Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0205 WINDING COVE ROAD - Health
205 WINDING COVE m,WggiM. MILLS A= 057 054 I� TOWN OF BARNSTABLE LOCATION I �f d.f L� �_ SEWAGE# �Jd 17 VILLAGE kJ ot�ASSESSOR'S MAP&PARCEL ]INSTALLER'S NAME&PHONE NO. •I_ '�� •°7?f-��� SEPTIC TANK CAPACITY 1 A 4 ClC' -iGr_6 G A-t— i LEACHING FACILITY.(type) r1 LP JG t+ (size),3® `Kl f JCS NO.OF BEDROOMS _S _�- OWNER L?I.c� ►��p / l PERMIT DATE: 6L-A COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) A-- Feet FURNISHED BY D,, -e _41/✓>�� i Nc f .. ��br �76r i / t 4�O.�eL I <—4..� � y No.C2(7' al f Fee & THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitatlon for Misposal *pstem Construction Permit Application for a Permit to Construct( ) Repair(X Upgrade Q ) Abandon( ) ❑Complete System grindividual Components Location Address or Lot No. oC f) ,/ Owner's Name,Address,and Tel.No. Sors'�'��o -09&:2 �tc�%rS6A-- Pt 45 ' �""t-`ry^ /U�tl�0/) �1,,u9.'✓�a/��'vv�Rd Assessor's Map/Parcel�� j SJ I Yy}z� �S 11 L 5 0- Installer's Name,Address,and Tel.No. 62*f—Y,9L f- 93aL4 Designer's Name,Address, d Tel.No. c5rg%Q"S/�5 L q15XrALrkU Rd- Mar--hnns NN's.di 4,0XiC 2:5E/Y,29r1_ it A4 TI pe of Building: Dwelling No.of Bedrooms Lot Size O51 1 i V3V sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 336- gpd Plan Date LeaF- �� o�lb1n Number of sheets / Revision Date Title I. �eS SI l e Pj",W- A/4 r5boasNW-S /44 Size of Septic Tank eXi.-L �I— 4� Type of S.A.St,� Sa e�� (jx, t 3U k`7-&3 X a, Description of Soil _ Sx2 !b«en Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental t to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Date ��(l Application Approved by Date 1 Application Disapproved Date for the following reasons Permit No. ?OG Z93 Date Issued U low No.� 1 r s Fee !W / �- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Npfiration for Disposal *pstern Construction i3ertait Application for a Permit to Construct( ) Repair(X Upgrade44t A,�bldon( ) ❑Complete System eIndividual Components Location Address or Lot No.oC OS /yx Vr�Cj(jr� Owner's Name,Address,and Tel.No. o oS -7*X -O rC.D 14c&— lveu-*wn Assessor's Map/Parcel,,f 5'L/ Installer's Name,Address,and Tel.No. Sf-5���' �5g o`►G� Designer's Name,Address,and Tel.No. 5 a ySy� Qj r,( + C'ors� ruc�i o rt �a_��c. ,� y�.c sac ��.���i~i , '4s�,nAus1-/u .1• ►�1�t s i1(s. oxS q49 1,fr.�5� %., .rr rt 0 75' Type of Building:j f Dwelling No.of Bedrooms Lot Size vZ i, V3V sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 3 Co gpd Plan Date AtA ts,l�C� p c(oi 10 Number of sheets ,7� Revision Date A 1 Title 1,t-}Ito. 51 p/an ces(i_)id"r)c ( l�,k�%�l�,r` /✓✓i�r/S{t�rts/�(/�I5 , Size of Septic Tank CA 1`S�~t� 1sj6r)pal Type of S.A.S(=),) 0 el)S -70 x S•S3/X;L� Description of Soil-d•, Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: ... The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code"and not to place the'§ystem in operation until a Certificate of Compliance has been issued by this Board of Health. Signefl — Date q Application Approved Approved by _ Date Application,Disapproved by (/ Date for the following reasons Permit No. GFf 17 793 Date Issued 1111901_ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance, THIS IS TO CERTIIFFY,that the On-site Se/wage Disposal system Constructed( ) Repaired(4 Upgraded Abandoned( )by /aY T-o f<o(il/,� �( t14 � _//.an l)ZC at o�05 (I )i n i V%%0/,W P has been constructed in accordance J - with the provisions of Title 5 and the for Disposalri'7g3 dated / System Construction Permit No. n [,� Installer `it"`tt���a t ��,r� Tf"c E`i t�/I Designer Jn in 0a XWT i�� � Qa A,7r,�C � . #bedrooms Approved"desi- flow 3340 gpd The issuance of this permit shall not t bee const/r��as a guarantee that the system will fun(c'o as 'signed. Date - ---------------- ------------------- -- - -- -- - - - - - ---- -- No.3,0 Fee�1co� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS -Misposai *pstem Construction permit Permission is hereby granted to Construct( /f) Repair( Upgrade( ) Abandon( ) System located at a� �1 J//►'kX! (►stP ,-I i �i1/1 t�iiYi r ,�� - 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 permi. ' Date q1112 Approved by i -23-2017 21:11 From: To:15087906304 Pa9e:1/1 17-Z?-8 Town ®f Barnstable .�r Regulatory Services Thomms lF-Geiler, Director KAn Public Health Division Thomas McKean,Director 200 Win Street,Hyannis,MA 02601 Office: S08-862.4644 Fax: 508-790-6304 Installer&]Dc ' er Certification gorrm Date: l (� Sewage Permit¢# 2017-Z9 3 Assessor's MapTarcel �l 7 ]Designer: DDOUN O,h,PE &GLh=.pV. Installer: IOZ'f"l' — ��iG�j01� Address: %rimf Address: 4 WbUgM gD ,- YA --M 2M MA ObB H5 a o��FB On 30-O oM C'oN4 0 was issued a permit to install a -((fate) (installer) septic system at 2D 5 WeA Gw 1U. VL1j based on a design drawn by (address) dated !II21 ( signer) 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. 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 auy component of the septic cyst= ut in accordance with State&Local Regulations. Plan revision or certified as- y 'gner to follow. SN OF M48�9 (Installer'sSignature) DANIELA. OJALA CIVIL C), F01 81'Ep.