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HomeMy WebLinkAbout0351 HOLLIDGE HILL LANE - Health J 351 Hollidge Hill bane Marstons Mills --- - — - - - - - A= 081-015 III No. Oc DI —49 Fee D THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ~Yes 01ppliLAtion for Veposal *pstrm Construction VffmIt �� IN �a Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components !W' t Location Address or Lot No JS 1 N 011 i lg )4 i 11 L,iJ Owner's Name,Address,and Tel No.we ,B Crt,J i rid ? ;_A Assessor's Map/Parcel �� —/5 `35) 1�0�1 i�9� fIi I I L� M, r'1 i 1 I s Installer's Name Address and Tel.No. r tq EXGR.✓oC110A Designer's Name,Address,and Tel.No. !y'Tc--1crry LN For-csictc c- Type of Building: P� Dwelling No.of Bedrooms 1 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 /✓/47- gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable)�� BOX O Q L.Y 0 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si Date 0• ']- 1? Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 0�$ 7TJ c� Date Issued 3 No. � / -- � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplicatlon for Disposal 6pstent Construction 3permit Application for a Permit to Construct( ) Repair Vu pgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.,3$! Ho11 i 9 _ )4;I l LQ Owner's Name,Address,and Tel.No. WcrN4Lj Q;cry:rit Assessor's Map/Parcel MH ---�� �S! °!1 rc�9 c r 1 �'� >n• r� i 1 )S Installer's Name,Address,and Tel.No. (� (� Fuca t/o,4 o A Designer's Name,Address,and Tel.No. Z iy Type of Building: Dwelling No.of Bedrooms /'1 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 gpd � 4 "• Plan Date Number of sheets Revision Date F Title ,1. Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) BOX Q I Date last inspected: r, Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in I accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si ed Date Application Approved by 4Date Application Disapproved by Date , for the following reasons Oles Permit No. Date Issued a .3 zoo ----------------------------------------------- ------------ 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 ,B )iCa y<,),A 0 n at 351 0 C,)) t j q c- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No, - dated a/, -7 20 Installer r Designer #bedrooms }- Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will fimctto_n asesi d ed. jj �D t ate ��/� � ,� Inspector No. 1;10 j 3c;-f rs�(lt5_ Fee 1 _�_S -00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem (Construction 3permit Permission is hereby granted to Construct( ) Repair( k,,Y" Upgrade( ) Abandon.( ) System located at a.S 1 d o)it 4 y<— M 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 orspecial conditions. Provided:Construction must be completed within three years of the date of this permit. Date / /�� /��d/� Approved by �`� Town of Barnstable Barnstable Regulatory Services Cky Department p STASM : p 1 M" �'1639. ,� Public b c Health Division ��fO"AP�a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL47015 1130 0001 4990 6685 September 14, 2018 BIERWIRTH, WENDY &BETTE ANN 377 WHEELER ROAD MARSTONS MILLS, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 351 Hollidge Hill Lane, Marstons Mills, MA was inspected on 08/28/2018 by James D. Sears, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Distribution box needs to be replaced. You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH 4cVl�s T o as McKean R.S. Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mai ling\Conditionally Passes Letters\351 Hollidge HIII Lane Marstons Mills.doc II h Town of Barnstable Z awruvsrnsM 9�A "5 ,�� Regulatory Services Department rFD µA'l h Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool y"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER ❑ Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc OR - O rS y Commonwealth of Massachusetts Title 5 Official Inspection Form •� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 351 Hollidge Hill Lane Property Address Wendy Bierwiah Owner Owner's Name information is required for every Marston Mills t/ MA 02648 8-28-18 Page- City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. `o"' vA OF w41q��i Important:When A. Inspector Information sly 13r filling out forms o; G on the computer, 'JAMES use only the tab James D.Sears =' key to move your Name of Inspector = :cn cursor-do not use the return Company Enterprises key. Name 5 I N SO--�'`\10. 153 Commercial StreetVQ Company Address Mashpee MA 02649 City/Town State Zip Code nwn 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the properfunction and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ® Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 9-4-18 ;sp!!tors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate ` regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: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. 