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HomeMy WebLinkAbout0070 CINDERELLA TERRACE - Health 70 .CINDERELLA TERRACE Marstons Mills JA = 047 - 118 No.V'� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered;ncomputer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppYitation for Disposal *pstem Construction i3ermit Application for a Permit to Construct( ) Repair(�j upgrade(t4bandon( ) ❑Complete System 21ndividual Components Location Address or Lot No. Owner's Name,Address,and Tel.No.7 7-( Assessor's Map/Parcel O� < nstaller's Name,Address,and Tel.No. 6cDG75' Designer's Name,Address,and Tel.No. -3 3 �O ecS� ww,O.r.) h ' �,e Ci Type of Building: Dwelling No.of Bedrooms _-�( Lot Size 6�1<6 \�\-4a.t-5 st-ft'. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures C' Design Flow(min.required) �y ceO gpd Design flow provided 7. gpd Plan Date V caw e. �S�) Number of sheets_ Revision Date Title Size of Septic Tank `Q0C_'*) QX`s Type of S.A.S. Ce3Inc,y,� w SiQ,ea Description of Soil Nature of Repairs or Alterations(Answer when applicable) L( Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date ��- Application Disapproved by Date for the following reasons Permit No. Xj 1 a Date Issued No. Iq Fee Y THOCOMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVJ:S ON -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for isposal 6pstrm Construction Permit Application for a Permit to Construct( ) Repair_( pgride Abandon( ) ❑Complete System Individual Components Location Address or Lot No. O G. 75'S`c\" Vc Owner's Name,Address,and Tel.No.-7 7'-(-3©Q-6C_)Ce" Assessor's Map/Parcel ®�( O C; r \ Installer's Name,Address,and Tel.No. 3 ,59'Z7- 60 Designer's Name,Address,and Tel.No. 3 3 Type of Building: / Dwelling No.of Bedrooms -y Lot Size 5 seprff Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures -r? Design Flow(min.required) Y YO gpd Design flow provided t gpd Plan Date 7:�_�w�. \S�� `a��� Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Gc� ^c 1• _ Clg,n i�y»,i-3 cu� SYQ,�� Description of Soil 'AA, i Nature of Repairs or Alterations(Answer when applicable) 3 �{ ct vim. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date G / Application Approved by Date 6— Application Disapproved by Date for the following reasons Permit No. �� Date Issued G -------------------------------------------------------------------------------------- ------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(V< Abandoned( )by at --I O C �.oS2�2 `\sp 1 C J•it .pc -P_, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Ncr,�-/7 _ -/ dated tp d tW i Installer=.o��✓��cx�� 1� �t�� y� Designer CSn #bedrooms ( Approved design flow gpd The issuance of this permit shall n^o�t:/,construed as a guarantee that the system wi,7 tunction` designed. Date (! /a / / Inspector �.. �— 7 -----No.-------------------------------------------- ------------------------------------------------ ----Fee------------------- 7 - Lqq THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction 3permit Permission is hereby granted to Construct( ) Repair( ) Upgrade Abandon( ) System located at © G t\ �s� `�+d ��.r �n 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 e c mpleted wit in three years of the date of this permit. Date yh 1 Approved by �� f Town of Barnstable Regulatory Services Richard V. Scati,Interim Director BARNWABM Public Health Division a6g¢ A� c r� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 A Fax: 508-790-6304 Installer&Designer Certification Form Date: Sewage Permit#`? ��� Assessor's Map\Parcel Q+7P/1 Designer: MC�J& 6-0 S I Vl-r!i Installer: Address: pd -1 I Address: � t l Ong issued a permit to install a (datd) N (instal ) ' YY septic system at �b Cl 4 6�? I I a , NI M115based on a design drawn by (address) mC 4-�'� date (designer) ( 61 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. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was construct f e with the terms of the IAA approval letters(if applicable) (Ins ,ller s Signature) 4948 '-(Designer's Signature) (Affix Designer�mp Here) PLEASE RETURN TO BARN ABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc r Fk ND_ N #11 n131 Building Sketch Borrower. NdtmA Darrel Pri. AWress 70Cirde la Ter Muslomwis Gu Batr>sWe SW MA hpCWq OM Lender/Cl(nt Cagie.Cod CwmafideB& r I f t i 1 i 1 S i 3 {' t i Deck 34 34' Bath Dining.;kitchen Bath Bedroom E zo. Bedroom Bedroom co i � N N 'p. i Livin Bedroom 9 1 I i i 34' i i 1 � 1 I r i {4 F i {£1 TON-SaPtr.br ais rcod tWr .Aree'Calculntions Summary- 'Cal..... .m..a . � _First Flow 816 Sq ft 24 x 34 Bi6 k f Second.Fiba '612.soft 18.x34= 612 �Total.Living Area(Rounded): 1428 Sq R J.. forin SKLBL➢SM--'TOTAL'amnSa]sdtwm by a la rrl k Irr:-1-800-ALAMODE Jack A Daniel 70 Cinderella Terrace Marstons Mills, MA 02648 (508)826-1599 To whom it may concern My late wife and I purchased the house at 70 Cinderella Terrace, Marstons Mills,as a two-bedroom house with an incomplete upstairs.The upstairs was framed for two bedrooms and a bathroom when we purchased it.We completed the upstairs in 1984 in anticipation of the birth of our second child in the sprin 1985.The house has had four bedrooms and two bathrooms since November of 1984. Jack A Daniel �[ TOWN OF BARNSTABLE LOCATION �� �`�sc�l,�,f"G``d`c S�SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL® ' INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) k 3 K NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility , ' Feet Private Water Supply Well and Leaching Facility(If any wells exist bn site or within 200 feet of leaching facility) L Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ti Feet FURNISHED BY'1�14c'QYt �C�r°o�•U'wa�� 1 { 1 s ,V N r /Q�G 1 `G a, f Town of Barnstable Barnstable . �° Regulatory Services Department 1 e,eac j BARNSrABU- ;�: ,m� Public Health Division �fDA"A�a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 6124 May 22, 2017 DANIEL, JACK A & RAMONA A 70 CINDERELLA TERRACE MARSTONS MILLS, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 70 Cinderella Terrace, Marstons Mills, MA was inspected on 05/12/2017 by Patrick T. Sullivan, 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: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE 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\70 Cinderella Terrace Marstons Mills.doc Town of Barnstable s�xtryz",mow : . XAS& Regulatory Services Department 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. 