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0016 CLAUS WAY - Health
t r 16 Claus 1IVay Marstons Mills P -- -- - - - - - - 043 062002 - -- - -- - i I i r I. 4 44 Vt I' rI i4 AsBuilt Page 1 of 1 T0�1NOFANSTMLE t pp LOCAl1OI U SEA'RGE# I� V111,�OE� ASSESSDR'S bUP&L Ca i lS$TaI,LF,R'SNASIE&PflGVEha. ���.. SlEmc TANK CAPAMti LEACING FAC)LIT}: t 0;OF BEDROOMS B DHR�OROW R �1� }I J { PRRPOI DATE: - )•.b. CO1"PM. CE DATE; J Sip�iauon Dis'.a ice Delwa k, Maxi��mAEjcs(cdGio�dalc TaS!aic(heBa umaf LachaagFaciGly Jed . Psi(Wale;Supple Well andW6,io F9 ir!(ll aq wells east Quilt orµiN.P Nfetlofleachingfciliq) Fe( rdgeaf Welland�d Ltach��g Facie any w:ilands tusi wiJun?(gfse. f. Fupiishcd'oy ' � � �� Y q�ppJ i V y i t j http://issgl2/intranet/propdata/prebuilt.aspx?mappar=043062002&seq=3 10/9/2018 ' TOWN OF BARNSTABLE j p LOCATION C, 4e!S � _.,/ SEWAGE # .2o l�- o O VILLAGE ASSESSOR'S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 100, d SEPTIC TANK CAPACITY LEACHING FACILITY: (type) =-V (size) NO. OF BEDROOMS_5 BUILDER OR OWNER J N `1 (-"4Q&64 I PERMIT DATE: 1—a 5--f,I9 COMP 1ANCE DATE: 3 / 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 o'leaching facility) Feet Edge of Wetland and Leaching Facili any wetlands exist within 300 V a biff faanV Feet Furnished by 4 e A- igel-- --� i t IIII, No. 10 s Fee G THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Vsposaf *pstem Construction Permit Application for a Permit to Construct( ) Repair grade( ) Abandon( ) ❑Complete System ndii idual Components Location Addregss or Lot No.1,/6 C440 J U),Pijo Owner's Name,Address,and Tel. Asse��QaplPa2cel ll/S _ — 0 2 Installer's Name,Address,and Tel.No. GUI//iP. l Designer's Name,Ad s,and Tel. o. ZAA6n_*401 ysr s G � Type of Building: V Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building �� S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) D�_2 gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title 7 Size of Septic Tank-y �/Oc)d Type of S.A.S. �ZL 4 Description of Soil �} Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt Sign Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. �d �1& Date Issued T No. lJ h U A Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:x✓ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 21pplication for Disposal �&pstem Construction 3permit Application for a Permit to*construct(. ) Repair(f,Upgrade( ) Abandon( ) ❑Complete System ndividual Components ' Location Address or Lot No. S (,l j4� Owner's Name,Address,and Tel.No. Ass �Map/Pa oel ll�S 6 _ ( )_ _ 002 Installer's Name,Address and Tel.No. /11j / Designer's Name,Addre s,and Tel. t �� Type of Building: Dwelling No.of Bedrooms Lot Size —7 sq.ft. Garbage Grinder( ) f Other Type of Building S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) � (/ gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank �� 1900 L Type of S.A.S. j C, Description of Soil r}} Nature of Repairs or Alterations(Answer when applicable) L✓ 12 .;;>/r. ,- A S Date 1 t.inspected0 , +� , Ag e'ment: 'I l Phe 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 Healt . t Sign d- Date , '/� Application Approved by a \n t Date Application Disapproved by Date for the following reasons Permit No. 0 ll Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(/-I Upgraded( ) Abandoned b / t at �� �J�, (�,GS/ f f�i�f has been constructed in accordance with the provisions of Title 5 andAhe fo Disposal`System Construction Permit No —� dated I — 2 /mob � �� Installer „��,;,r-���;. Designer #bedrooms Approved design'flow n o gpd -The issuance of th Jpe it shall not be construed as a guarantee that the system wil�f function fas designed Date Inspector C I' No. 2 o /.b — , �j/r� Fee - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstent ConstrUrtion permit Permission is hereby granted to Construct( ) Repair(li)' Upgrade ) Abandon( ) System located at tp -2 ! Wx -, , ky 6� 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. t« Provided:Construction must be completed within three years of the date of this permit. n� Date / 2 V I' Approved by ✓ K f t� Town of Barnstable Barnstable oF � . Regulatory Services DepartmentAl* � + ft BARNSrABW. ' y q , 0 Public Health Division . 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 1520 0000 1971 7002 November 9, 2015 David Holt Today Real Estate 1533 Falmouth Road/Rte 28 Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 16 Claus Way,Marstons Mills, MA was last inspected on October 23,2015,by Shawn Mcelroy, a certified septic inspector for.the State of Massachusetts. The inspection of the septic system showed that the system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code q 360-9.1) You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ER OF THE BOARD OF HEALTH as McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\16 Claus Way MM Nov 2015.doc Parcel Detail Page 1 of 3 el/A Logged In As: Parcel Detail Monday, November 9 2015 Parcel Lookuo Parcel Info Parcel ID£043-062-002 ,..... . ,_ Developer LOT31 BLo Location 156 CLAUS WAY I Pri Frontage 20 w Sec Road Sec Frontage .° u Village WAR STONS MILLS Fire District TC-0 � Town sewer exists at this address INO l Road Index 0415 � � Asbuilt Septic Scan: Interactive 043062002 1 Map ,I a Owner Info owner FEDERAL NATIONAL MORTGAGE AS Co-OwnerF-- . �-", Streetl aP0 BOX 650043 Street2 City';DALLAS ( State TX zip75265-004 Country Land Info -- Acres!1.01 � � use tr Ingle Fam MDL 01 -I_ Zoning RF ) Nghbd 0105 I Topography Below Street , I Road Unpaved Utilities{Public Water,Gas,Septic I Locations Construction Info Building 1 of 1 year11982 -""� ' Roof Gable/Hi W 11 Built sRoof I p wall Wood Shingle Living . .- _ . . -v. Roof . AC Area'1952 Cover rAsph/F GIs/Cmp ( Type Nonet Style Raised Ranch �I Int'Drywall I Bed 14"ged—room s I 4 wall Rooms BAS A _ BA& Model Residential Int CP"arpet" -" I Bath 4 FUII-0 Half Floor` Rooms Heat Total' st1.b Grade,.Average Type iElec Baseboard Rooms s5 ROOMS stories Story YaI Fuel YElectric I RK Heat Foation Poured Concmm�....,,I Gross 14432 Area Permit History http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=2920 11/9/2015 I Town of Barnstable anRrrsr�sLF, MA 9 �,�� Regulatory Services Department fD MA 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. 