15insp.doc•rev,7(26/2018 Title 5 Official Inspection Form:5u0surface Sewage Disposal System•Page 1 of 18 5 a5ed xeJ dH 9t?U 81,0Z 0 (:,aS Commonwealth of Massachusetts Title 5 Official 'Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments 351 Hollidge Hill Lane Property Address Wendy Bierwiah Owner Owner's Name information is required for every Marston Mills MA 02648 8-28-18 pa". City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: Conn Pass - D Box. The system is a 1500 Gal. Tank D Box and two pit's. 2) 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 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. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.726/2018 Title 5 Ofrwial Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 9 a6ed xed dH 9tqZ 8l•0Z b0 d@S Commonwealth of Massachusetts f Titie 5 Official Inspection Form I' Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 351 Hollidge Hill Lane v Property Address Wendy Bierwiah Owner Owner's Name information is required for every Marston Mills MA 02648 8-28-18 page. City/7own State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ® Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ® distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): Need to replace D Box. ❑ 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): 3) 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. a. 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: t5insp.doc rev.701201E Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 18 L a5ed xed dH 9b:£Z 860Z t,0 daS Commonwealth of Massachusetts ,-9 Title 5 Official Inspection Form F t' Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 351 Hollidge Hill Lane Property Address Wendy Bierwiah Owner Owner's Name information is required for every Marston Mills MA 02648 8-28-18 page. CiWTown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply*well**. Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No I El ® 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 t5lnsp.doc•rev.7126/201B Title 5 Official Inspection Form:Subsurface sewage Disposal System•Page 4 of 16 9 a5ed xe� dH &E2 9l,0Z b0 dag Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 351 Hollidge Hill Lane Property Address Wendy Bierwiah Owner Owner's Name information is required for every Marston Mills MA 02648 8-28-18 page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth In is less than 6"below invert or available volume is less than '/z day flow PiT s ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number.of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 a mapped Zone 11 of a public water supply well 15insp.doc•rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 6 a6ed xed dH Lt,:EZ 91.0Z t70 daS Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form • Not for Voluntary Assessments 351 Hollid a Hill Lane u, Property Address Wendy Bierwiah Owner Owners Name information is required for every Marston Mills MA 02648 8-28-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cost.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 15insp.doc-rev.7/260016 Title 5 Official Inspection Form:Subsurface Sewage Dlsposel Sy$IDM Page 6 or 16 Oil, a5ed xed dH 8t,:£Z 860Z t,0 daS Commonwealth of Massachusetts Title 5 Official Inspection Form i} Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 351 Hollidge Hill Lane Property Address Wendy Bierwiah Owner Owner's Name information is Marston Mills MA 02648 8-28-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 Description: 0 Number of:current residents: Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes,discharges to: Is laundry cn a separate sewage system? (Include laundry system inspection ❑ Yes'® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water mete�a readings, if available last 2 ears usage d Well Water 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No NA Last date of-occupancy: Date I t5insp.doc•rev.7/28/2018 Title 5 Official Inspection Forth:Subsurface sewage Disposal System-Page 7 of 18 6l a5ed xe:1 dH 8t7:£Z 860Z b0 daS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Dis Deal System Form •Not for Voluntary Assessments S rface g p Y 351 Hollidge Hill Lane Property Address Wendy Bierwiah Owner Owner's Name information is required for every Marston Mills MA 02648 8-28-18 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: 16insp.doc•rov.7126/2018 Title 5 Official Inspection Form:Subswiace Sewage Disposal System-Page 8 of 18 Z 6 a6ed xed dH 6b:£Z 9I,0Z b0 daS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 351 Hollidge Hill Lane Property Address Wendy Bierwiah Owner Owner's Name Information is Marston Mills MA 02648 8-28-18 required for every page, Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 1987- Permit # 87- 314. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 6- -4" Depth below grade: feel Material of construction: ❑ cast iron 2].40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH -40. t5insp.doc-rev.7/2612018 Title 5 Official Inspection form:Subsurface Sewage Disposal System Page g of 18 Et, abed xe:1 dH 6VU 9I,0Z t70 daS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 351 Hollidge Hill_Lane Property Address Wendy Bierwiah Owner Owners Name information is required for every Marston Mills MA 02648 8-28-18 page. Clty(rown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast - H-10 Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 26' Scum thickness 2'r Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Asbuilt-Plan-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level.Tank at 5'-6"below grade wlboth covers at 10", In and outlet baffles. No sign of leakage or over loading. t5insp.doe•rev.712&2018 rifle 5 Official nspeclion Form:Subsurface Sewage Disposal System•Page 10 of ill bl• a6ed xed dH 6t,:EZ 860Z b0 daS Commonwealth of Massachusetts Title 5 Official Inspection Form j Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 361 Hollidge Hill Lane Property Address Wendy Bierwiah Owner Owner's Name requinform r on is Marston Mills MA 02648 8-28-18 requiredd for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions; Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5lnsp.doc-rev.7/282D18 Tine 5 Mial Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 S6 abed xed dH 09U 860Z b0 d@S I Commonwealth of Massachusetts Title 5 Official Inspection Form �e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 351 Hollidge Hill Lane Property Address Wendy Bierwiah Owner Owner's Name ti is reequirequired f for every Marston Milts MA 02648 8-28-18 a page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ' Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"-6' below grade wltwo line's out.Wall's are gone on box. Need to replace D Box. t5insp.doc•rev.7126/2818 Title 5 Official Inspection Form:Subsurface Savage Disposal System-Page 12 of 18 9� a6ed xed dH 09:EZ 960Z b0 daS t\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments �JJ7,r� 351 Hollidge Hill Lane Property Address Wendy Bierwiah Owner Owner's Name information is required for every Marston Mills MA 02648 8-28-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont) 10. 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. 11, Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5lnsp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 L6 a6ed xed dH OS:£Z 960Z t0 daS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �S 351 Hollidge Hill Lane Property Address Wendy Bierwiah Owner Owner's Name information is required for every Marston Mills MA 02648 8-28-18 page. City/Town State Zip Code Date of Inspection D. System Information (coot.) 11. Soil Absorption System (SAS)(cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is two 1000 Gal. precast pits. Pit#1 at 64" below w/cover at 10" and Twater. Pit#2 at W-3" below grade w/cover at 10"and wet bottom. No sign of over loading or solid carry over. 12. Cesspools (cesspool must be pumped as part of Inspection)(locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.)* t5insp.dac-rev.7/26IM18 Title 5Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 abed xe da 8 1. d dH OS'£Z 8 60Z b0 S Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form•Not for Voluntary Assessments .� 351 Hollidge Hill Lane L Property Address Wendy Bierwiah Owner Owner's Name information is required for every Marston Mills MA 02648 8-28-18 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.MU2018 Tale 5 Official Inspection Form:Subsurface Sewage Disposal Syswm-Page 15 of 1B 66 @Bed xed dH 65:£Z 960Z b0 daS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 351 Hollidge Hill Lane LY Property Address Wendy Bierwiah Owner Owner's Name informatrequired is Marston Mills MA 02648 8-28-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cant.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately R EAR �AI'ALi Q r3 l9 v1�r 3 I, 3 OL S O : .for t5insp.doc•rev.712612018 Title 5 Official nspeelion Form:Subsurface Sewage Disposal System•Page 16 of t6 OZ abed xed dH l•5£Z 8l•0Z b0 daS y Commonwealth of Massachusetts ,lp Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 351 Hollid a Hill Lane Property Address Wendy Bierwiah Owner Owner's Name information is Marston Mills MA 02648 8-28-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 12'+ Estimated depth to No ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 12-20-81Date ❑ Observed site (abutting propertylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health- explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T H on Design plan 12-20-81 -12' no G.W.. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc rev.7/26/2018 Title 5 Official Inspection Form!Subsurface Sewage Disposal System-Page 17 of iS I,Z a5ed xed dH 65EZ 960Z b0 daS Commonwealth of Massachusetts : gia Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments v 351 Hollidge Hill Lane Property Address Wendy Bierwiah Owner Owner's Name information Is required for every Marston Mills MA 02648 8-28-18 page. Citylrown State Zip Code Date of Inspedion E. Report Completeness Checklist Complete all applicable sections of this form Inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed 8, Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included 15insp.doc-rev.7/26/2018 Title 5 Official Inspedlon Form:Subsurface Sewage Disposal System-Page 18 of 10 ZZ abed xed dH 65:EZ 860Z t,0 daS S g COMMONWEALTH OF MASSACHUSETTS EXECUTIY,E OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION r G y; TITLE 5 OFFICIAL INSPECTION FORM-. NOT FOR VOLUNTARY ASSESSMENTS r SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A y CERTIFICATION pF �_ t Property Address: 351 HollidQe Hills Lane t Marston Mills,MA_ 02648 Owner's Name: Dianne Burden 4i Owner's Address: Date of Inspection: March 12, 2012 Name of Inspector: (Please Print) James M.Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I I certify that I have personally inspected the sewage disposal system at this address and that the information reported jbelow 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(3.10 CMR 15.600). The system: i , ✓ Passes C nditionally Passes e ds.Further Evaluation by the Local Approving Authority a s Inspector's Signature: Date: March 14, 2012 The system inspector shaysu *tpy oft is 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 I` 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 Forni 6/15/2000 page 1 � S r P.agb 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 4 PART C SYSTEM INFORMATION.(continued) Property Address: 351 HolliQe Hip'Lane Marston Mills. A Owner: Dianne Burden Date of Inspection: March 12, 2012 SKETCH OF SEWAGE DISPOSAL.SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 1 (3Ac GAM 2 Q 3 S a as t� y 3 a� as S (43 a� 10 r"`wt Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 351 Hollige Hill Lane Marston Mills, MA Owner: Dianne Burden Date of Inspection: March 12, 2012 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 14+1 _feet Please indicate (check) all methods used to det_;rmine the high ground water elevation: 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: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the liigh.ground water elevation: Using Barnstable topographic and water contours maps, the maps were showing approximately 14'+1-to groundwater at this site. j i This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the fixture. There hC.ve been no warranties or guarantees, either expressed, written or implied, relating to the septic system, theinspection, this report and/or any components of the septic system which have not been located.and inspected. 11 ,I -Nutter Eliza Cox Direct Line: (508)790-5431 Fax: (508)771-8079 E-mail: ecox@nutter.com May 8, 2012 #111711-2 Tom Perry, Building Commissioner Thomas McKean Health Agent g � g Town of Barnstable Town of Barnstable 200 Main Street 200 Main Street Hyannis, MA 02601 Hyannis, MA 02601 Re: Dianne S. Burden- 351-Hollidge Hill Lane,.Marstons Mills Dear Tom and Tom: On behalf of my client, Dianne S. Burden, owner of the above-referenced property, I enclose herewith for your files a copy of the deed restriction which you both previously reviewed and approved, as recorded with the Barnstable County Registry of Deeds in Book 26312, Page 86. As you will recall, this deed restriction confirms that the improvements which my client's contractor completed in 2002 in the ground level floor of the dwelling are authorized and do not create any zoning or.health.issues. The deed restriction, as you know, limits the dwelling to a total of four(4)bedrooms, which is consistent and compliant with the onsite septic system, and further confirms that the ground level improvements are accessory, incidental and subordinate to the use of the single family dwelling. As we discussed, my client has also made arrangements to obtain an electrical permit and, I understand, that an inspection has been completed for the ground level improvements. Accordingly, with this recorded deed restriction and based upon our prior discussions, it is my understanding that nothing further is required from the Town to permit and maintain these improvements. � � C5 Please do not hesitate to contact me with any questions or comments. T alc you 15-1 very much, for all of your time and assistance with this matter. Very truly yours, ° tAkr0�-- ' Eliza Cox EZC:cam Enclosure cc: Dianne Burden (w/encl.) NUTTER McCLENNEN & FISH LLP • ATTORNEYS AT LAW 1471 Iyannough Road • P.O. Box 1630 • Hyannis, Massachusetts 02601-1630 • 508-790-5400• Fax: 508-771-8079 www.nutter.com f DEED RESTRICTION WHEREAS, Dianne S. Burden (hereafter, the "Grantor") is the owner of the property known as and numbered 351 Hollidge Hill Lane, Marstons Mills, (Barnstable County), Massachusetts, which property is more particularly described in the deed recorded with the Barnstable County Registry of Deeds (the "Registry") in Book 13662, Page 213, and is shown as Lot 19 on the plan recorded with the Registry in Plan Book 265, Page 68 (the "Property"); WHEREAS, in 2002, the Grantor hired a contractor to finish a portion of the ground level floor of the existing dwelling located on the Property to include a kitchenette (with no stove), a bathroom, and two additional rooms, one of which may qualify as a"bedroom" as that term is defined by the State Environmental Code, Title 5, 310 CMR 15.00 (hereafter, the "Ground Level Improvements"); WHEREAS, to permit the Ground Level Improvements to be maintained on the Property, the Grantor has agreed with the Town of Barnstable to place this restriction on the Property, which shall be recorded at the Registry, limiting the number of rooms which may be used as a bedroom for sleeping purposes and also restricting the use of the Ground Level Improvements. NOW, THEREFORE, the following restrictions are hereby placed upon the Property, which restrictions shall run with the land and be binding upon all successors in title until such time as the applicable regulations are amended to permit any of the uses allowed herein, or until the Grantor, or a future owner of the Property, obtains all necessary permits and approvals to allow for a different use of the Property. 