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Home My WebLink About0031 HILLTOP DRIVE - Health 31 Hilltop Drive Marstons Mills A= 077 - 021 { No. 200.5 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Mtgool *pgtem Congtructton Vertu Application for a Permit to Construct(, )Repair( )Upgrade(�� andon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3/ /��g� (7P(VF Owner's Name,Ad/dress and Tel.No. Assessor's Map/Parcel �'`�` tOy /EAU/' DOLifrrq 077 ,102- / #lMo l r" Installer's Namy,Address,and Tel.No. 5-69 —y2" Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations Answer when applicable)�dTl9��ylylo�!/-f?' eg__y d� / Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this oard o Health. Signed Date Application Approved by Date t/S� Application Disapproved for th ollowing reasons Permit No. �cU S'� � �� Date Issued Y raw r C� �r d( .J r No. S / -. i Fee2�: THE COMMONWEALTH OF MASSACHUSETTS Entered in compnte— �` PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes 01ppYication for �Digaaf *p.5tem Construction Permit' Application for a Permit to Construct( )Repair( )Upgrade( bin( ) ❑Complete System 1:1 Individual Components ' Location Address or Lot No. 31 1-1,1r&,o !fir(v�= Owner's Name Nress and Tel.No. o l-I"1`y Assessor's Map/Parcel 07 .0 Install is Nam ,A ress, d Tel.No 6�f^ ' p � ��pr� S 973a Designer's Name,Address and Tel.No. c3 / Type of Building: Dwelling . No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature R=Alte ation Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure he construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-' cate of Compliance has been issue by this oard of Health. ra Signed Date y _ Application Approved by `e S Date Application Disapproved for th following reasons Permit No. Date Issued _o Y THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS r Certificate of Compliance THIS IS O CERTIFY, tlt the Op-site Sews `D`sopo�al System Constructed( )Repaired ( )Upgraded( ) Alb nd��ned( Y �/oS -6 /,SW at 111rolo has been constructed in accordance with he,provisions of Title 5 and he for Disposal System Construction Permit No. �'° 3 dated Installer tiff` Designer The issuance s-/of/t s permit shall,not be construed as a guarantee that the sy tern 'll f nct on s gt�,ed.r Date o Il Inspector vC V No. 30J — --------. -----------------Fee �s :r-THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS ligpoe;al *pgtem Construction Permit Permission is hereby granted to Construct( Repa r )Upgrade(' )Abandon(4-tr— System located at e /�� af!V/: and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Conststr ctio l must be completed within three years of the date of t s p its Date:_ C1 �7, Approved by �/`. TWINS 70 Watershed Way Marstons Mills, MA 02W Plumbing & Heating 508-771-2394 SERVICE INVOICE 2005 JUL 18 PM 1 : 40 CUSTOMER ~ ADDRESS 4 ` 0�1� TOWN `� S DATE �5OJ> v/47-352V 2a�� DESCRIPTION OF WORK `5\t'4e- cp OrA ,z N <Q 3 5 SERVI srS. MATERIAL r� HELPER LABOR 900 �--• TOTAL $ RVICEMAN'S SIGNATURE I HEREBY ACKNOWLEDGE THE SATISFACTORY CO LETION '04 OF THE ABOVE DESCRIBED WORK CUSTOM 'S SIGNATURE M °FIME A °.� Town of Barnstable * sARNSTABM * Regulatory Services 9 MASS. 1639• Thomas F. Geiler,Director TFD MA't A Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 29, 2005 Mr Paul Doherty 31 Hilltop Drive Marstons Mills, MA 02648 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. The septic system owned by you located at 31 Hilltop Drive,Marstons Mills,MA was inspected on June 21 , 2005 by Patrick M. O'Connell a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has "Failed"under guidelines of 1995 TITLE 5 (310 CMR 15.00) DUE TO THE FOLLOWING: Single cesspool must be removed or abandoned. You have two years from the date of the system inspection to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE H TH DEPARTMENT t °F THE ti Town of Barnstable * BSTABLE. * Regulatory Services �p 1639. a1� Thomas F. Geiler,Director tFD MAC Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-8624644 Fax: 508-790-6304 July 19, 2005 Mr Paul Doherty 31 Hilltop Drive Marstons Mills, MA 02648 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. The septic system owned by you located at 31 Hilltop Drive,Marstons Mills,MA was inspected on June 10"', 2005 by James M. Ford, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has "Conditionally Passed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00)DUE TO THE FOLLOWING: Plumbing needs to be changed in basement; single cesspool must be removed or abandoned. You have two years from the date of the system inspection to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. %B'A�R%NSTABLE EALTH DEPARTMENT Alk COMMONWEALTH OF MASSACHUSETTS f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a d DEPARTMENT OF ENVIRONMENTAL PROTECTION See TITLE 5 OFFICIAL INSPECTION FORM—NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION G Property Address: 31 Hilltop Drive Marstons Mills MA.02648 Owner's Name: Paul Doherty n Owner's Address: Same cr,l co z~' a _ :C Date of Inspection: June 6,2005 Job#05-162 ry Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. o rr Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 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 approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The systr �::��Ht Passes �`2 .