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Home My WebLink About0178 WINDING COVE ROAD - Health 178 Winding-Cove Road Marstons Mills P --- - — - - , A'= 057' 036„ i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .� 178 Winding Cove Rd. Property Address Mitchell Owner Owner's Name information is required for every Marstons Mills MA 02648 8/6/20 page. Cityfrown 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. A. Inspector Information 151* f y_-(v1' Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityfrown State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification 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 8/6/20 Inspecto ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments u 178 Winding Cove Rd. Property Address Mitchell Owner Owner's Name information is required for every Marstons Mills MA 02648 8/6/20 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2013 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 178 Winding Cove Rd. Property Address Mitchell Owner Owner's Name information is required for every Marstons Mills MA 02648 8/6/20 page. Cityrrown 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): ❑ 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.7/26/2018 Idle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 178 Winding Cove Rd. Property Address Mitchell Owner Owner's Name information is required for every Marstons Mills MA 02648 8/6/20 page. Citylrown 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 ❑ ® 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,. 178 Winding Cove Rd. Property Address Mitchell Owner Owner's Name information is required for every Marstons Mills MA 02648 8/6/20 page. Cityrrown 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 ❑ ® 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. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone 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 178 Winding Cove Rd. Property Address Mitchell Owner Owners Name information is required for every Marstons Mills MA 02648 8/6/20 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 ® ❑ 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �a 178 Winding Cove Rd. Property Address Mitchell Owner Owner's Name information is required for every Marstons Mills MA 02648 8/6/20 page. City/Town State Zip Code Date of Inspection D. System Information 1. 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 Description: Engineered plan and permit on file at BOH Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 I Commonwealth of Massachusetts �6 (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 178 Winding Cove Rd. Property Address Mitchell Owner Owner s Name information is required for every Marstons Mills MA 02648 8/6/20 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? '❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding 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: No recent pumping per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/2 61201 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments o 178 Winding Cove Rd. Property Address Mitchell Owner Owners Name information is required for every Marstons Mills MA 02648 8/6/20 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/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: 1997 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 12"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet 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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 178 Winding Cove Rd. Property Address Mitchell Owner Owner's Name information is required for every Marstons Mills MA 02648 8/6/20 page. Citylrown State Zip Code Date of Inspection D. System Information (coot.) 6. Septic Tank(locate on site plan): 8" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) H-10 tank appears to be structurally sound If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500g Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle >12" Scum thickness trace-1/4" Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3yrs