.For example,a plan at the Board of Health. _ Z Determined in the fiend(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 140 White Moss Drive Marstons Mills Owner: John&Terri McDonald Date of Inspection: 7/31/2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): -S Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 33o Number of current residents: J Does residence have a garbage grinder(yes or no):.�� Is laundry on a separate sewage system(yes or no):�[if yes separate inspection required] Laundry system inspected(yes or no): Season3l use:(yes or no):t� J�- Water meter readings, if available(last 2 years usage(gpd)): p = 14T G, P Q Sump Pump(yes or no): Last date of occupancy: 4 boo COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMRZ gpd Basis of design flow(seats/persoGrease trap present(yes or no):Industrial waste holding tank preNon-sanitary waste discharged tom(yes or no): Water meter readings, if availabl Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Q,,r�,r — Q S Z Was system pumped as part of the inspection(yes or no):L�j 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: Were sewage odors detected when arriving at the site(yes or no):-ND� Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 140 White Moss Drive Marstons Mills Owner: John&Terri McDonald Date of Inspection: 7/31/2006 BUILDING SEWER(locate on site plan) Deptr below grade: ':) a" Materials of construction:_cast iron ✓40 PVC_other(e plain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leak ge,etc.): SEPTIC TANK: (locate on site plan) Depth below grade:�Q) Material of construction: ✓oncrete_metal_fiberglass_polyethylene _oter(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: x- .- K . S� Sludge depth: V4 Distance from the top of sludge to bottom of outlet tee or baffle: 3 S Scum thickness: `4a " Distance from top of scum to top of outlet tee or baffle: " Distance from bottom of scum to bottom of outlet tee or baffle: 7 How were dimensions determined:_�� ---- Yv� a� +-�• wK�2 0'„� - � e Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): t^' rT.' Ccs.� GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:_concrete_metal fiberglass_polyethylene_other (explain): / Dimersions: �- Scum thickness: i Distance from top of scum to top of outlet tee,or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of 6akage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 140 White Moss Drive Marston Mills Owner: John&Terri McDonald Date of Inspection: 7/31/2006 TIGHT or HOLDING TANK: (tank must be p ped 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 ay Alarm present(yes or no): Alarm level: Alarm in wor ng order(yes or no): Date of last pumping: Comments(condition of alarm a float switches,etc.): DISTRIBUTION BOX: V (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: C:�)n Comments(not 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 or no): Alarms in working order(yes or no): Comments(note condition of pump chamb/ondition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 140 White Moss Drive Marstons Mills Owner: John&Terri McDonald Date of Inspection: 7/31/2006 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: cD leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): L-e..