Loading...
HomeMy WebLinkAbout0166 HOLLIDGE HILL LANE - Health f 56 HollI i Hill - Marstons Mills A= 081 007 erer UPC 12L343No. 531-Y HASTINGS, PAN a� S (° w4r d' I ,rr i f .� a s�9U�wGGs a �0% a l - TOWN OF BARNSTABLE J,OCATION —1-YO hJ 2-&•Ck---q. SEWAGE# VILLAGE „ 1 i6W //klJtj ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. O " SEPTIC TANK CAPACITY U "� r-- LEACHING FACILITY:(type) (size) NO.OF BEDROOMS } OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist 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 �b(o s O Jr zz i v d' J TOWN OF BARNSTABLE LOCATION 1/�-6 �LAb&gg .ALL- Lm: SEWAGE# J-0IS-- 0-3 VILLAGE , ,bj,lf 4tL4P ASSESSOR'S MAP&PARCEL 91- 007- 00� INSTALLER'S NAME&PHONE NO. C. f. '. -1-7r -q Tat, SEPTIC TANK CAPACITY CK�_C,1t. LEACHING FACILITY:(type) QC -t 1 tom. (size) NO.OF BEDROOMS A =tZGc.Gte gt_t3"L_ OWNER i�t St c... 4VI3 mac-l� -►� 1 Akb V Ltd �eAL$4` PERMIT DATE: COMPLIANCE DATE: t Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Y � rz, z? .v-o /yjv.As- va tv r+: 00 (,gyp (/ c 0 �35i-Ov Chew �r`v►e �� 4 / No.�/ 6 Fee THE COMMONWEALTH'OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Vsposal 6pst>em Construction Permit Application for a Permit to Construct(<Repair( ) Upgrade( ) Abandon(<*"❑Complete System Individual Components Location Address or Lot No. /� li o Se 4'ie Owner's Name,Address,and Tel.No. ,vt a r 54,-A S /�'1.`l!S Assessor's Map/Parcel ( P.rc-e oo7A( R v 55-e Ins ller's Name Address,and Tel.No. Designer's Name Address and Tel.No VUA=m W� C_Ail lv` 7'71 — ,Su(l owil Name, fCaA5,,14.n5 J;nC. giny 39 sod-Y - Y Type of Building: AC S F Dwelling No.of Bedrooms Lot Size 2,5G ///973 sq.ft. Garbage Grinder( ) Other Type of Building S'F7b t 6a r No.of Persons A Showers( ) Cafeteria( ) Other Fixtures t a� �ti t v/o*ce Design Flow(min.required) 33o gpd Design flow provided `33 gpd Plan Date Vn Q Z 7 l — Number of sheets Revision Date Title $ { mot 'P.-WeSeW Size of Septic Tank J5'1( S(y 0 6Q/(0j Type of S.A.S. 4e,,c C ?C 6 Z �d Soo�L Q Description of Soil 1l/` R S Per S w-`C Nature of Repairs or Alterations(Answer when applicable)62 `fTlOOe •� t�, �,'st e Q / l Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental C &and n f to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. ed Date / Application Approved by Date Jr" Application Disapproved by Date for the following reasons Permit No. ���J / Date Issued VIP— No.C90/ Fee So THE COMMONWCALTWOF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF'BARNSTABLE, MASSACHUSETTS YeS 2ppliLatlon for Disposal 6pstpm Construction permit Application for a Permit to Construct(-j Repair( ) Upgrade( ) Abandon(-<❑Complete System .Individual Components Location Address or Lot No. 1�6 ff a 16'oS e 6(. Q't P Owner's Name,Address,and Tel.No. » Assessor's Map/Parcel ( A-rC c( ac,� c,( le U SS e�f Installer's Name,Address,and Tel.No. 7-7 1 _ Designer's Name,Address,and Tel No U/%=m W u� a7 S ull,'✓qn (- n m '' ee r33 ; �J�1 vQ f S Type of Building: Dwelling No.of Bedrooms Lot Size Z 5 4 I//s/3 sq.ft. Garbage Grinder P Other Type of Building S FT) No.of Persons Showers( ) Cafeteria( •) Other Fixtures / S F O t 1 'Orw o - 6,rG r e W�a��'�e A�i01,e- Design Flow(min.required) 330 gpd Design flow provided 33 O gpd ~ � Plan Date 77 q,./ 5-,_ Number of sheets Revision Date T Title e VS ev _ Size of Septic G Tank C- X G eG 0� Type of S.A.S Z P, C /?'{ 6 X 1ri h.�Z w 5-40 Description of Soil 1l/`/ G S �Pr S•�>< 2ti s,p rC� 'a.� •a Nature of Repairs or Alterations(Answer when applicable) _777w P L, 'c 7G 2e ti,c.',e,. ✓ Date last inspected: Agreement: I 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 n fto place the system in operation until a Certificate of Compliance has been issued by this Board of Health. �iKed Date 7 — Application Approved by Date Application Disapproved by $ Date for the following reasons Permit No. /S G► Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS `� r•2 '� BARNSTABLE,MASSACHUSETTS N tw Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by 3 d h.:� o�, Cti N at (�(oir / j�(� �q h has been constructed in accordance �r with the provisions of Title 5 and the for Disposal System Construction Permit No S-/�3 dated 6/�5 Installer Designer Sv1 Zdze-14 efl'-'n (/O ,SL #bedrooms pd, Approved design flovA ►V ✓ ✓gpd The issuance o this permit shall not be construed as a guarantee that the system will i�as designed. n e Date t Inspector ! 1 i No. � I S I 3 Fee 1� d THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Vsposal *pstem Construction i3Prmit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at 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. i Provided:Construction must b/co 'lleted within three years of the date of t i12 s permit. Date �P / Approve • t Bedroom #3 Closet Bath Room Bedroom #4 Bath Room I ' Second Floor Russel Floor Plans Page 2 of 2 M Living Room Bedroom #1 l Family Room Kitchen Unfinished Basement Dining Room Bedroom #2 First Floor Basement Floor Russel Floor Plans Page 1 of 2 LIGHT AND VENTII 1• 1■ 1• - 4 3'-71. UNIT LIGH 3-7 5-72 2-02 5-62 9-6 2 11 11 SKY LIGHT 5.4E 6'"�11 8'-�I° 9'-40 6"52 2446 7.5C Ilk 2446 7.5C 2° 12'- 2' TOTAL 20.z 2446 2446 2446 r------- ------ II II II II II II II II II II II II II II 2/4-6/8 I 0 I I j l to II II II II II II I � 00 I \ o co I N cn F===I 2. , �2° i t t o L I t o I0 _ I I0 o u1 -- - 1- - -I I I I I N L- -J ------- -------------------- - -----SITTING--------- OFFICE N h AREA 221 SF L=17.7 V=8.8 AREA 248SF L=19.8 V=9.9 3'-8° 00 co co (o ro (D c\o I I I \ I I I 0 N N N O N N N ——————————————— ——————————————————— --�--------- ————————————— N H U EYSTEM TYP HDU SYSTEM (3) HDU2—SDS2.5 TYPICAL -- . JUL-20-2015 23:29 From: To:15087906304 Pa9e:2/2 I • `Town,af;Ba>taistebte - ' I Re ulatoxy.Services 1 t '; r )�icl1'ard`\':tinau;Ilif!;�±Direalsr' .. ��,.w,wc• Pgbtic"i{��t1�'f11VEblgn I E TIio11�:iticK�ao,direethe• .. .2s]II,A1>e[n�streef:,tlfpanlS:pi�Od601,. + ' :QEilcr.,'SO$-86Z:bbW. �.SQBrT�103: . .• tulle i ,Cerfi ilon.Forli+ - patc:,]�zf� SeastgePeru�itp•. ���.Ai9�s6N8AlaplPorecl �.��: t. . • Deslglier � .�a'. .:p'..•.. Iuslauer:''�)("� y i4f'. aderess:; �s�•�<. LR ; P0. '_ - . YF�d[Y�: C] ._. � ` �, qas is3tll`4,a povit tp:ih all a # ' 'Ltlul' e9i druive b` t scpsit:�atclgat.j�te l liuscG'oii,iid :m. Y css),• ITS � (. lr4"rnett, _datedItS i E.cerhiytllat•the:triltie syytCm'rCflsQiCCd ebnve,.was.i>13taH�d: ane01ly uceoidl' 'tu: j 1. 'the.dcsil�;?wliic1i;1110y indlluiC Iluimrtippinid!'eharlgeg suehas labia!IelomliWi;othe di�n�uuoabuxshdipi,seplie t9ak::5 '0 (if ieguired)ivas.11t5P ed'md ilie:soils I ' a_erc friiu�•'shlipfactoiy: ,. . - 'Qja' t y�esli'r3f�trocoA etibve.was in9d911o3�!ilh; p[,ehantpes'(i a. 1 =i caitil)r put ua vettirstii3otigni•atiy,complaient cr tbun l O'letia»t reloeaiinn' thg`SAS'l+� or 8 yy LocaE RCgulntiei+s Pi�o.i+m�sion• + y of the ptic'sysfcn?);liat,ili'aecosdi+r�kith State dt wa5... ed and tlte'YOT- C(Yjified��uill.by,'dts$fieitofiilkiw Siripwf(i tegiu!e<I?,,:.. ! !..,.. .., i , '-.j o:xtiry;;ti,' �u'm'�pr►xc?wcd'nbvye:!'k�e dia3fn�...... . � — — itir vil tktp t • '•(• to !t 9.IgM1tlKC�.. � 'fi.'.i+�;`J.I.iQ' .'. 3 •, . tir ri�•At2r . •.OF,.0 \i•L C.{•� G^N .1.`t � TA els .D V.titl):. . . Q:1S �sie�Q•,CiififipNboFaig4eF�F14u.Ax': T w TOWN OF BARNSTABLE L:OCA_TION _l y` -&"66�#ZZ L'¢ SEWAGE# VILLAGE R r�f ASSESSOR'S MAP&PARCELf , INSTALLERS NAME&PHONE NO. 19,44 SEPTIC TANK CAPACITY /SOD LEACHING FACILITY: t � (type) ���� size���' c � ) �3x��c�. NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist 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 a (J SOX VIVA 00 �.r �d No.. Fee ��r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes RppliCation for 3Digp0$a1 6psStem QCon5trUCtton Vermtt Application for a Permit to Constru pgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. l�c );�h r(L �s Owner's Name,Address,and Tel.No. � ,1�Ae6 Assessor'sMap/Pazcel �/� �y.� !v9 jl(s' �(�S Installer's Name,Address,and Tel.No. ' `01Y `�r� Designer's Name,Address and Tel.No. o� 712&V CIA MR 0VS 01141 #M PO q91 Type of Building: Dwelling No.of Bedrooms 40tf Lot Size .�, sq.ft. Garbage Grinder ( ) Other Type of Building _ No.of Persons Showers{ ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided al�� gpd Plan Date 73G'-o7 Number of sheets Revision Date Title Size of Septic Tank ®O Type of S.A.S. 12 — 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 Environ a ode an of to place the system in operation until a Certificate of Compliance has been issued by this Bo o ealth Signed Date —.2—o7 Application Approved by —^ Date 8 ^3`0:7 Application Disapproved by: Date for the following reasons Permit No. 900 ®° 3A Date Issued 5"a —— __—_—— —_------ jVanEngineeringSull Consulting,Inca Chuck Rowland chuck@sullivanengin.com (508)428.3344 • w.ww.sullivanengin.com P.O. Box 659, 7 Parker Road, Osterville, MA 02655 fi `f � r A, No.. / v Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN,,OF BARNSTABLE, MASSACHUSETTS Yes 01ppYication for 33f5po!,gal *p5tet Con.5tructiou .permit Application for a Permit to Construe ( epair( Upgrade O Abandon O ❑ stem Complete Sy stem y ❑Individual Components Location Address or Lot No. ' I�HQ M[ yl�[ � Owner's Name,Address,and Tel.No. 6111* 7 ,Of_S T�{�9N4 AWAssessor's Map/Parcel �/CYl�Gt` i� l,,t! Installer's Name,Address,and Tel.No. !Vr` Designer's Name,Address and Tel.No. A&W ao 7,gft6 c/R Type of Building: j t .• Dwelling No.of Bedrooms Lot Size . sq.ft. 'Garbage Grinder Other Type of Building No.of Persons Showe s.(,' )J Cafeteria(/ Other Fixtures Design Flow(min.required) gpd Design flow piovided � gpd Plan Date 7-3,a_/7 Number of sheets Revision Date Title <� Size of Septic Tank �`SoQ Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: ' t 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 .ode and of to place the system in operation until a Certificate of Compliance has been issued by this Boa of ealth. Signed r++: i Date -,2 07 Application Approved by Date )p "3-2:Z Application Disapproved by: Date for the following reasons Permit No. a 00 /" 33-A Date Issued — 3—d --------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS / Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired Upgraded ( ) Abandoned( )by 8)gAX/�`YO'r 4 4�_ at e Ab I44KX'///LG LA. K 1-6&.5M&a6een constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Ov7 33.6 dated installer �7�/ll/�ll`�dG Designer #bedrooms 3 z_may Approved design flow e^ gpd The issuance of this permit shall not be •onstrue o as a guarantee that the system 11 funetii n as designed. ! � ����n� 0& Date - Inspector ------ Fee -- --- /00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS wi5po!gal *patent Con5tructiou. Permit Permission is hereby granted to Construct ( ) Repair ( V)� Upgrade ( ) Abandon ( ) System located at /� `4 /1?Ay�T�IIi3- M/Z/ and as described in the above Application for Disposal System Construction Permit.The applicant recognizeOs/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this_4� c - / Date Approved by O�� IGT��, � � � fGl ���, ',� � �� i 4 Z Miorandi, Donna From: Schlegel, Frank Sent: Thursday, August 16, 2007 11:57 AM To: Miorandi, Donna Subject: RE: Map and Parcel Hi Donna, This is a subdivision of Map 081 Parcel 007 which# 166 was pre-existing as a multiple address on this parcel. The new parcel as a result of the subdivision will be Map 081 Parcel 007.001 for Dev Lot#2, # 166 Hollidge Hill Lane, M.Mills. Frank -----Original Message----- From: Miorandi, Donna Sent: Wednesday,August 15,2007 4:06 PM To: Schlegel, Frank Subject: Map and Parcel Frank, Do you have a map and parcel for 166 Hollidge Hill Lane, Marstons Mills? Thanks! Donna 1 i r Town of Barnstable Regulatory Services .