• , y _X_ Conditionally Passes RIC cGn' Needs Further Evaluation by the Local proving Authority = ' n F :co g , F,1�Q',Q' `` Inspector's Si nature. Date: June 6, 201 INSPEG�O��` 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. Notes and Comments: Kitchen sink on single cesspool,plumbing to be changed in basement to have all waste flow to cesspool with overflow.Overflow pit has 18"standing water and has never been more than half full. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page ] Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 31 Hilltop Drive Marstons Mills MA 02648 Owner: Paul Doherty Date of Inspection: June 6,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: XX _XX_ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Kitchen Plumbing to be repined to cesspool with overflow. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: 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: Title+S T--tin" 17-All VIAnn 2 Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 31 Hilltop Drive Marstons Mills MA 02648 Owner: Paul Doherty Date of Inspection: June 6,2005 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria.are triggered.A copy of the analysis must be attached to this form. 3. Other: Titles r, lncnartinn Rnrm 411 Vinon 3 Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 31 Hilltop Drive Marstons Mills MA 02648 Owner: Paul Doherty Date of Inspection: June 6,2005 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: 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 the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than %2 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 1 of a public well. _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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _No_(Yes/No)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. 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 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. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 31 Hilltop Drive Marstons Mills MA 02648 Owner: Paul Doherty Date of Inspection: June 6,2005 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: 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 part of 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 back up? _X_ _ Was the site inspected for signs of break out? _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? _X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _ _X_ Existing information.For example,a plan at the Board of Health. _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)] Tifla G incr�anfinn Fnrm�/1 i/7llrlll 5 L Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 31 Hilltop Drive Marstons Mills MA 02648 Owner: Paul Doherty Date of Inspection: June 6,2005 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no):N/A Seasonal use:(yes or no):No Water meter readings, if available(last 2 years usage(gpd)): 2003-56,000 gal.2004—56,000 gal.=153 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,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: None Source of information: owner Was system pumped as part of the inspection(yes or no): Yes If yes,volume pumped:_1000—gallons--How was quantity pumped determined? Size of cesspool Reason for pumping: Cesspool inspection. TYPE OF SYSTEM _Septic tank,distribution box,soil absorption system _X_Single cesspool _X_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: unknown Were sewage odors detected when arriving at the site(yes or no): No Titles G incnn`tinn Pn—411 ciInnn 6 Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 Hilltop Drive Marstons Mills MA 02648 Owner: Paul Doherty Date of Inspection: June 6,2005 BUILDING SEWER: XX (locate on site plan) Depth below grade: 6" Materials of construction:_X_cast iron _40 PVC other(explain): Distance from private water supply well or suction line: 20' Comments(on condition of joints, venting,evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) Depth below grade: - Material of construction: 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:- Sludge depth: - Distance from top of sludge to bottom of outlet tee or baffle: - Scum thickness: - Distance from top of scum to top of outlet tee or baffle: - Distance from bottom of scum to bottom of outlet tee or baffle:- How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP: No (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.): T41.G T.--f;n 17-411 si)nnn 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 Hilltop Drive Marstons Mills MA 02648 Owner: Paul Doherty Date of Inspection: June 6,2005 TIGHT or HOLDING TANK: No (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: No (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.): PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): T41.f incnon*inn P—4rl cionnn 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 Hilltop Drive Marstons Mills MA 02648 Owner: Paul Doherty Date of Inspection: June 6,2005 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number, dimensions: _X_overflow cesspool,number: One 6x6 block overflow pit. 