� (Designer's Signature) (Affix p Here) EASE RETURN TO B LIC MALIM mWIMON, CERTIFICATE O COB PLUNC19 WILL NOT' BE IS UNTI[, BOTH THM F QRM AND CARD RECEIVED]Dy j E AARNSTABLR Ji'PLI_C HEALTH DIVISION. YOU Q:Health/Septic/Designer Cmfificallon Form 3-26-04.doc �aYt�l���� winstablae- Dep.I di aunt of Rogwatory.Sexvaoos "17 > % Public ealf . M'Slon ua p. 200 Ivtala 5trrot,Hyannis MA 02601 T,pp xua s, �1 Date Scheduled l l/ .'A�zz�c � � Fe'e Jodi ®(��y ---- Isml y._ r � Soil Suitability Assessmentfor S07 E Perforzncd H v' Witnessed By: � � Location Addres4 Owner's Namei W1 { �k 0 ,) 'ja"f-fi of t) O✓� Adda wss Assossor'sTYIap/k'arcel: LJJ� / Bnglneer'sI'la(tAo NEW CONSTR.Ut<M01\I REPAIR X "� t '«�• � • Land Use: Distancesfirm: OpenWaterEody ft Possible Wet-Area fk Drinking Water Well k�o— ft Draibage Way �. !+ ft Property Line ft Other ft �1E IC 'J�3f o(S(zcet name,dimensions of lot,exact locations of test holes&pert tests;locakc y�cklandsn pxoxirnity ko holes) x JJ 33 Q Parent material(gcologic) Dapth-to Groundwater. 5tan�dlngWatcrin plolo:_k C Wacpingfrom pit F'Ans;•�'� Estimated Seasonal High Groundwater Mothod Used: ��"' Depth Observed standing in obs.hole: Ip, :D0polA0-,3pl]I177.ChI�3�_ ltl, Depth to wcepingfrom side of obs.hole: ln, f3roundwaturAdJ4e1trtank Sndex Well fi Rcading)Dote: Irtdo�c We111pYa[ , _ m A dJ.fit Eb1. ._ _ �t((.:Clix?U11tLWllkel'1.aYa1 PERCOLATION TEST —Vft:� Observation Dole#k Tixne•at.S�" ,. P DepthofPerc. 'Ilnxaat6, S tart Pre-s oak Time @ E_v 'Pima.V1,611? End Fro-soalc Rate Min./luoll S4gSultab1llty,A.sscssmczit, Sltokassnd S1tpFnilod:� Additional'l'ostingNeeded(: IN) , Original: Publir Health Dlvlsloa Obnarvatioa Holy Data To Be Completed ou Back—------_- x`*'1`]CiF p�x�zaAa�>ta�n��5t zs to k�� eond�a�t d vazt rn xOO" O WetIaLud,you must first notify the. Barnstable Colasolpvataon.Divaszona at least one(1)WeelK pxxox to' beginning. �:15RP'I'IC1PE13,CFOZt1Yi'.I�OC a '�TO' 70 5T 2J711Ia OTt ur pogljosop eouaraadxo Pui;as-7aodxo"zuIuT w j pwin, -1 airy. R11a quQjgTSuoo om Xq,pouTxopQd 9•aM 91g.jU E 9A4q'9 941JU111 PUL'UOPOOIOJa jElileTll OITAIIa1O 3uoUT4EdBQ oq4 4R patio zddv uppuxw.axw ao:IznPAQ Xtos alp poseadeAaIj x(g4vp) uo;uu}4pmo x ...00010 41a1.[pl u snorn,zga 5UPTL000 41JUXT494�o TdoP o�;sI TRT M 440u JI qua�t�o>��Tiaaga g n.T�aga 9n ors rrn Tdi�S - —�n=}rx�� iqzugu uo'Rdiosga pos og4.1alo p os saoad oad aa.za� a srx - — ao� -- a six ax 6xupunoq,pool;xxaf QQI u!gl.lt& sah �'° o fi�pnnogsea�S QQ&uT saA oAI �xePunagpaa .aea�i94Sanogy, axmq POOR 4 'sxapino�;satto�s'axnianzl5) �ulliaa?N (ilasuri�l (1fCIBC1) xayaQ IIdS xa1Qa IF'S axnTRoyllos uozuaH 11os M04 gid¢q # Qx ages milymasgo aaaa • a o a�t o� , •sxapino�'soual6'oxninn.gs) �u]Ti7aYd (llasnn�i) (1{QSIz) (•ttI)aoa�.Zns xe o IIoS xolao Iias axnIxa,LINS UMIJoklltos uioa,I.gadaa -------------------- An an73x�o,� ua.srsuo szapinog'sauoas'a�aianAS) 5uti�7oult (iiasun�() (VQ511) (,Ur)aaa!sn, xagao I1os .ioloalloa" axnlxad;.IRS uoxuoklllos U104yIdaq �dA r Aoa T 0 '=pinoa!pauoas 'ozrgu ils) .RaIlgayi (iIasunylt) t'4 Q5C1) ' (ur)ao p"S xayifJ "IFS a0100IIpS' axryxaj Ilos uoxlxolq I?RS uioz�tlidaq f �Za tMF T Town of Barnstable Barn . �°} Regulatory Services Department j�'��j L�tNSTABIds. 9 ; : �� Public Health Division m fDN4 � 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4E44 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4990 6388 July 11, 2017 NEWTON, HELEN R TR 205 WINDING COVE ROAD MARSTONS MILLS,MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 205 Winding Cove Road,Marstons Mills, MA was inspected on 06/29/2017 by David Walsh, 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 TH OARD OF HEALTH Thomas McKean,R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\205 Winding Cove Rd Marstons Mills.doc r , Town of Barnstable s�xtvs-r,�atE, 6 9. ,�� Regulatory Services Department QED M11�} 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 v . ❑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 ❑ 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). O 2 YEAR EADLINE CRITERIA p Sm e esspool- ❑Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑Leaching pit or cesspool with high liquid level, <12"below inlet (per Town Code §360-9J) Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ; 205 Winding Cove Rd t Property Address Helen Newton Owner Owner's Name -b information is Marstons Mills Ma 02648 6/29/2017 r required for every page. Cityrrown State Zip Code Date of Inspection h.! 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. General Information s1 y�l a on the computer, use only the tab 1. Inspector: key to move your cursor-do not David Walsh use the return Name of Inspector key. David Walsh Services r� Company Name 66 Maureen Way Company Address r Plymouth Ma 02360 City/rown State Zip Code 774.404.4082 13725 Telephone Number License Number B. Certification 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 ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 6/29/2017 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 should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 V-S Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 205 Winding Cove Rd Property Address Helen Newton Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/29/2017 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This system does not pass Title 5. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Boar of Health, will pass. Check the box for",yQs", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please exp ain. The septic tank is metal and, ver 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 than20years old is available. ❑ Y ❑ N ❑ ND (Explain below t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205 Winding Cove Rd Property Address Helen Newton Owner Owner's Name information is Marstons Mills Ma 02648 6/29/2017 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Ob rvation of sewage backup or break out or high static water level in the distribution box due to bro en or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass ins,ection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstructi is removed ❑ Y El ❑ ND (Explain below): ❑ distribution b x is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): N% ❑ 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 W Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Wealth in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a,salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 h Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 205 Winding Cove Rd Property Address Helen Newton Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/29/2017 page. CityfTown State Zip Code Date of Inspection B. Certification (cont.) 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 sys s a septic tank and soil absorption system (SAS)and the SAS is within 100 feet oi- su ce water supply or tributary to a surface water supply. ❑ The system ha a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a s tic tank and SAS and the SAS is within 50 feet of a private water supply well. ElThe system has a septic tan nd SAS and the SAS is less than 100 feet but 50 feet or more from a private water supp y,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 preser ce of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure riteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge r n i El ® ge o po d ng of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM ,.•�'�p 205 Winding Cove Rd Property Address Helen Newton Owner Owner's Name information is Marstons Mills Ma 02648 6/29/2017 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: 1. ❑ ® 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 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 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow f 10,000 gpd to 15,000 gpd. For large systems, u must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is ithin 400 feet of a surface drinking water supply ❑ ❑ the system is within 0 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a itrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped ne II of a public water supply well If you have answered "yes"to any question in Section he system is considered a significant threat, or answered"yes" in Section D above the large system ha failed. The owner or operator of any large system considered a significant threat under Section E or fail under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner hould contact the appropriate regional office of the Department. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 205 Winding Cove Rd 'Property Address Helen Newton Owner Owner's Name information is Marstons Mills Ma 02648 6/29/2017 required for every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 gpd t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ,M 205 Winding Cove Rd Property Address Helen Newton Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/29/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: This is a 3 bedroom design with a 1000 gallon tank, D box and leaching pit with a 330 gpd flow, with a 425 gpd design. The system is from 1979. The DBox and DBox cover needs replacement and the leaching pit is full. Liquid levels are at the incomimg pipe in the leaching pit. Number of current residents: 1 Does residence have a garbage grinder? ® Yes ❑ No 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 ears usage d 223 gpd 9 ( Y 9 (gpd)): Detail: This property has irrigation. 2015 water use was 84,000 gallons. 2016 water usage was 79,000 gallons=163,000 gallons/730 days=223 gpd avg. Sump pump? ❑ Yes ® No Last date of occupancy: currentDate Commercial/Industrial Flow Conditions: Type of Establishm t: Design flow(based on 310 R 15.203): Gallons per day(gpd) Basis of design flow(seats/person qft, etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205 Winding Cove Rd Property Address Helen Newton Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/29/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of o pancy/use: Date Other(describe below . General Information Pumping Records: Source of information: owner, last pumped fall 2016 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: general maintenance 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): I t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 205 Winding Cove Rd Property Address Helen Newton Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/29/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: system installed 1979 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): no signs of backups inside property, flow comes into tank freely. Septic Tank(locate on site plan): 8" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) The septic tank is a 1000 gallon tank assumed original from 1979. There is a pvc tee on the inlet side and concrete baffle on the outgoing side. No signs of leakage in or out at this time. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: 2" t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �. 