�. Thomas F. Geiler, Director • aexxsres�,E, Arm s, ' Public Health Division Thomas McKean, Director - — 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer s aller & Designer Certification Form Date: Sewage Permit# `'" Assessor's Nlap\Parcel_b L—x�—M Designer: DNWO Iq t elyl' Installer: Address: PO EN W Address: 20 7962520 C�K- ,0zM On 87/5'07 A04/1/ (�� was issued a permit to install a (date) (installer) septic system at �lO �� ' based on a desian drawn by (address) y L 1",�' dated (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. 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 vertica n of any component of the septic system) but in accordance with State & Lo1q-. Plan revision or certified as-built by designer to follow. No. 1140 (Installer's • re� CISTEEz G (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: Heaith/Septic/Designer Certification Form 3=264!doc Commonwealth of Massachuso is Title 6 Official Inspection Form � r Subsurface Se Wage Disposal System Form -Not for Voluntary Assessments 166 Hollidge Hill Rd. (Front System .._ Property Address DE ST'EFANO CHARLES Owner Owner's Name Information is Marstolns Mills MA 02648 . 4/11/14 requited for every � ..eoa _. - . ...�.. .page. CityfTown State Zip Code. Date of inspection Inspection results must be submitted on this.form.Inspection forms may not be altered to any way. Please see completeness checklist at the end of the farm. Important:when A. Genera Information filling out forms on the.computer, use only the tab 1. Inspector. key to move your cursor do not Robert Paolini use the return Awe key Name of Inspector Robert Raolini Septic Service company Name company Address Yarmouthport AMA 02675 City/Town state Zip Code 508 362-3555 S14454 Telephone Number License Number w B. Certification. I certify that I have personally inspected the sewage disposal system atthis 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 experienc a in the proper function and maintenance of on site sewage disposal systems.. t am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 WR 15.000).The system. .0 Passes 0 Conditionally Passes 0 Fans El Needs Further Evaluati n by the Local Approving Authority 41'1 1L14 Inspecto s' a Elate 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 DER 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 systern will pet foirm in the.future under: the same or different conditions of use. 15ms-W13 Tdo Sot W bmpotWn Farm:Suburftce sewooe or sS*swm P»¢e t 17. Commonwealth of MassachOsetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 166 Ho!!id a Hill Rd. Front S stem . . . _._Y �......_... w_._..__ _ ......... Property Address. DE STEFANO,CHARLES�F.� �_ � _u Owner Owner's Name Information is Marstons Mills MA 02648 4/11/14 required for every ._. � _ _.:._�m,_ ....,.�,...,,.._��_._. page. CityfTow n 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. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Robert Paolinl use the return _ .. .� _ —_.__ .... key. Name of Inspector Robert Paolini Se tic Service Company Name 17 Plground Lane Company-Address __..... Yarmout4po MA 02675 w_ cityfrowrn state zip code 508.362_-3655 S14454 �. ... Telephone Number Uoense 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 ezperiehce in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system Inspector pursuant to Section 16.340 of Title S(310 CMR 16.000).The system; Lasses ❑ Conditionally Passes ❑ Fails ❑ Needs.Further Evaluation by the Local Approving.Authority 4/11/14 . .._ . Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. if the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should.be sent to the system owner and copies sent to the buyer,.if applicable, and the approving authority. ""This report only describes conditions at the time of Inspection and under the conditions of use at that time.This inspection does not address how.the system will.perform in the future under the same or different conditions of use. tsins 3113 r►le 6 Ofiidal Inspection Form:subsurfam Sewage Aispoasi system•Pie t of 17 I Commonwealth of Massachusetts =u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ` 166 Hoilidge Hill Rd. (FrontSvstem) Property Address Owner's dame O,.CHARLES F Owner ,.. _ _._ ®.ee. �._ information is required for every �Marstons Mills .MA ........... 02548 4...-- page. CRY/Town state Zip Code Date of inspection B. Certification (cunt.) Inspection Summary:Check A.8,C,D or E I 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: ❑ one or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Check the box for"yes","no"or"not determined"(Y,N, ND)for the following statements. if"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiitration 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. D Y ❑ N ❑ ND(Explain below): 15ins•3t13 Tits 5 offtaat trmpedion Fom Subsurface Sewage Disposer System-Page 2 of 17 Commonwealth of Massachusetf Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '1.66 Holiidge Hill wRd. Fro.System-..�.��� �_.......� Property Address DE TEFANo CljARLE F .... � Owner Owner's,Name information is Marstons Mills MA 02648__ 4111114 _ required for every - n-- . _ _ _ _. page. CitylTowrn State Zip Code Date of inspettion - Q. 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(coat.): 0 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 pipes)are replaced ❑ Y ❑ N ❑ ND(Explain below): obstruction is removed ❑ Y ❑ N ❑ NQ(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 to 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 tsfns, /13 T+t1Q s oWai ktsj�n S Fwm:Subswface Sewage Disposalystent•Paid 3 of 17 Commonwealth of Massachusetts Tale 5 official Inspection Form Subsurface Sewage Disposal System,Form-Not for Voluntary Assessments .° 166 Hollidge Hill Rd. Front Property Address DE STEFANQ,,,CNARt ES F............_.___owner Owner's Name information is 02 4/11t14 required for every Marstons Mills MA 648_..�._.�__._ ......._.._._�___.�_._. _�... ... ._.�_ _..._ page. City/Town state Zip Code Date of inspedion .B. Certification (coat.) 2. System will fail unless the Board of Wealth(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: ._. _..... .___. _._..._............... w....... _� 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 ElLiquid depth in cesspool is less than 6"below invert or available volume is less than%day flow t5ins•3113 TWa 5 Oifidal hspeftn Fonm Subwgfa.a Sewage DiSPOW.SyetM Page 4 d 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 166 Hull dge Hill Rd.((Front Systems Property Address DO STEFANO,GH RiLES F�_ .___a ._........ ...................� ...... . Owner Owner's Name information is Mastons Mills 02Mmm 4/11/14 regWredforevery page. _._ � _.... ._ Cityfown state Zip code [fate of Inspection B. Certification (cant.) 'Yes No o Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipes). Number of times pumped; Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 9 Any portion of cesspool or privy is within 1.00 feet of a surface water supply or tributary to a surface water supply. ® Any portion of a cesspool or privy is within a Zone i of a public.well. S Any portion of a cesspool or privy is within 50 feet of a private water supply well. ri ® 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- 10,00090d. ❑ The system falls.I have determined that one or more of the above failure criteria exist as described in 310 CMR 1.5.303,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 0 ❑ 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 o the system is located in a nitrogen sensitive area{Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 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. Tft 5 Oftal inspectim F um:.S03K ifaW Sewage D`apusa!System-Peke 5 of 17 15ins 3113 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 166 Hollid a Milt Rd Front S stem �.._. Y Property Address DE STE[ ANO MARLES..F_ Owner owners Mama information is Marstons Mills MA 02648_� 4/11/14 required for every _ _ page. cityfrown _._,. _ State Zip Code Date of tnspedion C. Checklist Check if the following have been done.You must indicate"yes"or"nog 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 0 this inspection? ❑ Were as built plans of the system obtained and examined?(if they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage backup? ® ❑ Was the site inspected for signs of break out? ❑ Were all system components,excluding the SAS, located on site? ® E] Were the septic tank manholes uncovered,opened,and the interior of the tank inspected forthe condition of the baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge and depth of scum? ❑ . Was the facility owner(and occupants if different from owner)provided with information on the proper imaintenance'of subsurface.sewage disposal systems? The size and location of the Soll.Abssorption System(SAS)on the site has been determined based on: Existing information. For example, a plan at the Beard of Health. ❑ Determined in the field(if any.of the failure criteria related to Part C is at issue approximation of distance is unacceptable)131.0 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(actual): 4 Number of bedrooms(design): �-�-� - ( ) __�_.. . DESIGN flow based on 310.CMR 15.203(for example: 110 0 330 x#of bedrooms): r..---_ Tid t5ins-3113 e s ofrrdw inspedion form:S&uAace Sewage OLVOsst System•Pap 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Farm 'Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ` 166 Hollidge Hill Rd. (Front System) _ Property Address DE STEFANO, CHARLES F Owner owner's Name infortrlation is Marstons Mills MA 02648 4/11/94 required for every ..._...�. _ .. _ _....... page. C' (Town State Zip.Code Date of Inspectiton Q. System Information Description: d Number of current residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system?(include laundry system inspection ❑ Yes Na information in this report.) Laundry system inspected? ® Yes F1 No Seasonal use? ❑ Yes ® No na Water meter readings,if available(last 2 years usage(gpd)): -- Detail: Sump pump? ❑ Yes 0 No. NA Last date of occupancy: __: .. .... Date Commerciaitindustrial Flow Conditions: Type of Estaiblishment: ,,.... . ._ _... Design flow.(based on 310 CMR-9 5.203): Gallons per day tgpda _._ .w Basis of design flow(seats/personstsq ft.,etc.): .w-.�.� --. 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: µ "...�. t5ins•3M 3 Tide 5 official h*eciiDn Fomr.Subswfaw Sewage Disposal System•Pap 7 of 17. I Commonwealth of Massachusetts Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form Not for Voluntary Assessments 166 Hollidc Hi0_Rd (Front ... Property Address DE STEFANO GMARLE S F Owner owner's Name infrequired is Marstons Mills MA 02648 _ 4111114 required#or every ..�__,.. ._ � �� page. cit /Trt awn _ state Zip code __Date of lnspechon D. System Information (cunt.) Last date of occupancy/use: gate �.... ..... . Other(describe below): General Information Pumping Records: Source ofinformation:Was system pumped as part of the inspection? ❑ Yes 0 No If yes,volume pumped: D illons 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) ❑ InnovativetAiternative 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 11A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP"approval. ❑ Other(describe): t5irse•3/1 3 TWO 5 offidal Mspecuon Form Subsurface Sewage pieposat System.Pop 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Farm Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments 16Ei Nollid a Hill Rd pront S _... _m. ......