1. Only four(4) of the five (5) rooms on the Property offering privacy in accordance with Title 5's definition of a"bedroom" may be used as bedrooms for sleeping purposes. The fifth such room shall not contain a bed or a mattress, and may not be used as a bedroom. 2. The kitchenette constructed as part of the Ground Level Improvements shall not include an oven or a stove. The kitchenette may include counters, cabinets, a sink, a dishwasher and a refrigerator. 3. The Ground Level Improvements shall be accessory, incidental and subordinate to the use of the dwelling on the Property and shall not be utilized or rented as a separate dwelling unit or apartment. [SIGNATURES ON FOLLOWING PAGE] 2012. Executed as a sealed instrument this/y of_day �, Dianne S. Burden' COMMONWEALTH OF MASSACHUSETTS L2 , ss. On this day of , 2012, before me, the undersigned notary public, personally appeared Dianne S. Burden, proved to me through satisfactor evidence of identification, which were i(,t/1 QL,0a rap , to be the v person whose name is signed on the preceding or attached document, and acknowledged to me that she signed it for voluntarily for its stated purpose. AMY L. GREEN UI Notary'Public COMtdoNwEALTH of MASSACHUSETTS Notary Pub nay Commission Expires ���J j/ KV September 1s.21017 My Commission Expires: C 2092404.3 2 TOWN OF BARNSTABLE LOCATION e f SEWAGE # li VILLAGE /�<</s ASSESSOR'S MAP & LOT IL INSTALLER'S NAME PHONE NO. T IV 3 3a�c� SEPTIC TANK CAPACITY /,57;D LEACHING FACILITY:(type) l�f 7`S (size)_/® 0 ,3 NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER . BUILDER OR OWNERS DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: ��, ._ P G VARIANCE GRANTED: Yes No ,� Y � I ilk, CA R A Le ASSESSORS;MAP N0: Nb....�7 -.3�,` PARCEL NOa Fm3....,7t. ..._....... THE COMMONWEALTH OF MASSACHUSETTS i BOAR® OF HEALTH Town Barnstable o F... ................................ Allp iratinn for Bi_qpnatt1 Works Tomitrnrtinn Famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Lot 19 hollidge hill Ln Marston Mills ................_................................................................................ ---.._..--•---...-•-----•-........._..---••-•--------------•--••----------._...-----------.....•-- Joseph & Lindi°°V ff'4lrt6 4.1 Blantyre Av°r L°1 ''0'enterville , Ma. ......................-.......................................................................... ..........--...................................................................................... W J P Morin Owner Salt Rock Rd. B'fffttable 9 Installer Address UType of Building Size Lot.__.45.,_O.OQ_____\,.Sq. feet Dwelling—No. of Bedrooms___.4__...................................Expansion Attic ( ) Garbage Grinder (XX aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ---------------------------------------------------------•••--••--•------••••------•-- ....................................................... W Design Flow_____5-5..................................gallons per person per day. Total daily flow....51_Q_0 ................................gallons. WSeptic Tank—Liquid capacitv1_50_Q__gallons Lengthy 6_____ Width_S_.Q__.._._ Diameter________________ Depth6___3_...... x Disposal Trench—No. ........ Width_______________`_:_ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-_2------_--------- Diameter___6_��_�._�___ Depth below inlet__6_�Q..._..._. Total leaching area l Q_98__.._.sq. ft. z Other Distribution box M Dosing tank ( )" '-' Percolation Test Results Performed b E 1 dre dge E nge ne e r ing Date_1�12 9/81_____________ !i a y.. ------•- --. Test Pit No. 1.2____________minutes per inch Depth of Test Pit....l ......... Depth to ground water._Non2•_--------" 4q Test Pit No. 2....2.........minutes per inch Depth of Test Pit..... 2.......... Depth to ground water_.None ----------------------------------•----•--------------...-•----._... O Description of Soil...0' to2•'• loam & subsoil- 2'1�•'_--clay-----_'-112'___med:brown .sand x 0'�2' topsoil , trace of clay 2'l3 ' clay 3'J10 ' med brown sand ___U___.-- 101 , 12 me d..white s amd U Nature of Repairs or Alterations—Answer when applicable............................................................................._.................. •-•••--••-••------•-•••---------••-••-•---•-------••----•-•-••••--••---•---••••••--._...•--•--••---•--••---••••---------------•----•••-•••----•-••-----•----•-•-••••-••-•--•••••--•-•--•••--•--•-•-•••• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TI YjE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is e ble oard of health. Signed••••--•--•-•-• Date Application Approved By........... ___ - ---------•------------ --------•-------- Date Application Disapproved for the following reasons----------------•---------------------------------------•--------------------------------------------......