�,V., �' U,...cS2,�,J-- C9 •�.V�2�y� � �...5�`�<�:,�c'Q, cam,Vy� G�w..d.l� 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( s or no): Comments(note condition of soi,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) A Materials of construction: / Dimensions: Depth of solids: Comments(note condition of soil,signs of h draulic failure,level of ponding, condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 140 White Moss Drive Marstons Mills Owner: John&Terri McDonald Date of Inspection: 7/31/2006 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. T I '4 I (A_ J� i I � I i 1 I\ f r I Page I 1 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 140 White Moss Drive Marstons Mills Owner: John&Terri McDonald Date of Inspection: 7/31/2006 SITE EXAM Slope,,/"'- Surface water Check:cellar✓ Shallow wells Estimated depth to ground water_ S feet Please indicate(check)all methods used to determine the high ground water elevation: _Z0btained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with the local Board of Health-explain: Checked with local excavators, installers-(attach documentation) =Accessed USGS database-explain: -��J :-as�s��.r •• _,��,. � � You must describe how you established the high ground water elevation: TOWN OF BARNSTABLE LOCATION CD Cxj -c `(Y�5 SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL CS-S ( INSTALLERS NAME&PHONE NO. �,_,_��o�\ 771 - 3 6/ SEPTIC TANK CAPACITY (DZ�D® 5 LEACHING FACILITY:(type) t-.1 La&cj^ P;-c (size) 60¢� c'j/s. NO. OF BEDROOMS OWNER PERMIT DATE: ,/7 J V- COMPLIANCE DATE: g" 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 -71 ��� 6 i 3 = N or 1 t + `1 fo TOWN OF BARNSTABLE LOCAtION L04 l3 I•J�;� ASS ®��y-@ SEWAGE VILLAGE VMa s 54 ti 5 UA \� s ASSESSOR'S MAP & LOT t . D' f INSTALLER'S NAME PHONE NO. -7-71 -�G l& %SEPTIC TANK CAPACITY 1,o`y BLEACHING FACILITY:(type) �-1 �"`�^ ��`� (size) (o 06 (��1 IO. OF BEDROOMS 3 PRIVATE WELL O PUBLIC WATE BUILDER OR OWNER 6 �c►.r � �p ( QQv��, Co3 p DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 14— st WN m �r r x f, ASSESSORS MAP NO: f a3 A PARCEL NO.- 'THE COMMONWEALTH OF tAASSACHUSETTS BOARD OF HEALTH .. ..OF....... ,r. . ...&� ............ 4) ..A . . ............. Appliration for Disposal Works Tonstrurtion Prrutit l 4D Application is hereby made for a Permit to Construct ( 4r Repair an Individual Sewage Disposal I System at: Y-0-r -IY,., ............ ..1�_- 13......AArrc...A.��...VXLO(5��...... ...)-h .......... L a n Add s or Lo No----- - ------ - .... ...... .....C ................ Owner Address ................................ .......... .................................................................. Installer Address Type of Building Size Lot-----13,35fSq. feet U .._3..............................Expansion Attic Garbage Grinder (A4 Dwelling—No. of Bedrooms... (40 PL4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria 04 Other fiY,tures ....................................................................................................................................................... Design Flow..............!!.;Y....................gallons per person per day. Total daily flow................;��.................gallons. P4 Septic Tank—Liquid capacity---/ gallons Length................ Width................ Diameter-___-__-____-__- Depth...._........... Disposal Trench—'No. ..................... Width_....__........_._.. Total Length__...........__....- Total leaching area-------_----------sq. ft. Seepage Pit No--------------------- Diameter_-____-_--_--___-_-- Depth below inlet__.......-......_... Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosin tank Percolation Test Results Performed .........1.j.(6)t6........... 