_... ��.y........ } Property address _ .___ ,. _� .��_ . _.. ., DE ST FANO,CHARLES F Owner Owner's Name required for every information ie Marstons.Mills __.._.._ _ _. MA 02648 4/11/14 page. Cityrrown State Zip Code Grate of Insp!!dion D. System information (cone) Approximate age of all components,date installed(if known)and source of information:. Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): Depth below grade: "..— feet Material of construction: ❑cast iron Z 40 PVC ❑other(explain): Distance from private water supply well or suction line: 1 �} t01 a __ eet Comments(on condition of joints,venting, evidence of leakage,etc.): Ja>nts appear ight.,qc evidence of leakage System vented through the building Mvents � � m Septic Tank(locate.on site plan): Depth below grade: 21 _ 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) n Yes ❑ No Dimensions: 150021. Sludge depth: 311 1�i..W13 Title 5 Official inspecfion Form Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachuseft Title 5 Official Inspection Form e Subsurface Sewage Disposal system Form-Not for Voluntary Assessments 166 Hollidge Hill Rd. (Front Systems .....___..... _ _..--. _.... ......... Property Address DE STFFANO-CHARLES F. _ ...... Owner Ownees Name information is arstons M Mills MA 02648m._ 4/11/1�4 required for every - __ _......_ page. C' ttowfi State Zip Code Date of Inspection tion D. System information (cunt.) Septic Tank(corn.) 33" 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 12" Distance from bottom of scum to bottom of outlet tee or bale -�-- Measured _ How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage.,etc.): Pump tank every 2 years.Iniet and outlet tees are in place,No evidence of leakageTank appears structurafl�_sound. . Grease Trap(locate on site plan). Depth below grade: feet Material of construction: 0 concrete El meta. ❑fiberglass Q 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 T"jfe 5 offitw k4pearon Form:Subsurface Sewage UISPOW SYStOm•:Page 10 of 17 15ins•3if 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 166 Hollid eHill Rd. Front 5 stern _ _.. Property Address DE STEFANO CMARLES owner Owner's game information is Marstons Mills MA 02648 4t11/14 required for every page. Cityfrown state Zip Code Date of tnsped:on D. System Information (cunt.) 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 Q concrete ❑metal [l fiberglass 0 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: Daze Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). is copy attached? 0 Yes [] No Title 5 o[rteiat k%pection Foam:Sulu 60W Sewage DispOsat SysteM•Fage 11 Of.17 t5ins•3113 Commonwealth of Massachusetts Title 5 Official Inspection Form _T Subsurface Sewage Disposal System Form•Not for Voluntary Assessments 166 Hollid a Hill Rd. Front System) n_ _y _ Property Address DE STEFANO,CHARLES F Owner Owner's Name ... information is Marstans Mills .. �. ._.._.._ _ A . 02648 .4111114 ... required for every µ —_ _. page. Cityfrown State Zip Code Date of inspec tiion .D System Information (cons) Distribution Sox(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert No 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.): Box is level.Box has two outlet lateral.No evidence of solids carryover.No evidence of leakage. Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes d Ne Alarms in working order: n Yes E3 o* Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order;system is a conditional pass. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Tt%5 Ofr W Umpeelm Farm:Su fif=6 SeWags DisPWW System•Pegs 120117 Commonwealth of Massachusetts Title 5 Offic I Inspectia►n farm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1e66 Holiid a Hill Rd. Front�„stem ._ .,.r�.._...... .... Property Address DE STEFANO, CHARL,ES�F..__._.__._... . ......._ � . _._ ........._...m._............ � Owner Owner's Warne information is Marstons Mills MA 02648 4/11/14 required for every _. page. ci frown State Zip Code Date of Inspection p. system information (coat.) Type: leaching pits number. —........._�-_ leaching chambers number 2 ❑ leaching galleries number: - M M— ❑ leaching trenches number, length: _ ._.. w._. .., . leaching fields number, dimensions: El overflow cesspool number. Q innovative/alternative system Type/name of technology: i Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.)* Sar1 soli No signs of hydraulic failure. Le.achinci Chambers were dry at tlme_Qf 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 �a_:.��__,.,,�.__.............._..._.�,.__....�.. � Dimensions of cesspool _..,._._m...�._.�...�..�._.._ _..___.__. Materials of construction Indication of groundwater inflow ❑ Yes ❑ No. t5irrs 3(13 pile 8 offidat,thspedw form:Subsurrace Sewage E?LVw9l System Page 13 of 17 Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form=Not for Voluntary Assessments _w 166 Mollidge Hill Rd._(Fro tem}nt Sys _....... Property Address _ DE STEF_ ANO CHARLES F ..... Owner _ �._ _......._.___�. information is Owner's(dame required for every Marston Mills _._,._�_ �w. _... MA 02648 4111/14 _ page. CitylTo}an state Zip Code Date of inspes on _ D. System Information (cunt.) Comments mote condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: .µ,......._.... ..... _V... ....__.»................ .__ �.._._._.._.. Dimensions Depth of solids _._._a_ _ ___ ................ _ Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): t5ins•3113 Two 5 OfridW VapeCOM Form Submiaos Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts . E . Title 5 Official Inspect on Form Wm Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments 166 Hollidge Hill Rd. {Front System} _ _... Property Address DE STEFANO, CHARLES F Owner information is Owner s Name required for every Marstons Mips MA 02648 4/11114 page. city/Town State Zip Code Date of insp ogion 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: [Q hand-sketch in the area below El drawing attached separately t6im•W Tdie 5 Ofltcial irr 4mwn form:Subsurrace Sewage Disposal System•'Rage 15 of 17 Commonwealth of Massachusetts Title. 5 Official Inspect on porn Subsurface Sewage Disposal System Form.•Not for Voluntary Assessments 166 Hollidge Hill Front ystem „T Property Address __..... ._ DE STEFANO CHARLES F __......._.__. Owner . Owners Name information Marstons Mills MA 02648 4111/14 required for every . ..___._ .. page, cityt Own State Zip Code gate of Inspection D. System Information (cunt.) Site Exam: Check Slope Surface water Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of leaching 10 a_ . feet Please indicate all methods used to detennine the high ground water elevation ❑ Obtained from system design plans on record If checked,date of design plan reviewed. -- pate Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: As-Built ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you.established the high ground water elevation: USED:USGS observation well data.USED:Technical bulletin 92-0001 annual ranges of groundwater elevations. Before filing this Inspection Report,please see Report.Completeness Checklist on next page. t5.ins.•3M3 Tithe 5 Qkt 631 hwPedion FOW SubvO(SM$GWaP rliSPWW SY M`Page 16 0 1.7 Commonwealth of Massachusetts Title 5 Official Inspecton Dorm Subsurface Sewage disposal System Form-Not for Voluntary Assessments 166 Hollidga Hill Rd (Front System} _.. . _ .. .w,_r..... ��..... . . ..__. Property Address DE STEFANO,CHARLES F Owner information is owner's Name required for every Marrstons Mills MA,._..._._ r02648 4111/14 page. Cityfrown state Zip Code Date of lnspe0ion E. Report.Completeness Checklist Z 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 fife (Sins•W 3 Titta 5 MOW W4=fion Form.Subwrfa a Sewage sposW SysWn Page 17 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Farm subsurface Sewage Disposal System Form-Not for Voluntary Assessments 166 Hollidge Hill Rd. Back stem Property Andress DE STEFANO.CHARLES F _.._ -Owner Owner's Name information is Marstons Mills ... :NIA 02648 4111114 required for every _ . _. page. CitytTown 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. Important:When Q. General Information filling out forms on the computer, use only the tab 1. inspector key to move your cursor-do not Robert Paolini use the return key. Name of Inspector Robert Paolini Septic Service Company Name 17"a lqund Lane Company Address Yarrno_.uthport _ 02675 Cityrrown State Zip Code 508 362-3555 -- _. ._ S14454 .: Telephone Number License Number �L 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 aim a DEP approved system inspector pursuant. Section.15.340 of Title 6(310 CMR 16 000).The system: - Passes ❑ Conditionally.Passes ❑ Fails 0 Needs Further Evaluation by the Local Approving Authority 4t11114 Inspector's Signature Date The system,inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within.30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should:be sent to the system owner and copies sent to the buyer,.if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under.the conditions of use at that time.This inspection does not address how the system will perform.in the future under the same or different conditions of use. tsins•3113 rate s omaw hspscton Fow Subswfm Sewage D40sel SY m.-PaW 1 of 17 I Commonwealth of Massachusetts Title 5 official Inspection Form 'Subsurface Sewage Disposal System Form Not for Voluntary Assessments 166 Hollidge Hill„rRd (Back System) . .. , ..... _... m. _ _.... ............. 'Property Address DE STE.FANO CH, ,ARLES F _ M�� _ �w.� Owner Qwner's Name requir don is Marstons.Mills MA 02648 4/11114 required for every .. _,...._ ....,.._�_.... �_..._ _....�� page, p.State Zi Code Late of Inspection a C' !Yawn�. B. Certification (cont.) Inspection Summary:Check A,B,C,D or E/always complete all of Section A) System Passes: 1 have not.found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: �} System Conditionally passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by. the Board of Health,will pass. Check the box for"yes", "no".or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 pears old*or the septic tank(whether metal or not),is structurally unsound,`exhibits substantial infiltration or exiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old Is available. Y ❑ N ❑ Na(Explain.below): I&M•W13 ritle 5 Okfidai k%pecUon Pw;Subsuf am Sewage a€VOSSl SYMM•Page 2 of 11 Commonwealth of Massachusetts Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments v 166mHollidge Hill Rd (Back.Sy_stem) _._...... ........ Property Address DE STEFANO CHARIES F Owner -- ........._____. ._W. �..K. w _._ Owners Name information is required for every Marstons Mills w MA 02648 4111f14 page. CitytTown state Zip Code Rate of Inspection B. Certification (font.) ❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval if pumpslalarms are repaired. B) System Conditionally Passes(cont.): ❑ 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 J, ❑ Y ❑ N ❑ ND(Explain below): El obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): e_..._................ .._._ _ _ .._.......