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.): Observed 18"standing water with a high stain line indicating pit has never been more than half full CESSPOOLS: XX (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: One with overflow Depth—top of liquid to inlet invert: 8" Depth of solids layer: 10" Depth of scum layer: 6" Dimensions of cesspool: 6x6 Materials of construction: Block Indication of groundwater inflow(yes or no): No Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Blocks are intact,liquid level at bottom of overflow pipe Recommend annual pumping PRIVY: No (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.): T41a C Tncnonfinn Fnrm 4/1 ci,)nnn 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 Hilltop Drive Marstons Mills MA 02648 Owner: Paul Doherty Date of Inspection: June 6,2005 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. Hilltop Drive Water service 36 22 25 24 Kitchen Cesspool #31 Title i r—m 411 c/')nnn 10 Page I of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 Hilltop Drive Marstons Mills MA 02648 Owner: Paul Doherty Date of Inspection: June 6,2005 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 20 feet Please indicate(check)all methods used to determine 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) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS You must describe how you established the high ground water elevation: Abutting property is more than 20 feet lower than SAS. Town groundwater contour map shows water below el. 15 and topo map shows property above el.40. Titla S Tncnartinn Anr 4/1;/)()()A 11 l TOWN OF BARNSTABLE WY �f LOCATION M t II tota SEWAGE # T' s 'ems d� VILLAGE 1M ui') 15 ASSESSOR'S MAP & LOT Z 'S NAME&PHONE NO. a * +'C-►L (` 0—at1+2t,4l CI KE'"17-75 SEPTIC TANK CAPACITY �Co 55 no t LEACHING FACIL=: (type) QUe/r slaw/ do.6 (size) NO.OF BEDROOMS BUILDER OR ' PER ITDATE: p�� E DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility z�"~ Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by J' rF-- 3� �� .. ,. y �5 ,.., _ Z �d'®r�� 1-N-5-7-tL. �► P�S— -/�-W-1 E�� A - -D-R-E-SS— D o►TE-P_E R_Iv�1-T 1_SSU E.D — - � ,_ .. � ,. _ :., t , ; r-. ,; - r .. _ .. - _ ...... �. ., ,� .... .. r.. -�. � f` _ _. . .. _ CJ�-� -tea �.�_ O J`� __. -. . .._,,,.. rf _.. ,... _ .•�\,. . � / „ F � Ln Ln Postage $ 0 3 �!�/S Certified Fee q d� Pos Return Receipt Fee ? He M (Endorsement Required) 04 O ICJ Restricted Delivery Fee S C7 (Endorsement Required) t3 Total Postage&Fees ru M Sent To ^ a. LQ_�_ety: Street,Apt.No.: -------------------------------- or PO Box No. C3 -------- ZW5+4 N L Lt�� ---------'---e C7 City,State ZIP+4 ___________________________ :.. �. J I Certified Mail Provides: o A mailing receipt o A unique identifier for your mailpiece e o A signature upon delivery o A record of delivery kept by the Postal Service for two years Y Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail or Priority.Mail. o Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. n For an additional fee,a Retii n Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece 'Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,January 2001 (Reverse) 102595-01-M-1049 I .� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Appliration -for Biiipasal Ourko Cnongtrurtion Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal jl"1 S.. a =�� - JI `/,�' G�✓ !/7- ....---o.L c No.'------••--•---•--•------.,...-----•----- l� at - ress ) r o _. •-- . .. ..... --•- ... ....................................................•.....................-_....._.._............. _ caner Address Installer //��i Address Type of Building Size Lot_____ ______________________Sq. feet U Dwelling—No. of Bedrooms___________________________________________Expansion Attic ( ) Garbage Grinder ( ) Other—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_-_-_._____gallons Length---------------- Width.--_-----._.-_ Diameter-------.------_ Deptli-------------- - x Disposal Trench—No. .................... Width------------------.. Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet------------........ Total leaching area------------------sq. it. z Othe',V,Pistribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------- ----------------------------------•---•---------------•-------•- Date--------------------------------------- ,a Test Pit No. 1----------------minutes per inch Depth of Test Pit..------------------ Depth to ground water.----------- f� Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water...---------------- ---------------------------------------------------------------------------------------------------- .................................................................................................... ODescription of Soil-------- --------------•---------••-------•-•• ------•----------•------------•---------------------------------------------•----- ----------------.-----•--------------- x U W --------------------=----------------------------------------------•---•---•----------•-----•--•-----------------------------------------------------------•------- •-----------•-•----••--.--- ----- VNature of Repairs pr,Alterations-Answer w en applicable-------- _ ________i____a..____-_Ar.------------------------------- _ ---._.. Agreement The undersigned agrees to. install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI.of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of-Compliance has b _n issued b the board of heal h Signed- '; — ----— 4-60--kcr;- ----------- at Application Approved BY---'•,� --------•.. •- - - --•-.. ---� n------ Date Application Disapproved for the following reasons-------------------------•-••----•-• -- ----•--•------------------------------------•--------------------------- --•-----•-------------------------------••-------- ------------------•-----------------------------------------------•-----------•-------------------------•---------•--------_-----.