7/6/15 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the o is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑Any.portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components, etc) XLeaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc TOWN 0E BARNSTABLE .LOCATfQI�i i 4- SEWAGE# - VII:F.A{sE G�S 7S" M J �S' ASSESSOR'S�r1AI?:c` LOT` WSTALLER'S NAME&PHONE NO, SfsMC TP RX CAPAC. M. IACfmi�iG FAcT°I tom)° .. ( � NO.OFBBI3i t3o1+ 5 ' Separation Dtstanrx Betvrn ttae Max rnumAd usteii t"rraundjuater Table to,i Battom of mashing Facility Feet` Private Water Supgly We and Leachin' F�ctlicY ally em exist c n seta at witWit2i :feet of lest ii(ig f ixy) Edge of WWand ai d Lead mg#" a�ity(,Cf any wellaiids exist withi4�Q�} ��tG3C�1ti89.$Ciltty� r Famished by..- cam- / G p � 4 n Y O FC..9 1, 0 1 q, { Commonwealth of Massachusetts 060?- ooc�_ Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 16 Claus Way ' 50J� 4.T� Property Address P�7 Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) } Owner Owner's Name information is required for every Marstons Mills MA 02648 10-23-15 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 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 16.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Eval ocal Approving Authority 10-23-15 nspec ors 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. 40 rp V5 t5ins•,3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 l i Commonwealth of Massachusetts ' Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 16 Claus Way Property Address Bank Owned (Contact David Holt ,,Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 10-23-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check KB,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. I Comments: a c B) System Conditionally Passes: El One or more system components as described in the:'Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by , the Board of Health,wi'I pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined,"please explai'i. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substan`ial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tE.nk is replaced with'a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts . ., Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 16 Claus Way Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 10-23-15 page. Cityrrown 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.): _ El' observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ 'Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N `❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is'Required by the Board of Health: . ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System,Form -Not for Voluntary Assessments M 16 Claus Way Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 10-23-15 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 tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: i D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or.system,component due to overloaded or ® ' ❑ clogged SAS or cesspool ❑ ® Discharge or ponding of efFluent to the surface.of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ` t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 16 Claus Way Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 10-23-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) - Yes No , ❑ ® Required pumping more than 4 times in the last year MOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public 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 of 10,000 gpd to 15,000 gpd. -For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a,surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area`—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 16 Claus Way Property Address Bank Owned (Contact David Holt @.Today Real+Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 10-23-15 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) I ® ❑ -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 ® El information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has f 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 :a 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts A Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "¢ 16 Claus Way Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 10-23-15 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 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 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Unknown Date 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., 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-3113 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 ' M 16 Claus Way Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 10-23-15 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: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: r 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 E ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 I -- I c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM 16 Claus Way Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 10-23-15 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: 1982 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 24"feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 18"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" t5ins•3113 Title 5 Official inspection Form:Subsurface Sewage Disposal p g System•Page 9 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 16 Claus Way Property Address Bank Owned (Contact David Holt @'Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 10-23-15 page. City/Town 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 20" + Scum thickness • '., I . • 5" Distance from top of scum to top of outlet tee or baffle 2" Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? 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.