__ .............. ❑ 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 t5iras•SM 3 Title 6 Oftat trmpeation Foam.Subsuftoo Sewage Disposal System-Pee 3 0l 17 Commonwealth of Massachusetts W Title 5 Official Inspection. Firm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 166 Ho o e i Lill Rd. Back Property Address DE STEFAN©, CHARLES F� q owner owner's Name inforrhation is t+�arstons Mills required for every MA 02648 4/11?1.4__._ _ _. page. Cty/Town State Zip code Rate of Inspection E . Certification (cons.) 2. System will fall unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public heatth, safety and environment: El 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. 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%day flaw • Two s otfidat k*p Pcn Font Subsurface Sewage.pispwel Sygem•Page 4 of 17 twins 3h 3 f Commonwealth of Massachusetts Title 5 Official Inspection Form w_ Subsurface Sewage[3isposa!System Form-Not,for Voluntary Assessments 166 Hollid a Hili Rd Back stem Property address DE STEFANO,_CHARLES F._ Owner Owner's Name information is MA 02648 4111t14 required for every Marstons Mills _ � page. C' !Town state Zip code Date of lnspeciion B. Certification (cunt,) Yes No ❑ Required pumping more than 4 times in the last year NOTdue to clogged or obstructed pipes).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. ❑ 0 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. El criteria 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 El ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or 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 sign,ificant.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. T&s oHiciat Inspedioti Fomx subsurtace sewsp Disposal swam•Page 5 of 17 t5irts•'3M 3 L—__ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form•Not for Voluntary Assessments " 166 Hollid a Hill Rd, Back S stem Property Address DE.aSTEFANO, CHARLES F Owner owner's Name information ie Marstons Mills_ MA 02648 4/11/14 required for every page. Cityrrown State Zip Code Rate 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 n Pumping information was provided by the owner,occupant, or Board of Health ❑ Z Were any oftthe system components pumped out in the previous two weeks? 0 Has the system received normal flows in the previous two week period? 0 Have large volumes of water been introduced to the system recently or as part of this inspection? z ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ Was the facility or dwelling inspected.for signs of sewage back up? Z ❑ Was the site inspected for signs of break out? 0 ❑ Were all system components,excluding the SAS, located on site? 0 ❑ Were the septic tank manholes uncovered, opened, and.the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner).provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ Z Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): - Number of bedrooms(actual): ` --� ---- DESIGN flow based on.310 CMR 15.203(for example: 110 gpd.x#of bedrooms): 33i0.~ Wins•W3 Ties 5DffldW hspatidn Fbw S.ubwdace.S wap 0#osat System•.Palo 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Farm-Not for Voluntary Assessments 166 Hollidge HiII Rd _..._......_. Property Address DE STEFANO,CHARLESF .owner Owner's Name information is MA 02648 4111/14 _ rstons MaMills required.forever ..._., .__.:_._�.�. .._..��...�. Rene �p : state Zip Code .Date of Ins ction D. System Information Description: 0 Number of current residents; Does residence have.a garbage grinder? ❑ Yes 0 No ( sewage system? include laundry system inspection Is laundry on a separate g Y ❑ Yes No information in this report) .Laundry system inspected? � Yes ❑ No Seasonal use? ❑ Yes ® No na Water meter readings, if available(last 2 years usage(gpd)): Detail; Sump pump? ❑ Yes No NA Last date of occupancy: Date Commerciallindustrial Flow Conditions: Type of Establishment: �- Design flow(based on 310 CMR 15.203): Gallons per day tgpd> 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: Us S MON Inspect On Fomt:Subsurface Severe D'sPmei System.POW 7 of 17 tSsns•3tt s Commonwealth of Massachusetts Title 5 Official. nepection dorm 4 Subsurface Sewage Disposal System Form•Not.for Voluntary Assessments 166 Hollidge Hill Rd. (Back System) _ Property Address DE STEFANO.CHARLES F_._.. . . . .. owner Owners Owner's Name Ruedfor is every Marstons Mills .__. MA _ 02648 4/11/14 r page. qjX own state Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: ©ate Other(describe below): General Information Pumping Records: source.of information: Was system pumped as part of the inspection? ❑ Yes 0 No If yes,volume pumped: gallons How was quantity pumped determiners? - — - a. ......... Reason for purnping. -- - �� .__._ ____._ Type of System: Septic tank, distribution box,soil absorption system Single cesspool ❑ Overflow cesspool Privy ❑ Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology;Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the i/A system by system operator under contract Tight tank.Attach a copy of the DER approval. ❑ Other(describe): thins 8m 3 Us 6 Official h apactioa Form:3utsrttace Sewap Disposal System"•page 8 of 17 Commonwealth of Massachusetts :_- Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 166 Hollidge Hill Rd.(Back Sit m) Property Address DE STEFANU CHARLES F .� ._ . _... . Owner Owner's Name inforrnation is Marstons Mills MA 02648 4111114 required for every _ _. ...__ m__ _.... page. CitylTown _ - State Zip Code Date of inspection D. System Information (cont.) Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site? ElYes ® No Building Sewer(locate on site plan): Depth below grade: 2,5"_._....,_ �.. ...._.......... . feet Material of construction: ❑cast iron 0 40 PVC ❑other(explain): 10+ Distance from private water supply well or suction line: feat ........ Comments(on condition of joints, venting,evidence of leakage, etc.): Joints appear#igtk. evidence of leakage.System vented through the building cents. _ Septic Tank locate on site plan): 2' Depth below grade: feet Material of construction: concrete ❑metal [3 fiberglass ❑polyethylene ❑other(explain) If tank is metal, list age: _._.v_....�.......�_.._,.__..m.m.,_. .... ..._ .. years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 4II Sludge depth: --. t6ms-3113 Tioe 6 ooidst hspedfion Fomi SubUdOCO SOW80 Dispasal 8Ystam-P890 9 of 17 Commonwealth of Massachusetts Tide 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 166 Hollidge Hill R Back System) Property Address DE STEFANt GHARIES F _._ Owner Owner's blame Information is requiredfor�every MarstonsMills ._.. a.__ ��A__ 02648 �111t1.- page. Ci frown state Zip Code Date of inspection D. System Information (cons.) Septic Tank(cont.) ;32` Distance from top of sludge to bottom of outlet tee or baffle —~----.. — - Scum thickness 2-1 Distance from top of scum to top of outlet tee or baffle 61" ..__._, _ ........... Distance from'bottom of scum to bottom of outlet tee or baffle --- --- How were dimensions determined? Measured Comments ton pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Pump tank every 2 years.iniet and outlet tees are in place.No evidence of leakage.Tank appears structurally sound. Grease Trap(locate on site plan): Depth below grade: _�_ ....._...:. _.....: feet Material of construction: Q concrete 0 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 W 3 Tiffs S Ofte l kispedonform Subswlew Sewage QisposW System-Page 10 or 17 Commonwealth of Massachusetts - 'Title 5 Official Inspection Form > Subsurface Sewage Disposal System Form•.Nest for Voluntary Assessments �y 166 Hollidge Hill Rd. Back S stem Property Address DE STEFANO,CHARLES F -- Owner . Ownees Name information is Marstons Mills MA 02648 ..._ 4/11/1`t .._._ required for every � _ _ _ - �._.._.._ .page. Ci n State Zip Code Date of inspection D. System information (cunt.) 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 Bolding 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: _.. ....�---....r _......._.. _._ .__. Capacity:ty: 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 ofalarm and float switches,etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins"3113 Title 6 thrCW MspCOM Rapt:subsume sewage 0!pWmt System"Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 166 Hollidge Hill Rd. Back System) Property Address DE STEFANO, CHARLES F ,Owner -.__.__.._...................a..__ _ �__� ____ — information is Uwner's.Name required for every Marstons Mills ._ MA 02648 4f11114 page. Cityjown State Lip Code Date of InNnction D. System Information (coat.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert No ----.-- - Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidences of leakage into or out of box, etc.): Box is level Box has one outlet lateral No evidence of.solids�ca over.No evidence of leakage. 'Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ 'No* Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): •if pumps or.alarms are not in working order,system is a conditional pass. Soli absorption System(SAS)(locate on site plan,excavation not required): If SAS not located,explain why: t5ins M3 We 5 of W hspact onFam$ubsudace Sewage D mel System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 166 Hollidge Hill Rd. Sack S stem Property Address Owner DE STEFANO,CHARLES F information is Owners Name required for every Marstons Mills _ ...._.._ MA _.. 02648 411111 page. Cityltown State Zip Code Date of inspection D. System Information (cont.) Type: leaching pits number; 1 6 'x6'with 2'stone Q leaching chambers number. ..leaching galleries number: --- Q leaching trenchesnumber, length: [] leaching Melds number,dimensions: .❑ overflow cesspool number: ❑ innovativelalternative system Type/name of technology; Comments(note condition of soil,signs of hydraulic failure,level of ponding, damp soil,condition of vegetation, etc.): Sandy soil No,signs of hydraulic failure. Leaching pit was dry at time of in Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert -..-. Depth of solids layer _ __.................. Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow Q Yes n No t5im•3113 title 5 Offidel ftpaWon form:SOSU tace Sewage Disposal Sri•Page 13 of 17 Commonwealth of Massachusetts u Titie 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 166 Nollidge Hill Rd.(Back System Property Address DE STEFANO CNARLES F_...... __ MarStanS Mills _ _.....w. Owner Owner's Name inforrrlation is 264$ 4/11... required for every __....- _.ill ..� �....._,.._.. � � A page. Cftyrrown State Zip Code Date of inspection D. System Information (coat.) 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.), t5ins•3li3 True 5 Official IsspecUm Farm:.Sul slot Setivae Msposw System•Pale 14 of 17 Commonwealth of Massachusetts - Tine 5 Official Inspection Form .Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ti:,._ 1�66 Hollici a liiil Rd. Back S stem g _ .._........... Property Address DE STEFANO.CHARLES F - -- - Owner &y e-is Name information is MarStons Mills MA 02648 4111/14 required for every ._�__.... —�... page. CitytTawvn �PrvN _ State Zip Code Date of Inspection - D. System Information (cant.) Sketch Of Sewage Disposal System: Provide a view of me 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 t5itq•'3r1 3 T&5 O tiaai inspectdon form.SubsixfamSewer Orsposat System•P :45 of V Commonwealth of Massachuse is Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 16 1114ge Hil1_Rd. stem)___ Property Address DE STEFANO CHARLES F . ..._.._ _r Owner owner's Name information"is MarstanS Mills MA„ 02648 _ 4111/14 requited for every _ �._,..� .