5111116 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 Y ❑Pumping more than 4 times during the last year not due to clogged or obstructed Pipe ❑Backup of s , uagginto the house due to an overloaded or clogged SAS or cesspool O 1 YEAR DZADLINE CRITERIA evel 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). TWO (2)YEAR DEADLINE CRITERIA q Single Cesspool - ❑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 §360-9.1) ❑Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER El Repair deadline: WSEPTIMDEADUNES TO REPAIR FAILED SYSTEMS.doc - Commonwealth of Massachusetts ��F i ial Inspection Form � . _ Title 5 Official p �.: Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70_Cinderella Terra_ce___ - Property Address _ t� Jack Daniel --_ _—.__----------- " �-- — Owner Owner's Name X. information is Marstons Mills I/ MA 02 1tj 2017 required for every ___—_ — ___ —___ — -648 Malt� ------ State Zip Code Date of�;tspection page. City/Town Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When /A. General Information filling out forms Stet / on the computer, use only the tab 1. Inspector. key to move your cursor-do not Patrick T. Sullivanuse the return Name of Inspector key. Ready Rooter_Excavating Company Name _P.O. Box 89 __--- ------------- Company Address — ---------- —_ _—. ---------- re Forestdale MA _ 02644 City/Town -- - ----- -------- -- State Zip Code 508-888-6055 ___ _--_ _-- S112843 ___-.----- _--.—.------__------- 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 _ May 15, 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 is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Official Inspection Fonn:Subsurface Sewage Disposal System-Page 1 of 17 15ins•3/13 — l D� V Commonwealth of Massachusetts Title 5 Official Inspection Fora } Subsurface Sewage Disposal System Form - Not for Voluntary Assessments /4. ^�4 70 Cinderella Terrace Property Address --- _—.— Jack Daniel _ Owner Owner's Name -- - — ---- information is required for every Marstons Mills _ MA 02648 May 12, 2017 _ page. City/Town 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 indicate/that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated.are indicated below. Comments: ------------------------ B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired,. The system, upon comple ion of the replacement or repair, as approved by the Board of Health,lwill 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/�it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is lass than 20 years old is available. ❑ Y ❑ N ❑ 7xplain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 ` . Commonwealth 0fMassachusetts Title=�°��N�� �� ��������~��0 N��������^��~���� ����N°��� �� �~�� � @�~���� �mm���������N��mm N—�pwmmm Subsurface Sewage Disposal System Form ' Not for Voluntary Assessments 7O Cinderella Terrace ------- Property Address Jack Daniel 0 --- �no, Owner's Name information i» K8arshonsK8i||s ouvnown --8A—--- -0-26—'4-8—---- Wa 12 20_17 r*qui,oum,o*e� State Zip Code �m�uf|nopomi Inspection P000 B. Certification (cont.) Fl Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cnnL): Ob��ma�oncKsewagabaokuporbreahuutorhighatadcwator �ve| inMhedisthbudonboxdua to broken or obstructed pipe(s) or due to a bryken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health)i Ej broken pipe(s) are replaced [] Y Ej N E] ND (Explain below)� obstruction is removed E] Y 0 N E] ND (Explain below): Place E' ,/ed El distribution box is leveled replaced E] Y F1 N El ND (Explain below): �l 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 ofHeo|th): El broken pipe(s) are replaced El Y E] N Fl ND (Explain be|mw): �l obstruction isremoved Y Fl N [—] ND (Explain be|ow): � C\ Further Evaluation s Required oythe Bw 7r�d of Health: Fl nby the Board of Health in order tndeterrnineif the system is failing to protect public- fetyortheenvironmont. 1' System will pass unless Em— � determines \n accordance with 31OCNR 1S.3O3<1Xb)that the system is ottctioningin a manner which will protect public health, safety and the environment: Cesspool or privy iswith 0 feet ofo surface water Cesspool or privy is with r in 50 feet of a bordering vegetated wetland or a salt marsh Title 5 Official inspection po,,".Subsurface Sewage Disposal System'Page 3"/^ | m.ns'3/1; � Commonwealth of Massachusetts W Title 5 official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments VA y< 70 Cinderella Terrace Property Address Jack Daniel — Owner Owner's Name information is MA 02648 Ma 12, 2017 required for every Marstons Mills__- _ _. __ --.--- Y— --- page. City/Town 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 system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributaj to a surface water supply. ❑ The system has a septic tank and SAnd the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and S S and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SA� and the SAS is less than 100 feet but 50 feet or more from a private water supply we] *. Method used to determine distance: —_ ** This system passes if the well wat analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent anA the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: l D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® El or 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 '/2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 4 of 17 Commonwealth of Massachusetts Titl e le 5 Official Inspection Form .. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Cinderella Terrace --- --- ` Property Address —_--_-------------- Jack Daniel ------- ---_---- --.