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form "g Subsurface.Sewage Disposal System Form -Not for Voluntary Assessments M 16 Claus Way Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 10-23-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) t 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: 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 i t5ins•3113 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 wM ' 16 Claus Way Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 10-23-15 page. Cityfrown 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 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with stain lines above inlet invert. Pump Chamber(locate on.site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): I * 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 Disposal System-Page 12 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 16 Claus Way Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 10-23-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure;level,of ponding,damp soil, condition of vegetation, etc.): Leach pit was filled beyond capacity at inspection. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins 3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form .j Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 16 Claus Way Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 10-23-15 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 soil, signs of hydraulic failure;level of ponding, condition of vegetation, etc.): r . t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 16 Claus Way Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is Marstons Mills MA 02648 :10-23-15 required for every page. City/Town 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 EL- 0 r 3` •� `� rt* y V _ .. .. } 3}is t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 16 Claus Way Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 10-23-15 page. City/Town 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: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed- Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5iris•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 I ' Commonwealth of Massachusetts Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,e� 16 Claus Way Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 10-23-15 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 • (.NI�stS Ex��1 O Exr. DEc� 3 vrKe of iCE 2 cASEo b►31NDOt�16 "Non CupSc� C.iPt'NI N6 rl'1..►DC2 1�31�Da+3s y H ALLWA% VI (' Q a va d. C)o sc .y1M "Writ M IJ6 Opp-CIL- r �(v CUAtJS t�JIP�� ISO n, asTor� r► u LL5 mA� b2k>4� P42096SCD R��ov k- -eiD AaE iA- �Lp�t,2 Cj' A 0 3 S.0 J ►sHED P�ac-A L d O � WlN DOu1 to!I4,5DOW 1 CLADS fy)A(2->TN\-6 M i LLS MA Dztw L}g i CLALZ VJALA � +� MA �s�rvs � C1�S r MDdN'�"� er10�NiM ` r�-r 'Fi Nix D 1�t 3 �►�t� o ° � � A a GA5 CO S►AV w M►oaa Sl1 �-- w,NP�w� 1706� Lot�� l l.:v6L_ Town of Barnstable Regulatory Services Richard V. Scali,Interim Director • BMMSTABM 9�A MAM. ��� Public Health Division Tf16,39. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: t \to Sewage Permit# Assessor's Map\Parcel Designer: NVl&k COJe IGB hpr Installer: Address: � � C7�'i IRYoIe( 500*y Address: 2 0,\s ", c, Sc 02,633 On VV-, was issued a permit to install a (date) (installer septic system at (6 C qvS L'✓°ty based on a design drawn by (address) JA Q_ ,64-VAh0V r dated DeC 27, /L01 � (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. 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 constructed in compliance with the terms of the I\A approval le s (if applicable) (Ins a er's Signa re) (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc r f Town of Barnstable ' Department of Regulatory Services $ .F Public Health Division Date Dec 12, 205 200 Main Street,Hyannis MA 02601' Date Scheduled Tl'ine; ' .M Fee Pd. lob• , Foil Suitability Assessment for Sewage Dispos. l Performed Hy . 1 J tC° �p U�H 6J0W�- Wltne'ased By: LOCATION&GENERAL INFORMATION Location Address 16 Claus Way Owner's Name FNMA Marstons Mills Address POB 650043, Dallas, TX Assessor's Map/Parcel:43162-2 Engincer'sName David Coughanowr NEW CONSTRUCnON REPAIR X Telephone# 508 364-0894 , Land Use < Slopes Surface Stones! d Distances from: Open Water Body ,y+oD } ft- Possible Wet•Area oy+ ft Drinking Water Well L Qp ft Dml'nage Way 2 } ft Property Line �� + ' ft ;Other SKETCH:(Street name,dimensions of lot,exact locations of test holes&pars tests,localo wetlands i'n proximity to hales) ' Zop .pO . `fP-1 tp�L 41 • Zd ari � 8 ZOO. 00 3 ' Q J V Parent material(geologic) Pro lRGfa 1 Ovt Wq S h Depth to Bedrock n.g � Depth to Groundwater. Standing Water In Hole: N'0 h(' Weeping 11om Pit Face Vi o q! Estimated Seasonal High Groundwater D DETERMINATION FOR SEASONAL'HIGH WATER TABU Method Used: Bgra 5+ t� G1$ Depth Observed standing in obs.hole: in, Depth to soil mottles: In. Depth to wecping fmm side of obs.hole: —in, Groundwater Adjustment ft. index Well# Reading Date: Index Well level -___ AdJ:thetor- ,r Adj.Groundwater level PERCOLATION TEST bate i2 $ 4sl 7111te�1 a Observation Hole# P Time at 9" 9 Depth of Pero •S• Time at 6" n Start Pre-soak Time® e/y Time(9"-6") k End Prc-soak h/ Rate Min./loch Site Suitability Assessment: Site Passed Sitp Failed: Additional Testing Needed(Y/N) yV r i Original: Public Health Division Observ*a:tion Holt'Data To Be Completed on Back-- r ***If percolation test is to be conducted within 100'of wetland,you must first notify the h B®rnstable�Conseirvation Division at least one(1)Week prior to beginning, d Q:ISEPTICIPERCFORM.DOC ' �o VS JDI'EP.OBSIERVATION HOLE LOG Hole�# I Depth from Soil Horizon Soil Texture Sdil Color Soil. Outer Surface(in:) (USDA) (Munsell) Mottling (Stnucture,.Stones;Boulders. -3 O Sandy.(Mt-n (a�R 3�z o Xe Fri'ybh 3'6' -55 © nr 5od. W<2 4/6 Fri ab I0- - It Ci Lobtot Ede- lW25 - • � rnedUurtn - t FI^i ulo[e 72 �¢` GZ roe e vA 10 Y. K G a DRI1,P OBSERVATION HOLD LOG' Hole Dcpth from Soil Iloiizou Soil Texture Soil Color Soil_ Other Surface(in.) (USDA) (Mmtsell) Mottling (Slruchhru;'Stoncs,Boulders. • ConSla toy, Oravel) 10 R �/4 N oxco �rig6l� G- G;6 gw U. 4, . ' an (0 itR4l6 Friabl'r� 5� _ 0 C t Gdglq Rho, Iz 54 Friable D t EP OBSE,R.VATION HOLE LOG- ..Hole## Depth from Soil lorizon Soil Texture soil Color Soil Other Surface(in.) (USDA) (Muuscll) Mottling (Structure,Stones,Boulders. Coi c 11 DEEP OBSERVATION HOLE LOG ;Hole# Depth from Soil Hodwn Soil Texture Soil Color, Boll Other Surface(in.) (U$DA) (Mmtsell) Mottling (Strgelure,StoaeC Boulders, consistency. 