1.4 Test Pit No. I...... ....minutes per inch Depth of Test Pit.................... Depth to ground water_.__:_____.._........._. Test Pit No. 2_4.2n..niinutes per inch Depth of Test Pit.................... Depth to ground water.___._.___.._...._..__.. ......7------------ 6................................. - orl ........ - -------- ---------- .....r 0 Description of S,oil..,V....6., Wff- ................... ........... ........................................................7... ...;..... --------------------------------- U V- W ------------------ 1?�-----540---------------------------------------------b- . Ila! -------------------------- ... .....1.3.... .....j.!t ...................... U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL__"L LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation un-,il a Certificate of Compliance has been issued by the board of health. Signed----..... ...... Date Application Approved By............ ........................ ............... Date Application Disapproved for the following reasons:............................................................................................................ ...................................................................................................................................................................................................... Date PermitNo._------ .................. IssuedL....................................................... Date No. r. THE COMMONWEALtH OF MASSACHUSETTS BOARD OF HEALTH ` OF... ............. 4, , pVftra ion for Nyos al Works Tonstrnrfion ramit Application is hereby made for a Permit to Construct ( /or Repair ( ) an Individual Sewage Disposal System at -.-- f'*�-`rat u' � r k � �------ Locat n-Address ''T or LotTo, rP- - .r. ..........A_ r ,_r ...................... �Cd... 1 f - .._ t Y& l`.j,' .�. ----- _ -------- Owner - Address Installer Address /! Ga s S feet U Type of Building Size Lot.._.--.._.................. q. Dwelling—No. of Bedrooms.......,.; ..............................Expansion Attic WO) Garbage Grinder (,, pal Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QI Other fixtures ----------------------------- - W Design Flow.............. , ....................gallons per person per day. Total daily flow................ -•-_._._--•---••.•gallons. 1:4 Septic Tank—Liquid capacity._1k(�Lgallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—NTo. .................... 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. _x _. ? ', :_. `r �.II>' p ; Date-. ���----_ .._)2�6.._.•.__...... aTest Pit No. 1.___ ----_?___.minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil i �If +x` = rful --- ---------------- ---- {-- ,� " x { ----... •-----------------------------------------------------•--------------•----------------••------••-----------•--•-----------••-•---...--•-••••••-••--••-----•-•----•--•-•-....._.•---••----•--------•------ 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 TTT_'17 ; 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 hdalth r Signed...r tt_ �, t _ sq- s`� ( { ..�--r..----- tt Date Application Approved BY---- --------------------Da.--•••---•-•----- .... Date Application Disapproved for the ollowing reasons: - __...-- ------. .................... ---•---------•--•-•-----•--•................•----------•.._......•••-•••----•---------........------------•-••••-•---•-•--------------------•------•-•••-------••••-•-----------•----•---•--•......-•-•- Date PermitNo.....