----•- -------------------•-•-----------•--•---•---------••-----•••-• •-•----•----••••••-•---••----•••••••------•••••-----•••--•---- Date PermitNo ?--Lr_--__2x-/G%-----•-•-•••-------_.... Issued_----•-•---•----------------------------•-- ----------- Date ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable .. -------•-•-......OF............... ...................... ................. _......._. Appliratiun for Uhipati tl Works Tonstrurtiun amit Application is hereby made fora Permit fo Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ° Lot 19 hollidge hi1111n Marston Mills •-------------------------------------------c-p-�-yp---•--•••�-•••,.�.--•-•---••--.;...................... ..........••-••••--••----••-----------------.......-------------•--...--••------............------ Joseph & LindaLold i�cs t 4.1 Blantyre AV or Lot Venterville , Ma. ......................... -... - �.:._.... -- W J P Morin owner Salt Rock Rd. B01Mtable Installer Address Type of Building Size Lot._45...00 ......... feet aDwelling—No. of Bedrooms...4......�................................Expan�ion Attic ( ) Garbage Grinder xX) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------------------••-------------•-•-•-••--••-------•-•-•-•----•--••-••---••--•••....-•-•-•---•----•--••••-•....---.....--•- W Design Flow....55...................................gallons per person per day. Total daily flow__ QQ.................................gallons. • � W Septic Tank—Liquid capacit�.5QQ...gallons Length'�_0 S._e.._. Width5._aa_ ._f....__ e Diameter................ Depth.1-3.#_-.,--__. x Disposal Trench—No......... ..... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.2_________________ Diameter.. .... Depth below inlet.6_..0.r.......... Total leaching areal.P .......sq. ft. Z Other Distribution boxX(X ) Dosingg tank ) '-' Percolation Test Results Performed byHdre ge_.Engeneering..... Date12129/81.................. ,aa Test Pit No. 12______________minutes per inch Depth of Test Pit..12-'_ Depth to ground water None fro Test Pit No. 2---2..........minutes per inch Depth of Test Pit...1.2�._.._._.. Depth to ground water.None O Descr' tionof Soil_.�'___t02'._.lOam_._8c.._SUbS011 2' 3_'__._clay-:_3:'J'12'_ med brown sand x 0' 2' topsoil, . trace of clay 2'75- clay___- 3' 10' med brown sand V .._ -- •••....._ ......•• ......... ......... .......... W 10 /12 med wh.x to s amd U .Nature of Repairs or Alterations—Answer when applicable............................................................................................... -------------------------- •--------------------------------------- •---•-----------------------------------------------•--------------------------------•- Agreement: . The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITUE -of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i u },the oard of.health. Signed............. .................•--------` --- ---------------- .. Date Application Approved BY `,.�` .'"� --•----••-----------------•-•--.......-- Date Application Disapproved for the following reasons:----•-------------------------••------------•---------••------•------------------------------------------.._.-- ......................................................-.................................................................................................................................................. Date PermitNo-----IK-L ....I ........................ Issued-....................................................... Date THE,COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN BARNS TABLE ..............................................._.... ................................O F................................. uprrtifiratr of Tuutplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by...................................................................................................•••-----.....•-----•-•......--•...--•-•-----•---•-------------------------------•....__....--•--- Installer at---•••..................•--•-•---•-----•-•-....----•---------•--•....-••--•-•---•----•-------...••---- has been installed in accordance with the provisions of TT 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT HE SYSTEM WILL FUNCTION SATISFACTORY. DATE DATE...........................).'- 1 cx '— . �t.- ...................... Inspector ._......... �.,..:�D.............................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH {^ TOWN BARNS. .TABLE ��.. ...................OF....................... ................._._..... ................................ FEE........................ . �t��ou�tl ork� �onutrnrtion rrutit Permission is hereby granted...... = =-•••---&ercym-.--••---------•-----•----....-•-------------------------•-•-••------.....-----..........--•----- to Construct ()<') or Repair ( ) an Individual Sewage Disposal System at No.......1 _ T---/J..._�7�C T Street � as shown on the application for Disposal Works Construction Permit Nof! _". __ ,? Dated.......................................... DATE-----------------------------y...