6 AmYaU a Flood Insurance Rate Mau: Above 500 yearfloal boundary No Yes Within 500 year boundnry lyu Yes _ Within too year flood boundary No.,V/ Yes Death of Naturally Occurring:Pervious Material Does at least four feet of naturally occurring pervious mliterial exist in all Areas observed throughout the area proposed for the-soil absorption system? ES If not,what is the depth of naturally occurring pervious material? Certification �0 J I'certify that on (date)Lhave passed the soil evaluator oxarriination approved by the ent of Environmental Protection and that the above analysis was performed by in consisten , th Department , the requir( aiding, orlisc d xperienpc�e described in10 CIv11215.O17. 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ApplirFation for Uhipati al Workii Tomilrurtion Vamit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal w'System at: -- Locatio C�d� r ss or-Lot No. STEAL -.- �(.1CCLr O r f r/q Address u� l �t m4 & r�tc cj c � '-..... �� ...._._.....� -------------- ----- -------------- Installer Address Type of Building Size Lot._.Z.3.ftAO...Sq. feet Dwelling—No. of Bedrooms......................................Expansion Attic ( ) Garbage Grinder ( ) PP-, Other—Type of Building ................•.._.___... No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures .................................. W Design Flow................ ...................gallons per person per day. Total daily flow----33®..............................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......I.............. Diameter....J0_.�- Depth below inlet......4..fj�... Total leaching area----Z7Q...sq. ft. Other Distribution box ( ) Dosing tank ( ) Z Percolation Test Results Performed by...._....A' -( 'w-D . "'S� _. Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gx Test Pit No. 2................minutes per inch Depth of Test.Pit.................... Depth to ground water...................... ---•-------------------•----------------•--•----•-•--------..........................---........-•--......................................................... 0 Description of Soil......... . ... x --• -•--vl . -_ -. r�-..__.. _.._ --......................... �., 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 iITL% 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 th board of health. t Signed.. • . . --....... 12��t r, � .......... .4 /1�1,/Date Application Approved By..... `- / �'" ------------------•------- 1.2_ -- ..----......•--••- Date Application Disapproved for the following reasons:............................................................................................................. .............•-----------•-••--------•------------••••-----•-------•••-•--•-----•---..........-•...--•---•----•-----•-••-•------••------------•-•-------------•••---•-•-•••-••-•••---••••••------------ Date PermitNo.............................................. Issued-....................................................... Date r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -•-----...................................OF App irtation for Disposal Works Tonstratrtion runtit Application is hereby made for a Permit to Construct (k ) or Repair ( ) an Individual Sewage Disposal System at: _ .............. 3T._...: . � O M � --------•------•----...------. •--------- .......................... •• ..................................................... ocation- d r ss OSSI .�....... —o i��. TZ!�_ �S.J (�if L l or Lot No ..............•____._... .......... .......----------y------..-. -*........... ..... a �CC.:�t?, t... ' :......�t�r ......-•-•-'....................•---... ............::1�..... / l� rt..s ...i aI{..._1---•-•---•--............. Installer Address Q Type of Building Size Lot_----: ---___Sq. feet V a Dwelling—No. of Bedrooms............................. .. .Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------------•------------------•-••------------•--•--••----•-•--....-=------------........---•---'--•--•--------- W Design Flow................5 ......:.............gallons per person per day. Total daily flow...31,d._.... ................gallons. t4 Septic Tank—Liquid capacity_l.�!._gallons Length................ Width................ Diameter................ Depth................. Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.....!-------------- Diameter....f O..6E.. Depth below inlet.....{t_..�'... Total leaching area....Z.7Q...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) fit Percolation Test Results Performed by.................................... ... ._ +tVf. Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------------------------'-'-------------•--------...-----------....------.................-•---..•--..................----...-- .........._....•---•-•..--- 0 Description of Soil........ .. ,Z.. ..•�r -- ---------------------•--• ------------------------------------------------------------------------------------------------------------------------------------'---------------------------••--•-_.... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------•-..................--.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 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 been ssued by th board of health. Signed--- . • l � �// � -----------------••-....------.....-----•------------------ ....-- .................. Dat Application Approved BY---- -r.�G.--. .: t` ' "'r' '�'�' • 2-�z/**--------------- Date �* Application Disapproved for the following 'reasons:___......................................................................................... .............. •------------------------------------------------'-----------.......-------------•------•------.....--'-•-•-•-••-••--....--•-•-•---•••-------------------•...--------.....----------- ................. Date ' PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �:........OF...... * ................................... (Irrtif irFatr of TontpliFanrr THIS IS TO,,C,� RTIFY-That e Individual Sewage Disposal System constructed � or Repaired ( ) by � ` .•�._-------•- = stauer ,at---------------- .................................... .....j-- --- = :I has been installed in accordance with the pro4ions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._ " _Z.r ______________ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............. s 4. Inspector .z ,1 ..................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r �2 ............OF........ � ......... .. ............................................................... No..................:..... FEE........................ Disposal Works ,tTpn,,otrnrtion rrntit Permission is hereby granted........e�.---------/ c'`�` ....................................-.................................................. to Construct ( or-Repair ( ) an Indvvid al Sewage Disposal System Street as shown on the application for Disposal Works Construction Permit No..................... Date.............._.............._............ ? Board o DATE...................------------ ------------------- FORM 1255 HOBBS & WARREN, INC.,-PUBLISHERS COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS,, DEPARTMENT OFXNVIRONNiENTAL PROTECTION MAP `PARCEL Z Cj TITLE 5 OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY,ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 16 Claus Way° Marston Mills,MA 02648 Owner's Name:Ralph and Alice Fri Owner's Address: 16 Claus-Way - - Marston•Mills,MA 02648 - Date of Inspection:04/21/04 RECEDED Name of Inspector: (please print) Ray B.Waterman Jr. Company Name: Ray Waterman Enterprises MpY 2 5 2004 Mailing Address..'• P.Q.Box `Middleboro,MA 02346` t, TOWN F B NST BLE Telephone Number: (508)-923-0500 CERTIFICATION"STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection.was performed based on my training and experience in the proper•function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector'.pursuant to'Section.,15.346of,Title 5(310 CMR15.000).,The system. r X' ' Passes Conditionally Passes Needs Furthe v tion by the Local Approving Authority Fails tludoq Inspector's Sigriatur Date' X The system inspector shall submi c y of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing t 's inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system'owner shall-submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments,• :r. fi, .�: << . . , x ""This report only describes conditions at the time of inspection and Junder 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. _ i Page 2 of 11 .. OFFICIAL'INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS:;: SUBSURFACE SEWAGE'DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 16 Claus Way Marston Mills,MA 02648 Owners Name:Ralph and Alice Fp L Date t of Inspection:ion: 04/21/04 , Pe Inspection Summary.' Check k,B,C,D or E'/ALWAYS complete all of Section D A. System Passes: _X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in`3.10 CMR 1,5.304,exist.Any failure criteria_not evaluated are indicated below. Comments: - ,. ... - • t B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or t repaired.The:systern upon completion of the replacement or repair,as approved by the Board of Health,will pass. ` Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. :. The septic`tank is metal and over 20 years old*'or the septic tank(whether metal or riot)is structurally unsound;exhibits substantial infiltration or exfiltration or'taiik failure is immment'System will pass inspection if the' existing tank is replaced with a complying septic tanklas'approved by the Board'of Health.' *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: M Observation of sewage backup or break out or high static water..level in the distribution box due to broken or obstructed pipe(s)or due to a broken,`settled or uneven.distribution.box..System.will pass inspection:if(with approval of Board of Health): - • , broken pipe(s) replaced . ,. .. .. - .,,obstruction is removed ,.. •_distribution.boxiis.leveledor replaced. ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).`The-system will ' pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL'INSPECTION FORM" NOT FOR VOLUNTARY ASSESSMENTS= SUBSURFACE SEWAGE'DISPOSAL".SYSTEM INSPECTIONYORM- PART'A, CERTIFICATION'(continued) Property Address: 16 Claus Way Marston Mills.MA 02648 :. Owner's Name:Ralph and Alice Frye Date of Inspection:04/21/04 C. Further Evaluation is Required by the Board of Health:( _ Conditions exist which require further evaluation by the Board of Health in order to determine if the:system is failing to protect public health,safety or the environment. 1.', System will pass,unless.Boardof Health determines in.accordance with 310 CMR.15.303(1)('b)that the system is'not functioning-in a manner which will protect public health;,safety and the environment: Cesspool or privy is within 50 feet of a,surface water, Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public'health;safety-and environment:, is . . The system.has.a septic:tank and soil.absorption;system(SAS)and the SAS.is within 100.feet of a r,surface:wate •supply`outributary to a surface water:supply;.p .. . < .. ".1 � '.. .. •$. Y ...a iE . . .. t .. ,.. ....s Thesystem has.a septic tank-and SAS;andthe SAS-is.within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and•the.SAS is within 50 feet of a private water,supply well. The system has a septic tank and SAS and the SAS is less.than 100 feet but M feet or more from a private water supply well**.Method used to determineAistance t -Q:. **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm;provided that no other failure;criteria+are triggered.A copy,of.the analysis mustbe zftachedto this forma •• 5 .Y" 3. Other: t Page 4 of l l OFFICIAL INSPECTION FORM `NOT'FOR•VOLUNTARY ASSESSMENTS: SUBSURFACE SEWAGE'DISPOSAL.SYSTEM INSPECTION FORM-' PART A" CERTIFICATION(continued) Property Address: 16 Claus Wav Marston Mills,MA 02648 s.f Owner's Name:Ralph and Alice Frve 1 . Date of Inspection: 04/21/04 D. System Failure Criteria applicable to all systems: You'must indicate"yes'.'_or"no to each of the following for all:inspections:• s Yes No _ X, ' Backup of sewage into facility.or system component due to,overloaded:or.clogged.SAS.,or cesspool — _X Discharge or ponding.of..effluent-to.th_a surface-of the ground..or surfacematers due'to•an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above.outlet•invert due.to•ari overloaded or clogged SAS or — — cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow _X Required pumping more:than 4 times in the last year.NOT due to clogged or,obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or,privy is below high ground water elevation.. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface —water.supply. .. _X_ Any portion of a cesspool,or privy'�is within a Zone l of a public well.:=t., s .: _X_ Any portion of a cesspool or privy is within 50 feet.of a private water supply well. _X -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,jThis system,passa f the., ell water.analysis,,, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates-.that the well is-free from pollution fr6m4hat facility and,the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are,triggered.,A copy of4he analysis must tie attached to this form.] " _No .jYes/No):The system ails.'I have determined that'one.or m6fe,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. l 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• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking_water supply. .. the system is within 200 feet of a tributary to a surface,drinking.watersupply_ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE-SEWAGE�DISPOSAL`SYSTEM,INSPECTION FORM y ' F r CHECKLIST Property Address: 16 Claus Way Marston Mills,MA 02648 Owner's Name:Ralph and Alice Frye ' Date of Inspection:04/21/04 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: r Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous`two weeks?. _X— _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as'partof this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X _ Was the facility or dwelling inspected for signs of sewage backup'? ' X_ _ Was the site inspected for signs of break out? s; X _ Were all system components,excluding the SAS,located-on site,? _X_ _ 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? s _X _ Was the facility owner(and occupants ifdiffereiit from.owner)provided with information on the proper maintenance of subsurface sewage disposal systems? i The size and location of the.Soil'Absorption System.(SAS)on the'site has been�defermined based 'n Yes no X_ Existing information.For example,a plan at the`Board of Health: _" ' J _X_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation,of ' distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-.NOT FOR:VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -,PAR.T.C. SYSTEM INFORMATION Property Address: 16 Claus Way Marston Mills,MA 02648 , Alice F e e Name:Ral hand wn r s O , P ry Date of Inspection:04/ 1/04 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): ND Number of bedrooms'(actual): '$,- DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):_ND Number of current residents:_3 Does residence have a garbage grinder(yes or no):,•_N_ : Is laundry on a separate sewage system(yes or no): N [if yes separate inspection required] Laundry system inspected(yes or.no):_Y Seasonal use:(yes or no): N_ Water meter readings,if available(last 2 years usage(gpd)): .NA Sump pump(yes or no): N_ Last date of occupancy:Present COMMERCIAL/INDUSTRIAL , , •:, .�• r. Type of establishment: Design flow(based on 310 CMR 15.203):',^ gpd „ Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title,5 system(yes or no):.�' ; Water meter readings,if available: Last date of occupancy/use:, OTHER(describe): „ GENERAL INFORMATION Pumping Records Source of information: The date of the last pump is unknown,according to the owners. Was system pumped as part of the inspection(yes or no):_Y_ If yes,volume pumped:_1,000___gallons--How was quantity pumped determined? Trucks gauge Reason fonpumping:.The system was pumped to clean out the solids and to check the,tanks structure.. TYPE OF SYSTEM X_Septic tank,distribution box,soil absorption-system , _Single cesspool Overflow.cesspool,- Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 25 years Were sewage odors detected when arriving at the site(yes or no): NO Page 7 of 11 OFFICIAL:'INSPECTION FORM=NOT:FOR VOLUNTARY ASSESS'MENTS� SUBSURFAC E,SEWAGEDISPOSAL SYSTEM-INSPECTION-FORM: PART C•: SYSTEM INFORMATION(continued). Property Address: 16 Claus Way r Marston Mills,MA 02648 r- r Owner's Name:Ralph and Alice Frye Date of Inspection:04/21/04 a .;_..; >3. BUILDING SEWER(locate on site'plan) •. . Depth below grade:3' Materials of construction: : cast iron,.,X 1:40 PVC:°._other(explain): .;.,:.: Distance from private water supply well,or suction line: Comments(on condition of joints„venting,evidence of leakage,etc.): , SEPTIC TANK:_X_(locate on site plan) ;+� : y > .. , •, . Depth below grade:2' Material of construction:_X_concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 1,000 aallons, Sludge depth: 8" Distance from top of sludge to bottom of outlet tee or baffle:22" �4 Scum thickness:T? Distance from top of scum to top of outlet tee or baffle:6" a, ; Distance from bottom of scum to bottom_'of,outlet tee.or baffle,9'.7.; r .. How were dimensions determined: ' with a measuring pole:-and when pumped Comments(on pumping recommendations,inlet and outlet tee or baffle.condition structural integrity',•liquid levels as related to outlet invert,evidence of leakage,etc.): The tank was pumped to remove solids. All tees are:properly installed' , The liquid level was at the bottom of the outlet pipe. The tank is structurally sound. GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:_concrete metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM=.NOT FOR VOLUNTARY- ASSESSMENTS' SUBSURFACE'SEWAGE'DISPOSAL SYSTEM:INSPECTION'FORM PART.C.' SYSTEM INFORMATION(continued) Property Address: 16 Claus Way _..� +:•.., �u ,N,: ,.� Marston Mills,MA 02648 ` Owner's Name:Ralph and Alice Frve , Date of Inspection: 04/21/04 - ,a p .. 