- ---•-• ---------------------- Issued--•---.....---...- ................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Ay . E .......oF........ .�' . .. , ......... TrrtifirFatr of Toutph anrr THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed (LA or Repaired ( } by '1 -= --...- •� f--- - ---------------------------------------------------------------------------------------------------------------------------- A . I Installer t� .............................................. has been installed in accordance with the provisions of TIL"LiE 7 of The State Sanitary Code as described in the application for Disposal Works Construction Permit -___ _- dated--_-------------_------ ._--.-- -------______-•- .yi THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE---•----......--•.....-•$'...-•-t.a-•-.-... _ ................... Inspector....... -•-----•----------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r� dk11U/V......0F..... z/.. ....•...., NO.?.7;R FEE Disposal Worko Tono#.rurtion Upermit Permission iVhereby granted _ ` ........ ---------------------------------•---.............••••.._.._. to Construct (a�/y) yor Repair ( ) an Individual Sewage 1Disposal System at 1��0._ �? ...#:`_._{: •--•-�r� - {rr--.-.. r:?y.;:`'•-_. x :as,..t1 r..---• ./-`{ _g ¢ - as shown on the application for Disposal Works Construction Permit N -r_ Dated.......................................... of -----•--••-••--•--------------•--------------------------------------•------------------••------....---- Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS n tee s F x i. No . b t�eFRKov r 6 a dV I /o, Iz �. l 4300 f wx LF- /1 " z` 43 / 3 I � %, lip AF 1100 i LEGEND EXISTING SPOT ELEVATION 0 PROPOSED SPOT ELEVATION 9M ��1H of j EXISTING CONTOUR ---0——— ��" Mgss9� ��'�� OF 'Qs PROPOSED.CONTOUR y O moo` P,A U L ROBIN I NOTE THE LOCATION OF ANY UNDERGROUND G A. SEWERAGE,WELLS, OR OTHER UTILITIES SHOWN ON V.E v Y . : No:10050 THIS PLAN IS APPROXIMATE ONLY AS DETERMINED FROM RECORDS AND/OR VERBAL INFORMATION. �� gFcTEg�� �Q;L THE CONTRACTOR IS RESPONSIBLE FOR THE Fss�oN E s%W�, �Aa�� �` r 3 Iv,' VERIFICATION OF THE EXISTING LOCATIONS IN THE FIELD. _ . I N I T .z w : LEVY aEL�EDGE ASS�CIQ'!'ES�INC. CLIEN ��� � �� . �,x•;A �» ,ENGINEERS- LANDSCAPE ARCHITECTS JOB NO, ' PLANNERS - LAND SURVEYORS ®�. �: .. ..- ..,. ., ley IN n 889 WEST MAIN STREET CHKD.SYt CENTERVILLE, MA. 02632 SHEET.Z .,OE 2-' SCAa=� DATE. ? � 7NeSEPTIC -r-A�Vj4,Lf ®R ` ,.. ACN/iilCa P/T ARE 110RC- 7 JV 12.",gEZ.OW L 3 /d► P'7�;/+3!/iv . ' 4.0D049. GR.E1®E� 2Q �/�8MFT R ®y0 �T'.E COYE� ScH�uGE•FO S��BLL �.� ,®R004a.V r rO EXTRA . C®JWCREP'E PKG. P/PE tt�.4VY Co4S7 /A-0IV Codes.-/� S/ ,{L� L l3� f/SE0 MIN. P/TCH coyeR.S e /F/IV DR%."FWA Y . T �-w . 4 Cv Y�R CLEAN .SAN O L/Q[/i0 LEYEL. .l�lT' RIPE OF va'-J141. IWIA1.P/TC/ 1 f�/SL.. D/SY 6s ` e ® • ► •e s t, ®,� /ryASH O ,SANE �. s ? 1 e o a • eel' g e r4 _ . BOX a � e >a ® , . • eee oes o ` o� .bo o.m� 314 WASH- � ® a. ee. ® • e ® •� e !eo • .+ • � � v ee a A e • • ee w. ,� a o e e o ® e • e • e /' PRECAS 7-SEEP.4r.9 .• a a•o a e • ® •. s • • a e aee o P/7 OR EQii/V_ F3;', G•�T ®/SNP. 'IN4 E7 .S.gPrlc -r.4,/K 9(��`f FT. 1_ � FJ: O/i4 J►'9. � C(5C5 7.-'W /"7.0OAN) SEP7'/C 7"ANIK °18'1 Fr . /NL 7'®/VTR✓�3U7"/®N Box 9Z•3 GROUNo WATER SABLE SEC7"10AI OF Fr DR5/6M Cat i 7;C-N/A ArT 5�.�L E' :: �,�•• � !=O p. OIME/�l.F/O N � � F.T. AWN'S€off ®F&EADROOMS -3 DOI�EIlI.Sl®i� Cs -x SOIL.. LOG rO7, - &-j-r/astsreL> # - olra/0 30 G.4c:./pAv SOIL T SOIL 7ESTA�2 NUM8,-R Wr 4-ACAUHr, P17-S_ — f�L��! 