— ------- Owner Owner's Name information is MA 02648 Ma 12, 2017 required for every Marstons Mills -- ---- --- — page. City/Town 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: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® 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 El criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 /tofsurface drinking water supply ❑ ❑ the system is within 200 eet of a tributary to a surface drinking water supply ❑ El Area system is located i a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a 7 apped Zone II of a public water supply well If you have answered "yes" to any quepfion in Section E the system is considered a significant threat, or answered "yes" in Section D abovE4e large system has failed. The owner or operator of any large . system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 15ins•3/13 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 70_Cinderella Terrace ______-.---_--_-_---------------- _ ---------------------- Property Address Jack Daniel --- Owner Owner's Name information is Marstons Mills MA 02648 May 12_, 2017 required for every page. Cltyrfown — 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? ® El available as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® El information 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. ® El approximation 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: 4 --- Number of bedrooms (design): -3 -- -- Number of bedrooms (actual): 678 GPD DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): - -- Title 5 Official Inspection Form.Subsurface Sewage Disposal Systern•Page 6 of 17 t5ins•3113 Commonwealth of Massachusetts -)- Title 5 Official Inspection Form P!� sl Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Cinderella Terrace_ Property Address Jack Daniel -- Owner Owner's Name information is y Marstons Mills MA 02648 Ma 12, 2017 required for every — — — - page. City/Town State Zip Code Date of Inspection D. System Information Description: 2 Number of current residents: 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 2015= 93 GPD Water meter readings, if available (last 2 years usage (gpd)): 2016= 140 GPD Detail: Sump pump? ---- ---------- ----- ❑ Yes ® No Current_ _ Last date of occupancy: Cate Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., tc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to t �e Title 5 system? ❑ Yes ❑ No Water meter readings, if availabl -- Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 7 of 17 t5ins•3/13 E Commonwealth of Massachusetts Title 5 Official Inspection Form 81 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 70 Cinderella Terrace Property Address Jack Daniel Owner Owner's Name information is Marstons Mills MA 02648 May 12, 2017 required for every __ __--- --- --_--- -- - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Not pumped in 12+ years Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? ----- — -----— -- Reason for pumping: — — — Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) 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): 15ins•3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 8 of 17 � , . Commonwealth of Massachusetts �N~~��N�� �� m�������~��N N��������°��~���� ����0°��� @N���~ �� �*�� � �����w� Inspection 0—��mmmm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7U Cinderella Terrace ________________ � Property Address � � Jack Daniel Owner Owner's Name mh`nnah»»i» MarstnnsK8iUn MA 02848 KAo 12 2017 equimdfo'eva�page. City/Town State Zip Code Date In spection D. System Information (cont.) Approximate age of all ozmponents, dobo installed (if known) and source cfinformation: Tank installed 1984 D'box and leach pit added UO/1U/1Sy1. Certificate of Compliance on file at H lth Qept. Yes Y �� No VVeresewage odors detected when arriving at the site? ^[�~ .~ Building Sewer (locate on site plan): 18" Depth below grade: fee � material ofconstruction: n cast iron Z 40 PVC El other(explain)-. Distance from private water supply well orsucb n�nn line: fee Comments (on condition of joints, venting, evidence of leakage, etcj. � Septic Tank (locate on site p|an): � 1 � Depth below grade: feet � Material ofconstruction: Z concrete metal n fiberglass Fl polyethylene U other(explain) |f tank ks metal, list agsc years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) El Yes [:] No 88' 5' 45' 100O aUnns Dimensions: -----��� 101, Sludge depth'. -------�� ! m'",-3/13 Title,Official inspection Form:Subsurface Sewage Disposal System'Page oof,r Commonwealth of Massachusetts �u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments v^ 70 Cinderella Terrace.--------- --------- --- ----- ----- - Property Address Jack Daniel --_-- - i Owner Owner's Name — ---- _- ----' ---—---- information is MA 02648 Ma 12, 2017 required for every Marstons Mills _ __ —_ -- - --- State Zip Code Date of Inspection page. City/Town D. System Information (cont.) Septic Tank (cont.) 21" Distance from top of sludge to bottom of outlet tee or baffle --- — 10+„ Scum thickness ---- Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle ---------- - Tape measure and dip tube. _ How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Concrete baffles in place. Liquid level at outlet invert. No sign of leackage into or out of septic tank. To be purred and cleaned at install of new SAS. 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 f outlet tee or baffle -- ---— —- -- Distance from bottom of scum'to bottom of outlet tee or baffle --- — -------- Date of last pumping: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 I f Commonwealth of Massachusetts a Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °r 70 Cinderella Terrace---- Property Address Jack Daniel Owner Owner's Name information is MA 02648 May_12, 2017 Marstons Mills -__ --_ -__ - --- -- required for every required CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 Alarm present: ❑ Yes ❑ No Alarm level: 4- 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 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 11 of 17 t5ins•3/13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments �a 70 Cinderella Terrace ---------------------- ------------------------ Property Address Jack Daniel Owner Owner's Name information is Marstons Mills MA 02648 May 12, 2017 required for every -.