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:_0_ Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box is level and the liquid is:being dispersed equally: t There was no sign of solid.carruover. PUMP CHAMBER (locate•on.site,plan)' :. . . ;T Pumps in working order(yes or.no)-:,, Alarms•in working order(yes or no): i f ! - Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): I Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBS URFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM =PART C- " SYSTEM INFORMATION(continued)`- T E •� Property Address: 16 Claus Marston Mills,MA 02648 Owner's Name:Ralph and Alice Fry Date of Inspection:04/21/04 SOIL ABSORPTION SYSTEM(SAS):—X (locate on site plan,excavation:not required) If SAS not located explain why: P Y i r ' • " ., r�r' i'♦ ��. . .... , , t ^. - n. _. ...fir ,. ,''�', Type X leaching pits,number:_1_ leaching chambers,number: Y; leaching galleries,number: M 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.): The soil in the area was dg. There was no sign of ponding or abnormal vegetation._ CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM'. PART C SYSTEM INFORMATION(continued) Property Address: 16 Claus Way Marston Mills,MA 02648 Owner's Name:Ralth and Alice Frve. > Date of Inspection:04/21/04 _ .r SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. See Attached Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C . SYSTEM INFORMATION(continued) Property Address: 16 Claus Way Marston Mills.MA 02648 Owner's Name:Ralph and Alice Frye bate of Inspection:04/21/04 SITE EXAM Slope Hill Surface water None Check cellar Dry . "I Shallow wells None Estimated depth to ground water 20' feet Please indicate(check)all methods used toideterriiine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: X_Observed site(abutting property/observation hole within 150 feet of SAS) _X_Checked with local Board of Health-explain: _X_Checked with local excavators,installers-(attach documentation) X_Accessed USGS database-explain:Web site You must describe how you established the high ground water elevation: All of the above sources were used. The house sits near the top of a large hill No water was seen in the area A hole was dug near the D-Box with a backhoe. I 508-923-0500 yJ ATE P.O.Box 1474 Middleboro,MA 02W Cnterprioeo i 1,e 50 o v� 0)J.!� ? t"vlw C tam V Town of Barnstable Health Inspector op THE rosy Office Hours Regulatory Services 8:30—9:30 - Thomas F. Geiler,Director 1:00—2:00 • snHNSr"LE. - 9� "9. Public Health Division ATf p MAI a Thomas McKean,Director 4 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-63 AMNESTY PROGRAM APPLICANT— SEPTIC QUESTIONNAIRE 1 General Information: Size of Property: 4 0 0 Address: / 0 Map Parcel Name: V LBf1 /y'L,tf7 Phone #: -U/- 2a. How many bedrooms exist at your property now? 2b. Are you planning to add any bedrooms? /)O If yes, how many? 2c. How many bedrooms total are proposed at this property (including the amnesty unit)? 2d. Please include a copy of the floor plans for the entire property - showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label . each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or NO If the dwelling is connected to public server slap questions##4 through#9;below:: 4: Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? 5. Is the dwelling connected to an ONSITE WELL or to U=WATER? 6. Is a disposal works construction permit on file? YES or NO 6a. If yes, how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or NO 8. Is there an engineered septic system plan on file at the Health Division? YES or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO -- - ----------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY Division has no objection to bedrooms at this property. Special Conditions: Signed: Date: �%Ih, es/amnestyapp alth/wpfil I'_ n Q w ' -*4 aS- a 2- c12e��d cr 2tSG T�/� ,siz�/1 "( �1 J - ^'--VQ 1 �- CV\l i n , I i d n Anti r f _.rllf• �II f . I I 1 a 3 NOT L�L�GL�11VD � � � ?� SLOE 9��E SEPTIC COMPONENTS o S E p T I " " O p _ LOCUS 9 9� EXISTING ® a T'ECHe tJ b WAKEBY d 2 ROAD qa 1000 GAL �� O SEPTIC TANK a v W n OEXISTING 2 LEACH PIT/ CESSPOOL z DISTRIBUTION BOX a TEST PIT ®: pp ,�a nMpARSTONS I�tM�ILLgS. MA LI-. 0 C lw S ul!'N A P PROPOSED SOIL �� 200.00 ft ABSORPTION SYSTEM - -SO DETAIL ; VARIANCE REQUESTED - ON BACK - ,� MAY BE GRANTED IMMEDIATELY BY HEALTH AGENT OR HEALTH INSPECTOR. - - - - -310 CMR 15.221(7) — COMPONENT DEPTH TO FINISH GRADE. 36 in MAX REQUIRED — VARIANCE TO pp 72 in OF COVER REQUESTED. LOT 1— LQ - AREA = 44136 sf+— / PLAN BOOK 361 PAGE 61 / ASSR MAP 43 PCL 62-2 / O QNQ08LE GIs D ELEVATION 78 �o - o 76. 89 P� p OF FNDN 9 b APE ���� N kti .10 o �SFONE y^ a, VENT PIP / DRIVEWAY -- -` UTILITY "" ' POLE �P '� x a GARB r i Kt'"` - 78 G R 77 OT ��, Vv �� 75 9 MINIMAL `--- ---, ' - - GRADING / PROPOSED - THIS IS A pL� Q N 75 76 A , COLOR . SCALE: 1 in = 30 ft ` 20 QOO fr PLAN USE COLOR PLAN ONLY 30 60 FOR INSTALLATION FULL DETAIL.IS BEST. 0 10 2 0 3 0 VIEWED IN FULL COLOR. PRINT ON 11 x 17 in PAPER FOR PROPER SCALE F L p Q TOP OF FNDN SLAB RAISE COVERS TO WITHIN ALL PIPE TO BE SCH. 40 PVC VENT EL = 76.89 +- b in OF FINAL GRADE AND TO PITCH AT 1/8 in/ft MIN PIPE 76.0 6 f t USE MAX ATED E TWG USE H-20 TEE 70.50 UNITS EXISTING 1000 GALLOON o o PRECAST o 0 0 0 000 0 000 o 000 00 ooa SCp= TA�I� 7s.00 ooa �aoo a°o_ DRYWELL 0000 0 00 0 �00000000��pp 69.60 00�0 fio�o:o. ,aoQ oO OQo�o EXISTING REFER TO DETAIL BOX ST NE 800L A°,BSORPTT ON + 41 6 9.77 BASE 69.5 0 6 In STONE BASE IF NEW SYSTEM -REFER TO O EXISTING 14 ft 5-12 ft DETAIL BOX Ln 67.50 GROUNDWATER PER NOT ES BARNSTABLE GIS __ 45.0 NIO U ES ` oFMgss9 �H OF Jo.a-, SEWAGE DISPOSAL EXISTING LEACH PIT TO BE REMOVED. REPLACE ryQP S9�y SYSTEM PLAN ALL ASSOCIATED CONTAMINATED SOILS DOWN . DAVID G DAVID G � s -TO SERVE EXISTING DWELLING TO THE C2 MEDIUM SAND HORIZON AND REPLACE D. a D. WITH CLEAN MEDIUM SAND PER TITLE 5. COUGHANOWR N COUGHANOWR N FEDERAL NATIONAL INSTALLER MAY MOVE VENT PIPE TO A No. 1093 No. 461 MORTGAGE ASSN. DIFFERENT LOCATION. �FGISTE��� 'qpPRO'E4 OJ IOWNER(S) OF RECORD TREE REMOVAL AT INSTALLERS DISCRETION. SA so// E o� = 16 CLAUS WAY i iss G der ads MARSTONS MILLS ea R , MA WATER LINE SHOWN IS APPROXIMATE. INSTALLER y PROPERTY ADDRESS SHALL SLEEVE LINE IF CLOSER THAN 10 FEET / Chatham. MA 02633 FROM SYSTEM COMPONENT. Dovidcou@HotmoiLcom DATE: DECEMBER 27. 2015 508 364-0894 PG.1/2 -joB# ETE-4025 I DATE: D SOL TEST (BOO PE C# 4916 EMBER 23, 2015 WITNESSED BY: DAVID STANTON, HEALTH DEPT. DESIGN wc1r►LCUL7►r►`a lJ �O a8 SOIL EVALUATOR: DAVID D. COUGHANOWR, ASE #461 TEST PIT NO GROUNDWATER ENCOUNTERED DESIGN FLOW: 3 BEDROOMS X 110 GPD 330 GPD PERC RATE 2 MIN/INCH IN C2 SOILS SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER INCHES HORIZON TEXTURE (MUNSELL) MOTTLES USE EXISTING 1000 GALLON SEPTIC TANK IF IN 75.85 0-30 FILL SOUND STRUCTURAL CONDITION. IF NOT, INSTALL NEW 1500 GALLON SEPTIC TANK.. 30-33 O SANDY LOAM 10 YR 3/2 NONE FRIABLE 33-38 A SANDY LOAM 10 YR 4/4 NONE FRIABLE DISTRIBUTION BOX: INSTALL UNIT DEPICTED BELOW. 