�. page. CityRown State Zip Code Date of Inspection .D. System Information (cunt.) Site Exam: Check Slope Surface water ❑ Check cellar El Shallow wells Bottom of leachin i 10'__...._ Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: El Obtained from system design plans on record If checked, date of design.plan reviewed: ...... .._._ ww�..... _- .........— Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) E Checked with local Board of Health-'explain: As-Built _. _ ❑ Checked with local excavators; installers_(attach documentation) ❑ Accessed USGS database explain: You must describe how you established the high ground water elevation: USEp:USGS observation well data.U SEDIechnical bulletin 92l0001 annual ranges of groundwater elevations ._._._� _�_w.. .� .,._ __.__ Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins.3113 Tine 5 Ofdsi tns*ton Form:$ubsutfam sewage Disposal system•Pap 16 0 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Farm-Not for Voluntary Assessments 166 Hoilidge Hill Rd. (Back S ystem Property Address DE STEFANQ CHARLES F Owner Owner's Name information is Marstons Mills _�. .,_._. _ _MA 02648 4111/14 required for every _� page. City/Town State Zip Code Date of InspecUon E. Report Completeness Checklist Z inspection Summary:A, B.C, D,or E checked 0 inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater 0 Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 3n 3 Me 5 o9rtcia9 roim:St ate Sewage Dis wd$yswn Page 17 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 166 Flollid e.Hill Rd. Front System) Property Address DE STEFANo C ARLES F owner information is Owner's Name Cequiredforevsry iUlarstons,Milis MA _ 02648 .: 4111114 Page. citynown State Zip Code Cate Of inspection D. System .Information (cunt.) 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 public water supply enters the building.Check one of the boxes below: where pub I pp Y � 11 hand-sketch in the area below C) drawing attached separately 69 97 f O •ern a raosoftut imp Farm:was a .:6M9e or$YeAM.P.P ss or t7 y - I I i V Town of B i instable. P# �D ,1tE Department of Regulatory Services • '-� Public Health Division Date tareattr 1' 200 Main Street.Hj+arinis MA 02601 � Jl � � I ! Date Scheduled !Time Fee Pd. _ i ' i Foal Suitability Assessment for Sewage Disposal Performed By. Witnessed By: LOCATION &GENERAL INFORMATION _ Location Address (06�170 i4 i l-d j H•l l GN Owner's Name Ctt�C.�� pis j�F/�� s 1 t S j A ,C �ess 16��1'�v L4ro at ,V l I La N&w C�ivt$ � p� p Assessor's Map/Nrcel: b� �7 L�� 2—C j,p-� ,y,,� Engineer's Name NEWCONSTRU(ti'ION REPAIR xi�Q "telephone* Land Use / Slopes(%) '� � Surface Stones Distances from: Open Water Body,>2 00 ft Possible Wei Area �2-06 ft Drinking Water Well � �ft i • ))rainage Way 0 C) ft Property Line � /Ca ft Other ft SKETCH:'($treet name,dimensioosbf lot,exact locations of tot holes&perc tests,locate wetlands in proximity to holes) �•. ���J � �iL�dew • J I I ` I 1 I ,rl� L I t Parent material(geologic)e 10, 1 �<'d S ) Depth o Bedrock Co Depth to GroundwaWr. Standing Water in Hole:' i Weeping from Pit PaCe N A ' Estimated Seasonali[.gh Groundwater i nc X 00 DtTERMINATION FOR SEASONAL HIGH WATER TALE 77 Method Used: In. CJ7 t't Depth 0.4erved standing in obs.hole: _in. Depth to Sto Adjust: Depth toiweeping from side of obs.hole: i in, aroundwit AdJutitment ft. Index Well# Reading Date Index Well level.. Adj.CtY7undWetelr I.eYal.,,.,e PERCOL;ATION.T +'"�' ' Data `� t l 'rltue Observation q I Hole# Tiineat9" - i Depth of Pere S-7 Y' z/ Time at b" e(7— Time qwl) Start Pre-soak Titne.0 End Pre-soak a VVY Rate MinAnch i Site Suitability Assessment: Site Passed Site Failed; Additional Testing Needed(YIN) original:.Public H41th Division Observation Hole Data To Be Completed on Back-- ***If percol4ipn test is to be conducted within 100'of wetland,you must first notify the Barnstable C . 'servation Division at least one(1)week prior to beginning. �� DEEP 0011BISERVATION:HO14LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consis enc %Gravel) ©tl 20 l-d J.•l ,r t, DEEP OBSERVATION ROLE,LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C nsistenc %Gravel) /`1'1—4t, Sqiyi L4m 435" 44M 16'V12 �A 3 ''- 123� Q�t v cS 2. 1 DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. I1 J /� / Consistent %Gravel �ttr. It A L:o Ib e,4/rf/ 3"-3V rt 5 bay v ,�-1 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. nsist n I Fil 11- %1' 3. 5etoV4 Lom I OVR sw float 12 C. /+�C 2.5 (0/4 Flood Insurance Rate Mai): ovc 5V yc::r fl_—_,d bcurdary No— YeE LJ Within 500 year boundary No - Yes Within 100 year flood boundary No X Yes.- Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist,in all areas observed throughout the area proposed for the soil absorption system? A, _" fl If not,what is the depth of naturally occurring pervious material? Certification �� I certify that on (date)I have passed the soil evaluator examination approved by the [] Departmen f Environmental Protection and that the above analysis was performed by me consistent with the required trat ' expertise and exper ce described in 3..10 CMR 15,017. Signature 11� Q� Date Q:\.SEPTICVERCFORM.DOC t Town of Barnstable _ t l \ Regulatory Services BA MAW'LE, Thomas F. Geder,Director ••� Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 5 -862- 644 Fax: 508-790-6304 Jun 12, 06 Estate o 1VIa xann Q , , p 166 Holli e ane Vv Marstons Is, 02648 J ORDER TO O WITH STATE ENV NMENTAL CODE, Title 5 S The septic system wne you located 166- i dge Hill Lane, Marstons Mills,MA, was last inspected on a 1 , 2006 by, A. Paolini a certified septic inspector for the State of Massachu tts. The inspection of your sep 'c s't wed that your system has "Failed" under the guidelines of 1995 TITLE 9 0 15.00) due to the following: 2J to eeds to be replaced. You have 2 years from the e of t s s e failure to bring the system into compliance. Y g Y P If there are any question out this remi de lease feel free to contact the Barnstable Health Department. BARNSTABLE TH DEPARTMENT / l I Thomas A. Kean, R.S., C.H.O. Agent of Board of Health S � G.S jj b p'I • I���VI J � Co s� -� a DATE 5/1 0/06 PROPERTY ADDRESS ollidge Hill Lane Marstons Mills MA 02648 On the above date, the septic system at the address above was Inspected. This system consists of the following: . 1. 1- 1000 gaUon zept.ic tank., 2.1 1-Di st2.igut-ioa Box., 3.1 1-1000 gai2o.n eeach.ing pit., Based on Inspection, I certify the following conditions: 4., 7h.i,3 .ins a 7.i.t Pe Five zepi-ic zy,stemo (78Code) 5., Septic zyztem .ins -in /22o12e/L woltk.ing mdea at the - 12/Leb.ent time r -1 ti-- f- SIGNATUR - Name: Robert A. Paolini Company: Joseg)h P. Macomber & Son Inc . Address: P. O. Box 66 Centerville. Mass 02632 Phone: 508-775.3338 or. 508-775-6412 JOSEPH P. MACOMBER & SON;. INC. Tanks-Cesspools•Leachfields Pumped &.Installed Town Sewer Connections P.O. Box 66 Centerville, MA.026.32-0066 775-3338 775.6412 I COMMONWEALTH OF MASSACHUSETTS I EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION y TITLE 5 OFFICIAL INSPECTION FORM NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART-A CERTIFICATION 1 70 Hollid e Hill Lane Property Address: g �Q Marstons Mills MA 02648 / Owner's Name: Estate of Mary urann h J Owner's Address: c/o CPnf f rPW Tank .,.r- po Rnx 475 F —ganiduL,ch MA 02537 Date of Inspection: 5/1 0/0 6 Name of Inspector: (please print) Robert A Paolini Company Name: 7 P macom&ea & Sion Inc. Mailing Address: Cen eavz e, azz. 02632 Telephone Number: 5 08-715 3 3 3 8 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 15:340 of Title 5(310 CMR 15.000). The system: XXX Passes _ Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fa s Inspector's Signature: Date: Q �� 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 ****This report only describes conditions at the time of inspection and under the conditions of use at that. time..This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 -OFFICIAL INSPECTION:.FORM—,NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1 7 0 Ho l l i dote Hill Lane Marstons Mills MA 02648 Owner: Pstat-P of Mary iirann Date of Inspection: r;.j1 of p j Inspection Summary: Check A,B,C,D or.E/ALWAlFS,eamplete atl of Section:D A. System Passes: £S NO I have not found any information which indieates'thaf any of the failure criteria described in 310 CMR. 15.303.or in 310 CMS 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: Se12t.iC system .i-s .in Raopea wo2k.iag oadea at .the /22ezen.t time., B. System Conditionally Passes: NO 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 approyed�by the Board of Health,will pass. Answer es no or not determined(Yfollowing N ND in thefor the st atements.If not det ermined" please explain. NO 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: NO 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 br replaced ND explain: NO 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 170 Hollidge Hill Lane Mars tons Mills MA 07648 Owner: Estate o Mary Urann Date of Inspection: 5 1 0[0 6 C. Further Evaluation is Required by the Board of Health: No 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: No Cesspool or privy is within 50 feet of a surface water lam. 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: U 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. No The system has aseptic tank and SAS and the SAS is within a Zone 1 of a public water supply. N_D_ The system has a septic tank and.SAS and the SAS is within 50 feet of a private water supply well. No 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 visual "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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 170 Hollidge Hill Lane Mars tons Milis MA 02648 Owner: Estate of Mary Urann Date of Inspection:. 5 1 0 0 6 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'h•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 wgter 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 privateEwater 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 .ppm, provided that no other failure criteria are triggered.A copy of the analysis.must be attached.to this ford] 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 1.0,000 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 X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply _ X 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. 4 Page 5of11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 170 Ho.11idge Hill Lane Marstons Mills MA 02648 Owner: Estate of Mary Urann Date of Inspection: 5 1 0/6 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? N 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'1ip:O X _ Was the site inspected for signs of break out X _ 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? 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 CNM 15.3020)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM" NOT FOR VOLUNTARY ASSESSMENTS .SUBSURFACE SEWAGE.DISPOSAL-SYSTEM.:INSPECTION FORM � PART C SYSTEM INFORMATION Property Address: 170 Hollidcre Hill Lane Marstons Mills MA 02648 Owner: Pst-af•a. of Mare rTrann Date of Inspection: �f 1 n/n 6 FLOW CONDITIONS RESIDENTIAL Number of bedrooms desi 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CNIR 15.203 (for example:110 gpd x#of bedrooms): 3.3 0 Number of current residents: 2 Does residence have a garbage grinder(yes or no):a Is laundry on a separate sewage system(yes or no):a o [.if yes separate inspection required] Laundry system inspected(yes or no):n o Seasonal use: (yes or no): n o Water meter readings, if available(last 2 years usage(gpd)): we P wa t e? Sump pump(yes or no):a o Last date of occupancy: /22 e 6 e n t COMMERCIAL11AUSTRIAL Type of estabb. hment: N/4 Design flow(#as`ed on 310 CMR 15.203): Vd �. 