— - page. City/Town 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 - — 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.): One inlet, one outlet_Solids persant. Static level over outlet invert._T below grade. _ Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No` Alarms in working order: ❑ Yes ❑ No' Comments (note condition of pump cha er, 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: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage nisposal System•Page 12 of 17 Commonwealth of Massachusetts R= r� Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Cinderella Terrace _____—_—___—_—__—___—.--------------- — Property Address Jack Daniel — Owner Owner's Name information is MA 02648 May 12, 2017 required for every Marstons Mills __ — --- -- City/Town State Zip Code Date of Inspection page. D. System Information (cont.) Type: 1-6' x6' w/ 3' of ® leaching pits number: stone._—____. ❑ 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 level in leach pit over inlet invert. SAS is in hydraulic failure. _-- Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth -top of liquid to inlet invert j Depth of solids layer Depth of scum layer Dimensions of cesspool / Materials of construction / Indication of groundwater intiow ❑ Yes ❑ No Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 t51ns•3/13 Commonwealth of Massachusetts Title 5 Official Inspection Form 61 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 70 Cinderella Terrace Property Address Jack Daniel Owner Owner's Name information is required for every Marstons Mills MA 02648 May 12, 2017 page. City/Town 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 soil, sign of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official inspection Forms 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 70 Cinderella Terrace Property Address -------------- ----- _ Jack Daniel_ _ —_-- Owner Owner's Name information is MA 02648 Ma 12, 2017 required for every Marstons Mills v — page. City/Town _ State Zip Code Date of Inspection If 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 I � i 1 i I t 0 / 3t o�( Title 5 official Inspection Form:Subsurface.Sewage Disposal System-Page 15 of 17 t5ins•3/13 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Cinderella Terrace Property Address Jack Daniel Owner Owner's Name information is Marstons Mills MA 02648 Ma r�12, 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: >5feet 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: 1991_ Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) ® Accessed USGS database -explain: maps.masses.state.ma.us/oliver.ph p You must describe how you established the high ground water elevation: Slope to East of system drops well below base of SAS. No ground water encountored in 1991 install. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form +R' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 70 Cinderella Terrace _ _ — Property Address Jack Daniel Owner Owner's Name information is MA 02648 May 12, 2017 required for every Marstons Mills __ —._. �`_ 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 ' TOWN OF BARNSTABLE LOC'GATION 7D Clti,04&Ze�4 T/Z� SEWAGE # �� VILLAGE A", ✓W/-1S ASSESSOR'S MAP & LOTDy7/1,y- INSTALLER'S NAME & PHONE NO.�z GfO 77 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) size) <;lo . 62 r NO. OF BEDROOMS v� P//R��IVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: Ap DATE COMPLIANCE ISSUED: #z I VARIANCE GRANTED: Yes No v �a 1" O N �Q 6V/7 n A, o P IT (, r� .y LOCATION SEWAGE PERMIT NO. VILLAGE INSTALLER'S NAME i ADDRESS N UILDE R OR OWNER DATE PERMIT ISSUED ��,7 `��_..�� DATE COMPLIANCE ISSUED Z E 4- 4-L. ry Town of Barnstable P# i /. S 3&�J Departinent of Regulatory Services 5 • I umirrAziA t Public Health Division Hate � sm3v 200 Main Street,Hyannis MA 02601 Ell ND " Date Scheduled C. 1y. e L Tltne i`ee P L -- -ri ftll Suitability Assessment for S e zs osal � Performed By: Nblu Witnessed B `'�✓� ,: y LOCATION&.GENERAL INFORMATION .--Location Address ��• o*n es Name , Addross 7G G;" i Ala 9rJ is Assessor's Map/Parcel: • Engineer's Name yyrLe l -6SAnf �G NBW CONSTRUCTION �^REPAM _l/ Tele hone# 5-G'$ tend Use i, jV 1 Slopes(96) l ®O Surface Stones r Distances fbm: Open Water Body }1 ft Possible Wet Ara � ft Drinking Water Nell�l ft Drainage Way. f� _ft Property Line ft Other ft SIM'TCHt(Street name,dimensions of lot,exact locations of test holes&pare tosts,locate wetlands In proximity to holes) 9-Y S A 4--d . i Paront material(geologic) Depth to Bedrock r Depth to Oroundwater. StUdIng Water In Halo: Weeping 1Yotn Pit Fnoa Hedmated Seasonal High Oroundwater DE ATION FOR SEASONAL'HIGH WATER TA LE Method Used: Do th Obsery standing In obs.hole: In. Depth to loll mottlem! Dzth to weeping front side of obs.hole: in. Groundwater Adjusttttent' Ifr. lndox Walla Roading Dato: Index Well ieval Adl,•fhotbr. ,,_ Ate.Orlundwatar•Levrl PERCOLATION TEST Buie Time Observation I Hole# Tlmo at 9" Depth of Pom )� 'Pima at 6" Start Pro-soak Time @ Time(9"4") End Pro-scak ` Rate Mle./lneh j f Sho Sultabllity Assessment: Slte Passed Addldonal Testing Noe ed(YM) Original: Public Health Division Observation Hole Data To Be Completed on tick ' ***If percolation test is to be conducted within 1001 of vvetland,you must first notify the, Barnstable Conservation Division at least one(i)week prior to beginning. • i Q:SBPTIMERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Sol Horizon Soil Texture Sdil Color Soil• Other Surfaca(in.) (USDA) (Munsell) Mottling (Structure,Stonat;Boulders, Tssi tency.%'t3ravoll 011-99 - ? Q bwy 9 D DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Hdrizon Soil Texture Soil Color Soil Other Surface(in.) I (USDA) (Munsoll) Mottling (Structure,Stones,Boulders. 9 3 : /✓� is I. t.- 2. 