to prolong the life of the system t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts ►ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 178 Winding Cove Rd. Property Address Mitchell Owner Owner's Name information is required for every Marstons Mills MA 02648 8/6/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 178 Winding Cove Rd. Property Address Mitchell Owner Owner s Name information is required for every Marstons Mills MA 02648 8/6/20 page. Cityrrown 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): Depth of liquid level above outlet invert 0" 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.): H-10 d-box is 3' below grade, cover raised to 6"of grade, no adverse conditions t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 178 Winding Cove Rd. Property Address Mitchell Owner Owners Name information is required for every Marstons Mills MA 02648 8/6/20 page. CityrFown 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.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 5 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments o 178 Winding Cove Rd. Property Address Mitchell Owner Owner's Name information is required for every Marstons Mills MA 02648 8/6/20 page. Citylrown 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.): Infiltrators were video inspected and are damp at this time, no indication of past hydraulic failure 12. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �a 178 Winding Cove Rd. Property Address Mitchell Owner Owners Name information is required for every Marstons Mills MA 02648 8/6/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 178 Winding Cove Rd. Property Address Mitchell Owner Owner's Name information is required for every Marstons Mills MA 02648 8/6/20 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 f� �- 3 r N T t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 178 Winding Cove Rd. Property Address Mitchell Owner Owners Name information is required for every Marstons Mills MA 02648 8/6/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells >144" I' Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 1997 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: 4'seperation per 1997 compliance ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping shows the site at 54'msl and nearby surface water at 2'msl You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts c Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �a 178 Winding Cove Rd. Property Address Mitchell Owner Owners Name information is required for every Marstons Mills MA 02648 8/6/20 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.7/23/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 _ J TOWN OF BARNSTABLE 1r LOCATION /� ` / � � fWJ SEWAGE # ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) S<oe iR ZO-0 (size).��/,001 NO. OF BEDROOMS BUILDER OR.OWNE Z` PERMIT DATE: Af 1 ,77 COMPLIANCE DATE: f�f�_' Separation Distance Between the: ,`;p& ;W 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 facili ) Feet Edge of Wetland an Leaching Facility (If wetlands exist within 00 et lea g facility Feet Furnish d b Ile Covc R el maT&4.0-,s W�•tl S vA�e( • DATE: 7/26/02 PROPERTY ADDRESS: 178_Winding Cove Road _-MarstonsMills , Mass__ -_-- ---Q2-CZ4 ----------------- On the above date, I inspected the septic system at the above This system consists of the following: 1 . 1-1500 gallon septic tank . AUG 8 2002 2 . 1-Distribution box . 3 . 5-infiltrators packed in 4 ' of 12" stone . ( . 38 'X11 'X1 ' TOWN OFBARNSTABLE HEALTH DEPT. Based on my inspection, I certify the following conditions: _ (o 4 . This is a title five septic system . ( 95 Code 5 . The septic system is in proper working order at the present time . 6 . The stone around the 5 infiltrators are dry . SIGNATUR Name:- J .