205 Winding Cove Rd Property Address Helen Newton Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/29/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness 0-1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? sludge judge and measuring tape Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): pvc inlet tee, concrete baffle on outgoing side, liquid levels are at the outlet invert. No signs of leakage in or out at this time. Pumping is recommended every 2-3 years based on usage. Pumping not needed at this time. Grease Trap(I cate 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 ba Date of last pumping: Date t5ins.doc•rev.6/16 Title 5 Official Inspection Form: bsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205 Winding Cove Rd Property Address Helen Newton Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/29/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid le Is as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(ta k 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: ganons :�:-- Design Flow: gallons per day Alarm present: © Yes ❑ No Alarm level: Ala 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 l5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 205 Winding Cove Rd Property Address Helen Newton Owner Owners Name information is required for every Marstons Mills Ma 02648 6/29/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at 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.): Both the Dbox and Cover need replacement.(as well as the SAS). A temporary cover was placed on the DBox at this time. Pump Chambe,(locate on site plan): Pumps in working ord r: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition\pupamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Liquid levels are at the inlet pipe invert at this time. This system does not pass Title 5 requirements. SAS is full. t5ins.doc•rev.6116 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M :205 Winding Cove Rd Property Address Helen Newton Owner Owner's Name information is Marstons Mills Ma 02648 6/29/2017 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ 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.): Liquid in SAS is full to inlet pipe. According to original 1979 documentation there appears to be reserve(future) area noted, this document is attached with groundwater data and design form at the end of this report. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configurati Depth—top of liquid to inlet in rt Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc-rev.6116 Title 5 Official Ins on Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205 Winding Cove Rd Property Address Helen Newton Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/29/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of\ofhyvdraulic, re, level of ponding, condition of vegetation, etc.): ti t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M ,•''p 205 Winding Cove Rd Property Address Helen Newton Owner Owner's Name information is required for every iMarstons Mills Ma, 02648 6/29/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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 T 1 tS A I -TG�� •a 'S2' 1 t� ' m� y e 6ttA 2 aNk, 5S'6 A'CVX1a".c'1 3 ox 5'7 " "? ' J V I +o din CL a 2 N r Glove,, t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205 Winding Cove Rd Property Address Helen Newton Owner Owner's Name information is Marstons Mills Ma 02648 6/29/2017 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >10'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: 3/1979 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Accessed online Data ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: owner had copy of original design data. This is attached to the back of this form. Test hole data shows no water at 4' below the bottom of the SAS, which is >10'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 205 Winding Cove Rd Property Address Helen Newton Owner owner's Name information is required for every Marstons Mills Ma 02648 6/29/2017 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information-Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file TEST_ ;: ToP Fun .too.c� .., i 0,0 27 y_ 4-p,Pe .. r, iW GAL 'b.s to IQV t►,v. Gnu t� 9ov Lac PiT e ., .N ;: MBA• 1 a/�17 e�i�ND WASi-IED Q CD W;n T-E r7 I G L I Z T u 4=-( T�-•t A T' T 14 r= S G,1ow Q t4E.L,t_z�rJ Ga.�.lPL�tS W tTP TO AtJD `E'T"l-AC G:GC;rJtQE.ME uTy OF 'T"toE i2EGl5 it.i�>✓D iJs\F..1�"j 5U2v�Yv 1�:I C7[._nt-1 1 t-I.UT LA.-7CL7USTEG= /TI,T_L"_ '[' v J�Cr�Sy• u 1i=:n� I.tn {=�`I�' l,:J�: /T=ti �• 1 t;i=: rr:Ft=j►=�i ��1-�LiJLS� i f}�tl t-1 �A.t-,!T t5ins.doc•rev.6116 Tide 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 17 of 17 C.��•�tGtil �1AT�.. SiUGt� �AMiL.�( - 3 731��aM � Lio GArz c bRt 4- oT-- Dat L�4 Low _ lib V- "3 = sscd G•F-V— f E�t-rc T�k = 33a,� 15c % = A-95 6.P.D. ISPOSAL FPiT - .uSE:: t o(Do G;dL. 6-7 CEO S.� TOT,&L ESIG�I 42S :C�P.D �' �- •��= � ToTQ L is i L`f F�.rwi i - -330 14 f PEf1GDLQTIOLJ 6ZlsTE l"Aki iQ' o2 7.1/ y ��. 7 r yy , L f T�sT F i 13 , plf 4rOp� a�isr' iw- eox 10 Z °;SEvrIc iQ ` .. IWV- 1000 4-� i�Nv. wv. G A t_ :ifs 9 o v , LeAGt-1 FAT A C'L�x�u VI TT , STOWS- k�•ii T /O .o _. LoC1sTly-1 � >T J1il, • �;Ar�h�_ �� -car .,E� � " • T�-(AT- T1a r— PL tot4 TZ►_f iv-ci-1Gt=„ 4a E.4,t=i71.] Gc�rlil f'IL•{S /.i Ti A T I.1.= 51 D E t_C►Ji <f mac t.tTy OP T'NE 2GGt.S t-C=�'CD 'uL�G SUe�I�Y� 6JUT LA=,GC") 061 A6.J O>TE /il_LC= v I�rLS . Tt-�1� nt_ntit t� �� it_�i=rn. 1_tn {=►,l;' fcJ:_�!i_1' 7- [t1i� c:Ft=jFs<<i ��1t[�iJLI� PUf?LIGA.F�T f j As essin s-Built Cards � g,R http://www.townofbarnstable.us/Assessing/HMdisplay.asp?mappai--0.: LOCATION SEWAGE PERMIT NO. VILLAGE -------------- INSTALLER'S NAME i ADDRESS Agm DOLLAWAX A082 OW t UlLDE R. OR OWNER '°'02 _ �CPA✓ /�61t /Pizy'SI �. DATE PERMIT ISSUED 5. 