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 - Source of information: N1R Was system pumped as part of the inspection(yes or no):n o If yes, volume pumped:__gallons--How was quantity pumped determined? Reason for pumping: 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: 20_ yea2h Were sewage odors detected when arriving'at the site(yes or no): n o 6 Page 7 of I l OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 170 Hol.lidge Hill Lane Marstons Mills MA 02648 Owner: Estate of Mary Urann Date of Inspection: 5/1 0/0 6 BUILDING SEWER(locate on site plan) Depth below grade: 2 4." Materials of construction:_cast iron X 40 PVC_other(explain): Distance from private water supply well or suction line:204- Comments(on condition of joints,venting,evidence of leakage,etc.): ao.int4 a/2/2ea2 t..ight.,No evidence o�e leakage., Vented thzoug,h houze Den SEPTIC TANK: y P-Jlocate on site plan) 1000 'ga e P o n z Depth below grade: 18" 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: Sludge depth:_ 2ace Distance from top of sludge to bot om of outlet tee or baffle: t 2a ce Scum thickness:to a c e Distance from top of scum to top of outlet tee or baffle: J ? c_v Distance from bottom of scum to bottom of outlet tee or baffle: f n n c e How were dimensions determined: measulced Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage, etc,): - um .tank eDea 2 ea2.6.-InPet an tz 2uc u2a y •sours GREASE TRAPNO (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.): G2ea3e taap .ins not /22esent - 7 Page 8 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 170 Hollidge Hill Lane Marstons Mills MA 02648 Owner: P.attate of Mary firann Date of Inspection: r;/1 n/n 6 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.): light oa hod.irig .tankz ate not /2aezernt DISTRIBUTION BOX: yes(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.): /3ox 1.6 .Pevei., /Ias 1 ateILai., No .soeid eaaaUovP,,Z., No P_vakngp in 02 out 01 &ox , PUMP CHAMBER: NU (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.): l um12 cham4ea. i.3 not /22ezen.t 8 r Page 9 of 11 OFFICIAL INSPECTION FORM—'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 170 Hollidge Hill Lane Marstons Mills -MA 02648 Owner:. Estate of Mary Urann Date of Inspection:. 5 1 0 06 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Located .See /?¢ge 70., Type X leaching pits,number: 1 leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition.of soil,signs of hydraulic failure,level of pondin,g,damp soil, condition of vegetation, e�damy to medium •s¢nd.- No -signs ole �a.4h4)ze, .36.i2z ¢ae day., to pondtago Vegetation tz n am¢ CESSPOOLS: NO (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.): Ce.s,3/?ooi.s. ¢ae not /?aebent PRIVY: IV (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.): P/tivy. 1-6 not /?aesent 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS x SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1,70 Hollidge Hill Lane Marstons Mills MA 02648 Owner: Estate of Mary Urann Date of Inspection: 5/1 0/0 6 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent referenee'landmarks or berichmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. v (j 3 i J • I hI1LL 10 r Page 11 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION(continued) Property Address: .170 Hollidge Hill Lane Marstons Mills MA 02648 Owner: Estate of Mary Urann Date of Inspection: 5/10 06 SITE EXAM . Slope Surface water Check cellar Shallow wells Estimated depth to ground water _feet Please indicate(check).all methods used to determine the high ground water elevation: •NO Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150•feet of SAS) Checked with local Board.of Health-explain:n,4 R a f caad no Checked:with local excavators,installers-(attach documentation) Accessed USGSdatabase=explainAtt/2:town.,ka/tazi-a&.2e,-me.-uz You must describe how you established the high ground water elevation: 11zed : Cape Cool Commi.6ion 1date2 7agig, Coritouah And Pugiic lJa.tea Supply 0eii head p4o.tect.ian aaeaz mal2o Sept 1995 ldate2 aesouzees o,Zl'.ice cage cod eomm.i.5.ion., Top of C;rounzl Leaching Pit Feet Groundwate�.`:�Feet Below Bottom-of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore,the vertical separation distance between the bottom of the leaching pit and the adjusted groundwater table is feet. . +wwm'!:Kiir,ram•• .•.I„n.,-�I•..-..T,.w,-,rwln+.ln..•+.R...w.w.rl,�.•►nwiv�..+.*w.n�^o''�'^'" } TOWNOF _ BARNSTABLE I10ARD QF HEALTH .SUI)SURFACK SFWA09 DISPOSA4 SYSTRM INSPECTION FORM - PART D' CERTIFiCATdON '"•"""*'`'"^"">s•tis,�,n+nw�nr.i,�+l. 1+ -TYPE OR PRINT CLURLY- ' PIZQPERTY m8prI CTED STREET .ADDRESS 170 :Hollidge Hill Lane Marstons Mills •02648 ASS•EsSORS MAP, BLWK AND 'PARCEIL OWNER's NAME Estate 4-f-'-•Mar Urann- PART'. D CRIRTIFICATION NAME 'OF INSPECTOR • Rojitt Pd.o"n.i , COMPANY NAME obe h :P. l7acomlie2, Son. Inc ' Box 66 '' Cen ea�L2Ce Oa.6.6' .02.6.32 ' COhf PANY AUDitgSS �. Town-or City. _ 8laLt LIP COMPANY TELEPHONE t 508. Q7.5 - 3338 FAX 1'.508',1T 90 f M . WOH CERTIFICATION. STATEMENT I certify that I b'ave persocial'ly .ins-pected .,the sewage digposa`l. system at this address And that th ' information reported .is true,. govUra•te-i and ;omplete as of the time ..af••inspection..• The in4peotiorn was. Performed and any ^ecommendations regarding upgrade-) •ma•inteneince,' and repair •afie• oon$is'tent 4ith my training and exP.erience in the proper function' and maintenance of on- aite sewage disposal. systems . , heck one; ' &Syste�* PASS*D The inspection wh ic.h -I have .,conducted has .,n•qt Yound any information . which indicates ttlat the system' .fails to ' adequately, protect .public health or the envi.rgpment as defined io- .310 CMR. 1C30.3•s Any fei1ttre criteria t,ot evaluated are as stated in the FAILURE' CRITERIA ;see,tion o:f this. form. System FAILED* The inspection which II have co'rcrCfited 'has 'found that the system fails to protect the public health end the env, ronmen•t * in acaoxd•ance with Title 61 310 CMR 15 . 303, and as . specifically noted -on .PA'RT' C -. FAILURE CRITERIA of this inspection .form. Ins.pector Signature' PRU no .I rneopy of this eei t1fi.0at•iah, must be rovided 'to the .pWN>rR, the BUYER re a pli•.oa•ble) and th!e DQARD OV HEA TH• I M I •" * If the inspection FAIL'Eb., thb .owner' .ox1"operator e:hal� . upgrnde'•the system. within o'ne year of the dn't'e of the inspection, unless. aI'loasd Qr' requ.l.;red - n�►,A1+WiAA an provided iT WO CMR 16 ,305.1. � . • . ff eQ L-*q DATE 5/10/06 PROPERTY ADDRESS 166 xollidge Hill Lane Marstons Mills MA 02648 On the above date, the septic system at the address above was Inspected. This system consists of the following:. .. 1., 1-6 'X6 ' giock .ceZ.61200i., Based on inspection, I certify the following conditions: 2., 7h.i,6 i.6 not a 7.it ee Five zept.ic zy.6tem., 3., Sep4ic zyhtem .iz in la.i&Ae at this time., Ce.6.612ooi .is heay.iiy aootgoundo Need.6 to ge aepjaced., SIGNATURE Name: Robert A. Paolini Company: Joseph P. Macomber & Son Inc . Address: P. O. Box 66 Centerville, Mass 02632 Phone: 508-775-3338 or 508-775-6412 JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, NIA 02632-0066 775-3338 775.6412 COMMONWEALTH OF MASSACHUSETTS ExECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a DEPARTMENT OF LNVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART'A - CERTIFICATION Property Address: . 166 Hollidge Hill Lane Marstons MillsMA 02648 Owner's Name: Estate of. Mary TTrann Owner's Address: c/n Genf f rey Tank PO Box 475 F' Sanrjwjch MA 02537 Date of Inspection: 5/1 0/0 6 Name of Inspector: (please print) ` Robgrt .A Pao.lin Company Name: g_ !.. acom9eA T .S.oA Inc. Mailing Address: Ce v :razz.'02632 Telephone Number: 5 0 8-7. 7 5=3 3 3 8 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.15:340 of Title 5(310 CMR 15:000). The system: Passes — Conditionally Passes Needs Further Evaluation by the Local Approving Authority -XY�4Fa . ; -- D�(P Inspector's Signature: /'�' Date: The system inspector shall submit a copy of this inspection report to the.Approving Authority(Board of Health or DEP)within 30'days of completing this inspection.If the system,is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner.shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title S Tnenortinn Fnrm All V7000 T)aee I Page 2 of 11 OFFICIAL INSPECTION:.FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 166 Hollidge. Hill Lane Marstons Mills MA 02648 owner: Estate of Mary urann Date of Inspection: 5/1 0/0 6 Inspection Summary: Check A,B,C,D or E/ALWAI'S-.eomplete�all of Section.D A. System Passes:A/V y 8S I havemoLfound any information which indioates`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: Ce,3.a ooi je in , B. System Conditionally Passes: NO One or more system components as described in the"Conditional Pass".,section need tote.replaced.or repaired.The system,upon completion of the replacement or repair,as approved:by the Board of Health,will pass. Answer yes,no or not.determined(Y,N,N in the for the following statements. If"not determined"please D). explain. NO 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 ex.filtration 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: NO 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: NO 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 166 Hollidge Hill Lane Marstons Mills MA 02648 Owner: Estate of Mary Urann Date of Inspection: 511 0/0 6 C. Further Evaluation is Required by.the Board of Health: No 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(l)(b)that the system is not functioning in a manner which Will protect public health,safety and the environment: no Cesspool or privy is within 50 feet of a surface water no 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: no The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet..ofa surface water supply or tributary to a.surface water supply. n° The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. no The system has aseptic tank and.SAS.and the SAS is within 50 feet of a private water supply well. no 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 V-&3uai "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: 1\r 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 166 Hollidge Hill Lane Marstons Mills- MA 02648 Owner: Estate of Mary Urann Date of Inspection:. 5/1 0/0 6 D. System Failure Criteria applicable to all systems:. You must indicate"yes"or"no"to each of the followingfor 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 X clogged SAS or cesspool 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 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. �.. y 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 most be attached to this form.] yES (Yes/No)The system fails. I have determined that one or moreof 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 X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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 S' . 