38-58 B LOAMY SAND 10 YR 4/6 NONE FRIABLE SOIL ABSORBTION SYSTEM: 69.85 58-72 Cl LOAMY FINE SAND 10 YR 5/4 NONE FRIABLE THE LONG TERM ACCEPTANCE RATE FOR A CLASS ONE 72-144 C2 MED-CSE SAND 10 YR 6/4 NONE LOOSE SOIL WITH A PERCOLATION RATE. BELOW 5 MINUTES 63.85 PER INCH = 0.74 .GALLONS PER DAY. PER SQUARE FOOT. NO GROUNDWATER ENCOUNTERED THE MODIFIED V SHAPED GALLERY, DEPICTED CAN LEACH: TEST PST 2 PERC RATE - 2 MIN/INCH IN C2 SOILS BOTTOM AREA 12:8.3 (16.5 + 8.5) = 320.75 sq. ft ELEVATION COLOR DEPTH SOIL USDA SOIL SOIL C SOIL OTHER INCHES HORIZON TEXTURE (MUNSELL) MOTTLES -1/2 (5 X 5) =-1I2.50 sq. ft. 75.70 0-24 FILL SIDEWALL AREA (11.5+12.83+3.67+8.5 24-36 Ap SANDY LOAM 10 YR 4/4 NONE FRIABLE +:12.83+16.33+7.48)x2 = 146.28, sq. ft. _ 36-56 B LOAMY SAND 10 YR 4/6 NONE FRIABLE TOTAL AREA 454 sq. ft.: 69.87 56-10 Cl LOAMY FINE SAND 10 YR 5/4 NONE FRIABLE FLOW CAPACITY = 0.74 x 454 = 336 gal/day 70-148 C2 MED-CSE SAND 10 YR 6/3 NONE LOOSE 63.37 INSTALL THE MODIFIED 'L' SHAPED GALLERY AS CONFIGURED BELOW. FLOW CAPACITY = 336 gol/dog WHICH EXCEEDS THE 330 gal/doy REQUIRED FOR A THREE BEDROOM DESIGN. - SOIL �1 = SORPTION 1000 GALLOON SEPTIc'C `TANK INSTWO IMF o MM6110M a wym .,SYSTEM ' CON'STRUCTION DETAIL TANK TO BE PUMPED DRY AT TIME OF INSTALLATION OR •• �� • LEACHING DRYWELL AND EXAMINED FOR STRUCTURAL INTEGRITY. INSTALL 12.83 ft t NEW PVC OUTLET TEE EQUIPPED WITH A GAS BAFFLE. A INSTALL TWO DRYWELL REPLACE WITH. A. NEW °' UNITS AS SHOWN 8.5 f t WITH FOUR FEET OF 1. in �: 1500 GALLON TANK � STONE ALL AROUND. TAPER IF CRACKED:. ROTTED urI OR OTHERWISE o b COMPROMISED. rt -- - MARK INSPECTION 00 © c w RISER WITH c , MAGNETIC TAPE. 6 COF NOT cn ' - - TO rt-* ' ' � DRYWELL UNIT SCALE Sft 16.33 ft A w ,N0 500 DALLON DRYWELL DIMENSIONS INTO LL ONN THREE INSPECTION ION RISER ER INLET OUTLET & DETAIL FINAL GRADE & INDICATE COVER COVER LOCATION ON AS-BUILT 3 IN DROP >, t Al FROM -FLOW LINE oL�1p�4� 0, 0 n6 BUILDING 10 in 14 TO poo�a� o�qo. ����0. n to D-BOX �t--gnp USE >�L9)p �,�?��]�lp` 0 0 �(� RATED 48 In L�p� LIQUID GAS 5$ UNITS LEVEL BAFFLE /02 CROSS SECTION VIEW (SECTION A-A) I 6 in STONE BASE IF NEW INSTALL AN APPROVED GEOTEXTILE FABRIC OVER STONE SEPARATION BETWEEN INLET & OUTLET 4 TEES NO LESS THAN LIQUID DEPTH CROSS SEC TION VIEW 24 3/4 in TO 3/4 in TO 28 © EFFECTIVEa - I-1/2 in GRAVEL 1 1/2 in GRAVEL in a MMOMMilm DEPTH o En 48 in 58 in 48 in 154 in D 1 S T R 10�]U T 1 O N o .C�/V O•p - INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE Do STARTING WORK. laftydralwwO ► .O o ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM • ► ► �' O• o• ►0 0 REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). -INSTALLER TO. VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. 12 in -ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES c O O URES & APPLIANCES AND PERIODIC PUMPING , E —s PUMPING OF .THE SEPTIC TANK. � FROM < < � -SEPTIC TANK NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. N TANK TO . DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC TANK. p ^IT SA S O' 6 in STONE BASE IL 21 ; 2� CROSS SECTION VIEW SEWAGE DISPOSAL SYSTEM PLAN 16 CLAUS WAY MARSTONS MILLS, MA DECEMBEA 27, 2015 ETE-402 PG 2/2 ry a " _ DA l E U� TESTr/ Q RE, DATE TEST T - - :. �_ __:_�� RERC. TEST DATA *: SEPTIC TANK DETAIL • .�/�E� 1��� �� � � DIET. 80A ET'Q 1L • LEACHING FACILITY DETAIL* �o. DATE � TO CONFORM TO TITLE 5 REQUIREMENTS- WITNESSED BY r - - DATE OF TESTING'' �_ .- ` _ .. ' :__..__ s o-7Nk" , D CONFORM TO TITLE S REOU/REMENTS. P. _- ...___ . TEST BY: O �`/]/�'�`. O TS _ W/ TNE4.l�7ED BY., —� _. I ITITi�`/3' - 7+;•:;/t � - REMOVER&LE COVER I r —— MANHOL BROUGHT TO s a. }t `•►.'.*-a,.a'-•o.�•'ti',4 '.oa a ;:o,' o FINISH GRADE. ��, T „ Y` - a •.'fi.., -.•o:. AS 011E LG34M�F/LL /2 MAX. f �— _,.. .. - __._ _—.... -_ .______�_ __ ___ ._. ,• 3' CLEAR 3 CLEAR - ii t I Ors' TEST� � o�1TL£T PIPES DEPTH ra„MI,N, �^ 2„MIN. 6„M/N ° AS REQUIRED RA TE _ —__ INLET t �" '` �' TEE — ;; .IO""MIN � �''� r' 1 � DIST. IN i 3 LE OUTLET TEE s �� / I BOX I 1 loco- GAL,, i /NLEr AND oUTLET 4'0" MINIMUM , � I OUTLET TEE DEPTH V PT t /000-GAL. 24 SE /C TANK I4; AT LIQUID DEPTH OF 4; / 1 PRECAST 0R BLOCK M/ `: /9 „ 5 o SEEPAGE P!T TE£S �O BE CAST L t QUIO DEPTH CONCRETE t /RON, SCHED. 40 i f DEPTH OF TEST ------_�_ vc. DR CAST/N "` ' 24;; „ 6' ".� coNSTRucrroxv to '' , PLACE CONCRETE 29 „ T a ': MIN, I. RATE° _ CONCRETE , 34" ., k B` BOTTOM DN LEVEL_ STABL£BAS£ t _ (WATERTiGHCOVSrRUCrlON I . ,' .• i ._-__W.,.. FOUNDAT/ON t, INLET TEE PROVJOt D WHERE SLOPE • t t __ _• OF INLET PIPE EXCEEDS O.OB % OR OTT M F TA ,K .- E TO WITHSTAND � ----------- TA NK TO BEABL IN A PUMPED SYSTEM. 9 $ U O N ON LEVEL STABL£ BASE ! WASHED STONE t H-IO LOADkNG UN PAVEMENT OR/N LESS UNDER N' MlN. f ORrVE.H-20 t r LOADING UNDEFr PAVEMENT OR { j DRIVE I t A,EC0bf4fENDEO AfANUFACTURER ,: RECOMMENDED MANUFACTL! — _ R I (OR APPROVED EDUAL 1 l OR APPROVED EQUAL)NOTES : INVERT EL EV,A TIONS: t�LAN VIE I. THIS PLAN/5 F�?R THE DESIGN AND CONSTRUCTION OF THE SEWAGE DISPOSAL FACIL I T Y ONL Y. SCALE , I . . . . ... ... INV AT BUILDING , 2. AL L CONSTRUCTION METHODS AND MATERIAI,=S . `HALL CONFORM TG3 �! MASS. DE.O.E. TITLE 5 AND THE BOARD_ . , BOARD OF INV AT SEPTIC TANK, .N1 _ . _._ "__:._ �°-�EAL TH REGULATIONS, �:_ INV AT•SEPTIC TANK(ajTTi' � r .� as y JI►1'!1 ? ry £ r k s� �: AT DIET BOXt'IN; 9 INV AT DIST BC1X(OU7 ` cr q 4T LEACHING FAC'ILITY: �. x. BOSTON, MASS. �..� " - AS HALIFAX, MASS. NORWELL, MASS, BEDFORD, MASS. LEXINGTON, MASS,. HYANNIS, MASS. MANSFIELD, MASS, CRANSTON, R.I. DERRY, N,i-t, r 4 » .gyp f�.+(}]p bJ`�.a"k'J d�..E 3 - 3p ,• kQ e ( a , s , r 0 , t t - �111 SN �4 `x x , u r, s DESIGN FLOWAd w"> - , x R, �.w {{ i w . :. ! : REQUIRED SEPTIC TANKa GAL 14 AN PROVIDED - A . SEPTIC T K ^._.���GAL..? - . . _... LEACHING FACILITY:, , _ REQUIRED SIZE <� ,�: - g � -- — — __ 1 —,75 -7155 DIVISION OF ----------- _._.__..__,_ { —_�__+___�,._ d ° ', ' BO TON SURVEY CONSULTANTS INC. SIZE OF LEACHING FACILITY PROVIDED: ENGINEERING � SURVEYING � PL ANWNG m. . TITLE s , TYPE OIL SYSTEM SCALD a f w ' AGE DISPOSAL SYSTEM — ---— -E --- - — �— DESIGN I I u i 1 , I " AN ; a , R -- — �� SCALE� day ai•iCYYi�f METERS i FEET 0 , , f - 4 DATE- COMP./DESIGN: � , CHECK: DRAWN: I IAA TUM FIELD: FILE NO: DWG. NO: JOB NO: I i SHEET: I OF , - I