30_-71 DATE COMPLIANCE ISSUED -7� iC�� 17 S2. a I'1.3USQ,, fi .. { I of 1 6/26/17, 11:44 PM 7 LOCATION ° SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NAME i ADDRESS AmEs DOLLAWA WN7RACTOR . Boaz oja.stage xa 4, an.02M B U I L D E R OR OWNER oce,4,. 4250=0 oer 6,f A4AVsT442-4. ,�Xr DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED .. � - • , �!12�yz `��u�e.: ���uq� , 0... _J Fxs.. LQ.,J...-.� No. .�. ........ ...... :._. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..Il.�'.............OF.... .................. Appliration for Uiiipniial Workg Tomitrurtim ramit Application is hereby made for a Permit to Construct (V ) or Repair ( ) an Individual Sewage Disposal System at: ....t �:r q.... .. .1 :..... ..l �. ............... ` ...6..7...................................................... 1 Location-Address� `., EX-L ---•----•--•_•__— ra. w er Address .16 Installer Address Type of Building ._..........Sq. feet Size Lot................ Dwelling—No. of Bedrooms......_...............................Expansion Attic (we) Garbage Grinder (�JO '4 Other—Type T e of Building No. of persons............................ Showers — Cafeteria G.� YP g p ( ) ( ) P4 Other fixtures -----------------------------•••-- • • -- W Design Flow................ ...................gallons per person per day. Total daily flow..........��O....................gallons. W Septic Tank—Liquid capacity,/M.gallns Lengt Total 1 Lien tidth.0.�--/O ToDtal leaching area.--Depth__Ljfe�u x Disposal Trench—No. .................... Widthg g ....................sq. ft. 3 Seepage Pit No............I........ Diameter.........L_0..... Depth below inl t_._...._.6 .... Total leaching area...�r�' ...sq. ft. Z Other Distribution box ( ) Dosing t ( ) B,� /10 G r................... Dat ..:_Percolation Test Results Performed by..Al ....a. ?:........ aTest Pit No. 1.......-!_-'-....minutes per inch Depth of 6est Pit------fI....... Depth to ground water________________________ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' ---••--•-------•----•-----••---•----•-••--._.......-•••••---•-•-•-••----•••......---••-•..................................................................... -4 0 Description of Soil.._.._....O. --t.°.....400A,&-.- S!/bS�t-�'-------`��-f ----- NL�-------------- V ------- ------/ts .._tattdt4_ ..--•---.....-------------•-•-----------------•--...--------------------------•------...------......--------------•-•--------- W ............... ...........•-•-•-•--------------•--•------.....•--------•-•-•-•--•---•••••--•--•----••-•...----...----------•----•-•-------•----••-•----••----•••-------•-------••••-••--••-----•••- UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT:E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be sued by the board board of health. Sig d.- Date Application Approved BY / l - ......-•••----.. lc�.� Date Application Disapproved for the following reasons:............................................................................................................... -----------------------------••---•-•••-...... ------•-----•-•----•-•....---•....._.............•-•-•----•••••----•--------••---•...-----•-•--•-•••-••-•--•-•-------•-•--------- ------•--•...._..._ Date Permit No...... ........ t��•--•••................... Issued----------- Date ..... 3 FEE. ... ' ...... }. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH yd y• k• f' / ----- ----OF.... 15. .A ? ' .g._.:.... rafiou for Uiipns�al Work, C�omitrartinn ami# +a• Appllcatictn;1is hereby`�,made for a Permit to Construct (;J) or Repair ( ) an Individual Sewage Disposal system at E t.! $ � :� 1 ---..61...................................................... }p 1� 'L/L'oca600n_'Address (/(}� or �J j SAC JSw� LA .................... ........ '9`: :-i- .....V1k.! .•---j-:•-...: ` 0 �O e Address W ................... °'�-- .. _`T. 16— •t�•--""...-"•"--•-•-----.......... .......--•-"-"-"... � 9J _1 +--..................... Installer Address Type of Building Size Lot............................Sq. feet U Expansion Attic Garbage Grinder ,., Dwelling—No. of Bedrooms.___.-•.. ...:....... p ( ) g ( �- '� Other—T e of Building ............................ No, of persons_________________........... Showers — Cafeteria 04 Other fixtures - - --. -- r : g - - ers - - -- flow -.----- 04' Septic Tank—Liquid capacity/fi _ allons Len h. -_. Width ._.ft�_... Diameter_____� gallons Design Flowloll._ ,;,,� _..__ gallons per person per day. Total dailyflow________,,,.� • ----loll-- Depth-•`�-•-�'- W Disposal Trench—No_____________________ Width.....................Total Length.................... Total leaching-area....................sq. eaching area..._.___-_-_._...---sq. ft. x Seepage Pit No________ ___ ______ Diameter.._.___ ........ Depth below inl t Total leaching area_ Sq. ft. , + - - . z Other Distribution box ( ) Dosing tpk ( ) Percolation Test Results Performed by.A _�.....0.. . ___________ Date_:_--..............7...1.........:... ,.a Test Pit No. I....,L 11, t s'.-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________________________ Ri r ' O Description of Soil .. i : � . ��'Z� :_.5ie�r 4� �' C `-- 1 ._ s t ........... V ...........-....................... W •-••----••••-----•-----------•---•-•-----••••-•---•-------------•--•••--•---•----------•--•--•••....----`-----------------------•-•••--------------_________-•-•------•-------•••-••••---•••---••--..._. UNature of Repairs or Alterations—Answer when applicable................................................