- -Macomber-Jr. Macomber-Jr. -- -- ------- ------- Company:JoseP_h P1_ Macomber & Son, Inc. Address:__Box_C ____________ __ Cent_erv_illeMa__Q2632-0066 Phone: 508-775-3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY rl JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 • COMMONWEALTH OF MASSACHUSETTS = EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION y TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 178 Winding Cove Road Marstons Mills .Mass . Owner's Name: J. Haddad Owner's Address: 7/2 h 0 2 - qamP Date bf Inspection: 7 2h ()2 Name of Inspector: (please print) Joseph P. Macomber Jr. Company Name: Joseph P_ Macnmher & Son, Inc. Mailing Address: gnx t;6 Telephone Number Want-ar17i11e Ma 02632-0066 508-775-33313 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported be'ow 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. 1 am a DEP .i pproved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: /to Passes _ Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: The system inspector shall ubmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ***This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2,of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) ProperryAddress: 178 Winding Cove Road Marstons Mi11s ,Mass . Owner: J . Haddad Date of Inspection: _ 7/2 6/0 2 Inspecti`.on Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information hich indicates that any of the failure criteria described in 310 CMR 15.303 or in 31 5.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present hi Mr- B. System Conditionally Passes: N(l 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 distribution box is leveled or replaced ND explain.;: lod The system required pumping more than 4 times a year due to broken nor obstructed pipe(s). The system will pass inspection if(with approval of the Board PP of Health): broken pipe(s) are replaced obstruction is removed ND explain Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Propem Address: 178 Winding Cove Road arstons i s , . Owner: J . Haddad Date of Inspection: 7 26 02 C. Further Evaluation is Required by the Board of Health: !Vo Conditions exist which requ•ve further evaluation by the Board of Health in order to determine if the system is fating to protect public health, safety or the environment. I. System Hill pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner wbich will protect public bealtb, safety and the environment. Cesspool or privy is within 50 feet of a surface water Cesspool or privy is witbin 50 feet of a bordering vegetated wetland or a salt marsh 2. System µill fail unless the Board of Health (and Public Water Supplier, if any) determines that the s.Nstem is functioning in a manner that protects the public health, safety and environment: X6 The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface "later supply or rributary to a surface water supply. tO The system has a septic tank and SAS and the SAS is within a Zone I of a public water supple 4 49 The system has a septic tank and SAS and the SAS is within 50 feet of a private water suppl} well .11l> The system has a septic tank and SAS and the SAS is less than 100jeet bu 50 feet or more from a private seater supply -ell" Method used to determine distance "This system passes if the well water analysis, performed at a DEP cenified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facihr5 and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are Triggered. A copy of the analysis must be anached to this form. 3. Other: M 3 i Pi ge : of I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Properry Address: 178 Winding Cove Road Marstons Mills ,Mass . Owocr: J . Haddad D:tc of lospccsion: 7/7F,1f1? D System Failure Criteria applicable to all systems: Yov must usdieate "yes" or "no" to each of the following for all inspections: Yes No �ackup of sewage into faciliry or system component due to overloaded or clogged SAS or cesspool ischargc or ponclung of efflvcnt to the surface of the ground or surface waters due to an overloadeo or Clogged SAS or cesspool Static liquid level to the dtsrhb�tion box above outlet inven due to an overloaded or clogged SAS or cesspool -1 / r Liquid depth urix.Lsp 4 is less than 6"below inven or available volume is less than 'A day now Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times