`---`I---7-:--............................... Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS _ Department of Environmental Management/Division of Water Resources 61 WATER WELL COMPLETION REPORT W L LOCATION Address City/Town 9 IV G.S.Quadrangle Map Grid Lo ion Owner Addr Qj�� e -G iWELL USE CONSOLIDATED WELL Domestic rrF Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones 1) From To Method Drilled t�- 21 From To Date Drilled d7 _ 3) From To 4) From To _ !, CASING Depth to Bedrock Length S- Diameter Type�fl C. UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land sur ac Iy Sand: fine❑ medium❑ coarse❑ Date measured Gravel: fine❑ medium❑ coarse❑ GRAVEL PACK WELL' / Screen: rUF( Slot#f O length from:zz/1 WSJ Yes ❑ No Split Screen (or 2nd screen) WATER QUALITY TESTS M Slot# lenqth from to Chemical r/ua/ Bioloqical o-�J� Depth To Bedrock N PUMP TEST Drawdown feet after pumping days hours at 14 GPM. How measured Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To 0t(9 2,0 cc) D C) DRI 11 LE R m ° Address City Registration o. 'PlAerator s ignature ease print firm y CUSTOMER COPY 2SM-10-85-807101 OFFICE LABORATORY 1498 HIGH STREET 176 PLYMOUTH STREET BRIDGEWATER, MA 02324 BRIDGEWATER, MA 02324 f OLIVEIRA ENVIRONMENTAL LABORATORIES, INC. FOOD- DAIRY PRODUCTS-WATER-WASTEWATER CHEMICAL Et BACTERIOLOGICAL ANALYSES 697-26M May 6, 1987 L. Wile & Son Drilling Co. 11 Annasnappitt Drive Plympton, Mass. 02367 Source: Well Water Drilled Well - 6 inch PVC well - 50 feet deep - producing 25 gals/min. Located on the property of Mr. Joseph Iafrate - Lot 19 - Hollidge Hill Rd. , Marstons Mills, Mass. Coliform Count /100 ml @ 35 C Membrane Filter 0 S.P.C./ml @35C 2 Color (APC units) 0 Sediment none Turbidity (NTU) 1.0 Odor none Taste satisfactory pH 6.6 Specific Conductance 75. micromhos/cm mg /liter Total Alkalinity (CaCO,) 8.00 Free CO, 3.92 Total Hardness (CACO,) 14.0 Calcium (Cal 2.40 Magnesium (Mg) 1.95 Sodium (Na) 10.4 Potassium (K) 0.63 Total Iron (Fe) L 0.01 Manganese (Mn) L 0.01 Silica (SiO2) 1.50 Sulfate (S0,) 8.00 Chloride (CI) 16.0 Nitrogen - Ammonia 0.08 Nitrogen - Nitrite 0.006 Nitrogen - Nitrate 0.18 Copper (Cu) _ L= less than On site collection made by Mr. L. Wile - 5/1/87 at 3:00 P.M. Sample delivered to laboratory by Mr. L. Wile - 5/1/87 at 5:00 P.M. Bacteriologically, this well water is of a satisfactory sanitary standard and is suitable for drinking and domestic purposes. Chemically, this well water meets the standards for all the chemicals tested. cc: Board of Health Marstons Mills, Mass. Director r ` r , , The Standard-Plate Count indicated the general bacterial population of the well at the time of collection. Coliform Group Bacteria: Significance The coliform group bacteria includes organisms found in the intestinal tracts of warm blooded animals, birds,decaying organic matter(hay, leaves, wood, etc.), the top 2 to 3 feet of the soil, lakes, ponds, brooks, rivers, drainage and types of vegetation. Because the organisms can cause some illness; because the presence of coliform organisms in the water suggests that other more harmful organisms may be present, water containing one or more coliform group bacteria per 100-ml of sample should not be used for drinking or cooking purposes unless boiled 5 minutes or disinfected by other means. This bacteria is of animal origin(intestinal tract)and may be considered as closely associated with disease causing organisms.On this factor, none should be present. Color — APC Units- Ground water ought to be practically free from color. For attractive water- color should not exceed 15 units. Turbidity — NT Units- Recommended limit not to exceed 5 units. Odor£t Taste — For water to be of high quality, the water should be odor free and taste good. pH — The pH value defines the concentration of free hydrogen ions in solution. Expressed on a scale extending from 0 or very acid to 14 or very alkaline with 7.0 being neutral. Specific Conductance — Conductivity is a good criterion for measuring the degree of mineralization and assessing the affect of diverse ions on chemical equilibria. Total Alkalinity — The alkalinity of this water represents its content of carbonates and bicarbonates. Free Carbon Dioxide — Well water having a low pH and a Free CO, level in excess of 50. mg/I will be corrosive to iron, bronze, brass and copper tubing and fittings. Total Hardness — Standard not to exceed 50. mg/I. Waters having a hardness level of 50 to 100 are in the medium hardness range, over 100 very hard. Calcium -- Calcium contributes to the total hardness of water.Appreciable amounts of calcium salts break down on heating and form scale in boilers, pipes and cooking utensils. Magnesium — Magnesium is a common constituent of natural water. Magnesium and calcium ions are principal contributors to water hard- ness. Concentrations in excess of 125 mg/I can exert a cathartic and diuretic action. Sodium — Recommended limit not to exceed 20 mg/I. Potassium — Potassium concentrations in drinking water seldom exceed 20. mg/I. Total Iron — Standard not to exceed 0.3 mg/I. Manganese — Standard not to exceed 0.05 mg/I.The principal reason for