------------------"-•loll--•loll-•loll---loll-: r" Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with' the provisions of TITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be -I sued by the board of health. Sig d. � 2 s /t� Date Application Approved By---- Date Application Disapproved for the Jollowing,reasons----------------"---""-- D i --------------•--�-•---...----------.._,,....-----"-----._..........._......._.�--=--..._..-------••---.._._..._....--"-------loll-- �. D - e --•ate Permit No. ._ tr< .... .......--••-•----•-.. Issued...--•-•................. . ....... . .......... ^" Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH A`?! ' of Trr#ifirtttr 'at Tompliatttrr THIS IDS TO CERTIFY, That the Individual Sewage Disposal System constructed (4T`or Repaired ( ) by............• ------ •. .....:........ Ins aller 'Nat = �s tom•p�•- - ....a;x �i has been installed in accordance with the provisions of�I' j of Thd"Se Sanitary Code-as de cribed in the application for Disposal Works Construction Permit'No:: ......... dated------ *_1L4:_-_ __ ........... w THE ISSUANCE OF THIS CERTIFICATE SK. L'NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. a:- 5 Inspector q/`�;/ ...__... Iti y� i< f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF Nb»�- ��.�.. HEALTH - /��_ ........ '��' 6 ..........oF._......... ...................... � ' �._ c ': FEE . ... .. Diapnoal Works Tut #rauan rMeY'IA Permission is hereby granted- - - -•--- w to Construct ( ) or Repair.( ) an Individ al Sewn e.Disposal System 0> > E tJ� ---t�. ----------- at No. ` .. �' ._ .............. ... ;i;;;` --.X ...... treet as shown on the application for Disposal VVorhs Cof�struction Pe No:_ ___ _____ __ ated___3_'�`�F�_ ��"........ w ' r. _ loll-- . ......-loll-- << Board of Health DATE.............--•---•---••••-•- _______.---_"------------------•----•-... _ . loll-- 4t •' ��,.�. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS 2stGh1 to "� ir,. ".�� �:• � _ _Cr►' �� Flo C�AtZIsAGt� (�t'ZI t,ID�� . �d 1 L--� T=Low 11 o .4 3 = 3�3 d 6.p.,D. l G A PT-IG T�i1C = 3so,r Fjc /o : 4-9C2 6-F.D. USA- I,OOC) GAL . tl�poSAL PIT usE l Ooo G�L " z,-tGu/ALL Av-EA = (5o S.P. BarToAA Zee- eO ST-. C.o / � Ste. A ► .o _ SO TOTAL = 42S '4 70-r&L Dal L�f r-Low = 330 G.F9D o 1 PElZCDLLTIC)0 CZl�TE �� I�.f 2�rtll.l OIZ La✓SS. TLl PAW peP 4 :,a , v I T>`ST Top VW =ico.o � PIP& �Poe tuv� `11,v /-ff I 000 Wv. ':n Q'�P� FIST I W �tvb sot L -Box Go.2 ScPr Ic l p Iwv. TnNK I o00 G t IUV. INv. GAL. y Ls+GN a P,T e% SAND %,vASWED STotit= ��.L CF--ZT 1ED pLbT F'L./�>.J Pr2o�t L� /- i LoC-A.TIot--1 NIAViv• , /1/Ii" tic- l//n T�fL (�r2v r'c,S e5j CLiZTtt= ,-r 7'�-(AT- TI-1C-- 5ta�/►� P�_��.1�1 R�_t=�Rc►�i� E 4�E.QtaZ�i�1 efo&N.PLg-, Wi-r-A Tl-t` 51D t_I►-�� G-^1 awe �:E"Ttl,nctG �:t=��1s`E�nC.uT, o� T•Nl•~ +°� -Tow►,2 I r 1 ! t- �T E .� 1 l{�,(n-n-• t �:4a,%��._•�=- g!-�.�r:-r C�z. �;,. ►-i Y E= I�-!G_ REGIS C'C_t��.D iJ�F.1G iU�VEyoi='- 05TE��/1LLC_ v tiCAS��. 11J�>`r�?•1'r�l;►JT' ,�it�i_\/l_�' - 7ftii= c:Ft=�r_�"�. �11GbilL2� A.NI'l_I CA,t-J,T I ! i C l'.',i : U'>t�� j i..� i J r:_�•l_�_/`'t�'�•�(~ 1__C���'- (_I IJ�.j — --- --� �� GC. V 1+-I��lib-' - \ i B'OR:TOLOTTI CONSTRUCTION INC. �8II88.ORYACL:':9ExAaE•_DISPOBAZ; SYSTEH INSPECTION PORX 1►dar4s's ,oftpropsrty � --- 1D4 @Lg t sv na?atr - psction. PART A CHECKLIST ..Check if• .the . folllowi.ng have been done: 1!_ Puxnine .Anf6rmation was: regues't.ed . of the owner, occupant , and ealth::. . . .,� None .ot .. the .system components°.have .been pumped for at least t,-,o and*-.,the system has• been receiving normal flow rates during that period. �I:arge `►o:lumas ,.of :water.have..not been introduced into r_hr- ystam:.raeantly...or: 'as. part, of this inspection. ✓ �►a built .pl•ans have .been obtained and examined . Note if they � r avaiIkbi' ''l ith. N/A. __Z I The fa`cij.ity�'or dwelling. was inspected for signs of sewage h-ace: .Tha sit4v.was. .inspected for signs of breakout . All. system components , excluding the SAS , have been located n `site:, The aepti'c .tank manholes were uncovered, opened , and the inters the:saptiV.tank::vas inspected for condition of baffles or tee naterW;.ot"'construction, .dizaansions, depth of liquid , depth o! s1;j00'7•; ..depth . of°•scum. The * a ie and-.location of the SAS on the site has been determined c+n existfna 'in�cirination o� alp:-�ox�.�ic�.ted o;� ��n_i Tr r,,:;;�L metho�:. . The fhcility :owher. (and occupants, if different from owners - . provided=with' information on the proper maintenance of SSDS . <"r•�pyM{s'CQss41AA0.S. ,' ..a+rz+�tvse.�na..... ,... ..wpm,. ...... _. 77 SUBSURFACE. SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART. B SYSTEM•.INFORMATION FLAW. CONDITIONS If rest dential n mber of bedrooms .member of :current .residents qPm age _gr;inder,. yes or no, ..laundry`connected. to. system, . yes or no s.�/� pasonal-*use;' ;yes or. no If nontesidential calculated flow: . . Watereter readings, .if available: rre` r Last :date of occupancy GENERAL INFORMATION Pumpinrecords and -source of ijn formation: A© SKstein pumped as part.. of inspection, yes or no voluMe---pumped Reason for pumping: -T)Tf;o system- S� c t x/d{ tri'but-C.