9 1, d �-- 0 L>A7"E OF" S®/L TEST SlDELEA=H/NG ®8i�P/T /9�/ S P3: / ' o To f Or-3 Tor'So/c. RESULTS w1-r11/.ESS,ED BY S d�®T'roM4CH/MG A>ZRPIT�so. PT. sag%orL f PE/vC®.CAT/D/V RA7-0 O - M/NVINCH 7'0)rA4 I-eACti//VC AREA S'q f'T_ r Ic�sl SUB So )cWNCBL�7"/OM Rr47',•j(k2 �L r91JV. /NCH, �': y l iesGSERi�ELE�t'f,+!/VG.s1RFAJSI,� FT ' '- ( 2 ) tl� � 17- 3 "T/L L / �`����► o�M ° _ z.Yz. — TESST' �-� /� 3 61 Z !o P Au L Al � LoT o CEVY �, M�lcJNf o. Q No.10050 .�4�C_lO F LEVY & ELDREDGE ASSOCIATES. INC. b O fG• F'jO. 0 889 WEST MAIN STREET CENTERVILLE,MASSACHUSETTS 02632 NO /.Eiv7 _, Goo uNo w.47-E.Q .4r EL El% ✓O® /Va: 1032 SHEETOF - TOP OF FOUNDATION COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM PROFILE EL. 60.0' EL. 58.0' BROUGHT TO WITHIN 6"OF FINAL GRADE (not to scale) Flaherty Environmental Services INSP. PORT W I 3" OF GRADE CLEAN SAND P.U. Box 331 2" of "to 1" DOUBLE WASHED EL. 56.0' - 58.0' Harwich, MA 02645 4"CAST IRON or EQUIVALENT PEAS ONE"OR GEOTEXTILE MIN. PITCH 1/4" PER FOOT FILTER FABRIC 774.994. 166 4"SCHEDULE 40 PVC PIPE 4" SCHEDULE 40 PVC PIPE ; FLOW LINE VENT IF REQUIRED INnst 2't0 be level) — :. •'. �- s'cii9s� s,ri��t •.:' ;.'•: L.EXIST. 14„ . :«: 0°°°°°°°C EL.EXI EL.54.6' 00000000000 0 0 0 .. ® I 60°o°o°oC 0 0 0 0 0 0 0 0 0 o C EL.52.73' 000 0 0 00°000°0 000°o°o°e 0 0 0 0 0 020.000 00 0 0 0 E-9: i o o°o°o°o°0°000 00000o0C 2.0 GAS BAFFLE 20 D BOX EL.52.7' 0000000000 000000 5R® OMM F 000000pf- 00C— "02020- A °o°o°o°o° EL.50.7' 6"CRUSHED STONE OR I"a ovElouTLE INVERT SOIL ABSORPTION SYSTEM 1000 GALLON SEPTIC TANK MECHANICALLY COMPACTED (2) 500 GALLON H-20 CHAMBERS (DATUM: ASSUMED) (EXISTING) WITH 4'STONE AROUND IN A 5'2' _" to A" DOUBLE WASHED STONE 12.83'X 25'X 2' CONFIGURATION 54 BOTTOM OF TEST HOLE EL. 45.5 EL.' 45.5' USGS ADJUSTMENT: N/A LOCATIONMAP LOT 13 56 GROUNDWATER ELEV: N/A 0.54 ACRESt . N TH MAP 31 LOT 04-05 Locus BENCHMARK: Cb h TOP OF FNDN � I( �� EL. 60.0' o- ^� I i f 58 i ��St. Asa Meigs Rd. :n "•. TH-2 11,9' NTS p 6s \ 0F TH-1 \ \ 7,6' EXISTING D O 3 BR DRIVEWAY \ \ DWELLING DECK R. p EXI T, S.T. 21 .P O \ DATE.6/2/2019 REV/S D: 56 5 se LEGEND 4 24 7,23' SITE AND SEWAGE PLAN FOR B & B EXCAVATION ZNC"/ e s—�- GAT LINE STEPHAN EWZNG W N �_�.. WATER LINE • -F E' = -.C_ EXIST. ELECTRIC 140 WHITE MOSS DRIVE MARSTONS MILLS ----_ yy extsr. caNrouRs II I (BARNSTABLE, MA) -- - 99 PROP, CDNTGURT SCALE : 1 = 3 0 EXIST. FENCE i REF.•LCP 32898-8 SH 1 PAGE i OF2 ................................................................................................................................................... ..................................................................................................................................................................................................................................................... .................. ........................ ....... ................................................ ............................................................... ... .................................... ............................................... ............. ................................ GENERAL NOTES DESIGN CAL CULA TIONS S YS TEM DETAIL Flaherty Environmental Servides P. 0 . Box 331 1. ALL PRECAST COMPONENTS TO BE H-1 0 Harwich, MA 02645 RATED UNLESS OTHERWISE SPECIFIED. NUMBER OFACTUAL BEDROOMS 3 774.994. 1166 DISTRIBUTION BOX(ES)AND ANY COMPONENTS WITH ANY ANTICIPATED GARBAGE DISPOSAL UNIT NO VEHICULAR TRAFFIC TO BE H-20 RATED. 