limiting the concentration of manganese is to reduce esthetic and economic problems. Silica — Silica content of natural water is most commonly in the 1 to 30 mg/I. Silica in water is undesirable because it forms difficult to remove silica scales. Sulfates — Standard not to exceed 250 mg/I. Chloride — Standard not to exceed 250 mg/I. Nitrogen — Ammonia is present in variable concentrations in many surface and ground waters. Its occurrence in ground water is generally a result of natural reduction processes. Nitrogen - Nitrite — Nitrite in water poses a health hazard, but fortunately seldom occurs in high concentrations. Waters with a nitrogen - nitrite concentration over 1 mg/I should not be used for infant feeding. Nitrogen - Nitrate — Standard not to exceed 10. mg/I. Nitrate, in high concentrations can and do cause methemoglobinemia or so-called nitrate poisoning in infants. Water with 10 or more mg/I of nitrate is unsatisfactory and is not considered safe for drinking or cook- ing. It is especially dangerous to children and should never be used in infant formulas. Copper — Standard not to exceed 1.0 mg/l. , TEST PIT #1 TEST PIT #2 GENERAL NOTES ELEV.=6Z)e5 ELEV.= 6Z-,5 10 o a �i 1. ALL ELEVATIONS SHOWN ARE BASED UPON L.o.n.Nr ToP so i l., r1 T2iztac� i IF7USG tr SJh�t�M GL Y ' ,I Ir 2. PITCH ALL LINES A MINIMUM OF 1/8" /FT. UNLESS �t i� ' f = 000000 0 0 (D 00000d OTHERWISE SPECIFIED. t 000000 0 O 0 000000 3. ALL PIPES TO AND IN THE SYSTEM SHALL BE CAST I .. �' - - - - - - - - - - - - � T `0 00000 @ (J 0 0 0 0 0 00 IRON OR SCHEDULE 40 :PVC. o I 4. ALL SEPTIC TANKS DISTRIBUTION BOXES, AND M nac Mir:. 000 0 0 0 4 O 0 0 0 0 0 00 ;� , - LEACHING PITS SHALL BE DESIGNED FOR H-20 WHEEL 000000 ® OO (D 000000 LOADINGS WHEN UNDER PAVING. �,/ � 000000 O O ® 000000 D 000000 ® O 0 000000 5. REMOVE ALL UNSUITABLE MATERIAL BENEATH THE . �L 14" 000001 @ O 0 000000 _INVERT `ELEVATIONS OF THE LEACHING PIT: FOR 4 TYPICAL DISTRIBUTION BOX 000 0 0 0 @ O 15) 0 0 0 000 A DISTANCE OF 1OFT. AND BACKFILL WITH CLAY- i o' 4-0 FREE SAND 8+ GRAVEL HAVING A PERCOLATION RATE M S LIQUID LEVEE C T� I NOT TO SCALE 6'_p OF 2 MINUTES PER INCH OR LESS. j 12 +2 L — - NOTE- DISTRIBUTION BOX AND I5©c) 6. THE c3t,—ZO6TA -15 BOARD OF HEALTH MUST o ��1�.-rE2 BE NOTIFIED WHEN THE SYSTEM IS NEAR COMPLETION GAL. REINFORCED SEPTIC TANK BY AND PRIOR TO BACKFI LLI NG OBSERVATION PIT TYPICALIr00 GAL. SEPTIC TANK ACME PRECAST OR EQUAL. TYPICAL LEACHING PIT 7. -UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS NOT TO SCALE NOT TO SCALE SHALL BE INSTALLED IN ACCORDANCE WITH TITLE V PERCOLATION RATE-- r-+ i_ plc OBSERVATIONS BY: NOTE- TANKS REINFORCED THROUGHOUT WITH OF THE STATE SANITARY CODE AND ANY LOCAL F *>✓r 4�aTt� RULES WHICH MAY APPLY. BOARD OF HEALTH ELECTRIC WELDED WIRE WITH 24--1/2" EMBEDDED STEEL RODS IN TOP'& BOT- ` 8. CONTRACTOR IS TO NOTIFY ENGINEER, PRIOR TO THE ENGINEER t`.L-rDL:_Lam-, �{.�G ,r�i�E.2 j I J. OBSERVATION PIT TO BE EXCAVATED 8+ TOM. CONCRETE IS 4000 PS.i TEST, 4' BE.LOW PROPOSED BOTTOM OF PIT INSTALLATION OF SEPTIC SYSTEM, OF ANY DISCREP- DATE i Z-D/ ELEVATION TO VERIFY. SOIL CONDITION ANCIES BETWEEN TEST PIT .RESULTS AND FIELD AND WATER TABLE. ENGINEER TO BE CONDITIONS. NOTIFIED PRIOR TO CONSTRUCTION. - E 9. ACCESS MANHOLES TO SEPTIC TANKS AND LEACHING PITS TO BE BUILT UP TO 12 INCHES BELOW FINISH )�L*55t8 GRADE. 4b TOP OF E FOUNDATION `�`'50" ELEV._ FINISH GRADE FINISH GRADE FINISH GRADE OVER LEACHING 5o yC' FINISH GRADE OVER TANK OVER "D" BOX AREA ELEV._ 5"7t8 ' . 1,145 , � ELEV 7,o ELEV._ 58to ELEV.:!- EXIST GROUNb - -` / � � 7171- n -.r�` 3 x /8 x /4 ..WASHED STONE INV. 5a�-+z ' .., INV,= _�zt° . ..,:•. ,o:. ' 5 � �INV. - jai, - INV.- o ... o 11 82��ctf� ,ti •' L �5a+o . :._ . GAL. INV.- 52-tz5 ... . ...... REINFORCED DIST. BOX o o°� �....... .. . . ....... ° Z� x 3/4 x 1'V2 cx CONCRETE (TO BE LEVEL °� """ ": """" � S�,vD a °�a . : ..... o0o WASHED STONE � F i 'J' � 8+ .STABLE) �8 �° :.::::,::: ..::::: o 0 0 °� b� . . . BOTTOM QF`PIT �e SEPTIC TANK I I2.► .f o p j (TO BE LEVEL8� STABLE) INV.- �z+0 ELEV.` --�', TYPICAL SEWAGE SYSTEM PROR LE PRECAST LEACHING PIT 1 (TO BE LEVEL 8, STABLE) NOT TO 5CALE LEGEND �•``� N MAP SECTION PARCEL LOT ADDRESS EXIST. CONTOUR — --- ---- 8 <� �►,_ � '� �' ,,._ sue_ 7 PROPOSED CONTOUR y ` 3< EXIST SPOT ELEVATION 8 X 0 54 + � .� y PROPOSED SPOT ELEVATION 8 +0 8. ZONING DISTRICT FLOOD HAZARD ZONE PERCOLATION TEST Q1 VF r A,� OBSERVATION'PIT �I c o , PROPOSED LOCATION OF DWELLING DESIGN -CRITERIAA' �4 ` ' � & SEWAGE DISPOSAL SYSTEM NUMBER OF BEDROOMS s mean' s PERSON PER BEDROOM -2_ la►r�+orm 1 GALLONS PER`PERSON PER DAY -55� ( � 5� - -t LEACHING `R E4 U I R E D _� P by _--- lOgaGPC� PROVIDED i SIT - S o DISPOSAL PR` 1 1 z-7fF7 APPLICANT . ENGINEER �- SEWER DESIGN 1&, �{Qv�..+1 �oep• ARROW ENGINEER ING`INC. ROSEW 17a)( 2aAv 10 CAPE DRIVE SMITE B _ -�, �► ^1t .L � <:> MASHPEE, MA 02649 SIDEWALL= z�r x 5 x,(6 x Z-6 �{11 ;��YMQNo No 21 x 7 0,� , s° SCALE DATE SHEET BOTTOM .n l D 8 � EcrsrE�` A SHOWN r t (�i87 I I �c 2- �n GpI7 °�,� os _ S l�la c�� t OF TOTAL ��-y G� t u� ; K Y: AP Y - AN N . DRAWN BY CHECKED B PD B PL 0 .. � .. PLAN SCALE I SEE/SEMI JTH RER