purrspcd Any ponion of the SAS, cesspool or privy is below high ground water elevation. Any ponion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface watcr supply _ /vsy ponion of a cesspool or privy is within a Zone I of a public well, _ y ponion of a cesspool or privy is within 50 feet of a private water supply well 4/ us) ponion of a cesspool or privy is less than 100 feet but g7cater than 50 feet.from a private water supply well with no acceptable water quality analysis. ITbis system passes If the well water analysis. pert.,rmed at a DEP earthed laboratory, for coliform bacteria and�volatlle organic compounds indicates that she 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 trust be attached to this form,j StL� O'cs"No) The system fails. I have determined that one or more of the above failure criteria exist as dcs:r bed to ;IO CMR 15 )0). therefore the system fails. The system owner should contact inc Boar: : Hcalin 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 wl(h a design now of 10,000 gpd to 15,000 00 Yo,, must irsdicatc cither 'ycs" or "no" to each of the following: tTTe following criteria apply to large systems u, addition to the criteria above) �es no _ the system is within 400 feet of a surface drinking water supply P/ihe 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 — I WWPA)or a mappec Zone II of a public water supply well !f you,• nave a.nswercd "yes" to any question in Section E the system is considered a significant threat, or answered es" in Section D above the large system has failed. The owner or operator of any large system considered a s:en:F;cant ttveai under Section E or failed under Section D shall upgrade the system in accordance with )10 CM?, i0- The s)stcm gwncr should contact the appropriate regional office of the DeparTmcni. 4 Page 5 c f 1 I OFFICIAL, INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 178 Winding Cove Road arstons Mi 1s ,Mass . Owner: J . Haddad Date of Inspection: 7/2 6/0 2 Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No 7Pumping 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 (lows ui the previous two week period ? 21-lave 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 ? l/ Were all system components,-+x1cluding 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 ? _Y — 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: ties ono Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)) 5 Page 6 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 178 Winding Cove Road Marstons Mills ,Mass . Owner: J. Haddad Date of Inspection:? 26 02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): Number of bedrooms(actual):<' D DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x q of bedrooms): XJ/0='�4`/'"0 Number of current residents: .0Z_ 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): Seasonal use: (yes or no) Water meter readings, if available (last 2 years usage (gpd)): 2000-51 , 000 gallons=139. 73 GPD Sump pump(yes or no): A'' 2001-137 , 000 gallons=375. 35 GPD Last date of occupancy:A� COMM ERCLALgNDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): gpd Basis of design now(seats/persons/sgft,etc.): w1f Grease trap present (yes or no): tlA Indusrrial waste holding tank present (yes or no):Xlt Non-sanitary waste discharged to the Title 5 system (yes or no):� Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as pan of the inspection (yes or no): If yes. volume pumped: gallons •• How was quantity pumped determined? /*�/Zti Reascn for pumping: TY OF SYSTEM Septic tank, disvibution box, soil absorption system OSiingle cesspool M)Overflow cesspool /V Privy ,V- PS:hared system (yes or no)(if yes, attach previous inspection records, if any) ;_D'lrutovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from syste owner) �d Tight tank ��nach a copy of the DEP approval ,4JOOther(describe): ltw A2proximate ate of all comp nts, date • stalled (if kn ) and so ce of information: Were sewage odors detected when arriving at the site (yes or no): �b'® 6 Page 7 of 1 I OFFICIAL INSPECTION FORM -- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 178 Winding Cove Road Marstons Mills ,Mass . Owner: J . Haddad Date of Inspection: 7 26 22 BUILDING SEWER (locate on site plan) J/ Depth below grade: 'r Materials of construction: t iron 240 PVCoeO other(explain): ,yrt Distance from private water supply well or suction line: Comments(on condition ofjoints, venting, evidence of leakage, etc.): Joints appear tight . No evidence of leakage .The system is vented through the house vents . SEPTIC TANK: locate on site plan)/✓e�yylt�t'f' Depth below grade: / Material of construction: concrete,e/fl meta l4 fiberglass/polyethylene ,ltother(explain) ,�/¢ If tank is metal list ag Is age confirmed by a Certificate of Compliance (yes or no):,(/d (attach a copy of certificate) Dimensions: /P��a.� —�)d"1(Iii�u Sludge depth: Distance from top2j>udge to bonom 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 bonom of outlet tee or baffle: How were d.mensions determined: L Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump the septic tank every Z-3 years . Inlet & outlet tees are in place .The tan is structuraiiy sound and snows no evidence of leakage . Liquideve at the out et invert is fifty one nches . GREASE TRA) (locate on site plan) Depth below grade: Material of construction:,IAconcrete.Vjm eta L,(Afiberglasstkpolyethylene40?other (explain): Dimensions: _4 Scum thickness: A_ Distance from top of scum to top of outlet tee or baffle: cif Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: " Comments(cn pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Grease trap is not present 7 I Page 8 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 178 Winding Cove Road arstons i s ,Mass . Owner: J.Haddad Date of Inspection: 7/26/02 TIGHT or HOLDING TANK(tank must be pumped at time of inspect ion)(locate on site plan) Depth below grade: " Material of consmiction: AIA concrete metal V4 fiberglass &2 polyethylene t4�other(explain): Dimensions- Capacity: A gallons Desie.i Flow: _ gallons/day Alarm present (yes or no): Alarm level: 41. Alarm in working order(yes or no): ,f Date cf last pumping: ,VA Comments (condition of alarm and float switches, etc.): Tight or holding tanks are not present DISTRIBUTION BOX: Zif present must be opened)(locate on site plan) Depth of liquid level above outlet invert: .410 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.): Distribution box has two laterals . No evidence of solids carry over . No evidence of leakage into or out of t1Te-9U-r-. PUMP CHAMBERtbIX (locate on site plan) Pumps.in working order(yes or no)- ZIR Alarms in working order(yes or no):—f Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber is not present 8 Page 9 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 178 Winding Cove Road Marstons Mills ,Mass . Owner:J . Haddad Date of Inspection: _ 7/26/02 SOIL ABSORPTION SYSTEM (SAS): locate on site plan, excavation not reqquired) 5 izfiltrators . Packed in 4 ' of 12" stone . 38 ' Xll ' X2 ' System is presently dry . All surrounding stone is dry . !f SAS not located explain why: Located see page 10 Type Bleaching pits, number: D leaching chambers, number: 5—infiltrators 38 'X11 X2 ' ,;0P Reaching galleries, number: , leaching trenches, number, length: l?) leaching fields, number, dimensions: (� overflow cesspool, number: 0 _ /'" trtnovative/alternative system Type/name of technology: 1//r,�� ILI Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Loamy sand to medium fine sand . No signs of hydraulic failure or ponding . Soi s are ry , ege a CESS?OOLS"(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: ,J Depth of scum laver: Dimensions of cesspool: Materials of construction: Indication of groundwater inwf eso ) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Cesspools are not presen . PRIVY/ (locate on site plan) Materials of construction: Dimensions: A Depth of solids: Comme.