7 . DEEP OBSERVATION HOLE LOG Hole# Depth f1orti Soil Horizon Soil Texture Soil Color Soil Othe r Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color moll #th,r Surface(in.) (U$DA) (Munsell) Mottling (Structure,SRopes;Boulders, consistency. QMypll Flood Insurance Rate Mal~: Above 500 year f lood boundary No Yes _ , Within 500 yertr boundary No X Yes Within 100 year flood boundary No-_X Yes : Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring p vies titorial oxist in all areas observed thrpughout the area proposed for the soil absorption system? If not,what Is the depth of naturally occurring p rvious material? .._.._. ertificatio I certify that on (data)I havepassed the soil evaluator examination.approved by the Departmen viro ental Protection and that the a vo analysis was performed by me consistent with the requir train , x ortis d exper nco descria d In�lQ CYCR 15.01 . Signature Datb � l ' Q;1RgFrrl 1PBRCPORM.DOC No....8.2.'3. . Fes$..... 4Cr............ . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .............OF..............a.C.n.-::.�.- ........................ ApplirFatiun for Biopuual Works Towitrnrtiun ranfit Application is hereby made for a Permit to Construct (vj or Repair ( ) an Individual Sewage Disposal System at: .. — •� s — : ................ .............�...--- L...........------............--------•--.....---- L ca ion-Address or t N - � .......... fir...... .n�:L �l Cn S O -- ....................... Owne Add es ........... .�.�s.......................... A� + •- Installer Address Type of Building Size .......Sq. feet Dwelling—No. of Bedrooms.............-3..........................Expansion Attic ( ) Garbage Grinder (00) pa, Other—Type of Building ............................ No. of persons..-----..............--...-- Showers ( ) — Cafeteria ( ) a' Other fixtures .................................. w Design Flow..............NA 0......................gallons per person per day. Total daily flow.-.._..._.__......��.......----.......gallons. WSeptic Tank—Liquid capacity M .gallons Length................ Width................ Diameter--.--.-.-------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing nk ( ) Percolation Test Results Performed by....... . ....... '-. Jv................. ............ Test Pit No. 1................minutes per inch Depth of Test Pit.--.--.....--....... Depth to ground water..-.-.-------.---------. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..--.................... 9 .........--- ------------------------------------------- ----------------------- ----------------- -------------- -............... ----------------------.... Description of Soil------.. a.... !-=..................' cx nm------- ---------- �h s ----- 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 iIli LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed �• ��` s Dat Application Approved BY r --• ------------•---•-------•-----..... ----- -t...------ Date Application Disapproved for the following reasons:....................................................................................................................•----•----------------------------------------------•-...------------.........-----------..•..---- ------------------ Date PermitNo......................................................... Issued....................................................... Date No.... .�{ y FE$........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH h..............OF............ U.(..n..s : .-U ........................ APPI atiun for Ui ipos al Works Tomitrur#iun ramit Application is hereby made for a Permit to Construct (vj or Repair ( ) an Individual Sewage Disposal System at: 71 r� Location-Address I .....---..... --•---�. 1.� .................. ...................U Ca ......IUIJN ........_.. -... •--- Owne,i ddr`ess Installer Address Type of Building Size .......Sq. feet Dwelling—No. of Bedrooms_____________ __________________________Expansion Attic ( ) Garbage Grinder (00) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures .........................--•--- W Design Flow..............\_\______________________.gallons per person per day. Total daily flow................ `..................gallons. WSeptic Tank—Liquid capacity N. _gallons Length................ Width................ Diameter.........:...... Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area......_...........sq. ft. Z Other Distribution box ( ) IDosing-tank ( ) _ '-' Percolation Test Results Performed by------- %_ v a k-•�-'______________ _`�! ._.____.______. Date._. _............................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ................................}------•----•-•---•-•-•-----------•------••--••-•----••••-•--_---•-•......................................................... Description of Soil = - --------------- .......--------------- •------- -------------------- -._--------- --•---------------------------------------- -•-----_----- V ....••--•------•--•......................::_._._.........•••-_-•--• •-•-•._..._•--••---=J• - - _.._. .. - _ . }__ 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed_--(j�S ='1n-----------------------•--•-- ............•-----•,............ Date Application Approved By---••--•- � `____•--------------•••--•- fD - •- - ate Application Disapproved for the following reasons:.............................................................................................................. .....................•-------•-----•------------------------------------------------------...-•--•---------------------••-------....-------------------------------------•------•--------------._._...__ Date PermitNo......................................................... Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................................O F..............:...................................................................... Trrtifiratr of TumpfiFaurr THIS IS TO CERTIFY,.-That the Individual Sewage Disposal System constructed ( or Repaired ( ) b ........... _n_ ..............� - -----•-----------•-•----•-- -- -- Instalr&, -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..... _-3-_7_7_._._______. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR A GUARANTEE THAT THE SYSTEM WILL U TION SATISFACTORY. DATE.... .lQ..,.7_...