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. d Page 5 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPO'SAL'SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 166 Holli.dge Hill Lane Marc;i-nnG Mi l l s MA 02648 Owner: Fst-ate of rotary. Urann Date of Inspection: _ 1 n/n 6 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? N1.4 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'bp:=fs 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)J Page 6 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISP.OSAL-,SYSTEM INSPECTI .N FORM PART C SYSTEM INFORMATION Property Address: 166 Hollidge Hill Lane Marstons Mills MA 02648 Owner: Estate of Mary irrann Date of Inspection: 5/1 0_/0 h FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):. Number of bedrooms(actual): 2.. . DESIGN flow based on 310 CMR 15.203 (for example:110 gpd x#of bedrooms):22 Q Number of current residents: unknown Does residence have a garbage grinder(yes or no):n o Is laundry on a separate sewage system(yes or no)n o [if,yes separate inspection required] Laundry system inspected(yes or no):a.o Seasonal use:(yes or no): a o Water meter readings, if available(last 2 years usage(gpd)): 0e e e wa t e 2 Sump Pump(yes or no):no Last date of occupancy: unknown COMMERCIAL/II4-bUSTRIAL N1R Type of esta '..iunent: Design flow asec]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 Source of information: NSA Was system pumped as part of the inspection(yes or no):_ If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption.system X 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: unknown Were sewage odors detected when arriving at the site(yes or no): a 0 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 166 Hollidge Hill Lane Marstons Mills MA 02648 Owner: Estate of Mary Urann Date of Inspection: 5 J 1 0/0 h BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction:_cast iron _40 PVC_other(explain): o 2an ye aua g Distance from private water supply well or suction line: Comments(on condition of joints,venting, evidence of leakage,etc.): �oint.6 a/2Rea2 ; .ight no iekag , Vented th2ough hou.3e vent SEPTIC TANK:IN 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:. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels .)rel ted to utlet invert,evid ce of.leakag ,etc.): e/2ZW-c inak .cis no? 122e13enz 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.): gaeaze t2ap iz not Raezeat - ,a I Page 8 of 11. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 166 Hollidge Hill Lane Marstons Mills MA 02648 Owner: Estate of Mary Urann Date of Inspection: 5/10 10 h 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.): 7.ight oa hoPd.ing tankz ate not paezent DISTRIBUTION BOX: (if present must be opened)(locate on site'pla.n) 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: (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.): —Pump cahm9ea .i-s not /2atezent o F Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 166 Hollidge Hill Lane Marstons Mills MA 02648 Owner:. Estate of Mary Urann Date of Inspection: 5/1 0/0 6 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Szn.9�e ceh.612oo e no beaching Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternatives stem T e/name of technology: Y �'P �. Comments(note condition.of soil, signs of hydraulic failure,level of ponding,damp soil, condition of vegetation, etc.): CESSPOOLS:ye,3 (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: — Depth—top of liquid to inlet invert: 0 Depth of solids layer: 0 _. Depth of scum layer: Dimensions of cesspool: Materials of construction: c o n c/LT t o g P o c k z Indication of groundwater inflow(yes'or no): n Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Loamu .to med.iam .sand.- Ce.6,612oo2 .i.6 hev.iiy aooted So.i z ate clay vege.ta.tion .i,6 no2ma.2 , No Rond.ing., PRIVY: N0 (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.): aZ ivy .i'6 not RaeZeni- 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM I PART C \. SYSTEM INFORMATION(continued) PropertyAddress: 166 Hollidge Hill Lane Marstons Mills MA 02648 Owner: Estate of Mary Urann Date of Inspection: 5/1 0/0 6 SKETCH OF SEWAGE DISPOSAL SYSTEM PPoyide 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. / v - - - - i a 4 �n •Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.0 SYSTEM INFORMATION(continued) Property Address: .166 Hol l idge Hill Lane , Marstons Mills MA 02648 Owner: Estate of Mary Urann Date of Inspection: 5/10 0 6 SITE EXAM . Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: u es Observed site(abutting property/observation hole within 150.feet of SAS) Checked with local Board of Health-explain:r/.s p u.i P.f r ri a d n o Checked:with local excavators,installers-(attach documentation) e,�accessed USGS database=explain4t;Cp r o wn•_&aILnz z<a1 2a,,m�,... u-s M You must describe how you established the high ground water elevation: Uzed. : Cape Cod Comm.is.ion /datea 7ag.Pe Corntouzz 4nd %ugtic ldate� Supl2.2y Oeii head paotection aaeaz map., Sept 1995 ldatea ze.3ou2ce.s o-J-ice cage cod comm.cs.con 1 Leaching Pit feet Groundwatell Feet Below Bottom:of Pit High Groundwater Adjustment 1.8 ft per Frim ter Method Therefore,the vertical separation distance between the bottom ��Z— of the leaching pit and the adjusted groundwater table is�.�v�a feet. a . ....... +�++,r.=ate:r-••}; .�R,�r� �..��--► �-^*^� TOWN OP BAR STABLE BOARD QF HEALTH ..9W)SURFACR SEWAOR DISPOSAL AYSUM INSPECTION FORH - PART D CERTIFICAV.ON w•TIY wT•:MIT"1 1t.11'S7R7M1111'R/1�1771r7f�M17/'IRR*�R AII 1�"q/'- -TYPE OR PRINT CLElIRLY- PRQPERTy INSPCCT�IP STREET ADDRESS 1 66, Hollidge Hill Lane Mars•tons Mills ' 02648 ASSESSORS MAP, BLOQSF: AND 'PARCEL Estate* o , Mar p ann ' OWNER's NAME �c7o Geof> n Y� Box 475E Sandwich MA 02537 PART` D - CPRTIFICAT:I;ON ; NAME OF INSPECTOR Ro&.eat fla.oni , COMPANY NAME 2o.seph_ �lacom�ez` Snn Inc - -- -- —•_-- Box 66 C•en�t4v.1j.ee COMPANY ApDR� S ToWn or City .sta • LIP COMPANY TELEPHONE t 508. ) 7.5 - 3338 FAX (' 508' 1790 f 578 . CERT TFICATION. STATEMENT I certify that I have personally .ins-pected .-the sewage 'dieposil. System at this address and that. .t)I$' information reported •is trues. s.00urate-, add this as of the time ..o;f •inspeetiony The inspevtion was performed and any recommendations regard.ini Upgrade., .maintenance ,' abd repair .ate. eon$is'tent with my trainitIg and experience in the proper functi,•on• and maintenance of on- site sewage disposal systems. Check one: ' Systeo PAS D _ The inspection which •I have ..conducted has .,n•oat found any information . which indicates that the system- ,fails to ' adeluately. protect .publiv health or the enviropment as defined in• .310 CMR. 1t'�30.3•i -Any failure criteria *6t -•evaluai'ed are as stated in the FAI•LUIM CRI`PLRIA :seetio"n o•f this. form. ,System FAILED* The inspectioh which I have cans ted •ha•s •'•found that the system fails to rrotec.t the public liealth and the env, ronmen•t ' in a000xd•ance with Title 61 310 CMR 15 , 308, and as . specifically noted -on .PAT- 0 FAILURE CRITERIA of this inspection lo ' Inspector Signature- v .,,:�._:... Date .OM rwnhere' copy of this ce ti,f ioat•i 6.b mu'at be V.rovi'ded 'to : the .QWNi;R•, t�h BUYER•• appil-cable) and th! I3QARD 08' HEA TIis ; * if the inspection FAIL-E.b., thb .owno'r' •or"'9"perator o'hoII . upS-r.i►de'' he eyetem• ... .►,4 ,;.,e vsknr o.r tl,e dat-e of the inepeation, unless. allowed Qr* requi.;red i D Middle RPOD RF Po ( aJL s ZONE: ) o 1 Area (min.) 87,120 SF �� C — Fronto a (min 150' � Width �min).0 j Setbacks: ra Front 30' x � " 1 Q Side 15' � � 6�o Rear 15' a 4s Permitted Stairs & Pier SE3—5214 2�w , REFERENCES:0 to I, . ,., A 1;1�\ Deed Book 28106/39 LOCATION MAP Plan Book 610145 (1'6 7 ?z `n 1 "Lot 2 N ASSESSORS REF.: 1 � 2.56f Acres Total °p Map 081, Parcel 007 001 \ 1 N 1 FLOOD ZONE: \ Zone C 1 Community Panel No. #250001 0015 C DH July 2, 1992 Fnd \ 1 Existing Septic I .Perm i t#2007-336 I o 1 DH/CB I Find o \ I � I Existing 2 Sty Single Family I w/f dwelling IP Clean Out Existing I Proposed Edge Typ• I Septic T k of Drive (as per #p inspe ion) Proposed 26x30' Existing 2 Car Garage - Garage with Office Above o° 27.1' I Proposed I Septic Line with Existing Clean Outs Septic Leach Pit I Existing Septic Proposed W Line & D—Box Relocated Septic I N To Be Removed Line & D—Box I co N I co co N CV)o 0 fq Z I I DH/O N QQ3° I Fnd 1+ .47 I D C F - .08, R�22 .35 Ov'rall _Site PlanLA - Scale 1"=60'� \a O lcic o_ tp a DH/CB Q Find t✓Qdr� RTLE: PREPARED BY: � PREPARED FOR.' NOTES Site Plan EII�neeI'IIIp� William D & Tommy J Russell 1.) The survey was performed from an on the Proposed Improvements b"' b ground survey on or between the dates of m At 166 Hollidge Hill Lane Sullivan Consulting,Ina 82 Stebbins Road s/z�/2o1s and s/1/2o15. Barnstable (Marston Mils) Mass. Monson MA 01057 (008)41&3344•P.0.Box669•7Pu1xRo�d,At�MIN,M110266ti 2.) The property line information shown INC*-:---- eom•www.al worstn.00m hereon was compiled from available record o Draft: CTR Field:CMIMKIJOD ea 0 30 60 information. DATE: SCALE." „ = ' Racier: J00 COMP.: CTR IN IN May 5, 2015 1 60 Project f 340078 ffyject jit 340018 'co � N N TYPE X GYP. BOARD AT CEILING , STAIR WELL WALLS -----� AND UNDERSIDE OF STAIR . a R38 INSULATION AT CEILING RK 'Q a -���--=L ® a ga it ---- - a QW�gg a Z � H N ��. a o �c a W �> O w C a � O f� O. b. N La Go 0 V 0 N 0� IN � u°� [Y r a do a. 5�_O• L W cq J W I 3/0-6/8 JJJ CONCRETE APRON JX p Cl W (2) LIGHT PANEL ENTRANCE DOOR - L 22'-11' ANTHONY 5 2 x 9. i" POWER BEAM HEADER a 1. 1. 11° 3-22 3-22 9'_O• 2�_6• i 9'-O' 2'-2° a O First Floor Plan Scale:.1/4" = 1'- 0 u- LIGHT..AND .VENTILATION - 3'-71' S,_7 2'-01° 5'-61. 3'-71: UNIT LIGHT VENT 2 2 2 9-6 2 SKY LIGHT 5.48 5.48 -52 2446 7.50 4.10 12'-72 12' 1' 4 7.50 410 2 4 6TOTAL 20.448 13.68 2446 2446 2446 , I I , 2/4-6/8 I: j co 00 .� 3� - a F =9 BHA x a IL 0 o 04 � Z L.7Z- I \ C A I I o to i..i pI1 u u W; a p ( I =�� pr~ SITTING O ��I CE N AREA 221 SF L=17.7 V=8.8 AREA 248SF L=19.8 V=9.9 - �`'1�. _ 0 CO ? 0 'r"r 0 00 �. i0100, 00 pp rP.. C l pi ri 10, 3 co 0 0 l AC \ \ \ I \ \ \ VT m Q -----N---- — �' ---N N-----N------ N N. N fuU' 2Ce'4 W o Y H U SYSTEM: 0��•,� Q Q F- d� )a- OTP TYP HDU SYSTEM (3) 'HDU2-SDS2.5 TYPICAL CS20 THRU BOLT DECK (2) + TOP PLATE' THRU BOLT W/ BP5/8-3 2M � Second Floor Plan.,, Scale: 1/411 = 11- 0" �`�+ r: ..•wow RARM . . OLD • •------------------- -------------------- --------------------- BEDROOM ., NEW ---- EXTERIORDECK ___________________ _ _ ____ __.___________--_ _ -____ _ _- - - --'__-- - _--______ --- - - ._ ]a U 6XH l7 O 1 ��6 6XB 12/1212 ; 6 X8 6/ , gg, 6 6/6 6XB 6/ , , NEW e• , m S ; ,n- EXISTING : , 1 . 1 .: --- °� O �p KTCHEN AREA ; 4 ; ( KITCHEN -� r , BAT • pull, NEW U. _ --------- .;i _ , , I I orromn w.eaLeeAn - - - - y - - ------- - m , IsEmoom , , I : oexreq a�.em ceu.,w � � � : ;------------------ ---- � ----•-- -. --- - - ---- --- ]'a GA. ,,.I, - m 6XH 12/12 an4r. U 0 ya•------------------ ------- m p, g':9' 2'-216" 2'-4" U °fl EXI o , -,-e--- -- -- EXISTING ------------------------------- GREA, ROOM 0 U 4'-2° 41-0II PORGN A• ' m _ • • orromro w4 edn. j - ,xp a•o• y - - - < .. - y EXISTING T c LIVING � ��- ROOM � STEP 10-6" e •_- __._ ^---^ ------- ._. _. ----- � BATH ' A " - — I 1 mX O Q 6X8 K $ _—�' 19'-bpi°-—-—�wmn we e�L mnn AOOVC B DR60M V TI G I: _ , IS N 9 _'_____`'M.►'•,waoe.x ocrroi i•] - ?Q AND NEW S 1'' • - O "�'' o , , , I O U PORGH Q �'-''•: 4{-0 •Q oLooRnm wear stare f EXISTING FOUNDATION PLAN jbxs 12n2 6xH 12n2 ________. _ �\ _____.__: ..;: 6X812/12 6X8 IYI2 W - erer 4-0 1T I _... 33'�° CISTINCz. AND NEW FIRST FLOOR PLAN' .. . '...___-_____•__________.____.__4_ __ ....-+awi:+�-+.__-wni:i_____ ____._._ _ _________ __. . 