-tts (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy is not present . i Ih I 9 pagc 10 0( I I OFFICLAL INSPECTION S ECTION FORM _ NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM TNFORN(ATION (continvcd) PrDprrly A00rC,,:178 Winding Cove Road Marstons i s ass . O�ocr: J. Ha a Om of Intpcctioo: 726 02 SKrTCH OF SEWACE DISPOSAL SYSTEM P10ri0f t lkttch o(Iht tcwt p oitpotti lyttcm inclvd(ng IIcs to 111 Icest cwo permincnt rc(crcncc 14nCmarx, Dcncrmvkt Lo(m ill ..-cliff within 100 (c(t. Loc41c whcrc pvblic wittcr supply cntcrt the bviloin;. 1,�Ocfc� \ i1 � �u0 Io --- LE - TOWN OF BARN STAB ��, f"N7 SEW AGE # _a3 fay ASSESSOR'S MAP 8`LOT LOCAnON .•�/ �a$-9 Sy �,LAGE NO. STALLER'S NAME�PHONE � g CAPACITY �'vPs 5" (size) SEPTIC TAN ) L,AC�G FACII- : (tYpc 3 V N �r .oh NO.OF BEDROOMs o w BUU,DER OR OWI.IER ` ' DATE'S A,�: Feet pERMIT D the: Facility ce Between d Bottom of Leaching Separation Distance Feet Adjusted Groundwater Table an If any wells exist Maximurn Ad] aching Facility ater Supply Well and Le facility) Feet private W n 200 feet of leaching wetlands exist ' on site or withi Facility(if any Edge of Wetland and Leaching within 300 feet of leaching facility) Furnished by—� Page 1 I of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 178 Winding Cove Road Marstons Mills .Mass . Owner: J . Haddad Date of Inspection: 7/2 6/0 2 SITE EXAM Slope Surface water Check cellar Shallow wells f, Estimated depth to ground water /`� feet Please indicate (check)all methods used to determine the high ground water elevation: 0 from system desi ans on record - If checked, date of design plan reviewed: Observed site unin ro e / bservation hole within 15,Q feet f Checked with local Board of Health-explain(Q�f*4 Checked with local excavators, installers- (attach documentation) I�AccessedUSGSdatabase-explain: http : //town . barnstable .ma . us . You must describe how you established the higgh ground water elevation: Jsed ; Gahrety & Miller Model. 12/16/94 Ground water levels above sea level . Jsed ; USGS ; Observation well data . June 1992 Jsed ; USGS ; Technical bulletin 92-000-1 Plate #2 January 1992 Annual . ranges of gt"ound water elevations ruuna 5—infiltrators 4 ' of 12" stone . 38 ' X11 ' X2 ' A9 Groundwater: feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Thercfore, the vertical separation distance between the bottom f of the leaching pit and the adjusted groundwater table is 7, feet. 11 f n ir-r--Tr•rTr.-rtrnm rr�+r:.-i••r.mr.:•.n•+•:rvrr:mrsrnrn nr�ncr*+a�rrc.mn .�--�r--.-..-._.-...' t• ^~T Barnstable TOWN OF WARD OF HEALTH 0 SUIISONFACR SEHAGF DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION r.. r ..-r.u..^-.-rLr.^n•n:*+ir�eF artrrT•rn•,r--•.1n:r++-•r.nvr'T*+rrR•an�tR+umnsTwTr7 rnmn ..—.r rr- r-•�. -. -TYPE OR PRINT CI•EARLY- PROPERT Y INSPECTED STREET ADDRESS 178 Winding Cove Road Marstons Mills ,Mass . ASSESSORS MAP , BLOCK AND PARCEL # 057-036 OWNER' s NAMEJ. Haddad PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P .Macomber Jr . COMPANY NAB:'E J . P.Macomber & Son Inc! COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Street Town or City state Clp COMPANY TELEPHONE ( 508 ) 775 -3338 FAX ( 508 ) 790 - 1578 R n, CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposa-j system at this address and that the information reported is true , accurate , and omplete as of the time ofeinspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , n i Ili, �• Ch/Sy one ; stem PASSED The inspection which I have conducted has not found any information which Indicates that the system fails to adequately protect public hea1Lh or Lhe environment as defined in 310 CMR 16 - 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA sectiol) of this form . System FAILED* The inspection which I have co "vcted has found that the system fails to Protect the j-)ublic health and the environment in accordance with Title 5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection for Inspector Signature Date D([wne copy of this` tAfication must be providedto the OWNER , the BUYER here applicable ) and the 130ARD OF HEAL'111. * If the inspection FAILED , the owner or"" 'p' orator shall upgrade ' the eyetem within one year of the date of the inspection , unless allowed or required otherwise as provided in 310 CHR 15 . 