-•-••-•-•••--•-•-•---••••---•--•----•--__---• Inspector... ..... ...................................................................... THE COMMONWEALTH OF MAS ACHUSETTS BOARD OF HEALTH OF...... ='•..................... ._..._..._.....__._._.......... FEE...3 f............ i u 1 arks Tuntrudivaa rani# Permission is hereby granted............. .----...-•-- ' ---------•--•---••-----------------•-._..........•--•--•-••-................. to Constr ct (✓) or Repair ( ) aA. .Individual Se ra .e Disposal Est n gm at No ee %�-- - �-- , Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... Z.Z/O fi Board of Health �Z DATE............................................ --•-----•-- ---•--•--.. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS T�t►.�! 1=Low z Ilb +c 3 • 33o G,.Pv � � , ���t-Ic -rAul� _ �30� iSc `.:. • �g F.P.D. ' . . . . usf-- POS"DL PIT u..E. to«� Gn,_. ° �?V'4-1 41 . Icy SF ,c 2.� • � y lS �.P.L7. .. _ .: .:; I . . . : . ... � . . . . • . : . . TOTAL -0E:616W 4 S NO • .'TvTA� D/ilt_�f Fc.ow • 3306�P.A• • � : � . : . • . j 04 lQ 2htlu' olz l Y, i QZ�� G{rf1GDl.dTIOL.I �2laTE i ��� � . � : �� Q�P� jCUD �itJ�� :�5v�•TP�t�S 5'tM'19 ( . . . : ; , . � VJ'tT1.1�',S.r�_._�`�.:..f'Qul...�_�!��12'I�.A`�.�.:��._o;.i�.�.:i.�. _ . .•:_; __ _ '_: _ -__. _�. , t�{ Cr.� s�, ,• jr:,�y dM: .. . 11D. 1A�lK /O ,��'` Fi;Cf1A.�i,.+. �• ,. 7;.��Y ._'•- + ,Vie �.-.._-.. .-- --- - -- /� �_ T��_..... . . �,�,.,,..,-rr PZ`�� "?rives-:-s e. � •1 Tor F°+o atoo.o �Q �Pp ORR- .___ __._ _._.._- . - , _•.._. __. 4 pva � . _. ._.I:N• .Gay• - . _ _ • ..; is Wv- T"A 01 K 1000 �A' INVi tIN. t. i _:. . _ .... - GAL. Wig' '�'Q.' ' '•. I : • PIT Pcz01='1 LEa l b GA T i /VI 1117�iTi7t�K. ��1 C.C.S w. M-4-� GGRTI�`l 7$4AT TOG- .40v4 t•ll:�t_a1J G�PL�lS W ITt•-� Tt�� St�E.�.1►-1� ; .' I ,.� 2� AIJr> �iCTC�ACIC 1+;Cy�tJlEMcuTS 0� TNT i L,d1.1� Cov12tT�pc.QtJ ' �Co` -Tow w o;= At4t) Is LOGATEb• WtTNtl.l T�-•l�l= �'LOv� PL-A141. • •�-,�L•� 1.��`�o� �-j��� •12-4-'1Z ba.T� 1-1-4- 81E3ayCTGt� I acc.(,; Rl`o t�s.uG 5u2v�Y� OW A.�J osTECv%LL.G a MASS. ItJSreuMcwT I,uc:�icY -"(t1C:. 01=G,1'=•t". 51.1cwt.n ANPLt GA.N-T JAMG(� �� �MITIA--t-1 Wa �V Log Number: Date:,--' 7/8/82 OF B4.9 s� BARNSTABLE COUNTY HEALTH DEPARTMENT �� SUPERIOR COURT HOUSE V 5 _s�" BARNSTABLE, MASSACHUSETTS 02630 o • Asa DRINKING WATER LABORATORY ANALYSIS PHONE: 982. 3 1 EXT. 391 Client: James K. Smith Collector: Frederick Clifford Mailing Address: F. 0. X 124 Affiliation: Clifford Well Barnstable$ MA 02630 Time & Date of Collection: 7/6/82, 4:00 p.m. Telephone: Type of Supply: well water Sample Location: Lot #26 Cinderella Terr. Date of Analysis: 7 7 2 Marstons Mills Parameter Sample Result Recommended Limits Coliform bacteria (organisms/100 ml) 0 0 pH 5.7 Conductivity 82. 500.0 Iron (ppm) .06 0.3 Nitrate-Nitrogen (ppm) -58 10.0 Water sample meets the recommended limits of all above tested parameters. Water sample is drinkable but has higher than average levels of This does not represent a health hazard but future monitoring is recommended (2-3 times per year). We will test for Sodium. Water sample is drinkable but may present aesthetic problems to users (staining, odor or taste). Water sample is of poor quality and is not recommended for human consumption. Resampling and.retesting is suggested. Results only. REMARKS: cc: Barnstable Board of Health cc: Clifford Well Drilling Analyst: 11/18/81 VU Explanation of Test Results Total Coliform Bacteria Coliform bacteria are an indicator of the sanitary quality of a water supply. Water supplies may become contaminated-frorn malfunctioning septic systems, cesspools and surface runoff. A tofal'coliform count of zero indicates that your water supply is safe and approved for human consumption.A total coliform count of greater than zero is most often the result of accidental contamination of the sample bottle through improper sampling methods. foT'this reason, it would be advisable to retest any well water that is not approved. pH pH is the measure of acidity or alkalinity of the water. On the pH scale, the number 7 is neutral, less than 7 is acidic and more than 7 is alkaline. The pH of water on Cape Cod tends to be acidic in the range of 5.O to 6.5 Conductivity. Conductivity is a measure of the dissolved salts.in solution. Amounts in excess of.500 micromhos/cm are generally considered unacceptable and may have a laxative effect upon users. Iron The presence of iron in water in concentration of .3 ppm or greater may: give the water a bittersweet astringent taste, cause an unpleasant odor, often gives the water a brownish color and cause staining of laundry and porcelain. The average concentration of iron in Cape Cod's water is .2 - .6 ppm. Although the presence of iron in water may cause the problems listed above, it is not considered deleterious to health. Iron may be removed by use of an iron removal system. Nitrate-nitrogen The Massachusetts Drinking Water Regulations have set a maximum contaminant level for nitrates at 10 ppm. Excessive concentrations may cause methemoglobinemia (an infant disease)and have been suggested to form potentially carcinogenic nitrosarnines. Contamination sources include fertilizers, cesspools and industrial wastes. Copper Due to the acidic nature of the water on Cape Cod, copper tends.to leach from pipes. This normally does not present a health hazard; however, concentrations in excess of 1.0 ppm may cause a metallic taste and/or a bluish green stain on porcelain fixtures. Sodium A concentration of sodium over 20 ppm is only of concern to people who are on a low sodium diet. If the water supply has more than 20 ppm sodium, it is up to the people who are on such a diet to find another source of drinking water or contact their doctor to determine if.consuming the water. is: advisable...Concentrations exceeding 50.ppm indicate that there may be ocean water or road salt runoff-wat:er_getting-into the well.,— r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ApplirFatiou for Dhipaii al Works Towitrurtiou ramit Application is hereby made for a Permit to Construct ( ) or Repair (DC) an Individual Sewage Disposal System at: ........:7d_................................� itJe .---• .�.��.`_-----/-i-'IGGS.......