2. THE DESIGN OF THIS SYSTEM DOES NOT TOTAL ESTIMATED FLOW (110GAUBR1VAYX3BR) 330 GALADAY, ALLOW FOR THE USE OFA GARBAGE GRINDER. REQUIRED SEPTIC TANK CAPACITY 660 GAL. 3. MUNICIPAL WATER IS AVAILABLE. 4. ALL CONSTRUCTION TO CONFORM WITH 2 5' SIZE OF SEPTIC TANK 1000 GAL. (EXISTING) 310 CMR 15.000 AND ALL OTHER APPLICABLE LOCAL, STATE AND FEDERAL SOIL CLASSIFICATION CODES AND REGULATIONS. 5. INSTALLERICONTRACrOR TO REVIEW& DESIGN PERCOLATION RATE <2 MINA/NCH VERIFY ALL ELEVATIONS AND DETAILS EFFLUENT LOADING RATE 0.74 GAL.IDAYIFT2 AND REPORT ANY DISCREPANCIES TO ' DESIGNER PRIOR TO CONSTRUCTION OR 12.83 LEACHING AREA ASSUME ALL RESPONSIBILITY. (2)X(25.0'+ 12.83)(2) =151 SF 6. INSTALLER/CONTRACTOR IS 25.O'x 12.83' =320 SF RESPONSIBLE FOR MAINTAINING SAFE 471 SFx a 74 =348 GPD WORK AREA, VERIFYING ALL UTILITIES AND NOTIFYING "DIG SAFE" USE(2)500 GALLON H-20 CHAMBERS WITH 4'STONE (1-888-344-7233) 72 HOURS PRIOR TO INA 12-83'X25'CONFIGUR4TIONASDIAGR,4MMED 4,' CONSTRUCTION. 7. ANY CHANGES TO OR DEVIATIONS FROM RESERVE LEACHING CAPACITY NIA THIS PLAN MUST BE APPROVED IN WRITING BY FLAHERTY ENVIRONMENTAL SERVICES AND LOCAL BOARD OF HEALTH. 8. FINISH COVER OVER COMPONENTS IS NOT TO EXCEED XPER 310 CMR 15.000 (NTS) UNLESS SHOWN PER PLAN 9. ALL ABANDONED SEPTIC SYSTEM COMPONENTS TO BE PUMPED DRY AND SOIL EVAL UA TION FILLED WITH CLEAN SAND OR REMOVED TEST HOLE#1 TPT#19-41 TESTHOLE#2 TPT#1941 OF AND REPLACED WITH CLEAN SAND. Evaluator. David D.Flahero,Jr.,RS,REHS Evaluator. David D.Flaherty Jr.,RS,REHS 10.ALL COMPONENTS TO BE PROVIDED SE#2755 SE#2755 WITH WA TER TIGHT ACCESS PORTS BOH Withess. David Stanton,RS BOH Winess David Stanton,RS Date: May 31,2019 Date. May 31,2019 F WITHIN 6"OF FINISH GRADE. 11.ALL SEPTIC TANKS, DISTRIBUTION 2 1 BOXES AND PIPING TO BE INSTALLED TH-1 ELEV.56.0' TH-2 ELEV 56.0' /STERN WA TER TIGHT. 0'-12' FILL 0'-12' FILL AuTA % 12.NO KNOWN WETLANDS OR WELLS WITHIN 150 FEET OF PROPOSED LEACHING. 13.THIS is NOT A CERTIFIED PLOT PLAN AND UNDER NO CIRCUMSTANCES IS THIS the(3r) Pero Y that on November 12,2002, have passed PLAN TO BE USED FOR ZONING OR E SITE AND SEWAGE PLAN the examination approved by Me Department of BUILDING PURPOSES. Envl=mantel Protecem and that the above anaws FOR 14.LOT IS SHOWN AS ASSESSORS MAP 31 has been performed by me cons/slant with the 12"-126" C MCS 2.5Y 616 LOT 04-05, 12'-120" C CMS 2.5Y 616 required traInIng everuse and ewer fence described 8 & 8 EXCAVATION, INC,/ 5%gravel 5%gravel In 310 CMR 15.018(2). STEPHAN EWING 15.LOCUS PROPERTY IS LOCATED WITHIN 140 WHITE MOSS DRIVE AN AQUIFER PROTECTION DISTRICT (ZONE II). G.W.ELEV.NIA G.W.ELEV N/A (MARSTONS MILLS) BOTTOM TH-I ELEV. 465' BOTTOM TH-2 ELEV 46.0'. BARNSTABLE, MA PAGE20F2 DA TE.-61212019 ..................................... ........... ............................................... .............. .............................................................................................................. ...................................................................................................................................................................................................................... ............... .......................... ........................................... .................................... ...................... ...... ......................... ............................... .... .............. .........................................