305 . partd . doc I�I TOWN OF BARNSTABLE LGtA,3N Za-t -?y l�✓,�o%w y Cove Aa. SEWAGE # 97— 5-27 VII,LAGE 52toc S / ��S ASSESSOR'S MAP & LOTA : ,-6&6 INSTALLER'S NAME&PHONE NO. L a4 i 19e,110 -IIa�-95 7y SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Ln �f� to�� $� (size) I'X f/'X R NO.OF BEDROOMS 3 BUILDER OR OWNER L��-s !�✓+oS Gpw+ spJa7`��h PERMITDATE: l •11 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 Cove o TuM k iR3 3 3 a 32 33+ y/ yv w 0 ,tr -7 O 3� f No. 'C Fee — �, 7�640 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN & BARNSTABLE., MASSACHUSETTS ZippYication for Migoear *pgtem Construction permit Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) P'Complete System El Individual Components Location Address or Lot No. / —t X L/ W KA I tV(r W-Q- Owner's Name,Address and Tel.No. Assessor's Map/Parcel 5 7 l3 6 (h `/d6— 1077 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. JON "LTO YAtvkec Sc.,rvE�tc-.Sj I-M MIS yn/3� >-vt-t D /0 cuNt-Nvr3�. /V*9157rrs .fills oa1,� 1"A L/.N 0c)S Type of Building: Dwelling No.of Bedrooms Lot SizeArp)a3a sq.ft. Garbage Grinder(AO Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 S 1 gallons per day. Calculated daily flow -33 0 gallons. Plan Date cf—A y-9 7 Number of sheets 1 Revision Date Title 5 c 4c*se n (_ Q f Aj Size of Septic Tank TKS Type of S.A.S. Fi 1-t,-AR-S lb n Q' Description of Soil Seg so`1 6�ti ►P1.a W 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 Envi onmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss by th' Board of Signed Date ld Application Approved by Date Application Disapproved for tw fol o mg reasons Permit No. C7 Z- `�r �� Date Issued l Fee t` `— r ��'.�.. Entered in computer: (/6 G D THE COMMONWEALTH"OF MASSACHUSETTS 7 „ .—L* Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 2pprtcation for Miqu ar *pgtem Congtruction Permit Application for a Permit to Construct(t Repair( )Upgrade( )Abandon( ) ktomplete System El Individual Components f 'Location Address or Lot No. 467 W i A'b I kV(r eW 42- Owner's Name,Address and Tel.No. Nlc-lk e-!A6-Ab/Po5 — �Q,Oty. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. ` Designer's Name,Address land Tel.No. /U u��crivr s�. �/rti'srtms 011115 oZGs� �'vt3 � N1& tj1 �� s'tt;NS MILc.S I"A Type of Building: -1 Dwelling No.of Bedrooms 3Lot Size A4;'103Z sq.ft. Garbage Grinder(W Other Type of Building No. of Persons Showers( } Cafeteria( ) Other Fixtures Design Flow 18 1 gallons per day. Calculated daily flow 330 ' gallons. Plan Date '/'-A q-9 I Number of sheets Revision Date Title 5 14C A-Se,21b'c p I_AA) Size of Septic Tank SOO Type of S.A.S. 5 /,% Fd11-Jo2S -4/' SlanQ' Description of Soil I See Sot Ajr.60 4h IQIAU Nature of Repairs or Alterations(Answer when applicable) i Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the-system in operation until a Certifi- cate of Compliance has been issu y thi Board of He"a -` _ Signed �`� ��"®' t Date f �., ti.- _ -- _ _-. . _. �- Application Approved by a PP PP Y � � _ Date Application Disapproved fort following reasons Permit No. 51 7- S- Date Issued -------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(`o-)*Aepaired ( )Upgraded( ) Abandoned( )by S C t 11 "1-,Tt at LISP a 41 W I N Jl. I N G' COVE R b has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. , dated ° f Installer It t?�1 VIVO L TY) Designer ►R vtI e� L.r v e ('O^Sut t A M�$ The issuance of this permit shall not be construed as a guarantee that the system will function as esigned. Date I I 1 a - G"7 Inspector \� — ! �� -------------`--------------Fee Ott THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mfgpogar *pgtem Congtruction Permit Permission is hereby granted to Construct( �epair( )Upgrade( )Aba don( ) System located at 46'T All, W(X b I N( ' COM' Qe 04 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: ( - Q' ,Approv'ed by�_,� � S a � i TOWN,.OF_BARN5TABLE ,/,-fay SEWAGE# Sy7 . t3 A110N :o ASSESSOR'S MAP & LOT , 'VII L'AGE y,711-9579 y INSTALLER'S NAME&PHONE NO. S$pnC TANK CAPACITY 0O r !"X ,.. . G FACII.ITY: (type).. :tvr:5ZE- (sine) — LEACHIN NO.OF BEDROOMS ,3 � ::. L•�5��z �'^oS Gam sfiycf:yh gUI;DER OR OWNER E P RMI TDATE: r� . �.. COMPLIANCE DATE: ;Sepiiration Distance Between the; Feet . Maitimum Adjusted Groundwater Table and Bottom of Leaching Facility ' wells exist private Water Su001Y Well and Leaching Facility (If any Feet.. on site or within 200.feet.of leaching facility) :.Eiige of Wetland and Leaching Facility(If any we exist Feet within 300 feet of leaching facility) :Furnished by J /I "U0 .h: G. n �605/ ° 7 w� 1 4s -► MARSTONS MILLS g� o 0 BENCHMARK- LOT. A.M. 5 7/35 _ C R. \ ` � TOP OF CA TCH BASIN `J' a o \\ ELEV. -100'(ASEVME'D) �o l LOT 24 \ LOCUS MAP A.M. 571361 o We N7 5Z13 p AREA=26,032fS.F. o o w 35 0 0 ' �� W \ \ PLAN REF. 272129 �\�' RES. ZONE »RE,,, 11 p W FLOOD ZONE "C" ' ° o ti W LOT 20 M. 57/25 J ) �� o _ 2.0 7,,, --- ®---- 1vr o_ 7 D DR ,- \\ r1i / /PROP05E � 12.0 I GARAGE PROJEC T L OCA TON o �,J C.R.\ LOT 24 WINDING COVE ROAD MARSTONS MILLS, MA. 0 APPLICANT.- i LOT 19 I „W NICK LA GADINO,.S' AIM, '57 26 ` YA NKEE SUR VEE Y CONSUL TA N TS c.R LOT 25 d P. O. BOX 265 A.M. 57137 UNIT 5, 408 INDUSTRY ROAD MARSTONS MILLS, MA, 0264,8 4 �`� OF PH. (508)428-0055 - FAX(508)420-555.3 e`: ga y 'tea PAUL n BR , r s MIURPHY MERITHEW SCA L E.� 1 "=30' DA TE. 912419 7 749 �' Rlm. 3 No Q F�rSTER�� REV. REV. JOB NO. 51415 SHEET 1 OF 2 106_5' s ` TOP OF FOUNDATION 20' MIN: 10' MIN. CONCRETE COVERS 4" SCHEDULE 40 P. V C. MIN. PITCH 118 PER FT. 2"LA YER OF EL=105.5 118"-112" �_ / CONCRETE CO VER WASHED STONE 6 12" MAX. / / EL.=104.5 i / / � i i i / / • 4" CAST IRON PIPE PITCH 1/4 EQUAL) M PER FT F CLEAN SAND 9 FLOW LINE MIN. INVERT 1 10" 14„ EL. =101.5 104' MIN. S'='Ifl �LE 2.0GAS INVERT JS VEL o 0 p0 00°o°p o BAFFLE _103.5' INVERT/ INVERT EL..—.-- INVERT o0 0 °0 000 EL. = 103, 75' EL.= 103.25 EL.= 103 ° ° o °° o EL.=100 (TO BE PLACED ON FIRM BASE) DISTRIBUTION l V TIO 4' 4 MECHANICALLY COMPACTED OR 6" OF STONE BO11 1500 GALLONS TOPLOAD 5 INFILTRATORS TO BE WATER TESTED Il' X 38' TRENCH FORMATION ,SEPTIC TANK IF MORE THAN ONE OUTLET PLACE ON 6" STONE 3/4"ED STONE TO 1-1/2" SOIL ABSORPTION WASH PROFILE OF SYSTEM SAS) SEWAGE WAGE DISPOSAL SYSTEM BOTTOM OF TEST HOLE OR VSGS PROBABLE WATER TABLE ELEV. =_9_1_7_5 NOT TO SCALE NO OBSERVED WATER TABLE (7131185) ELEV. __91. 75 OBSER VA TION HOLE 1 ELEV. =__103. 75 PERCOLATION RATE �2 _ MINI INCH DEPTH DESCRIPTION 0-36" TOPSOIL & SUBSOIL GENERAL NO TES _ 36"-144" MEDIUM SAND PERC. 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN OF _BARNSTABLE -- RULES AND NO WATER ENCOUNTERED REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO SOIL TEST WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" DATE OF SOIL TEST 7131185 SOIL TEST DONE BY CAPE & ISLANDS SURVEY 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN WITNESSED, BY: ✓ CONLON 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE p # 4660 DESIGN CALC ULA TjON�' USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL NUMBER OF BEDROOMS . . . . . . . . 3 BE .MORTERED IN PLACE. GARBAGE DISPOSAL . . . . . . . . NO r. 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH TOTAL ESTIMATED FL W DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO ( LI2--GAL./BR IDA Y x 3 BR.) 330 GALIDA Y � ODTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. TOP I,OAn REQUIRED SEPTIC TANK CAPACITY 1500 GAL 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCA VA TION CONTRACTOR 5 INFIL TRA TORS W/ IS TO CALL 'DIG— SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS 4' STONE SIDES AND ENDS SOIL CLASSIFICATION . . . . . 1 PRIOR TO COMMENCING WORK ON SITE. 11' X 38' DESIGN PERCOLATION RATE . . . . . < 5 MIN./IN. 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS EFFLUENT LOADING RATE . 74 GAL/DAY/S.F. SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. LEACHING CAPACITY (AREA X RATE) 381 GALIDA Y 8) PARCEL IS IN FLOOD ZONE___"C _ RESERVE LEACHING CAPACITY . . . 381 GAL/DAY 9) LOT IS SHOWN ON ASSESSORS MAP _57_ AS PARCEL _36___. (38X11X. 74)f(38+38f11f11 X 74 x 1) SHEET 2 OF 2 JOB NUMBER _ 51415 --_