-----•---------------------------•-•--•---••---------ocation-Address or Lot No. _ 't4......... .. ...Jt.s;cl••----•-------..._7.. - %... �_.. �.._.. ..-----•--- Ow r Address aG:© .S 7�s �1/--•--C�. !U ......... . .....-W. ...e J1G�---------------- Installer Address Type of Building Size Lot �,/_o�.�._Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------------------------•---•-•-------••-•-----•---•-•••--••---•--•-•-.....-•-••--•-••-............••••.....•---•- W Design Flow....................��.........gallons per person per day. Total daily flow.-.-...-._ ...................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.............--..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date----- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water........................ x ----------------------------------------------------------------------------------------------------........................................................ 0 Description of Soil..................... - .......4_4...z'E...... �1 ......... -----�� UA-------------------------------------------------------------------•--------------------------------------------------•------- W x ........................................................•----•••--...-----•-------•---...--••••--•-----•------•---•-•--------------•--•---••-•-•---•-............ U Nature of Repairs or Alterations—Answer when applicable... ./ ly --------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliant has been iss d b he board of health. g i� Si ned ..-- - - -�-- -- -- v6;te— =/ ApplicationApproved By ..................CJ .. ---- - ----------------- --------------------------------------------------------- - ---- Date Application Disapproved for the following reasons: ....................... ................................................--------.................................... --------------------------------- -----------------...---..........--...---...---....-..................-------------------------....-.......------------------...... ---------------------------------------- �y ^� Date PermitNo. ..........7/ / ...................... Issued .................................................. to Dare No...,�..1.:.. FE$..... D...." THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tomitrnrtiun jhrmft Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: . -.-- ocation-Address or Lot No. 11. ... ..................... ...... .............................................. Owner Address � —OGO7/ O�UST ��S /� �YjZD �/IiLLS -•------------- ---------- -- ----- ---.....-------- Installer Address _ Type of Building Size Lot 2 _a =.Sq. feet t--I Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aP4 Other—T e of Building No. of persons............................ Showers YP g ---------------------------- P (---->--- .Cafeteria ( ) Otherfixtures ------------------------------------•------•----------.•--•--------------•••-••-•••------------------...---- ----------- W Design Flow.....................:'��__-_--_-•gallons per person per day. Total daily flow.......... ...................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area_...................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) ,Dosing tank ( ) ~' Percolation Test Results Performed by.......................................................................... Date---------------------------------------- MTest Pit No. 1...............minutes per inch Depth of Test Pit.................... Depth to ground water-------_................ G4 Test Pit No. 2............_...minutes per inch Depth of.Test Pit.................... Depth to ground water........................ a -•---••...-------•--••••-•-•---------------------------•--------••••--------...•-•••.....--------------------------------...._.....--•---..........-------- O Description of Soil..................... __ U W ---------------------------------------------------------------------------------------------------------------------------------j-----•-•-•---------••----•-• • - ------------- U Nature of Repairs or Alterations—Answer when applicable--------- -___-_-__e�Q4 -O .__ --...._t_S�4 ---------------------------------------•--•---------------------------------------------------------------------------•------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia�/_Cznl s been iss d by he board of health. Signed i�-_ z ..le t�� -------------- -------- �9/ Date ApplicationApproved By -- ---S�_ �t,,,. �•-_ ----------------------------------------------------------- --- Dare Application Disapproved for the following reasons- -------------------------------------------------------------------------------------------------------------------------------------- , ------ --------------------------- --------------------------------------------------------------------------------------------------=----------------------------------- --------------------------------- ---=--- Date PermitNo. -----------7/ -------------- ----- Issued --------..........................................---......te Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (gertifir le of wIImpliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by-------------------------- ---------......................... o� ................................................7T7 rJGTia1 ------------------------------------------------- Installer has been installed in accordance with the provisions of TITLE 5 o The State Environmental Code as described in the application for Disposal Works Construction Permit No. -------- 7-------- dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCT ON SATISFACTORY. DATE . ------------------------------------- Ins to�--' ---v---------------------------- r a---------- P� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Dispos l Works Tonstrnrtiun rrrutft Permission is hereby granted--------------------- -----C �/s i. C�G7�Jn/ ........................................................---- to Construct ( ) or Repair (K) an Individual Sewage Di s sal System at No------------------------------------;�- ----------C /�tJ� ��LG CE: _..._ street as shown on the application for Disposal Works Construction Permit No..