`i absorption system Sigle cesspool. OvAerf164. cesspool P 4y.Sred: system ;(yes. or no) (if yes, attach previous ins records,.. if' 'any) P inspection Other.:-* (explain). Approximate age :of all components . Date installed, information,: if known . Source o: Sev' age odors detected when arrivin a g t the site, yes or no b: `$F SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORK. PART B SYSTEM INFORMATION continued SEPTIC TANK: (locate on: site plan) depth belo*4 grade• 2 `/ material of'. construction: concrete metal FRP _other ; e.::p ! ' dimensions: ,5�G X � -/ 'y -- ----------- sludge ''depth distance .trom top of sludge to bottom of outlet tee or baffle �! seuli-:thickness _z distance* from top of scum to top of outlet tee or baffle distance ' from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or ball , depth of Yiquid level in relation to outlet invert, structural integr t. , , evidence- ofLyeakage, recommendations for repairs , etc.) DISTRIBUTION BOX: (locate .on :site plan) depth of liquid level above outlet invert Comments: (note if level' and distribution is equal , evidence of solids carryover- , evi enee of leaks a int or out o box, ecommendation for repairs , et--: - ; ,p- oa9_?`L° ��i PUMP CHAMBER: (locate on site plan) pumps in working order, yes .-or no Commentsi (note condition of pump chamber, condition of pumps and appurtenances . recommendations for maintenance or repairs , etc . ) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INrOR ATION continued SOIL. ABSORPTION SYSTEM:-(SAS). (locate on-.-site. plan, ,.if possible;` excavation not required , but may be approximated-'by non-intrusive methods Y. . ) If not determined to be present, explain: Type. leaching pits:.am number J _._.. leaching chaAbers and number _._ leaching- galleries and -.number leaching::'trenches,:.number, length — l,eachinq: l3elds, number, dimensions overflow`cesspool; `number Comments ' -- (note cotaition ,of soil, signs of hydraulic failure, level of ponding , : con ition of ,vegetati on, recommendations for ma ntenance or repairs , etc, ) e y CESSPOOLS` ,(locate -on site plan) number and configuration -depth-top': of Ai iid .to:: inlet invert depth: of .4olids :layer ofm Idepth- ayer .. 04 dimeiisionsr ol::cesspool c'. saterials ,oi :construction :;.4 :.i'ndicatYonotf;;; roundwater --- - infhowcesspool -.must be pumped as part. of'Ins'*ection) Comments' . (no itic d,;. . .o .V. signs of hydraulic failure, level of ponding , con. 6.h' of vegetation;.' zecommendations for maintenance or repairs, etc . ) ,: (hocate:._�on•:aite,. plan), , .mater3als.:,Iof=construction dimensions :: .depth, ol:.solids — :'..Comments:. (note:-'condition of soil, signs of hydraulic failure, - level of ponding , -condition=of vegetation; recommendations 'for maintenance or repairs , etc . � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH -OF,: SEWAGE` DISPOSAL SYSTEM: include ties to at least. two .permanent references landmarks or benchmarks locate all wells within. 100 ' \4\ DEPTH TO GROUNDWATER �Z depth to •groundwater method of determination or approximation: j"�' _sUBSURFACE ..sEWAQE DISPOSAL SYSTEX INSPECTION FORM PART C FAILURE' CRITERIA Indicate ;yes,, no., or. not determined (Y, N, or ND) . Describe basis of detorminaat ion, in. all instances.. If "not determined" , explain why not) Backup.•ot. sewage into facility? Discharge or ponding of effluent to the surface of the ground or , surface waters? Static 11cr2id .level in the distribut:�on box above outlet invert? �Jrl Liquid depth in. cesspool <61' below invert or available volume< 112 d.t - f low?.. Requi;red. pumping .4 times or more in the last year? number. of times pumped , & Sep. ic. aank is.: metal? .cracked? structurally unsound? substantial infiltration? substantial` exfiltration? tank failure imminent? Is any portion of tfie $AS cesspool, or privy: below the high groundwater elevation? within 5d.: feet.`.ot a :surface water? within I00 feet., of a surface water supply or tributary to a surface water;;supply? within a: Zone.,.T- of.: a public well? within 50 feet of a bordering vegetated wetland or salt marsh ' (cesspools 4nd - privies` only, . the SAS) ? , .Within 50 feet of a private water supply well? l.ess;' than 100 teat. but_;greater than 50 feet from a private water supply well_::with no;:acceptab.le water quality analysis? If the well has been;:analyzed t6l be:'acceptable, attach copy of well water .analy= for::colitorm bacteria,ogeneria, volatile and nitrate nitr organic compounds, ammonia nitrogen . J.- sUBsURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM PART D CERTIYICATION 00, Name °of Inspector,. . Company` Name. t �---7,w � -7 rX- R� , Com an ; Address P Y r i ✓I� Q�G c� .� r.�.s r4 ;.'> Certifieation Statement "Y cepti :: at :Y na.i.e personallyihspect(d the sewage dizpasal system s at this .addres .;and :that the information reported is true, accurate and eomplete' as.;oi::the time of 'inspection. The inspection was performed and any reeommendations: regarding upgrade, maintenance and repair are consistiri4 Vith "my: training and .experience in the proper function and tanitenance"' of on-site .sewage disposal :systems. Chec ne• I have ,:not . found any ,information which indicates that the system . fail -, to" ad�gLiatsly` protect . public .,:health or the environment as defined in 10 CZ+iR' 15 103:.:'.`Any failure criteria not evaluated are as stated th.e FAILURE CRITERIA: section of this .form. I have.: determin.ed.-that the system fails to protect public health an:, the env�itonment : as:defined in 310 CMR 15. 303 . The basis for this de. arminati`on is 'provided In the FAILURE.,CRITERIA section of this .form. Inspector's Signature Date y9 0rigina1*, to':-,system owner - Or�pies -zos. Buyer (if applicable) Approvi.nq.