--------------- Date Permit No......................................................... Issued_� - .._a__..�''..... . ...... ..... Finc............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................................ Appliration -for IN-4pasal Marks Tonstrurtion Vrrmit Application is hereby made fora Permit to Construct or Repair an Individual Sewage Disposal sy 7r_ .......... .... --------------------------------------- ---------------------------- cat or'Lot-R--------------------------------------- C�............ . ....... ... ................................................................................................. 1?1. 04 Address . In ........ si.. ------- .... .............. ................................i................................................................ taile; Address U Type of Building §;!z_e__-L-ot...........................Sq. feet Dwelling—No. of Bedrooms______________________________________ .,"--Expansion Aitliz_( Garbage Grinder Other—Type of Building ---------------------------- No. of persons.-____-_____-__-__-. --- Showers Cafeteria Otherfixtures -------------------------------------------------------------- ---------------------------------------------------�111111-----------------------_---- Design Flow.........................----------------gallons per person per day.`�Total daily-flow......................�1------- ---------gallons. WSeptic Tank—Liquid capacity......:__...gallons Length................ Width_..__..-_. __--.Diameter_.___ -------- Depth. .._._____-... x Disposal Trench—No.----------- Width ............. , `, al Length---------------------....... Tot Total leaching area--------------------sq. f t. Seepage Pit No_____________________ Diameter..._.__._:......... Depth below inlet.....................Total leaching area------------------$(I. ft. Other Distribution box Dosing, tank Percolation Test Results Performed by ...............................;L................................. Date--------------------------- ----------- ,a Test Pit No. 1................minutes per inch Del5th.oV.Test Pit.:........_____.... Depth to ground water------- ---------------- f� Test Pit No. 2----------------minutes per inch Depth.of Test Pit.................... Depth to ground water........________-______- .............................................................................................................................................................. 0 Description of Soil..................................................................=,:-------------- ---------------------------------------------------------------------------------- U ....................................................................................................................................................................--------------------------------------- ---------- ------------------------------ ---------------------------------------------------------------------------------------------------W--------------------------- ----------- -- U Nature of Repairtw Alteratw&�_�_nswer 7hen appjicable---------------- ------ ----------------------- .... . ------------------------- ------ ...... - ----- ------ ---;Z_ d-- --------- - --------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with, the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has �Qei ued the board of healilat P 7 Signed. ........ -----74j Date Application Approved By---e .... ---- - ---- ----- Date ---------- ---17Y Application Disapproved for the followin'Neasons:-----*.......................... .. ........... .................................w-------------- ................................................................................. ....................................................................................................................... Date. PermitNo.-----:----'------•-----'----------•---••--------• issU'k......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH 104-t-02-V..............OF... .. ........... f TH CE IF hat t e �iv'dual age Disposal System constructed or %S TP Repaired .. .............. .. ...... b,y..!. ------------- ...... .stalle" V at------ ... -------------- - - ------- --- ------- has been installed in accordance with the provisions of Article XI f he�tate Sanitary d the application for Disposal Works Construction Permit No----------a-Z"_J-------------- dated...... ........;;� ....... THE ISSUANCE OF THI� CERTIFICATE SHALL NOT BE CONSTRU D-A4 A GUAR EE T YAT THE SYSTEM WILL TION/SATU5FACTORY. DATE_`__. ... .. .... ................ Inspector-------- .. .................................... ..................... :77 -------- THE COMMONWEALTH OF MASSACHUSETTS V BOARDV9F HEALTH ......OF .........................%....................................... ............ Na`;........ ...... FEE.Z. Bi-spnii ' lForkalf-a"' rur iaa err Permission is hereby gr a XrU e ..... ....... ... .. ... ....... ..... .... ....................... to Co r t R or Individual Sewage Dis al y t atNo.... .... . .... ... ... ........... .. .... - ---- --- ....................................... -- ---- ..... tre as shown on the Application for Disposal Works Construction ...it N .... .... .....Aed......................................... . . ....... .. .... .. ..oard of Health ,,DATE.....-•Xloz ..................................... FORM 1255 HOBBS & WARREN."INC.. PUBLISHERS