___�_�_ — Dated.................................•........ C Board of Health ---- DATE =-- --_..... ----------------------------------- FORM 36508 HOBBS Q WARREN.INC_.PUBLISHERS - r - - LEGEND MARSTONS MILLS PROPOSED CONTOUR r ® PROPOSED SPOT GRADE Qw -- 98 -- EXISTING CONTOUR ► Ci 6� +: 9 6.5 2 EXISTING SPOT GRADE W— EXISTING WATER SERVICE i _ �4p vol _ RACE LANE TEST PIT Is, 27 N % LOCUS v SCALE: 1 =20' r Sst< 00 l 336 LOCUS MAP LOT 26 TITLE REF: CTF# 95305 �O CA I \.4 PLAN REF: 36301—C SH.1 ZONING:FLOOD ZONE: "X" ��` • \� �' \\ COMMUNITY PANEL: DATED:07/16/14 vi, _ SEPTIC SYSTEM _ `` REPAIR PLAN C r LOCATED AT: - tc 70 CINDERELLA TERRACE UTILS G = TOF EL=87.00 ,� M ARSTON S MILLS, MA. � — r , r ' UTILS g.M. TOP FND LIP PREPARED FOR AT THE CHIM. , 61 �� r JACK A. DANIEL - EL=87.00 — — r _ ! JUNE 15, 2017 GIST. 1,000G? A SEPTIC TAN \ \ `\ —�� 0� \�\� O �Q��� OF Mgss9� SS e 86 / TP- D R E ' oo C/ TP 0 'P£G/STENO b ' � h 7 �` `�6'= _� PARCEL ID: ` LOT 25 047/010/003 MEYER & SONS, P.O. BOX 981 GRAPHIC SCALE EAST SANDWICH, MA. 02537 20 0 10 20 40 80 PH: (508)360-3311 FAX: (774)413-9468 ( IN FEET ) f * meyerandsonsinc@gmail.com 1 inch = 20 ft. 1 ' SHEET 1 OF 2 J#1927 NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS NOTE: TO PREVENT BREAKOUT,- THE-PROPOSED FINISH GENERAL NOTES: TOF SEPTIC TANK GRADE SHALL NOT BE < EL'81.15 FOR A DISTANCE INSTALL RISERS & COVERS OVER INLET & 15' AROUND THE PERIMETER OF THE S.A.S. EL.=87.0t PROPOSED D-BOX 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL OUTLET AND SET TO 6" OF FINISH GRADE PROPOSED S.A.S. BOARD OF HEALTH AND THE DESIGN ENGINEER. INSTALL RISER & COVER INSTALL LOCKING COVERS IF AT FINISH GRADE INSTALL A .RISER' OVER ONE CHAMBER (MIIN) 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SET TO 6. OF GRADE AND SET`TO 3" OF•F.G. OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE F.G. EL.=85.0-81.Of - LOCAL RULES AND REGULATIONS. �. F.G. EL.=84.5t F.G. EL: 84.Ot 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFlLLED PRIOR F.G. .EL: 84.0 MAX. ( - ) TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. 9" MIN COVER/ 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 36" MAX COVER L = 20' L = 40'(MAX) FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ® S=1% (MIN.) EL.=84.08t ® S=1% (MIN.) ® S=1% (MIN.) ENGINEER BEFORE CONSTRUCTION CONTINUES. 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC 2" OF 3/8" DOUBLE WASHED STONE OR FILTER FABRIC 3/4" - 1-1/2" 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 10. B f DOUBLE WASHED STONE 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF INV.=83.0 14" HEALTH FO CTOR OR OWNER TO PRO ER INSPECTIONS DTURING CONSTRUCTION.IFY THE LOCAL OF aB" LlDuiv INV.=82.75 ®®®®• p ®®®EM LEVEL 7. DWELLING IS SERVICED BY MUNICIPAL WATER. PROPOSED ®®®®®®®®®®® GAS BAFFLE EM E3 E3®®E3®EM E3 E3 EM 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED INV.=81.0 E3 E3 E3 EM E3 EM E3®EM®® TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. INV.=81.20 - DB-5 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE r LOCATION,OF ALL UNDERGROUND UTILITIES, PRIOR TO STARTING WORK. EXISTING 1,000 GALLON SEPTIC TANK 3.2 3 X 8.5 3.25 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. FEXIST. SEWER OUTLET EFFECTIVE LENGTH = 32.0' 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY INV. ELEV.- SO.15 AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 13. NO KNOWN PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING BREAKOUT 14. ALL PIPING TO BE 4" SCH 40 ® 1/8-/FT (UNLESS SPEC. ) NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING EL. 81.15 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW TOP CONC. ELEV.= 81.15 FOR THE USE OF A GARBAGE GRINDER. PIPE INVERTS PRIOR TO CONSTRUCTION INV. ELEV.= 80.15 ®® 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING 2) D-BOX SHALL BE SET LEVEL AND TRUE TO ®®® . GRADE ON A MECHANICALLY COMPACTED SIX I®08®®® } INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM EL.= 78.15 ®®®®®® 310 CMR 15.221(2) 4' 5 FT. 4' 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK WITH 1500 GALLON SEPTIC TANK IF FAILED, SEPARATION 5.01 FT. EFFECTIVE WIDTH = 13' DAMAGED, NOT H2O LOADING, OR UNDERSIZED. I SOIL ABSORPTION SYSTEM (SECTION) 4) INSTALL INLET & OUTLET TEES W/ SEPTIC SYSTEM PROFILE BOTTOM OF TESTHOLE EL: 73.14 (500 GALLON (H20) LEACH CHAMBER) GAS BAFFLE AS REQUIRED N.T.S. r 4 DESIGN CRITERIA SOIL LOGS P#:15365 NUMBER OF BEDROOMS: EXISTING 4 SEDROOOM SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) DATE: MAY 26, 2017 SOIL EVALUATOR: :DARREN M. MEYER, IRS, CSE DESIGN. PERCOLATION RATE: <2.. MIN/IN WITNESS: DON DESMARAIS, BARNSTABLE HEALTH �10 OF M9ss DAILY FLOW: 110 G.P.D. X 4 BR DESIGN FLOW: 440 G.P.D. GARBAGE GRINDER: NO (not designed for garbage grinder) Elev. TP- 1 Depth TP-2 E1e,, DA REN s oepcn I _ 11 SEPTIC TANK: 440 gpd x 200% = 880 gpd USE EXIST. 1,000G SEPTIC TANK 84.40 A LOAMY SAND O" 84.30 A LOAMY SAND O 1 40 10YR 3/2 3/2 1 LEACHING AREA REQUIRED: (440)/0.74 • 10YR 594.59 `S.F. 83.73 B 8" 83.63 8" 'PfG/SfE L USE THREE (3) 500 GALLON PRECAST LEACH CHAMBERS 8224 LOAMY 5/ B LOAMY SAND 8 261 10YR 5/8 �NITAR�� 1 W/ 3.25' STONE ON ENDS AND 4' ON SIDES: 32' L. x 13' W .x 2' D C 82'14 C1 2s" b 1 MEDIUM PERC TESTSAND MSAND. " .. BOTTOM AREA: 32 x 13 416 SF ® 79.07 2s7/4 2sr 7/4 ` SIDE AREA: (32 + 13) X 2, X 2 = 180 SF TOTAL SQUARE FEET PROVIDED = 596 .vs. 594.59 REQ'D PROPOSED SEPTIC SYSTEM UPGRADE PLAN DESIGN FLOW PROVIDED: 0.74(596 S.F.) = 441 G.P.D. .vs. 440 G.P.D. req'd 73.24 134" 73.14 134" 70 CINDERELLA TERRACE, MARSTONS MILLS, MA PERC RATE 52 MIN/IN: ("Cl" HORIZON) NO GROUNDWATER OBSERVED, Prepared for: Daniel/Re d Rooter Exc. System Design and Topography Plan by: SCALE DRAWN DATE MEYER&SONS,INC. N.T.S. DMM 06/15/17 I, Daman M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 PO BOX 981 to conduct soil evaluations and that the above analysis has been performed_ by me consistent with the EASTSANDWICH,MA02537 REV DATE CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam in October, 1999. 508362--2922 DMM 2 Of 2