-authority ALL SYSTEM COMPONENTS SHALL BE 4" SCH40 VENT WITH NOTES SYSTEM PROFILE MARKED WITH MAGNETIC TAPE OR CHARCOAL FILTER AS o COMPARABLE MEANS FOR FUTURE LOCATION. SHOWN PLAN VIEW 1. DATUM IS NAVD 88 PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) PITCH BACK TO SAS, boo �s� loin Sf ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE NO LOW POINTS. 2. MUNICIPAL WATER IS EXISTING '\ TOP FOUND. EL. 64.5 FILTER FABRIC OVER STONE -- —59' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. Route 28 OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 54' I 4. DESIGN L d W OADING FOR ALL PROPOSED PRECAST MINIMUM .75' Jstt R tie 28 NOTE: 2" MIN. WALL UNITS TO BE AASHO H—ZQ PRECAST H-10 BLOCKS OR RISERS T THICKNESS REQUIRED MORTAR ALL COMPONENTS PRECAST RISERS 5. PIPE JOINTS TO BE MADE WATERTIGHT. 2 o 56.1 ' 4"OSCH40 PVC H-10 Locus 6" MIN. SUMP PIPES LEVEL 1ST 2' 12" MIN. INT. DIM. 4' 5' 1,�p 5' 0� Zj ENDS I ET ( ) SIDES 53.25' WITH CONSTRUCTION DETAILS TO BE IN ACCORDANCE Jac e rl "EXISTING 14" ➢000000000 a°o°o WITH 10" EE' 310 CMR 15.000 (TITLE 5.) A TEE SEPTIC TANK TEE ®000EI 0 D�G�'�� o �0��O �00� �O N*54.7 j77' 0 0 o 0 0 > o 0 0 o O O O O S C] ° ° O O O O O O O O O ' o 0 0 0 0 0 0 0 0 o WATERTEST D'BOX o 0 0 0 ®®ao 7l7lr= �l oo°p°o oa000®aao�o �000°o°o° 00000000000 0 '°°o°°°o° o 0 0 0 0 o °°°o°° °°°°°°° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND ° GAS BAFFLE o 0 o FOR LEVELNESS °°°°°°°° ®®®����00�� °<°o°° °^° N ° ° ° ° ° ° ° ° ° ° NOT TO BE USED FOR LOT LINE STAKING OR ANY - > 00000 I�IJ I�I�I�I�I�I�I�I�� p0�°DODO ,°°°°°°°° °°°°° . °o°°°°° OTHER PURPOSE.4' LIQ. LEVEL (ACME OR EQUAL) 5 52.60 ° ° ° ° ° o°°° ° ° ° ° 50.25 o°o°o°o°o°o°o°000000000o0o0o0o0000000000000° 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4' PVC. Rd °0000000 g�o�g°g�o�oo00000�°0°q�°9°q°9°,g;0000OPL H-20 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. o Baxter e 3/4"-1-1/2" DOUBLE WASHED. STONE (2) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR a °} 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 30' X 9.83' CONCEALED WITHOUT INSPECTION BY BOARD OF COMPACTION. (15.221 [2]) HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP (200% SLOPE) ( 1 % SLOPE) CALLING DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION OF ALL UNDERGROUND & FOUNDATION— EXIST. SEPTIC TANK 1 D' BOX 12' LEACHING 42.5' BOTTOM TH-1 OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF SCALE 1"=2000'f FACILITY No GROUNDWATER FOUND ASSESSORS MAP 57 PARCEL 54 *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS TANK SIZE AT 1000 GALLONS AND ITS SUITABILITY BE REMOVED BENEATH AND 5' AROUND THE PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM PROPOSED LEACHING FACILITY. FOR RE—USE. REPLACE WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE CONDITIONS IF 12. EXISTING LEACHING FACILITY SHALL BE PUMPED NOT SUITABLE AND REMOVED OR PUMPED AND FILLED WITH CLEAN LEGEND SAND. VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY 99 — EXISTING CONTOUR BE IMMEDIATELY GRANTED BY THE BOARD OF SYSTEM DESIGN. HEALTH AGENT OR BY HEALTH INSPECTOR X 99•1 EXIST. SPOT ELEV. PAPERWORK AND HEARING REDUCTION PROPOSALS —[99]— PROPOSED CONTOUR APPROVED BY THE BOARD OF HEALTH REVISED GARBAGE DISPOSER IS NOT ALLOWED DURING A PUBLIC HEARING HELD ON DEC. 10, 2013 198.41 PROPOSED SPOT EL. 2) FOR ALL SYSTEMS THAT HAVE NO INCREASE IN FLOW — SYSTEM COMPONENT INSTALLATIONS DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD TH1 PROPOSED MORE THAT THREE FEET BELOW GRADE SHED USE A 330 GPD DESIGN FLOW TEST HOLE WITH PROPER VENTING (PIPED TO THE ATMOSPHERE) AND WITH H-20 LOADING, BUT IN NOT CASE SHALL 2� SLOPE OF GROUND THE SAS BE LOCATED MORE THAT SIX FEET BELOW �1p 39 62 SEPTIC TANK: 330 GPD (2) = 660 UTILITY POLE GRADE. **RE—USE EXISTING 1000 GAL. SEPTIC TANK FIRE HYDRANT LEACHING: NOTE: NOT ALL SYMBOLS MAY APPEARINoruwlNc SIDES: 2 (30 + 9.83) 2 (.74) = 118 GPD 62 BOTTOM 30 x 9.83 (.74) = 218 GPD BENCHMARK: CEMENT BOUND TOTAL: 454 S.F. 336 GPD TEST' HOLE LOGS 59.75' NAVD88 USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL ENGINEER: CRAIG J. FERRARI, SE #13871 WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5' DONALD DESMARAIS IRS VE LET t BETWEEN UNITS WITNESS: D E 21 ,434 S.F. DATE: 8/11/2017 PERC. RATE _ < 2 MIN/INCH DECK CLASS l SOILS p# 15446 APPROVED DATE BOARD OF HEALTH MA o SHED ELEV. ELEV. o p" 55' p" 55' ti 24, FI LL 24" FI LL a W W A A N TITLE 5 SITE PLAN /L S /LS EXISTING OF 1 OYR 3/2 1 OYR 3/2 6."�s;P 22. DWELLING 30" 30" ,� TOF = 64.5 #205 WINDING COVE ROAD B ' MARSTONS MILLS, MA �SL SL 5419 1OYR 6/8 4811 10YR 6/8 1 2, \ 6� s2' PREPARED FOR 50.5 51 _ - BORTOLOTTI CONSTRUCTION / o p S PROP. VENT WITH CHARCOAL FS L F LL p NEWTON FILTER AND BUGSCR'EEN s6 (FINAL PLACEMENT BY OF 102" 10YR 5/6 46.5' 78" 1 OYR 5/6 48 5' CONTRACTOR WITH o ���jN Mgss�Qy �P\�HoFP�q DATE: AUGUST 18, 2017 HOMEOWNER CON LTATION o�' DANIEL Gs �� q�y l� A DANI L A. off 508-362-4541 C C 5' RE I VAL OF U UITA LE OIL R QU ED 8o OJAL11 o OJALA SIEVE MS SIEVE MS AROUND P IMETER F L CHI FA ILI Y, No 40g80 CIVIL fax 508-362-9880 WN TO S BLE S ILL YER. E AC o P O No-46502 downca e.com WI LEAN ME . SA D, T MEE s � F �° �`�� • • 10YR 7/4 10YR 7/4 SPECIA TIONS 0 310 CMR 15.2 (3) !9'VpSU�N ��� ��F c, TE�G``a down cope engineering, //IC. TONAL 150 42.5 150 42.5 PROVIDE 30' F 40 MIL NER AT 5' \ `CA OFF engineers CA OFF SAS IN A EA SHOWN. AT l land surveyors NO GROUNDWATER ENCOUNTERED �57 ELEV. 53', B TOM AT EL. 49' Scale: 1"= 20' ` '--� '� rAUNSUITABLE SOIL 939 Main Street ( Rte 6A) LICE # , 7—�2� 0 10 20 30 40 5o FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 17—228 � I