7 6X8 12/12 6XB 12A2 6XB 6/6 r T s 4 BATH W.IyG. (�SJ IV O U UV ® - SLATE FINISH .Q'0 : BEDROOM °' /\ b •-- 4"POURED GONG,BLAB ol( EXISTING FOUNDATION WALLS o ElW ]"• ° a D g_•1�° 14-IW" g'.6v B._gll 4 /L0 Y Q °NEW FOUNDATION WALLS j / d M/gmROOM p ^I o v GOMPACTID GRANULAR a BITTING ?0 � Q m� R WALLS AREA U 2X6 KEY uN�a Q NEW EXTERIOR ------------------------------------------------ Q ------- Q to^xn"GONG.FTG. 7 p � O NEW INTERIOR WALLS j 40 0 - B•w Ig'-9" EXISTING WALLS m ,10 WG20X36-2 Ulf20X36-2 WG20x-M-2 WC20X36-2 , Q D -------------•- --- v • FOOTING PORCH FOOTING DETAILS 8" GONGRETE WALL ---------------------_------------_______________________________ 4'-0` 6•-6° 6'-6` 6-6^ 4-0" 4-0 NEW SECOND FLOOR PLAN6" 2 RENOVATE EXISTING HOMEDATE REVISION DRAWN BY PAGE or-ALEJ� p�oslans 045 REALTY t DEY. INC. MR C 4=< STEFANO � 01-03-0l e 166 HOLLIDGE HILL LANE a°"`�` �II N plWe"AK'Aa DRAUTAGO"MW.pLaor 4MN RL4i 0ga,.FOR Ce' j.ANCE WW ALl. rr EXCGT e¢e CND/�lNrpeCEl'6D4)CP ALL CA•�e FAa1/+LRe /U✓El¢�Y enaenLRAL 6Bfl8I7D FO`P OGer41N�9� I e P'A%DdF.bTABLL'ML dam. MARSTONS MILLS MA. ) L°� ° '"ma°-°N°eg 'WACTO eOFC0WMC?kWL�D,LP.54rDN� I ALR.A� FDR N1H comnoNe aR FAR T1E 1ldE OP rNsee oRA¢etize LYAtlMt CG°1feTIFYlCNWL rWCCr5 a OF CANer ornaN.L W 4L DEdFN ff6IN LOCAL eN1A" 401N co a ANWASM AND euruivNa ORacrAcs. RIDGE VENT . 2X12 RIDGE -- RIDGE VENT 2X12 RIDGE 2X10 RAFTERS•16'O.G. 1/2'PLY.SHEATHING 2X10 RAFTERS•1("O.G. 15-ASPHALT PAPER • 1/2'PLY.SHEATHING ASPHALT SHINGLES - a 15'ASPHALT PAPER ASPHALT SHINGLES EXISTING ZXS RAFTERS o I6°O.G. a ATTIC IQ"PLY,SHEATHING- e� AREA • ® 15'ASPHALT PAPER ' O°e T'•reme R90 INBUI.. ASPHALT SHINGLES 'L�\32XI2'e wr e®ryoet `xP,au MAC .w•o.a UC3 STRAPPING I/2'WALLBOARD • orc Tre'eRp° EXIST, NEW 3.2XI0'e oe. R30 INSUL. ;.�•am nL PORCH IX3 STRAPPING -- AREA I&WALLBOARD CUSTOM COLUMN EXISTING EXISTING AND NEW GREAT ROOM PORCH . rxroT.aeo'•.d'oe — grew.rew eult ero• A "t -/ _ _- _ r EXIST.7XY1'e•12"O.G. { -- EXISTING I' CROSS SECTION CG) /; BASEMENT 2X8 RAFTERS•16'O.C. RIDGE VENT CROSS SECTION CA) 1/2"PLY.SHEATHING 2Xtt RIDGE ` IS'ASPHALT PAPER RIDGE VENT - ASPHALT SHINGLES 2X12 RIDGE a v 2XIO RAFTERS•16"O.C. e� • 6 Qe I/2"PLY.SHEATHING IS-ASPHALT PAPER ASPHALT SHINGLES i • • - 1/2"WALLBOARD R30 INBUL, 2X4'e•16"O.C. IX3 STRAPPING RI3 INSULATION In'WALLBOARD 1/2"PLY.SHEATHING Q TYVEK WRAP OR EQUAL D e] BEDROM'2 SIDING a ARE 2X10 RAFTERS•I6"O.C. AREA 1/2"PLY, SHEATHING 3/4"T/G PLY. 15'ASPHALT PAPER NAILED 4 GLUED. ASPHALT SHINGLES • • ® WB STEEL BEAM - ASPHALT ROOFING ASPHALT ROOFING IS-ASPHALT PAPER NEW —1/2"PLY.SHEATHING IS-ASPHALT PAPER EXISTING KITCHEN 1/2"PLY,SHEATHING LIVING AREA AREA DRIP EDGE .pCIBT.2XI2'e•IZ"O.G. EXIST.2X12'e•12"O.G. EXIST-2XI2'e•12"O.G. B"GUTTER DRIP EDGE jTYP.EXIST.STEEL BEAMS 5"GUTTER jIXS FACIA EXISTING BASEMENT 8400 VENT IXS FACIA _ IX SOFFIT 6400 VENT / D 1-1/2"BED MLDG. IX SOFFIT ,. .. EAVE '--IX FREIZE D 1-1/2"BED MLDG. I EAVE IX FREIZE EAyE ;'DETAILS CROSS SECTION (B) i /•: SAVE DETAILS DdB REALTY i DEV. INC. MR CHUCK STEFANO RENOVATE EXISTING HOME DATE REVISION DRAWN BY PAGE SCALE J� �C�slgns I(o6 HOLLIDGE HILL LANE sl O1-03-01 +V -AL � 114. 0' MARSTONS MILLS MA. ,PABClNBBG�DfWeM4eL64✓FePR�iL6eEe Y9696EfLRCLMPLLwYGE erNAU m raere�ANDRENfGnGATffMQ"4LLLaMRB/BFQ7aNGe v ucrmnNaeew4eLexrewesauFlecert�sosQsreePTN. I I�r Paee�xaus• �s� p ecrJe eua.erus eoaea am avcn�aHesa.e o c+ve rrr.nr ee pro.-_._—•-,-. --osrewv n er ex ae m¢cormiTwave,um acrerr iaec iu vsxPr ene�ermaa.�F oea I� � ¢ f aaci+etmGe na oaue Y IGR M2 GQ•6VIKWe d¢FGW rl g INE OF 1.4•:1Y gYNU�e PUPIHb GLaVe11B'CTOK P 467!!1•e L04AL EAMMMe WN 40GAL SAW68e AND BwLDII�Y!GRKIALe. ,y1 , -------------- o -2 CA P� �t. r� y 'Q °O N 4°Gt301�sGF5F a c_ d- �1 f t QD i "_�1 -:PsO+�E EtE�lf��3 =arQ3PJCFiIt O_.O __ 1 _- f (29 4" j C) _ 7 Q" 2x"1:2 _p�scs� J�._...__ - Got-t_APz..T►E`7_.... _ _ 2x t o F7 t�1=Ti�l @(Cor10,G . -2x-fo-Ge1�..rtsC �ot5T5 i�_� r. 3-o'x'Co-S !n/O©t7 `1 L..T•- @ �lv" O.G. j • _1..�,�� c.o>�S-rr��ic;t©A.t �,r-tn��. �r n�l �.�N• - c` d' k �jl�►I y it�i r�- �o�� /tit.:C7 d.L= LG�L `a v,la<A '1 a= r �L�c•G�7-ruo�7 e ip OG 2.- AL- c�t�,l t�1.5 to�;t i �l)HAL-G (2�VL — '�] CDx S�IEA'FIt►f;� elfTb1f_ P�tn:=F,h AMC) 1-HE �t":�l�C__ <_p► 1. �) ` %P>AG7oP--> PFti 1oP7 0•D �p ._.;¢,r-Gr�r�►�P��T•E=. . � �nfF}a�� Cc^Dnl�, �1-11�.ici��rS _. ., (..au-kIcwn-rto).l ( ���►ro.C►�1.GE i cv " i I Mb: v-,-;v 1.A.It_LS.:�.M.AS`7�1.L►-{��i ETT`7. _.....--- t_ - . Z - �►- _ Imo o.�-rC; .. 9 MARSTONS MILLS 4" SCHEDULE 40 P.V.C. TOP OF FOUNDATION MIN. PITCH 1/8" PER !FOOT k 3 ELEV.= 75.76' Ap 10' MINIMUM �,„„ O 2" LAYER OF WAS8HED STONE EL= 70.7 - OR FILTER FABRIC 6" MAX.; ......... 6 EL= 69.5 Q i " }�»`Kk 's .k .} ... ': -':?b ..-...........x.x�x�xt���x�x�.�♦........♦ - : � .; 6" MAX. ...,,., EL= 69.0 1 a CONC. CONC. X/, �E I �/ CONCRETE FLOOR - „ RISER SER & INVERT ...................... ,.. ............ ; w d. / / = = CLEAN SAND...FILL 12 /� // ��� ka �. � � - 4 SCHEDULE 40 P.V.C. OR EQUAL COVER covER - t � ELEV. 67.26 RISER N �� � � x • Q ` CovE PER 310 C . MIN PITCH 1/4 PER FOOT c R FOR 2' LONGEST RUN EL 64.35 ��Q MR 15 255 MIN. FLOW LINE 25' s=.o2 8.0' =o.oi EL= 65.35 Vw V MIN 14 INVERT o 0 0 0 0 0 0 0 ° IN ERT 10 IN RT 00 65.30 EL= 65.10 INVERT �Csump INVERT ° ° ° ° a / ° °0 4' EL= 64.60 24" o °° 0 0 0 0 a 0 0 0 0 0 ° ° r GAS EL= 64.43 I ° °� • �` a4 -, ' e ,� ,, / L�� Q / EXISTING BAFFLE 6" BASE OF CRUSHED STONE OR I ° ° °° °°Q' °a' EL- 62.35 - INVERT MECHANICALLY COMPACTED 4 O' 8.5' 4.0' F � / / ° I/ tis < 6 BASE OF CRUSHED STONE OR // �, O PROPOSED 4-BAND MECHANICALLY COMPACTED P R 0 P . ( H - 2 0) ( ) 25.0 r, / / / c STAINLESS STEEL CONNECTOR D I S I R I B U TI ON 2-500 GAL.(H-20) DRY WELLS (4'-10" X 8'-6" X 3'-0") �.�� / 3 4" TO 1-1 2„ In . _ /, ti`�j .� / '� PROPOSED (H - 20) BOX ASHED STON SOIL ABSORBTION (TRENCH FORMATION ) '°�' / 1 , 500 GALLON TANK SYSTEM S. A. S. 12. 83' LOCUS MAP / / �/ / M/�' ( ) X 25. 00 .�' / l � / (NOT TO SCALE) �o��; `��o // R PROFILE OF SEWAGE DISPOSAL SYSTEM BOTTOM OF TEST HOLE #4 ELEV. = 57. 3 (NOT TO SCALE) (NO GROUND WATER) / LOT 2 _ N F 40� AREA=111,600t S.F.2.52 ACRES UPLAND SAGAMORE CRANBERRY CORP. A A.M. 81/22 1 / - TOP OF WATER \ 1 ' ( 1 �• � _ ^ _ � � � , 100 M\N• � � O 44.5 56.4' 8 0� J / TEST PIT RESULTS: s63• I �� o0 PERCOLATION RATE <2 MIN./IN. (2) PERCS 150 1 30"LOC. \ TP 1 \ EXIST. �, DATE OF SOIL TEST: JULY 11 , 2007 / �-m� ,cEssPooL WITNESSED BY: DONNA MIORANDI (B.O.H. SYSTEM DE VS GN „Pi E " TP 3 . ;.;.. a SOIL EVALUATOR: DARREN M. MEYER, R.S. WELL �89, / ( 48 N 1 36 PINE o :._ N/F NUMBER OF BEDROOMS........... 3 REPAIR 3 EXISTING 1 � ° .....' \ SAGAMORE CRANBERRY CORP. EXCAVATOR. N.P. CHRISTIANY -_ NO -_ ) (EXISTING) CO 62.6 GARBAGE DISPOSAL................._______ 1 A.M. 81/0 5 - TOTAL ESTIMATED FLOW TEST HOLE #1 660_-- 36"MAP. O (110 GAL./BR./DAY X 6 BR.) ___ GENERAL NOTES TBM - 67.8 ELEV. DEPTH (IN.) HORIZON TEXTURE COLOR MOTTLING OTHER GPD X 200% = 1320 GAL ELEV.=66.5' \ o , \ PROP. 66.1 0-20 FILL PROPOSED SEPTIC TANK........... 1500(GAL.)(H-20) 1 . ALL WORKMANSHIP AND MATERIALS SHALL CONFORM, TO D.E.P. TOP OF CB/DH 73 0' PORCHI - ; 63.4' 65.1 20-32" A SANDY LOAM 10YR4 2 _ - - \ ,,,;CONC. 64.1 32-44" B, SANDY LOAM 1OYR5/8 TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS I: _'�0' \ ;'"FL.=67.3% T - 1 u n�R _ c ' - _ / INS I ,L�: 2 �03 -,L. H--- 20;C. A; BEE - (W/4 , CRUSHED STONE FOR SUBSURFACE DISPOSAL OF SEWERAGE. - / '� \t �� co " 12•2 ` 5 .3 44-126 C11 MED. SAND 2.5Y6 4 ----- ( -__/``L`\ • `�\ �< #166 ,; .NO GROUNDWATER ENCOUNTERED ��, ON THE.. SIDES, 4' ON THE ENDS)(25'L X 12,83' W X 2'D) 2. AT BOTH ACCESS PORTS OVER THE TANK, TEES SHALL BE IY F` / (NO MOTTLES, NO REFUSAL) • ACCESSIBLE,:,WITHIN 6 OF FINISH GRADE, WITH ANY REMAINING 6-BR ACCESS PORTS BROUGHT TO WITHIN 12" OF FINISH GRADE. :2 STY PROPOSED DECK SOIL CLASSIFICATION................__ =_ 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE (SAME FOOTPRINT) DEEP TEST HOLE #2 DESIGN PERCOLATION RATE..... <2_MINIIN. CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE 69.7 ELEV. DEPTH (IN.) HORIIZON TEXTURE COLOR MOTTLING OTHER EFFLUENT LOADING RATE LTAR 74 UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS THEN THEY ,�, '�` ""' J,� 69.4 0-4" Al SANDY LOAM 10YR4/2 REQUIRED LEACHING CAPACITY.....- 330 GPD MUST WITHSTAND H-20 LOADING. ti, W o< 66.8 4-35 B3 SANDY LOAM 10YR5/8 LEACHING CAPACITY PROVIDED..... 349 GPD 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION LOT 1 �I �o ) APPROX. LOCATION �r'� 59.45 35-123" Cl MED. SAND 2.5Y6/4 - �. / SIDEWALL: (12.83 + 25 )x2x(2 SIDES)(.74)= 112 GPD OF ALL UTILITIES PRIOR TO ANY EXCAVATION. N/F ', ,�� OF EXISTING O, NO GROUNDWATER ENCOUNTERED _ 5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE BEAN SAS, ` 3-BEDROOM SEPTIC �" BOTTOM: 12.83 x 25 74 - 237 GPD " I PLACE. _ SYSTEM (NO MOTTLES, NO REFUSAL) )( ) OR WITHIN 6 OF GRADE SHALL BE MORTARED N A.M. 81 07 �' �N 6. FINISH GRADE SHALL HAVE A MINIMUM OF 2% GRADE / `30• 1 �D oN / GAL PROVIDED =349 GAL REQUIRED=330 GAL RESERVE=19 OVER THE S.A.S. AND DISTRIBUTION BOX. \ \ SEP R''-- -` DEE? TEST HOLE #3 Y TEES SHALL BE CONSTRUCTED OF 7. SEPTIC TANK SANITARY / `` --`- - W'� ~�. = - �'�,�/ , 69.0 ELEV. DEPTH (IN.) HORIIZON TEXTURE COLOR MOTTLING OTHER LOCU S NFORMAT� ON SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6" ABOVE - \ 1 68.75 0-3 Aa SANDY LOAM 10YR4/2 THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND - ___-__, ' , 66.2 3-34" B3 SANDY LOAM 10YR5 8 PLAN REF: 610 45 LOCATED DIRECTLY UNDER THE CLEANOUT MANHOLES. ! / / 58,751 34-123" Cl MED. SAND 2.5Y6/4 TITLE REF: 21832 155 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN ' / 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT 1 NO GROUNDWATER ENCOUNTERED ASSESSORS ID: 081 007 ELEVATION OF THE OUTLET PIPE. _ ((No MOTTLES, No REFUSAL) ZONING: 9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES. � I � N NG: RF 10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS / / / / / DEEP TEST HOLE #4 FLOOD ZONE: "C" BAFFLE, 4 INCHES IN DIAMETER AND CONTRUCTED OF 4 PVC. / / GROUNDWATER PROTECTION OVERLAY DISTRICT 11, ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND �� 68.2 ELEV. DEPTH (IN.) HORIZON TEXTURE COLOR MOTTLING OTHER SHALL BE SLOPED 1 /4 INCH PER FOOT MIN. EXCEPT FOR THE / / 66.7 0-18" FILL FIRST TWO FEET OUT OF THE DISTRIBUTION BOX WHICH SHALL 65.7 18-30 A SANDY LOAM 10YR4/2 BE LEVEL. 2 1 / '� ', 64.9 30-40" B SANDY LOAM 10YR5/8 I 12. CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION �o �`, 57.7 1 40-126" 1 Cl MED. SAND 2.5Y6/4 I I TOWN OF B A R N S TA B LE TO DESIGN ENGINEER FOR B.O.H. AND DESIGN ENGINEERS REVIEW / NO GROUNDWATER ENCOUNTERED AND APPROVAL. / / I I (NO MOTTLES, NO REFUSAL) SITE AND SEWAGE PLAN IW REPAIR / UPGRADE 1 Co �s LOCATED AT: 166 HOLL DGE HILL CONSTRUCTION NOTES: LANE ° M ARSTON S MILLS , 1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND M A < ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING WORK ON THE SITE. - / �';s,' SCALE: 1 " = 30' DATE: 07/30/07 2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE l WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT I PREPARED FOR IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. DGE H I L 1 L " Cry) w PROPOSED WATER SERVICE OWNER/APPLICANT: R\�/�0 TO BE CONNECTED TO MAIN 22°3S' CHARLES DESTEEANO I N s60. GRAPHIC SCALE 4s 15 30 60 . 120 �SF1 OF S cy D A R R E N �( S& 9 rA �aF 30 0 0�' DARRENGJ, So�� I�VANJ Rt3 �GN N . o M. M < CP ( IN FEET ) 6 11!_vER MEYER , R < S < o � a /S/ • 8 No. 140 1 inch = 30 ft. >> B >> o �Nd.FG,i � o ' PARCEL �.. N�TAR�PN P.O. BOX 981 ssoN S. L EAST SANDWICH, MA. 02537 � (ON HAMBLIN .POND) ,. ° J 1113 i �